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Sample records for dysphagia assessment tool

  1. Myotonic dystrophy (DM1) and dysphagia: the need for dysphagia management guidelines and an assessment tool

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    LaDonna, K.A.; Koopman, W.J.H.; Venance, S.L.

    2011-01-01

    Myotonic dystrophy (DM1) is the most prevalent muscular dystrophy occurring in adulthood. DM1 is a multi-systemic disorder resulting in early-onset cataracts, cardiac rhythm problems, muscle weakness, ptosis, and cognitive and psychiatric manifestations. Dysphagia is one of the most problematic

  2. Assessing esophageal dysphagia.

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    Kruger, Danielle

    2014-05-01

    Dysphagia, or difficulty swallowing, is a common problem. Although most cases are attributable to benign disease processes, dysphagia is also a key symptom in several malignancies, making it an important symptom to evaluate. The differential diagnosis of dysphagia requires an understanding of deglutition, in particular the oropharyngeal versus esophageal stages. Stroke is the leading cause of oropharyngeal dysphagia, which is common in older adults and frequently presents as part of a broader complex of clinical manifestations. In esophageal dysphagia, difficulty swallowing is often the main complaint and is caused by localized neuromuscular disorders or obstructive lesions.

  3. Postoperative dysphagia versus neurogenic dysphagia: scintigraphic assessment.

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    Galli, Jacopo; Valenza, Venanzio; D'Alatri, Lucia; Reale, Francesca; Gajate, AnaMaria Samanes; Di Girolamo, Stefano; Paludetti, Gaetano

    2003-01-01

    In order to differentiate the features of dysphagia that occur after supraglottic horizontal laryngectomy from those that occur during neurologic diseases, we divided 38 subjects into 3 groups and submitted them to oropharyngoesophageal scintigraphy. Group 1 (control group) included 15 healthy volunteeers; group 2 comprised 8 patients who had residual dysphagia at least 1 year after supraglottic laryngectomy; and group 3 included 15 patients with various neurologic and neuromuscular disorders. In group 1, the mean values (+/- 2 SD) of selected semiquantitative parameters were consistent with those reported in the literature for normal subjects. In group 2, oral, pharyngeal, and esophageal transit times were not significantly altered, and moderate tracheobronchial post-deglutitive aspiration was present (maximum value, 6.7%; mean value, 2.04%). The pharyngeal retention index was significantly increased (p = .0003) as compared to normal subjects in all cases (maximum value, 40%; mean value, 23%) and was associated in all cases with slight but consistent post-deglutitive aspiration. In group 3, the oral and esophageal phases were significantly prolonged and the retention indices were significantly increased. Statistical analysis documented a significant increase in oral transit time (p = .003), esophageal transit time (p = .01), oral retention index (p = .006), pharyngeal retention index (p = .0007), and esophageal retention index (p = .009) as compared to normal subjects. The swallowing pattern was also altered by 1) an early loss of the bolus from the oral cavity; 2) bolus fragmentation due to double or triple deglutition, reduced lingual propulsion, or the return of a small part of the bolus into the oral cavity during deglutition; and/or 3) double pharyngeal peaks in the activity-time curves. Tracheobronchial aspiration (maximum value, 90%; mean value, 9.70%) was present in some cases, mainly in patients affected by post-stroke dysphagia. On the basis of the

  4. The South African dysphagia screening tool (SADS: A screening tool for a developing context

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    Calli Ostrofsky

    2016-02-01

    Full Text Available Background: Notwithstanding its value, there are challenges and limitations to implementing a dysphagia screening tool from a developed contexts in a developing context. The need for a reliable and valid screening tool for dysphagia that considers context, systemic rules and resources was identified to prevent further medical compromise, optimise dysphagia prognosis and ultimately hasten patients’ return to home or work.Methodology: To establish the validity and reliability of the South African dysphagia screening tool (SADS for acute stroke patients accessing government hospital services. The study was a quantitative, non-experimental, correlational cross-sectional design with a retrospective component. Convenient sampling was used to recruit 18 speech-language therapists and 63 acute stroke patients from three South African government hospitals. The SADS consists of 20 test items and was administered by speech-language therapists. Screening was followed by a diagnostic dysphagia assessment. The administrator of the tool was not involved in completing the diagnostic assessment, to eliminate bias and prevent contamination of results from screener to diagnostic assessment. Sensitivity, validity and efficacy of the screening tool were evaluated against the results of the diagnostic dysphagia assessment. Cohen’s kappa measures determined inter-rater agreement between the results of the SADS and the diagnostic assessment.Results and conclusion: The SADS was proven to be valid and reliable. Cohen’s kappa indicated a high inter-rater reliability and showed high sensitivity and adequate specificity in detecting dysphagia amongst acute stroke patients who were at risk for dysphagia. The SADS was characterised by concurrent, content and face validity. As a first step in establishing contextual appropriateness, the SADS is a valid and reliable screening tool that is sensitive in identifying stroke patients at risk for dysphagia within government

  5. A visual analogue scale and a Likert scale are simple and responsive tools for assessing dysphagia in eosinophilic oesophagitis.

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    Reed, C C; Wolf, W A; Cotton, C C; Dellon, E S

    2017-06-01

    While symptom scores have been developed to evaluate dysphagia in eosinophilic oesophagitis (EoE), their complexity may limit clinical use. To evaluate a visual analogue scale (VAS) and a 10-point Likert scale (LS) for assessment of dysphagia severity before and after EoE treatment. We conducted a prospective cohort study enrolling consecutive adults undergoing out-patient endoscopy. Incident cases of EoE were diagnosed per consensus guidelines. At diagnosis and after 8 weeks of treatment, symptoms were measured using the VAS, LS and the Mayo Dysphagia Questionnaire (MDQ). The percentage change in scores before and after treatment were compared overall, in treatment responders (<15 eos/hpf) and non-responders, and in patients without baseline dilation. In 51 EoE cases, the median VAS decreased from 3.6 at baseline to 1.4 post-treatment (71% decrease), the LS decreased from 6 to 2 (67%) and the MDQ decreased from 20 to 10 (49%). The VAS correlated with both the LS (R = 0.77; P < 0.0001) and MDQ (R = 0.46, P = 0.001). After stratification by histological response, the LS decreased 70% in responders vs. 13% in non-responders (P = 0.02). In patients who did not receive baseline dilation, both the VAS and LS decreased significantly more in the histological responders. Both the VAS and LS were responsive to successful treatment as measured by histologic improvement. Because the VAS and LS are simple to administer and are responsive to treatment, they can provide an efficient and objective method for assessing dysphagia severity in EoE in clinical practice. © 2017 John Wiley & Sons Ltd.

  6. Measuring Outcomes for Dysphagia: Validity and Reliability of the European Portuguese Eating Assessment Tool (P-EAT-10).

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    Nogueira, Dália Santos; Ferreira, Pedro Lopes; Reis, Elizabeth Azevedo; Lopes, Inês Sousa

    2015-10-01

    The purpose of this study was to evaluate the validity and the reliability of the European Portuguese version of the EAT-10 (P-EAT-10). This research was conducted in three phases: (i) cultural and linguistic adaptation; (ii) feasibility and reliability test; and (iii) validity tests. The final sample was formed by a cohort of 520 subjects. The P-EAT-10 index was compared for socio-demographic and clinic variables. It was also compared for both dysphagic and non-dysphagic groups as well as for the results of the 3Oz wst. Lastly, the P-EAT-10 scores were correlated with the EuroQol Group Portuguese EQ-5D index. The Cronbach's α obtained for the P-EAT-10 scale was 0.952 and it remained excellent even if any item was deleted. The item-total and the intraclass correlation coefficients were very good. The P-EAT-10 mean of the non-dysphagic cohort was 0.56 and that of the dysphagic cohort was 14.26, the mean comparison between the 3Oz wst groups and the P-EAT-10 scores were significant. A significant higher perception of QoL was also found among the non-dysphagic subjects. P-EAT-10 is a valid and reliable measure that may be used to document dysphagia which makes it useful both for screening in clinical practice and in research.

  7. Validity and reliability of swallowing screening tools used by nurses for dysphagia: A systematic review.

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    Jiang, Jiin-Ling; Fu, Shu-Ying; Wang, Wan-Hsiang; Ma, Yu-Chin

    2016-01-01

    Dysphagia following neurological impairment increases the risk of dehydration, malnutrition, aspiration pneumonia, and even death. Screening for dysphagia has been reported to change negative outcomes. This review evaluated the validity and reliability of measurement tools for screening dysphagia in patients with neurological disorders to identify a feasible tool that can be used by nurses. Electronic databases were searched for studies from 1992 to 2015 related to dysphagia screening measurements. The search was applied to the Pubmed, CINAHL, Cochrane, Medline, EBSCO host, and CEPS + CETD databases. A checklist was used to evaluate the psychometric quality. The tools were evaluated for their feasibility for incorporation into routine care by nurses in hospitals. A total of 104 papers were retrieved, and eight articles finally met the inclusion criteria. The sensitivity and specificity of the screening tools ranged from 29% to 100% and from 65% to 100%, respectively. The interrater reliability ranged from good to excellent agreement. On the basis of quality evaluations, all the included studies had a risk of bias because of inadequate methodological characteristics. The Standardized Swallowing Assessment is the most suitable tool for detecting dysphagia because its psychometric properties and feasibility are higher than those of other screening tools that can be administered by nurses.

  8. Dysphagia.

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    Malandraki, Georgia; Robbins, JoAnne

    2013-01-01

    Swallowing is one of the primary functions that enable humans to sustain life. Likewise, it is an important element of healthy life and contributes to quality of life and well-being. When the ability to swallow is lost or impaired, the risk of disability or even death is greatly increased. Rehabilitation potential is diminished and the process is prolonged in the presence of dysphagia. This present chapter describes the anatomical and neurophysiological components of healthy adult swallowing and presbyphagia and the major consequences that swallowing disorders (dysphagia) may have if left untreated. The main neurogenic conditions and diseases leading to dysphagia are also introduced, as well as the major diagnostic and interventional approaches used by swallowing specialists to help patients with dysphagia. The role of the multidisciplinary team is emphasized and screening questions and guidelines are provided to help the neurologist and other professionals provide dysphagic patients with the best swallowing care. Copyright © 2013 Elsevier B.V. All rights reserved.

  9. Sensitivity and specificity of the Eating Assessment Tool and the Volume-Viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia

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    Rofes, L; Arreola, V; Mukherjee, R; Clavé, P

    2014-01-01

    Background Oropharyngeal dysphagia (OD) is an underdiagnosed digestive disorder that causes severe nutritional and respiratory complications. Our aim was to determine the accuracy of the Eating Assessment Tool (EAT-10) and the Volume-Viscosity Swallow Test (V-VST) for clinical evaluation of OD. Methods We studied 120 patients with swallowing difficulties and 14 healthy subjects. OD was evaluated by the 10-item screening questionnaire EAT-10 and the bedside method V-VST, videofluoroscopy (VFS) being the reference standard. The V-VST is an effort test that uses boluses of different volumes and viscosities to identify clinical signs of impaired efficacy (impaired labial seal, piecemeal deglutition, and residue) and impaired safety of swallow (cough, voice changes, and oxygen desaturation ≥3%). Discriminating ability was assessed by the AUC of the ROC curve and sensitivity and specificity values. Key Results According to VFS, prevalence of OD was 87%, 75.6% with impaired efficacy and 80.9% with impaired safety of swallow including 17.6% aspirations. The EAT-10 showed a ROC AUC of 0.89 for OD with an optimal cut-off at 2 (0.89 sensitivity and 0.82 specificity). The V-VST showed 0.94 sensitivity and 0.88 specificity for OD, 0.79 sensitivity and 0.75 specificity for impaired efficacy, 0.87 sensitivity and 0.81 specificity for impaired safety, and 0.91 sensitivity and 0.28 specificity for aspirations. Conclusions & Inferences Clinical methods for screening (EAT-10) and assessment (V-VST) of OD offer excellent psychometric proprieties that allow adequate management of OD. Their universal application among at-risk populations will improve the identification of patients with OD at risk for malnutrition and aspiration pneumonia. PMID:24909661

  10. [Dysphagia rehabilitation].

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    Saitoh, Eiichi

    2008-11-01

    Recently, many medical professionals become to realize eating problem affect deeply patient's quality of life (QOL), and they are very interested in dysphagia rehabilitation. I overviewed dysphagia rehabilitation along with the followings; (1) impact of dysphagia, (2) assessment of dysphagia, and (3) management of dysphagia. Eating is the most enjoyable activity. Dysphagia changes this enjoyable activity to the most fearful one. Dysphagia makes three major problems: risk of aspiration pneumonia and suffocation, risk of dehydration and malnutrition, and depriving enjoyable activity. As a recent conceptualization of eating, the Process model is the most important, that reveals eating (chew-swallow) is very different from just chewing plus swallowing in physiologically. In assessment, standardized functional tests such as the Repetitive saliva swallowing test, the Modified water swallowing test, and the Graded food test are used. The most important point in clinical assessment is identifying indication of direct therapy using food or starting period of oral feeding. Videofluorographic and videoendoscopic examinations are used as precise diagnostic and management-oriented assessment tools. In management, exercise, posture adjustment, and modification of food promote eating possibility. Oral care is essential in dysphagic patients. Surgical intervention is effective method if a patient has severe dysphagia.

  11. [Reliability and validity of the Chinese Eating Assessment Tool (EAT-10) in evaluation of acute stroke patients with dysphagia].

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    Wang, Rumi; Xiong, Xuehong; Zhang, Changjie; Fan, Yongmei

    2015-12-01

    目的:探讨进食评估问卷调查工具-10(eating assessment tool-10,EAT-10)中文版在急性期脑卒中后吞咽障碍评估中的信度和效度。方法:选择急性期脑卒中后住院患者180例,采用EAT-10中文版量表进行筛查评估,并用吞咽障碍的诊断金标准——视频透视吞咽功能检查(videofluoroscopic swallow study,VFSS)为效标进行检验。结果:180名入选患者中有130名问卷合格并顺利行VFS检查,EAT-10中文版总量表Cronbach’s α=0.845,各条目与总分均存在相关,相关系数最低的为条目2(r=0.271),相关系数最高的为条目3(r=0.772),重测信度均为0.7以上,重测信度符合要求。经调查员一致性信度检验,条目2有一位调查员的结果是恒定值,量表其余9个条目的一致相关系数均>0.7,各亚项和总分均值间一致性较高。分别对EAT-10分界值3,2,1进行效度检验,发现分界值1为最理想分界值,灵敏度及阴性预测值最高,判断吞咽障碍的灵敏度为77.9%,特异度为66.1%,阳性预测值71.6%,阴性预测值73.2%,阳性似然比2.30,阴性似然比0.33。结论:EAT-10中文版仅适用于已有饮水和进食经历的患者,EAT-10中文版对评估急性期脑卒中患者有良好的信度和效度,当分界值为1,EAT-10总分≥1时灵敏度和阴性预测值最佳,能够较好地预测急性期脑卒中患者吞咽障碍、吞咽能力受损、渗透和误吸。.

  12. Dysphagia in Duchenne Muscular Dystrophy Assessed by Validated Questionnaire

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    Archer, Sally K.; Garrod, Rachel; Hart, Nicholas; Miller, Simon

    2013-01-01

    Background: Duchenne muscular dystrophy (DMD) leads to progressive muscular weakness and death, most typically from respiratory complications. Dysphagia is common in DMD; however, the most appropriate swallowing assessments have not been universally agreed and the symptoms of dysphagia remain under-reported. Aims: To investigate symptoms of…

  13. Dysphagia in Duchenne Muscular Dystrophy Assessed by Validated Questionnaire

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    Archer, Sally K.; Garrod, Rachel; Hart, Nicholas; Miller, Simon

    2013-01-01

    Background: Duchenne muscular dystrophy (DMD) leads to progressive muscular weakness and death, most typically from respiratory complications. Dysphagia is common in DMD; however, the most appropriate swallowing assessments have not been universally agreed and the symptoms of dysphagia remain under-reported. Aims: To investigate symptoms of…

  14. Malingering dysphagia and odynophagia electromyographic assessment.

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    Vaiman, Michael; Shoval, Gal; Gavriel, Haim

    2009-01-01

    The article discusses the usefulness and investigation technique of suspected malingering dysphagia/odynophagia by surface electromyography (sEMG) of deglutition. Forty patients with suspected malingering dysphagia (group 1), 40 patients with dysphagia/odynophagia due to tonsillectomy (group 2), and 40 healthy individuals (group 3) were involved in the study. The timing, amplitude, and graphic patterns of activity of the masseter, submental, and trapezius muscles were examined during voluntary single water swallows ("normal") and continuous drinking of 100 mL of water. The muscle activity in oral, pharyngeal, and initial esophageal stages of swallowing was measured, and graphic records were evaluated in relation to timing and voltage. The main sEMG patterns of malingering dysphagia/odynophagia are prolonged time of the voluntary oral phase of a swallow (80% of cases, n = 32, P swallowing being at the same time absent during continuous drinking. Dysphagia due to malingering has no pathologic sEMG patterns associated with deglutition. Skeletal muscle tension during deglutition, being observed in some cases, has no connection with the act of swallowing itself. Prolonged oral phase of a swallow is factitious, nonpathologic. Surface EMG, being noninvasive, nonradiographic and inexpensive, can be used for patients with suspected malingering dysphagia, thus avoiding expensive and time-consuming investigation.

  15. Traducción y validación de la versión en español de la escala EAT-10 (Eating Assessment Tool-10 para el despistaje de la disfagia Translation and validation of the Spanish version of the EAT-10 (Eating Assessment Tool-10 for the screening of dysphagia

    Directory of Open Access Journals (Sweden)

    R. Burgos

    2012-12-01

    Full Text Available Introducción: El Eating Assessment Tool-10 (EAT-10 es un instrumento analógico verbal, unidimensional y autoadministrado, para el despistaje de la disfagia. Objetivos: Traducir y adaptar al español la escala EAT-10, y evaluar sus propiedades psicométricas, fiabilidad y validez. Métodos: Tras la traducción, traducción inversa y aprobación por los investigadores de la versión española de la escala (EAT-10 ES, se realizó un estudio prospectivo en pacientes con diagnóstico de disfagia (DD, pacientes no diagnosticados con riesgo de disfagia (RD y pacientes sin riesgo de disfagia (SRD, procedentes de tres escenarios clínicos: una unidad de soporte nutricional hospitalaria (USN, una residencia geriátrica (RG y un centro de atención primaria (CAP, que respondieron a la EAT-10 ES durante una única visita. Pacientes e investigadores respondieron a un cuestionario de comprensión del instrumento. Resultados: El estudio incluyó 65 pacientes (75±9,1 años de edad; 52,3% mujeres. El tiempo medio de administración fue de 3,8 ± 1,7 minutos. El 95,4% de los pacientes consideró comprensibles todos los ítems de la escala y el 72,3% consideró fácil la asignación de puntuaciones. El coeficiente de consistencia interna alfa de Cronbach fue 0,87. La correlación entre las puntuaciones de cada ítem y el total de la escala fue elevada (p Rationale: The Eating Assessment Tool-10 (EAT-10 is a self-administered, analogical, direct-scoring screening tool for dysphagia. Objective: To translate and adapt the EAT-10 into Spanish, and to evaluate its psychometric properties. Methods: After the translation and back-translation process of the EAT-10 ES, a prospective study was performed in adult patients with preserved cognitive and functional abilities. Patients in 3 clinical situations, diagnosed with dysphagia (DD, patients at risk of dysphagia (RD, and patients not at risk of dysphagia (SRD were recruited from 3 settings: a hospital Nutritional

  16. Development of a Multimedia Dysphagia Assessment Learning System Using Responsive Web Design: From e-Learning to m-Learning.

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    Huang, Hui-Chi; Guo, Sophie Huey-Ming

    2016-01-01

    Swallowing problems have significant affect the health outcome of some residents in long-term care facilities. Nursing staff who care these residents should have the ability of assessing dysphagia. However, nursing continued education to improve the performance of dysphagia assessment is still challenged. To enhance nurses' capability of dysphagia assessment, a Multimedia Dysphagia Assessment learning System was developed for nursing staff in long-term care institutions. This system was evaluated by performing a user usability test.

  17. Dysphagia in Parkinson's Disease.

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    Suttrup, Inga; Warnecke, Tobias

    2016-02-01

    More than 80 % of patients with Parkinson's disease (PD) develop dysphagia during the course of their disease. Swallowing impairment reduces quality of life, complicates medication intake and leads to malnutrition and aspiration pneumonia, which is a major cause of death in PD. Although the underlying pathophysiology is poorly understood, it has been shown that dopaminergic and non-dopaminergic mechanisms are involved in the development of dysphagia in PD. Clinical assessment of dysphagia in PD patients is challenging and often delivers unreliable results. A modified water test assessing maximum swallowing volume is recommended to uncover oropharyngeal dysphagia in PD. PD-specific questionnaires may also be useful to identify patients at risk for swallowing impairment. Fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing study are both considered to be the gold standard for evaluation of PD-related dysphagia. In addition, high-resolution manometry may be a helpful tool. These instrumental methods allow a reliable detection of aspiration events. Furthermore, typical patterns of impairment during the oral, pharyngeal and/or esophageal swallowing phase of PD patients can be identified. Therapy of dysphagia in PD consists of pharmacological interventions and swallowing treatment by speech and language therapists (SLTs). Fluctuating dysphagia with deterioration during the off-state should be treated by optimizing dopaminergic medication. The methods used during swallowing treatment by SLTs shall be selected according to the individual dysphagia pattern of each PD patient. A promising novel method is an intensive training of expiratory muscle strength. Deep brain stimulation does not seem to have a clinical relevant effect on swallowing function in PD. The goal of this review is giving an overview on current stages of epidemiology, pathophysiology, diagnosis, and treatment of PD-associated dysphagia, which might be helpful for neurologists

  18. Electrical bioimpedance measurement as a tool for dysphagia visualisation.

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    Chester, Chris J; Gaynor, Paul T; Jones, Richard D; Huckabee, Maggie-Lee

    2014-09-01

    A non-invasive and portable bioimpedance method and a device for detecting superior to inferior closure of the pharynx during swallowing have been developed. The 2-channel device measures electric impedance across the neck at two levels of the pharynx via injected currents at 40 and 70 kHz. The device has been trialled on both healthy and dysphagic subjects. Results from these trials revealed a relationship (r = 0.59) between the temporal separation of the second peaks in the bioimpedance waveforms and descending pressure sequence in the pharynx as measured by pharyngeal manometry. However, these features were only clearly visible in the bioimpedance waveforms for 64% of swallows. Further research is underway to improve the bioimpedance measurement reliability and validate waveform feature correlation to swallowing to maximise the device's efficacy in dysphagia rehabilitation.

  19. Formatting an experiential learning education module to encourage dysphagia assessment in apheresis patients.

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    West, James; Stutzman, Sonja E; Atem, Folefac; Olson, DaiWai M

    2017-08-02

    Dysphagia screening is oftentimes a focus of hospitalized patients, but dysphagia can also occur in outpatient settings. Dysphagia can be overlooked by nurses and clinicians, and it is therefore important to educate nurses on the importance of dysphagia screenings. This was a randomized prospective pilot study to compare the effect of experiential learning versus traditional PowerPoint learning regarding nurses' attitudes towards performing dysphagia screening in an outpatient setting. Twelve pre and post-test surveys were collected from nurses working in outpatient apheresis about their attitudes towards dysphagia screening. Additionally, 128 electronic medical records (EMR) were reviewed to determine if education increased the occurrence of dysphagia screening. There was a statistically significant difference in the pre vs. post-test group scores (P < .001), but due to small sample size, there was insufficient evidence to reject the null hypothesis that nurses had changed their attitudes towards dysphagia screening. Comparing documentation of dysphagia assessment in the EMR, there was not a significant difference in practice before or after the educational intervention (P = 0.18). The study results showed that the both types of teaching strategies are possible with nurses and they were receptive to both. Although the results of this study did not show a significant difference in practice, more research is needed to determine how to raise awareness and put this into practice. © 2017 Wiley Periodicals, Inc.

  20. The use of pulse oximetry as a screening assessment for paediatric neurogenic dysphagia.

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    Morgan, A T; Omahoney, R; Francis, H

    2008-01-01

    Early screening and intervention for dysphagia is crucial to offset potential outcomes such as compromised nutrition or reduced respiratory function. Current paediatric dysphagia screening tests are subjective with poor sensitivity and specificity. The present study examined whether an objective method, pulse oximetry (measuring oxygen saturation (SpO2) levels), could differentiate between children with and without dysphagia, in relation to (1) Average pre-feeding baseline SpO2 levels; (2) Average feeding SpO2 levels; (3) Average post-feeding SpO2 levels; and (4) The number of events of oxygen desaturation pre-, during and after feeding. Nine participants with chronic neurological disability (CND) (7 F, 2 M) (9; 7-15; 11 years) and nine control participants matched for age (9; 5-16; 0 years) and sex were assessed using a clinical bedside evaluation (CBE) and pulse oximetry. A statistically significant difference was found in SpO2 levels between the two groups (p dysphagia experienced 'events' of SpO2 desaturation during feeding. Pulse oximetry may provide a useful adjunct to the CBE for dysphagia screening, with average SpO2 levels during feeding predicting those with and without dysphagia with moderate levels of sensitivity and specificity. The finding of individual variation in desaturation 'events', however, warrants the provision of further data on large homogenous populations to provide definitive criterion for pathological SpO2 levels associated with dysphagia during oral feeding.

  1. Dysphagia in Duchenne muscular dystrophy assessed objectively by surface electromyography.

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    Archer, Sally K; Garrod, Rachel; Hart, Nicholas; Miller, Simon

    2013-06-01

    Objective swallowing assessment is indicated in the management of patients with Duchenne muscular dystrophy (DMD). Surface electromyography (sEMG) provides a non-invasive, objective method of quantifying muscle activity. It was hypothesised that the measurement of sEMG activity during swallowing would distinguish between preserved and disordered swallow function in DMD. This comparative study investigated the peak, duration, and relative timing of muscle activity during swallowing of four muscle groups: orbicularis oris, masseter, submental, and infrahyoid. The study included three groups of participants: Nine DMD patients with dysphagia (mean age = 21.7 ± 4.2 years), six DMD patients with preserved swallow function (21.0 ± 3.0 years), and 12 healthy controls (24.8 ± 3.1 years). Dysphagic DMD participants produced significantly higher normalised peak amplitude measurements than the healthy control group for masseter (61.77 vs. 5.07; p ≤ 0.01) and orbicularis oris muscles (71.87 vs. 26.22; p ≤ 0.05). Intrasubject variability for masseter peak amplitude was significantly greater for dysphagic DMD participants than the other groups (16.01 vs. 5.86 vs. 2.18; p ≤ 0.05). There were no differences in timing measurements between groups. Different characteristic sEMG waveforms were observed for the three groups. sEMG provides useful physiological information for the evaluation of swallowing in DMD patients, justifying further study.

  2. Oropharyngeal dysphagia assessment and treatment efficacy: setting the record straight (response to Campbell-Taylor).

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    Coyle, James L; Davis, Lori A; Easterling, Caryn; Graner, Darlene E; Langmore, Susan; Leder, Steven B; Lefton-Greif, Maureen A; Leslie, Paula; Logemann, Jeri A; Mackay, Linda; Martin-Harris, Bonnie; Murray, Joseph T; Sonies, Barbara; Steele, Catriona M

    2009-01-01

    In September 2008, an article was published in the Journal of the American Medical Directors Association criticizing current dysphagia assessment and management practices performed by speech-language pathologists in Long-Term Care (LTC) settings. In the same issue, an editorial invited dialogue on the points raised by Campbell-Taylor. We are responding to this call for dialogue. We find Campbell-Taylor's interpretation of the literature to be incomplete and one-sided, leading to misleading and pessimistic conclusions. We offer a complementary perspective to balance this discussion on the 4 specific questions raised: (1) Is the use of videofluoroscopy warranted for evaluating dysphagia in the LTC population? (2) How effective are thickened liquids and other interventions for preventing aspiration and do they contribute to reduction of morbidity? (3) Can aspiration be prevented and is its prevention important? and (4) Is there sufficient evidence to justify dysphagia intervention by speech language pathologists?

  3. Assessment of Pediatric Dysphagia and Feeding Disorders: Clinical and Instrumental Approaches

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    Arvedson, Joan C.

    2008-01-01

    Assessment of infants and children with dysphagia (swallowing problems) and feeding disorders involves significantly more considerations than a clinical observation of a feeding. In addition to the status of feeding in the child, considerations include health status, broad environment, parent-child interactions, and parental concerns.…

  4. Dysphagia in the elderly.

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    Khan, Abraham; Carmona, Richard; Traube, Morris

    2014-02-01

    Dysphagia, or difficulty swallowing, is a common problem in the elderly. Based on the initial clinical history and physical examination, the dysphagia is assessed as either primarily oropharyngeal or esophageal in origin. Most oropharyngeal dysphagia is of neurologic origin, and management is coordinated with a clinical swallow specialist in conjunction with an ear, nose, and throat (ENT) physician if warning signs imply malignancy. Several structural and functional esophageal disorders can cause dysphagia. If a patient has likely esophageal dysphagia, a video barium esophagram is a good initial test, and referral to a gastroenterologist is generally warranted leading to appropriate treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Presbyphagia and Sarcopenic Dysphagia: Association between Aging, Sarcopenia, and Deglutition Disorders.

    Science.gov (United States)

    Wakabayashi, H

    2014-01-01

    Presbyphagia refers to age-related changes in the swallowing mechanism in the elderly associated with a frailty in swallowing. Presbyphagia is different from dysphagia. Sarcopenic dysphagia is difficulty swallowing due to sarcopenia of generalized skeletal muscles and swallowing muscles. Age-related loss of swallowing muscle mass becomes evident in the geniohyoid muscle and tongue. Elderly subjects with both sarcopenia and dysphagia may have not only disease-related dysphagia but also sarcopenic dysphagia. In cases of aspiration pneumonia, deterioration in activity-, disease-, and nutrition-related sarcopenia of generalized skeletal muscles and swallowing muscles may develop into sarcopenic dysphagia. Assessment of sarcopenic dysphagia includes evaluation of both dysphagia and sarcopenia. The 10-item Eating Assessment Tool (EAT-10) and a water test combined with pulse oximetry are useful for dysphagia screening. Assessment of the multi-factorial causes of sarcopenia including nutritional review is important, because rehabilitation of sarcopenic dysphagia differs depending on its etiology. Consensus diagnostic criteria for sarcopenic dysphagia were proposed at the 19th Annual Meeting of the Japanese Society of Dysphagia Rehabilitation. Rehabilitation for sarcopenic dysphagia includes treatment of both dysphagia and sarcopenia. The core components of dysphagia rehabilitation are oral health care, rehabilitative techniques, and food modification. The causes of adult malnutrition may also contribute to the etiology of secondary sarcopenia and sarcopenic dysphagia. Therefore, nutrition management is indispensable for sarcopenic dysphagia rehabilitation. In cases of sarcopenia with numerous complicating causes, treatment should include pharmaceutical therapies for age-related sarcopenia and comorbid chronic diseases, resistance training, early ambulation, nutrition management, protein and amino acid supplementation, and non-smoking.

  6. Evaluation of a Clinical Service Model for Dysphagia Assessment via Telerehabilitation

    Directory of Open Access Journals (Sweden)

    Elizabeth C. Ward

    2013-01-01

    employed to examine the outcomes of a weekly dysphagia assessment clinic conducted via telerehabilitation and examine issues relating to service delivery and user perceptions. Data was collected across a total of 100 patient assessments. Information relating to primary patient outcomes, session statistics, patient perceptions, and clinician perceptions was examined. Results revealed that session durations averaged 45 minutes, there was minimal technical difficulty experienced, and clinical decisions made regarding primary patient outcomes were comparable between the online and face to face clinicians. Patient satisfaction was high and clinicians felt that they developed good rapport, found the system easy to use, and were satisfied with the service in over 90% of the assessments conducted. Key factors relating to screening patient suitability, having good general organization, and skilled staff were identified as facilitators for the service. This trial has highlighted important issues for consideration when planning or implementing a telerehabilitation service for dysphagia management.

  7. Validity of conducting clinical dysphagia assessments for patients with normal to mild cognitive impairment via telerehabilitation.

    Science.gov (United States)

    Ward, Elizabeth C; Sharma, Shobha; Burns, Clare; Theodoros, Deborah; Russell, Trevor

    2012-12-01

    To assess the validity of conducting clinical dysphagia assessments via telerehabilitation, 40 individuals with dysphagia from various etiologies were assessed simultaneously by a face-to-face speech-language pathologist (FTF-SLP) and a telerehabilitation SLP (T-SLP) via an Internet-based videoconferencing telerehabilitation system. Dysphagia status was assessed using a Clinical Swallowing Examination (CSE) protocol, delivered via a specialized telerehabilitation videoconferencing system and involving the use of an assistant at the patient's end of the consultation to facilitate the assessment. Levels of agreement between the FTF-SLP and T-SLP revealed that the majority of parameters reached set levels of clinically acceptable levels of agreement. Specifically, agreement between the T-SLP and FTF-SLP ratings for the oral, oromotor, and laryngeal function tasks revealed levels of exact agreement ranging from 75 to 100% (kappa = 0.36-1.0), while the parameters relating to food and fluid trials ranged in exact agreement from 79 to 100% (kappa = 0.61-1.0). Across the parameters related to aspiration risk and clinical management, exact agreement ranged between 79 and 100% (kappa = 0.49-1.0). The data show that a CSE conducted via telerehabilitation can provide valid and reliable outcomes comparable to clinical decisions made in the FTF environment.

  8. Dysphagia in Duchenne muscular dystrophy: practical recommendations to guide management.

    Science.gov (United States)

    Toussaint, Michel; Davidson, Zoe; Bouvoie, Veronique; Evenepoel, Nathalie; Haan, Jurn; Soudon, Philippe

    2016-10-01

    Duchenne muscular dystrophy (DMD) is a rapidly progressive neuromuscular disorder causing weakness of the skeletal, respiratory, cardiac and oropharyngeal muscles with up to one third of young men reporting difficulty swallowing (dysphagia). Recent studies on dysphagia in DMD clarify the pathophysiology of swallowing disorders and offer new tools for its assessment but little guidance is available for its management. This paper aims to provide a step-by-step algorithm to facilitate clinical decisions regarding dysphagia management in this patient population. This algorithm is based on 30 years of clinical experience with DMD in a specialised Centre for Neuromuscular Disorders (Inkendaal Rehabilitation Hospital, Belgium) and is supported by literature where available. Dysphagia can worsen the condition of ageing patients with DMD. Apart from the difficulties of chewing and oral fragmentation of the food bolus, dysphagia is rather a consequence of an impairment in the pharyngeal phase of swallowing. By contrast with central neurologic disorders, dysphagia in DMD accompanies solid rather than liquid intake. Symptoms of dysphagia may not be clinically evident; however laryngeal food penetration, accumulation of food residue in the pharynx and/or true laryngeal food aspiration may occur. The prevalence of these issues in DMD is likely underestimated. There is little guidance available for clinicians to manage dysphagia and improve feeding for young men with DMD. This report aims to provide a clinical algorithm to facilitate the diagnosis of dysphagia, to identify the symptoms and to propose practical recommendations to treat dysphagia in the adult DMD population. Implications for Rehabilitation Little guidance is available for the management of dysphagia in Duchenne dystrophy. Food can penetrate the vestibule, accumulate as residue or cause aspiration. We propose recommendations and an algorithm to guide management of dysphagia. Penetration/residue accumulation

  9. Screening tool for oropharyngeal dysphagia in stroke - Part I: evidence of validity based on the content and response processes.

    Science.gov (United States)

    Almeida, Tatiana Magalhães de; Cola, Paula Cristina; Pernambuco, Leandro de Araújo; Magalhães, Hipólito Virgílio; Magnoni, Carlos Daniel; Silva, Roberta Gonçalves da

    2017-08-17

    The aim of the present study was to identify the evidence of validity based on the content and response process of the Rastreamento de Disfagia Orofaríngea no Acidente Vascular Encefálico (RADAVE; "Screening Tool for Oropharyngeal Dysphagia in Stroke"). The criteria used to elaborate the questions were based on a literature review. A group of judges consisting of 19 different health professionals evaluated the relevance and representativeness of the questions, and the results were analyzed using the Content Validity Index. In order to evidence validity based on the response processes, 23 health professionals administered the screening tool and analyzed the questions using a structured scale and cognitive interview. The RADAVE structured to be applied in two stages. The first version consisted of 18 questions in stage I and 11 questions in stage II. Eight questions in stage I and four in stage II did not reach the minimum Content Validity Index, requiring reformulation by the authors. The cognitive interview demonstrated some misconceptions. New adjustments were made and the final version was produced with 12 questions in stage I and six questions in stage II. It was possible to develop a screening tool for dysphagia in stroke with adequate evidence of validity based on content and response processes. Both validity evidences obtained so far allowed to adjust the screening tool in relation to its construct. The next studies will analyze the other evidences of validity and the measures of accuracy.

  10. Nutrition assessment and intervention in the patient with dysphagia: challenges for quality improvement.

    Science.gov (United States)

    Ochoa, Juan B

    2012-01-01

    Dysphagia, a symptom characterized by difficulty swallowing, is an independent predictor of poor outcome, worsening morbidity, increasing the risk for hospital readmissions, health care costs and mortality. Dysphagia is a result of a number of illnesses including neurological diseases, after surgery for head and neck pathology, observed in the intensive care unit after prolonged endotracheal intubation among others, and is particularly frequent in the elderly. Dysphagia increases the incidence of malnutrition, which in turn delays patient recovery. Treatment of dysphagia can be successful, but requires the use of multidisciplinary teams. A focus on the management of malnutrition including prevention and treatment is essential. Perhaps the biggest challenge is the lack of awareness of the presence of dysphagia and malnutrition, so that only a minority of patients are identified and successfully treated. We propose that better identification and treatment of dysphagia could occur with the systematic implementation of clinical practice improvement processes with a consequent decrease in morbidity, mortality and cost.

  11. Team management of dysphagia in the institutional setting.

    Science.gov (United States)

    Robbins, JoAnne; Kays, Stephanie; McCallum, Shirley

    2007-01-01

    The capacity to swallow effectively and safely is a basic human need, yet nearly 40% of Americans over age 60 experience dysphagia. Since the resources in acute-care hospitals often are unavailable in institutional settings, the daily involvement of nursing and the dietitian's screening and continuous assessment are critical to timely, effective dysphagia identification, referral, and management. Upon referral, the speech pathologist executes comprehensive evaluation, leading the design and implementation of a team treatment plan. Literature highlighting a sample of dysphagia screening tools and interventions, care transitions and aspiration prevention strategies is reviewed herein to guide current practice and future research.

  12. Dysphagia in Head and Neck Cancer Patients: Pretreatment Evaluation, Predictive Factors, and Assessment during Radio-Chemotherapy, Recommendations.

    Science.gov (United States)

    Denaro, Nerina; Merlano, Marco C; Russi, Elvio G

    2013-09-01

    Progress in head and neck cancer (HNC) therapies has improved tumor response, loco-regional control, and survival. However, treatment intensification also increases early and late toxicities. Dysphagia is an underestimated symptom in HNC patients. Impairment of swallowing process could cause malnutrition, dehydration, aspiration, and pneumonia. A comprehensive literature review finalized in May 2012 included searches of electronic databases (Medline, Embase, and CAB abstracts) and scientific societies meetings materials (American Society of Clinical Oncology, Associazione Italiana Radioterapia Oncologica, Associazione Italiana di Oncologia Cervico-Cefalica, American Head and Neck Society, and European Society for Medical Oncology). Hand-searches of HNC journals and reference lists were carried out. Approximately one-third of dysphagia patients developed pneumonia requiring treatment. Aspiration pneumonia associated mortality ranged from 20% to 65%. Unidentified dysphagia caused significant morbidity, increased mortality, and decreased the quality of life. In this review we underline definition, causes, predictive factors of dysphagia and report on pretreatment and on-treatment evaluation, suggesting some key points to avoid underestimation. A multi-parameter assessment of swallowing problems may allow an earlier diagnosis. An appropriate evaluation might lead to a better treatment of both symptoms and cancer.

  13. Nutrition and gastrointestinal tract assessment and management of children with dysphagia.

    Science.gov (United States)

    Kirby, Midge; Noel, Richard J

    2007-08-01

    Limited ability to take in nutrients places young patients with dysphagia at risk for malnutrition and failure to gain weight. These children require careful evaluation and ongoing monitoring of growth and nutritional status. Gastroesophageal reflux and recurrent vomiting may contribute to dysphagia when the refluxate causes laryngopharyngeal irritation and can increase the morbidity in patients prone to aspiration. A paucity of evidence-based literature on relevant topics demands both clinical judgment and an interdisciplinary approach for management decisions for these issues. Advances in nutrition and management of aerodigestive conditions related to dysphagia will be reviewed.

  14. Dysphagia evaluation practices: inconsistencies in clinical assessment and instrumental examination decision-making.

    Science.gov (United States)

    Mathers-Schmidt, Barbara A; Kurlinski, Mary

    2003-01-01

    The purpose of this study was to determine the nature of swallowing evaluation practices in western Washington, specifically in terms of (a) components of the clinical examination most commonly used, (b) consistency of clinical examination practices across clinicians, and (c) consistency of clinical decision-making (instrumental vs. noninstrumental) given specific patient scenarios. A 21-question survey was sent to 150 speech-language pathologists who provide services to dysphagia patients. Of the 72 (48%) surveys that were returned, 64 provided the data for the study. The results revealed that clinicians who responded to the survey differ somewhat regarding which components they include in a clinical examination of swallowing. There was a high degree of consistency for 11 of the 19 components. Inconsistency across clinicians was revealed in four areas: assessment of sensory function, assessment of the gag reflex, cervical auscultation, and assessment of trial swallows using compensatory techniques. Clinicians agreed in their recommendations on two of the six clinical case scenarios. In general, participating clinicians varied widely in their clinical decision-making. These findings are compared with other studies where variability in clinical practice has raised concerns.

  15. Development of the Arabic Version of Dysphagia Handicap Index (DHI).

    Science.gov (United States)

    Farahat, Mohamed; Malki, Khalid H; Mesallam, Tamer A; Bukhari, Manal; Alharethy, Sami

    2014-08-01

    The Dysphagia Handicap Index (DHI) is a 25-item self-administered questionnaire. It is a noninvasive tool for measuring the handicapping effect of dysphagia on the physical, functional, and emotional aspects of people's lives. The purposes of the present study were to develop an Arabic version of the DHI and to evaluate its validity, consistency, and reliability in the normal Arabic population with oropharyngeal dysphagia. This was a prospective study that was carried out at the Communication and Swallowing Disorders Unit, King Saud University. The generated Arabic DHI was administered to 94 patients with oropharyngeal dysphagia and 98 control subjects. Internal consistency and test-retest reliability were evaluated. The results of the patients and the control group were compared. The Arabic DHI showed excellent internal consistency (Cronbach's α = 0.95). Also, good test-retest reliability was found for the total scores of the Arabic DHI (r = 0.9, p = 0.001). There was a significant difference between the DHI scores of the control group and those of the oropharyngeal dysphagia group (p DHI is a valid tool for self-assessment of the handicapping effect of dysphagia on the physical, functional, and emotional aspects of patients and can be used by Arabic language speakers.

  16. [Neurogenic dysphagia].

    Science.gov (United States)

    Wirth, R; Dziewas, R

    2017-02-01

    Approximately half of neurological and geriatric inpatients suffer from oropharyngeal dysphagia. This often leads to pneumonia, malnutrition and dehydration; however, the underlying dysphagia is frequently not diagnosed and treated. This is particularly the case for patients with so-called silent aspiration. Knowledge on the physiology of swallowing, including the central nervous system control of swallowing and the therapeutic options have achieved considerable progress in recent years. In particular, the increasing implementation of flexible endoscopic evaluation of swallowing (FEES) has significantly contributed to this knowledge. It provides the ability to identify the individual pattern of oropharyngeal dysphagia leading to a suitable selection of therapeutic and compensatory strategies for individual patients. The various therapeutic options range from modification of the consistency of the diet, over diverse logopedic strategies and stimulation techniques up to interventional procedures.

  17. Oropharyngeal dysphagia: manifestations and diagnosis.

    Science.gov (United States)

    Rommel, Nathalie; Hamdy, Shaheen

    2016-01-01

    Swallowing disorders (dysphagia) have been recognized by the WHO as a medical disability associated with increased morbidity, mortality and costs of care. With increasing survival rates and ageing of the population, swallowing disorders and their role in causing pulmonary and nutritional pathologies are becoming exceedingly important. Over the past two decades, the study of oropharyngeal dysphagia has been approached from various disciplines with considerable progress in understanding its pathophysiology. This Review describes the most frequent manifestations of oropharyngeal dysphagia and the clinical as well as instrumental techniques that are available to diagnose patients with dysphagia. However, the clinical value of these diagnostic tests and their sensitivity to predict outcomes is limited. Despite considerable clinical research efforts, conventional diagnostic methods for oropharyngeal dysphagia have limited proven accuracy in predicting aspiration and respiratory disease. We contend that incorporation of measurable objective assessments into clinical diagnosis is needed and might be key in developing novel therapeutic strategies.

  18. Acoustic analysis of swallowing sounds: a new technique for assessing dysphagia.

    Science.gov (United States)

    Santamato, Andrea; Panza, Francesco; Solfrizzi, Vincenzo; Russo, Anna; Frisardi, Vincenza; Megna, Marisa; Ranieri, Maurizio; Fiore, Pietro

    2009-07-01

    To perform acoustic analysis of swallowing sounds, using a microphone and a notebook computer system, in healthy subjects and patients with dysphagia affected by neurological diseases, testing the positive/negative predictive value of a pathological pattern of swallowing sounds for penetration/aspiration. Diagnostic test study, prospective, not blinded, with the penetration/aspiration evaluated by fibreoptic endoscopy of swallowing as criterion standard. Data from a previously recorded database of normal swallowing sounds for 60 healthy subjects according to gender, age, and bolus consistency was compared with those of 15 patients with dysphagia from a university hospital referral centre who were affected by various neurological diseases. Mean duration of the swallowing sounds and post-swallowing apnoea were recorded. Penetration/aspiration was verified by fibreoptic endoscopy of swallowing in all patients with dysphagia. The mean duration of swallowing sounds for a liquid bolus of 10 ml water was significantly different between patients with dysphagia and healthy patients. We also described patterns of swallowing sounds and tested the negative/positive predictive values of post-swallowing apnoea for penetration/aspiration verified by fibreoptic endoscopy of swallowing (sensitivity 0.67 (95% confidence interval 0.24-0.94); specificity 1.00 (95% confidence interval 0.56-1.00)). The proposed technique for recording and measuring swallowing sounds could be incorporated into the bedside evaluation, but it should not replace the use of more diagnostic and valuable measures.

  19. Decreased diaphragm excursion in stroke patients with dysphagia as assessed by M-mode sonography.

    Science.gov (United States)

    Park, Geun-Young; Kim, Seong-Rim; Kim, Young Woo; Jo, Kwang Wook; Lee, Eu Jeen; Kim, Young Moon; Im, Sun

    2015-01-01

    To record diaphragm excursion via M-mode ultrasonography in stroke patients with dysphagia and determine whether they present reduced diaphragm excursion during voluntary cough compared with stroke patients without dysphagia and healthy subjects. Prospective cross-sectional study. University rehabilitation hospital. Acute stroke patients with dysphagia (n=23), acute stroke patients without dysphagia (n=24), and healthy control participants (n=27) (N=74). Not applicable. Diaphragm motions during quiet breathing, deep breathing, and voluntary coughing were recorded via ultrasonography using M-mode tracing (mm). Maximum inspiratory and expiratory pressures (cmH2O) and peak cough flow (L/min) during voluntary coughing were measured. The mean diaphragm movement (mm) of the hemiplegic side for all groups during quiet breathing, deep breathing, and voluntary coughing was 14.8±4.3, 17.6±4.8, and 20.9±3.7 (Pdysphagia explained up to 60% (Pdysphagia have decreased diaphragm excursion and compromised respiratory function during voluntary coughing. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  20. Dysphagia after Stroke: an Overview.

    Science.gov (United States)

    González-Fernández, Marlís; Ottenstein, Lauren; Atanelov, Levan; Christian, Asare B

    2013-09-01

    Dysphagia affects the vast majority of acute stroke patients. Although it improves within 2 weeks for most, some face longstanding swallowing problems that place them at risk for pneumonia, malnutrition, dehydration, and significantly affect quality of life. This paper discusses the scope, the disease burden, and the tools available for screening and formal evaluation of dysphagia. The most common and recently developed treatment interventions that might be useful in the treatment of this population are discussed.

  1. Dysphagia after Stroke: an Overview

    OpenAIRE

    2013-01-01

    Dysphagia affects the vast majority of acute stroke patients. Although it improves within 2 weeks for most, some face longstanding swallowing problems that place them at risk for pneumonia, malnutrition, dehydration, and significantly affect quality of life. This paper discusses the scope, the disease burden, and the tools available for screening and formal evaluation of dysphagia. The most common and recently developed treatment interventions that might be useful in the treatment of this pop...

  2. Spontaneous swallow frequency compared with clinical screening in the identification of dysphagia in acute stroke.

    Science.gov (United States)

    Crary, Michael A; Carnaby, Giselle D; Sia, Isaac

    2014-09-01

    The aim of this study was to compare spontaneous swallow frequency analysis (SFA) with clinical screening protocols for identification of dysphagia in acute stroke. In all, 62 patients with acute stroke were evaluated for spontaneous swallow frequency rates using a validated acoustic analysis technique. Independent of SFA, these same patients received a routine nurse-administered clinical dysphagia screening as part of standard stroke care. Both screening tools were compared against a validated clinical assessment of dysphagia for acute stroke. In addition, psychometric properties of SFA were compared against published, validated clinical screening protocols. Spontaneous SFA differentiates patients with versus without dysphagia after acute stroke. Using a previously identified cut point based on swallows per minute, spontaneous SFA demonstrated superior ability to identify dysphagia cases compared with a nurse-administered clinical screening tool. In addition, spontaneous SFA demonstrated equal or superior psychometric properties to 4 validated, published clinical dysphagia screening tools. Spontaneous SFA has high potential to identify dysphagia in acute stroke with psychometric properties equal or superior to clinical screening protocols. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Predictors of Dysphagia in Acute Pontine Infarction.

    Science.gov (United States)

    Lapa, Sriramya; Luger, Sebastian; Pfeilschifter, Waltraud; Henke, Christian; Wagner, Marlies; Foerch, Christian

    2017-05-01

    Little is known about the frequency and the clinical characteristics of neurogenic dysphagia in pontine strokes. In this study, we sought to identify predictors for dysphagia in a cohort of patients with isolated pontine infarctions. We included all patients admitted to our department between 2008 and 2014 having an acute (dysphagia was the primary end point of the study and was assessed by a Speech-Language Pathologist according to defined criteria. The study recruited 59 patients, 14 with and 45 without dysphagia. Median (interquartile range) stroke severity (in terms of National Institutes of Health Stroke Scale values) was higher in the dysphagic group as compared with patients without dysphagia (8.5 [6-12] versus 2 [1-5]; Pdysphagia. Dysphagia occurs frequently in patients with isolated pontine infarctions. Clinical and imaging predictors of dysphagia may help to provide optimal screening, to prevent complications and to improve long-term prognosis. © 2017 American Heart Association, Inc.

  4. Pressure Flow Analysis in the Assessment of Preswallow Pharyngeal Bolus Presence in Dysphagia

    Directory of Open Access Journals (Sweden)

    Lara Ferris

    2015-01-01

    Full Text Available Objectives. Preswallow pharyngeal bolus presence is evident in patients with oropharyngeal dysphagia. Pressure flow analysis (PFA using high resolution manometry with impedance (HRMI with AIMplot software is a method for objective interpretation of pharyngeal and upper esophageal sphincter (UES pressures and bolus flow patterns during swallowing. This study aimed to observe alterations in PFA metrics in the event of preswallow pharyngeal bolus presence as seen on videofluoroscopy (VFSS. Methods. Swallows from 40 broad dysphagia patients and 8 controls were recorded with a HRMI catheter during simultaneous VFSS. Evidence of bolus presence and level reached prior to pharyngeal swallow onset was recorded. AIMPlot software derived automated PFA functional metrics. Results. Patients with bolus movement to the pyriform sinuses had a higher SRI, indicating greater swallow dysfunction. Amongst individual metrics, TNadImp to PeakP was shorter and flow interval longer in patient groups compared to controls. A higher pharyngeal mean impedance and UES mean impedance differentiated the two patient groups. Conclusions. This pilot study identifies specific altered PFA metrics in patients demonstrating preswallow pharyngeal bolus presence to the pyriform sinuses. PFA metrics may be used to guide diagnosis and treatment of patients with oropharyngeal dysphagia and track changes in swallow function over time.

  5. Dysphagia (Difficulty Swallowing)

    Science.gov (United States)

    ... falls into one of the following categories. Esophageal dysphagia Esophageal dysphagia refers to the sensation of food ... to inflammation and scarring of the esophagus. Oropharyngeal dysphagia Certain conditions can weaken your throat muscles, making ...

  6. [FEES for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German Stroke Society].

    Science.gov (United States)

    Dziewas, R; Glahn, J; Helfer, C; Ickenstein, G; Keller, J; Lapa, S; Ledl, C; Lindner-Pfleghar, B; Nabavi, D; Prosiegel, M; Riecker, A; Stanschus, S; Warnecke, T; Busse, O

    2014-08-01

    Neurogenic dysphagia is one of the most frequent and prognostically relevant neurological deficits in a variety of disorders, such as stroke, parkinsonism and advanced neuromuscular diseases. Flexible endoscopic evaluation of swallowing (FEES) is now probably the most frequently used tool for objective dysphagia assessment in Germany. It allows evaluation of the efficacy and safety of swallowing, determination of appropriate feeding strategies and assessment of the efficacy of different swallowing manoeuvres. The literature furthermore indicates that FEES is a safe and well-tolerated procedure. In spite of the huge demand for qualified dysphagia diagnostics in neurology, a systematic FEES education has yet not been established. The structured training curriculum presented in this article aims to close this gap and intends to enforce a robust and qualified FEES service. As management of neurogenic dysphagia is not confined to neurologists, this educational program is applicable to other clinicians and speech language therapists with expertise in dysphagia as well.

  7. [Transdisciplinary approach for sarcopenia. Sarcopenic Dysphagia].

    Science.gov (United States)

    Wakabayashi, Hidetaka

    2014-10-01

    Sarcopenic dysphagia is difficulty swallowing due to sarcopenia of generalized skeletal muscles and swallowing muscles. Presbyphagia refers to age-related changes in the swallowing mechanism in the elderly associated with a frailty in swallowing. Presbyphagia is different from dysphagia. The most common cause of dysphagia is stroke. However, sarcopenic dysphagia may be common in the elderly with sarcopenia and dysphagia. Frail elderly with aspiration pneumonia can simultaneously experience activity-, disease-, and nutrition-related sarcopenia of generalized skeletal muscles and swallowing muscles, resulting in the development of sarcopenic dysphagia. Consensus diagnostic criteria for sarcopenic dysphagia were proposed at the 19th Annual Meeting of the Japanese Society of Dysphagia Rehabilitation. The concept of rehabilitation nutrition as a combination of both rehabilitation and nutrition care management is useful for treatment of sarcopenic dysphagia. Therapy for sarcopenic dysphagia includes dysphagia rehabilitation, nutrition improvement and sarcopenia treatment. The core components of dysphagia rehabilitation are oral health care, rehabilitative techniques, and food modification. Nutrition improvement is important, because malnutrition contributes to the etiology of secondary sarcopenia and sarcopenic dysphagia. Assessment of the multi-factorial causes of primary and secondary sarcopenia is important because rehabilitation nutrition for sarcopenia differs depending on its etiology. Treatment of age-related sarcopenia should include resistance training and dietary supplements of amino acids. Therapy for activity-related sarcopenia includes reduced bed rest time and early mobilization and physical activity. Treatment for disease-related sarcopenia requires therapies for advanced organ failure, inflammatory disease, or malignancy, while therapy for nutrition-related sarcopenia involves appropriate nutrition management to increase muscle mass.

  8. Oropharyngeal Dysphagia: neurogenic etiology and manifestation.

    Science.gov (United States)

    Sebastian, Swapna; Nair, Prem G; Thomas, Philip; Tyagi, Amit Kumar

    2015-03-01

    To determine the type, severity and manifestation of dysphagia in patients with neurogenic etiology. Clinical documentation was done on the different etiologies, its manifestation, assessment findings and management strategies taken for patients with neurogenic oropharyngeal dysphagia who were referred for assessment and management of dysphagia over a period of three months in a tertiary care teaching hospital. Flexible endoscopic examination was done in all the patients. The severity of dysphagia in these patients were graded based on Gugging Swallowing Screen (GUSS). A total of 53 patients with neurogenic oropharyngeal dysphagia were evaluated by an otolaryngologist and a speech language pathologist over a period of three months. The grading of severity based on GUSS for these patients were done. There were 30 patients with recurrent laryngeal nerve injury due to various etiologies, one patient with Neurofibroma-vestibular schwanoma who underwent surgical excision, 16 patients with stroke, two patients with traumatic brain injury, two patients with Parkinsonism and two patients with myasthenia gravis. The manifestation of dysphagia was mainly in the form of prolonged masticatory time, oral transit time, and increased number of swallows required for each bolus, cricopharyngeal spasms and aspiration. Among the dysphagia patients with neurogenic etiology, dysphagia is manifested with a gradual onset and is found to have a progressive course in degenerative disorders. Morbidity and mortality may be reduced with early identification and management of neurogenic dysphagia.

  9. Water Quality Assessment Tool 2014

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The Water Quality Assessment Tool project was developed to assess the potential for water-borne contaminants to adversely affect biota and habitats on Service lands.

  10. Validation of the Swedish translation of eating assessment tool (S-EAT-10).

    Science.gov (United States)

    Möller, Riitta; Safa, Stephanie; Östberg, Per

    2016-07-01

    Conclusion The Swedish Eating Assessment Tool (S-EAT-10) is a reliable and valid self-administered tool in assessment of dysphagia in adult Swedish patients with high internal consistency, reliability, and discriminative validity. The normative data show that a score of 3 or more is abnormal. S-EAT-10 is recommended to be used in preliminary diagnostics of dysphagia. Objective To translate and adapt the EAT-10 for use in the Swedish patient population, and to present norms and measures of discriminative validity and reliability of a Swedish version of the Eating Assessment Tool-10 (S-EAT-10). Methods Prospective consecutive clinical study. In total, 134 community-dwelling adult respondents/controls without dysphagia completed the S-EAT-10, as did 119 patients referred for fiberendoscopic evaluation of swallowing at Karolinska University Hospital, Stockholm, Sweden. Patient vs control status was used as the criterion for discriminative validity assessment by logistic regression analysis. Results The mean S-EAT-10 score was 0.2 (range = 0-3) for controls and 18 (range = 0-38) for patients. Based on a cut-off score of ≥ 3 which was considered to be reflective of abnormalities, sensitivity was 98.5% and specificity 94.1%. Internal consistency reliability was high (Cronbach's alpha = 0.88), as was test-re-test reliability (ICC = 0.90).

  11. Dysphagia in children with repaired oesophageal atresia

    NARCIS (Netherlands)

    Coppens, C.H.; Engel-Hoek, L. van den; Scharbatke, H.E.; Groot, S.A. de; Draaisma, J.M.T.

    2016-01-01

    Dysphagia is a common problem in children with repaired oesophageal atresia (OA). Abnormalities in the oropharyngeal and oesophageal phase have hardly been studied. The aims of this study were to assess the prevalence of dysphagia in children with repaired OA and to identify and differentiate oral

  12. Formative assessments as pedagogic tools

    Directory of Open Access Journals (Sweden)

    Ashwin Kumar

    2013-03-01

    Full Text Available This article aims at presenting a state of the art status of formative assessment as a pedagogic tool. To this end, a brief developmental account of different modes of assessment over the last decades will be presented first. Then, formative assessment will be discussed in its constructivist guise. The present literature on assessment suggests that assessment for learning (formative assessment not only represents an assessment tool but it also serves as a pedagogic tool to enhance learning and thinking. It has also gone to lengths to affect the design of classroom tasks and activities. Attempts have been made to delineate the underlying principles of formative assessment which can be used to picture the formation process of learners’ knowledge and development. Subsequently, alternative assessment techniques of which the present article will give an account have been suggested by scholars to operationalize these principles.

  13. Videofluoroscopic assessment of dysphagia: A questionnaire survey of protocols, roles and responsibilities of radiology and speech and language therapy personnel

    Energy Technology Data Exchange (ETDEWEB)

    Power, Maxine [Section of Gastrointestinal Science, University of Manchester, Hope Hospital, Manchester (United Kingdom)]. E-mail: mpower@fs1.ho.man.ac.uk; Laasch, Hans-Ulrich [Academic Department of GI-Radiology, South Manchester University Hospitals, Manchester (United Kingdom); Kasthuri, Ram S. [Academic Department of GI-Radiology, South Manchester University Hospitals, Manchester (United Kingdom); Nicholson, David A. [Radiology, University of Manchester, Hope Hospital, Manchester (United Kingdom); Hamdy, Shaheen [Section of Gastrointestinal Science, University of Manchester, Hope Hospital, Manchester (United Kingdom)

    2006-02-15

    Videofluoroscopy (VF) is the 'gold standard' assessment for oropharyngeal dysphagia and radiographers are beginning to direct this examination independently, yet little is known about the roles and responsibilities of the core professions of radiology and speech and language therapy and their practice in this examination. Aim: To evaluate VF practice and identify the roles and responsibilities of radiology and speech and language therapy personnel. Materials and methods: A questionnaire was developed and distributed to speech and language therapists (SALT) and radiologists via national special interest networks. Information regarding protocols, test materials, supervision, radiation protection and training was obtained. Results: One hundred and thirteen questionnaires were completed, 83% of respondents had more than 5 years service. Most were carrying out VF on an 'ad hoc' basis with only 32% participating in more than 6 assessments per month. There was no consensus on protocol and 41% chose to thicken barium solutions by adding more barium sulphate powder, potentially predisposing patients to complications. Over 50% of SALTs had received one day post-graduate training in VF, whereas, only one radiologist had specific VF training. Conclusion: Despite its importance in determining the feeding route for patients, VF is carried out infrequently by most clinicians and protocols vary widely. Moreover, intra- and inter-disciplinary training and supervision is minimal. More work is needed to develop standard guidelines, to improve the quality of the examination and its reproducibility.

  14. Four FACTs Spiritual Assessment Tool.

    Science.gov (United States)

    LaRocca-Pitts, Mark

    2015-01-01

    The Four FACTs Spiritual Assessment Tool combines the Four Fs and the FACT Spiritual Assessment Tool of LaRocca-Pitts into a single tool. The Four FACTs Tool is specifically designed for beginning students, but can also meet the needs of professional chaplains. Though designed for use in an acute care setting, it can be easily adapted for other settings. The Four FACTs Tool is easy to learn and to use and it gathers and evaluates relevant clinical information that can then be used to develop a plan of care. In its shortened form, as ACT, it informs how the chaplain can be fully present with patients and their families, especially in a time of crisis.

  15. Tools for Microbiological risk assessment

    DEFF Research Database (Denmark)

    Bassett, john; Nauta, Maarten; Lindqvist, Roland

    Microbiological Risk Assessment (MRA) has emerged as a comprehensive and systematic approach for addressing the risk of pathogens in specific foods and/or processes. At government level, MRA is increasingly recognised as a structured and objective approach to understand the level of risk in a given...... can increase the understanding of microbiological risks in foods. It is timely to inform food safety professionals about the availability and utility of MRA tools. Therefore, the focus of this report is to aid the food safety manager by providing a concise summary of the tools available for the MRA...... food/pathogen scenario. Tools developed so far support qualitative and quantitative assessments of the risk that a food pathogen poses to a particular population. Risk can be expressed as absolute numbers or as relative (ranked) risks. The food industry is beginning to appreciate that the tools for MRA...

  16. Tools for microbiological risk assessment

    OpenAIRE

    Bassett, J; Nauta, M; Lindqvist, R.; Zwietering, M. H.

    2012-01-01

    Microbiological Risk Assessment (MRA) has emerged as a comprehensive and systematic approach for addressing the risk of pathogens in specific foods and/or processes. At government level, MRA is increasingly recognised as a structured and objective approach to understand the level of risk in a given food/pathogen scenario. Tools developed so far support qualitative and quantitative assessments of the risk that a food pathogen poses to a particular population. Risk can be expressed as absolute ...

  17. Employability Skills Assessment Tool Development

    Science.gov (United States)

    Rasul, Mohamad Sattar; Rauf, Rose Amnah Abd; Mansor, Azlin Norhaini; Puvanasvaran, A. P.

    2012-01-01

    Research nationally and internationally found that technical graduates are lacking in employability skills. As employability skills are crucial in outcome-based education, the main goal of this research is to develop an Employability Skill Assessment Tool to help students and lecturers produce competent graduates in employability skills needed by…

  18. DYSPHAGIA AND SIALORRHEA:

    Directory of Open Access Journals (Sweden)

    Denise Hack NICARETTA

    2013-03-01

    Full Text Available ContextDysphagia and sialorrhea in patients with Parkinson's disease are both automatically accepted as dependent on this neurological disease.ObjectiveThe aim were to establish if these two complaints are a consequence or associated manifestations of Parkinson's disease.MethodTwo Parkinson's diseases groups from the same outpatients' population were studied. Patients in the first group, with dysphagia, were studied by videofluoroscopy. The second, with sialorrhea, were studied by the scintigraphic method,ResultsVideofluoroscopic examination of the oral, pharyngeal and esophageal phases of swallowing showed that 94% of Parkinson's diseases patients present, structural causes, not related to Parkinson's diseases, able to produce or intensify the observed disphagia. The scintigraphic examination of Parkinson's diseases patients with sialorrhea showed that there is no increase of serous saliva production. Nevertheless, showed a significantly higher velocity of saliva excretion in the Parkinson's diseases patients.ConclusionsDysphagia can be due to the muscular rigidity often present in the Parkinson's diseases patient, or more usually by non Parkinson's disease associated causes. In Parkinson's diseases patients, sialorrhea is produced by saliva retention. Nevertheless, sialorrhea can produce discomfort in swallowing, although without a formal complaint of dysphagia. In this case, subclinical dysphagia must be considered. Sialorrhea is indicative of dysphagia or at least of subclinical dysphagia. As final conclusion, Parkinson's diseases can be an isolated cause of dysphagia and/or sialorrhea, but frequently, a factor unrelated to Parkinson's diseases is the main cause of or at least aggravates the dysphagia.

  19. Dysphagia in the elderly stroke patient.

    Science.gov (United States)

    Lugger, K E

    1994-04-01

    Of all strokes 75% occur in people over age 65, and the incidence of stroke rises with age. Because swallowing problems often result, the elderly stroke patient is at risk for dysphagia and its complications. Acute and chronic swallowing problems are associated with many complications including dehydration, malnutrition, aspiration, pneumonitis, depression and even death. These complications make swallowing problems in the aged stroke patient an important focus for nursing attention. Nurses must be aware of the complexity of normal swallowing mechanisms, knowledgeable about the aged stroke patient's risk for dysphagia, aware of the importance of early detection and treatment of dysphagia and confident about their role in dysphagia assessment and treatment regimen. This information can be used in the assessment, treatment and rehabilitation of the elderly dysphagic stroke patient.

  20. Probabilistic Flood Defence Assessment Tools

    Directory of Open Access Journals (Sweden)

    Slomp Robert

    2016-01-01

    Full Text Available The WTI2017 project is responsible for the development of flood defence assessment tools for the 3600 km of Dutch primary flood defences, dikes/levees, dunes and hydraulic structures. These tools are necessary, as per January 1st 2017, the new flood risk management policy for the Netherlands will be implemented. Then, the seven decades old design practice (maximum water level methodology of 1958 and two decades old safety standards (and maximum hydraulic load methodology of 1996 will formally be replaced by a more risked based approach for the national policy in flood risk management. The formal flood defence assessment is an important part of this new policy, especially for flood defence managers, since national and regional funding for reinforcement is based on this assessment. This new flood defence policy is based on a maximum allowable probability of flooding. For this, a maximum acceptable individual risk was determined at 1/100 000 per year, this is the probability of life loss of for every protected area in the Netherlands. Safety standards of flood defences were then determined based on this acceptable individual risk. The results were adjusted based on information from cost -benefit analysis, societal risk and large scale societal disruption due to the failure of critical infrastructure e.g. power stations. The resulting riskbased flood defence safety standards range from a 300 to a 100 000 year return period for failure. Two policy studies, WV21 (Safety from floods in the 21st century and VNK-2 (the National Flood Risk in 2010 provided the essential information to determine the new risk based safety standards for flood defences. The WTI2017 project will provide the safety assessment tools based on these new standards and is thus an essential element for the implementation of this policy change. A major issue to be tackled was the development of user-friendly tools, as the new assessment is to be carried out by personnel of the

  1. Validity and Reliability of the Persian Version of the Dysphagia Handicap Index (DHI

    Directory of Open Access Journals (Sweden)

    faezeh asadollahpour

    2015-05-01

    Full Text Available Introduction: The Dysphagia Handicap Index (DHI is one of the instruments used for measuring a dysphagic patient’s self-assessment. In some ways, it reflects the patient’s quality of life. Although it has been recognized and widely applied in English speaking populations, it has not been used in its present forms in Persian speaking countries. The purpose of this study was to adapt a Persian version of the DHI and to evaluate its validity, consistency, and reliability in the Persian population with oropharyngeal dysphagia.   Materials and Methods: Some stages for cross-cultural adaptation were performed, which consisted in translation, synthesis, back translation, review by an expert committee, and final proof reading. The generated Persian DHI was administered to 85 patients with oropharyngeal dysphagia and 89 control subjects at Zahedan city between May 2013 and August 2013. The patients and control subjects answered the same questionnaire 2 weeks later to verify the test-retest reliability. Internal consistency and test-retest reliability were evaluated. The results of the patients and the control group were compared.   Results: The Persian DHI showed good internal consistency (Cronbach’s alpha coefficients range from 0.82 to 0.94. Also, good test-retest reliability was found for the total scores of the Persian DHI (r=0.89. There was a significant difference between the DHI scores of the control group and those of the oropharyngeal dysphagia group (P‹0.001.   Conclusion:  The Persian version of the DHI achieved Face and translation validity. This study demonstrated that the Persian DHI is a valid tool for self-assessment of the handicapping effects of dysphagia on the physical, functional, and emotional aspects of patient life and can be a useful tool for screening and treatment planning for the Persian-speaking dysphagic patients, regardless of the cause or the severity of the dysphagia.

  2. Dementia and dysphagia.

    Science.gov (United States)

    Easterling, Caryn S; Robbins, Elizabeth

    2008-01-01

    In 2004, more than 12% of the population in the United States was aged 65 years or older. This percentage is expected to increase to 20% of the population by 2030. The prevalence of swallowing disorders, or dysphagia, in older individuals ranges from 7% to 22% and dramatically increases to 40% to 50% in older individuals who reside in long-term care facilities. For older individuals, those with neurologic disease, or those with dementia, the consequence of dysphagia may be dehydration, malnutrition, weight loss, and aspiration pneumonia. Dysphagia can be a result of behavioral, sensory, or motor problems (or a combination of these) and is common in individuals with neurologic disease and dementia. Although there are few studies of the incidence and prevalence of dysphagia in individuals with dementia, it is estimated that 45% of institutionalized dementia patients have dysphagia. The high prevalence of dysphagia in individuals with dementia likely is the result of age-related changes in sensory and motor function in addition to those produced by neuropathology. The following article describes evidence based practices in caring for those individuals with dementia and dysphagia with guidelines for evaluation and management.

  3. [Dysphagia and swallowing rehabilitation].

    Science.gov (United States)

    Shigematsu, Takashi; Fujishima, Ichiro

    2015-02-01

    Dysphagia is a life-threatening disorder caused by many medical conditions such as stroke, neurological disorders, tumors, etc. The symptoms of dysphagia are quite variable and diagnosed by observation or through screening involving instrumental swallowing examinations such as video-fluoroscopy and video-endoscopy, to determine functional severity and treatment-prognosis. Direct- and indirect-therapy is used with and without food, respectively. Swallowing rehabilitation is very effective, and could be used in conjunction with compensatory techniques. Here we present an overview of dysphagia and swallowing rehabilitation.

  4. Diagnostic evaluation of dysphagia.

    Science.gov (United States)

    Cook, Ian J

    2008-07-01

    Taking a careful history is vital for the evaluation of dysphagia. The history will yield the likely underlying pathophysiologic process and anatomic site of the problem in most patients, and is crucial for determining whether subsequently detected radiographic or endoscopic 'anomalies' are relevant or incidental. Although the symptoms of pharyngeal dysphagia can be multiple and varied, the typical features of neurogenic pharyngeal dysphagia are highly specific, and can accurately distinguish pharyngeal from esophageal disorders. The history will also dictate whether the next diagnostic procedure should be endoscopy, a barium swallow or esophageal manometry. In some difficult cases, all three diagnostic techniques may need to be performed to establish an accurate diagnosis. Stroke is the most common cause of pharyngeal dysphagia. A videoradiographic swallow study is vital in such cases to determine the extent and timing of aspiration and the severity and mechanics of dysfunction as a prelude to therapy.

  5. Human factors assessment mechanical compression tools

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, C. [BC Research Inc., Vancouver, BC (Canada)

    1999-09-01

    The design and use of mechanical compression tools in electrical distribution functions were examined from the point of view of effects of design and use of tools on human operators. Various alternative tools such as manual compression tools, battery operated tools, wedge pressure tools, hydraulic tools, and insulating piercing connectors were also examined for purposes of comparison. Results of the comparative assessment were summarized and a tool satisfaction ratings table was produced for Burndy MD6, Huskie-Robo (REC 258) and Ampact (small) tools, rating level of effort, fatigue experienced, tool mass, force required to crimp, ease of use, comfort while using the tool, maneuverability, and overall satisfaction. Both the battery operated tool as well as the wedge pressure tool have been found to have ergonomic advantages over the mechanical compression tool.

  6. Diagnostic value of "dysphagia limit" for neurogenic dysphagia: 17 years of experience in 1278 adults.

    Science.gov (United States)

    Aydogdu, Ibrahim; Kiylioglu, Nefati; Tarlaci, Sultan; Tanriverdi, Zeynep; Alpaydin, Sezin; Acarer, Ahmet; Baysal, Leyla; Arpaci, Esra; Yuceyar, Nur; Secil, Yaprak; Ozdemirkiran, Tolga; Ertekin, Cumhur

    2015-03-01

    Neurogenic dysphagia (ND) is a prevalent condition that accounts for significant mortality and morbidity worldwide. Screening and follow-up are critical for early diagnosis and management which can mitigate its complications and be cost-saving. The aims of this study are to provide a comprehensive investigation of the dysphagia limit (DL) in a large diverse cohort and to provide a longitudinal assessment of dysphagia in a subset of subjects. We developed a quantitative and noninvasive method for objective assessment of dysphagia by using laryngeal sensor and submental electromyography. DL is the volume at which second or more swallows become necessary to swallow the whole amount of bolus. This study represents 17 years experience with the DL approach in assessing ND in a cohort of 1278 adult subjects consisting of 292 healthy controls, 784 patients with dysphagia, and 202 patients without dysphagia. A total of 192 of all patients were also reevaluated longitudinally over a period of 1-19 months. DL has 92% sensitivity, 91% specificity, 94% positive predictive value, and 88% negative predictive value with an accuracy of 0.92. Patients with ALS, stroke, and movement disorders have the highest sensitivity (85-97%) and positive predictive value (90-99%). The clinical severity of dysphagia has significant negative correlation with DL (r=-0.67, pdysphagia and it can be performed in an EMG laboratory. Our study provides specific quantitative features of DL test that can be readily utilized by the neurologic community and nominates DL as an objective and robust method to evaluate dysphagia in a wide range of neurologic conditions. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  7. Schoolchildren with Dysphagia Associated with Medically Complex Conditions

    Science.gov (United States)

    Lefton-Greif, Maureen A.; Arvedson, Joan C.

    2008-01-01

    Purpose: This article reviews population trends and general characteristics of children with dysphagia in schools, provides an overview of dysphagia teams and the roles of the speech-language pathologist (SLP) in school and hospital settings, and describes assessment and treatment of swallowing and feeding problems in children with complex medical…

  8. Oral muscles are progressively affected in Duchenne muscular dystrophy: implications for dysphagia treatment

    NARCIS (Netherlands)

    Engel-Hoek, L. van den; Erasmus, C.E.; Hendriks, J.C.M.; Geurts, A.C.H.; Klein, W.M.; Pillen, S.; Sie, L.T.L.; Swart, B.J.M. de; Groot, I.J.M. de

    2013-01-01

    Dysphagia is reported in advanced stages of Duchenne muscular dystrophy (DMD). The population of DMD is changing due to an increasing survival. We aimed to describe the dysphagia in consecutive stages and to assess the underlying mechanisms of dysphagia in DMD, in order to develop mechanism based

  9. The Intensive Dysphagia Rehabilitation Approach Applied to Patients With Neurogenic Dysphagia: A Case Series Design Study.

    Science.gov (United States)

    Malandraki, Georgia A; Rajappa, Akila; Kantarcigil, Cagla; Wagner, Elise; Ivey, Chandra; Youse, Kathleen

    2016-04-01

    To examine the effects of the Intensive Dysphagia Rehabilitation approach on physiological and functional swallowing outcomes in adults with neurogenic dysphagia. Intervention study; before-after trial with 4-week follow-up through an online survey. Outpatient university clinics. A consecutive sample of subjects (N=10) recruited from outpatient university clinics. All subjects were diagnosed with adult-onset neurologic injury or disease. Dysphagia diagnosis was confirmed through clinical and endoscopic swallowing evaluations. No subjects withdrew from the study. Participants completed the 4-week Intensive Dysphagia Rehabilitation protocol, including 2 oropharyngeal exercise regimens, a targeted swallowing routine using salient stimuli, and caregiver participation. Treatment included hourly sessions twice per week and home practice for approximately 45 min/d. Outcome measures assessed pre- and posttreatment included airway safety using an 8-point Penetration Aspiration Scale, lingual isometric pressures, self-reported swallowing-related quality of life (QOL), and level of oral intake. Also, patients were monitored for adverse dysphagia-related effects. QOL and adverse effects were also assessed at the 4-week follow-up (online survey). The Intensive Dysphagia Rehabilitation approach was effective in improving maximum and mean Penetration Aspiration Scale scores (PDysphagia Rehabilitation approach was safe and improved physiological and some functional swallowing outcomes in our sample; however, further investigation is needed before it can be widely applied. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  10. Dysphagia in amyotrophic lateral sclerosis: prevalence and clinical findings.

    Science.gov (United States)

    Ruoppolo, G; Schettino, I; Frasca, V; Giacomelli, E; Prosperini, L; Cambieri, C; Roma, R; Greco, A; Mancini, P; De Vincentiis, M; Silani, V; Inghilleri, M

    2013-12-01

    To characterize swallowing deficits in amyotrophic lateral sclerosis (ALS); investigate the delay in dysphagia onset; estimate correlations between dysphagia severity and patients' functional status; identify the symptom(s) most likely to predict dysphagia. A group of 49 consecutive patients with ALS, 14 with bulbar onset and 35 with spinal onset, underwent swallowing evaluation including bedside and fiberoptic endoscopic examination to detect dysphagia. Patients with dysphagia were more likely than those without to have bulbar onset ALS (P = 0.02); more severely impaired chewing (P = 0.01); and tongue muscle deficits (P = 0.001). The only variable measured at first examination significantly associated with dysphagia was a more than mild tongue muscle deficit. The only variable useful in predicting dysphagia was a chewing deficit. In 10 of the 49 patients studied, swallowing evaluation disclosed an impaired cough reflex. Dysphagia in patients with ALS correlates significantly with bulbar onset and with oral swallowing impairment. Fiberoptic swallowing evaluation is a useful tool for detecting swallowing deficits and laryngeal sensitivity in patients with ALS. An impaired cough reflex is an unexpected finding in many patients with ALS. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. High resolution impedance manometric findings in dysphagia of Huntington's disease

    Institute of Scientific and Technical Information of China (English)

    Tae Hee Lee; Joon Seong Lee; Wan Jung Kim

    2012-01-01

    Conventional manometry presents significant challenges,espedally in assessment of pharyngeal swallowing,because of the asymmetry and deglutitive movements of oropharyngeal structures.It only provides information about intraluminal pressure and thus it is difficult to study functional details of esophageal motility disorders.New technology of solid high resolution impedance manometry (HRIM),with 32 pressure sensors and 6 impedance sensors,is likely to provide better assessment of pharyngeal swallowing as well as more information about esophageal motility disorders.However,the clinical usefulness of application of HRIM in patients with oropharyngeal dysphagia or esophageal dysphagia is not known.We experienced a case of Huntington's disease presenting with both oropharyngeal and esophageal dysphagia,in which HRIM revealed the mechanism of oropharyngeal dysphagia and provided comprehensive information about esophageal dysphagia.

  12. Calculational Tool for Skin Contamination Dose Assessment

    CERN Document Server

    Hill, R L

    2002-01-01

    Spreadsheet calculational tool was developed to automate the calculations preformed for dose assessment of skin contamination. This document reports on the design and testing of the spreadsheet calculational tool.

  13. Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society.

    Science.gov (United States)

    Dziewas, Rainer; Glahn, Jörg; Helfer, Christine; Ickenstein, Guntram; Keller, Jochen; Ledl, Christian; Lindner-Pfleghar, Beate; G Nabavi, Darius; Prosiegel, Mario; Riecker, Axel; Lapa, Sriramya; Stanschus, Sönke; Warnecke, Tobias; Busse, Otto

    2016-02-25

    Neurogenic dysphagia is one of the most frequent and prognostically relevant neurological deficits in a variety of disorders, such as stroke, parkinsonism and advanced neuromuscular diseases. Flexible endoscopic evaluation of swallowing (FEES) is now probably the most frequently used tool for objective dysphagia assessment in Germany. It allows evaluation of the efficacy and safety of swallowing, determination of appropriate feeding strategies and assessment of the efficacy of different swallowing manoeuvres. The literature furthermore indicates that FEES is a safe and well-tolerated procedure. In spite of the huge demand for qualified dysphagia diagnostics in neurology, a systematic FEES education has not yet been established. The structured training curriculum presented in this article aims to close this gap and intends to enforce a robust and qualified FEES service. As management of neurogenic dysphagia is not confined to neurologists, this educational programme is applicable to other clinicians and speech-language therapists with expertise in dysphagia as well. The systematic education in carrying out FEES across a variety of different professions proposed by this curriculum will help to spread this instrumental approach and to improve dysphagia management.

  14. Frailty measurements and dysphagia in the outpatient setting.

    Science.gov (United States)

    Hathaway, Bridget; Vaezi, Alec; Egloff, Ann Marie; Smith, Libby; Wasserman-Wincko, Tamara; Johnson, Jonas T

    2014-09-01

    Deconditioning and frailty may contribute to dysphagia and aspiration. Early identification of patients at risk of aspiration is important. Aspiration prevention would lead to reduced morbidity and health care costs. We therefore wondered whether objective measurements of frailty could help identify patients at risk for dysphagia and aspiration. Consecutive patients (n = 183) were enrolled. Patient characteristics and objective measures of frailty were recorded prospectively. Variables tested included age, body mass index, grip strength, and 5 meter walk pace. Statistical analysis tested for association between these parameters and dysphagia or aspiration, diagnosed by instrumental swallowing examination. Of variables tested for association with grip strength, only age category (P = .003) and ambulatory status (P dysphagia or aspiration, ambulatory status was significantly associated with dysphagia and aspiration in multivariable model building. Nonambulatory status is a predictor of aspiration and should be included in risk assessments for dysphagia. The relationship between frailty and dysphagia deserves further investigation. Frailty assessments may help identify those at risk for complications of dysphagia. © The Author(s) 2014.

  15. Revolutionary Wake Hazard Assessment Tool Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Continuum Dynamics, Inc. (CDI) has developed a Multiple Aircraft Simulation Tool (MAST) that revolutionizes the ability to predict and assess wake interactions...

  16. Colorectal Cancer Risk Assessment Tool

    Science.gov (United States)

    ... 11/12/2014 Risk Calculator About the Tool Colorectal Cancer Risk Factors Download SAS and Gauss Code Page ... Rectal Cancer: Prevention, Genetics, Causes Tests to Detect Colorectal Cancer and Polyps Cancer Risk Prediction Resources Update November ...

  17. [Efficacy of high-frequency cinematography in diagnosis of dysphagia].

    Science.gov (United States)

    Oelerich, M; Mai, R; Müller-Miny, H; Peters, P E

    1995-10-01

    Dysphagia is a common symptom in clinical practice. Due to the broad spectrum of underlying diseases many disciplines are involved in the therapy and diagnosis of dysphagia, where radiology plays a central role. The radiologist is confronted with different diagnostic problems and has to choose the most appropriate type of investigation. In many cases no organic disorder can be demonstrated by clinical examination, endoscopy or conventional radiological techniques. In this setting cineradiography is an outstanding tool for finding functional or structural changes in the swallowing chain. This study underlines the efficiency of cineradiography in the diagnosis of dysphagia.

  18. Dysphagia in Huntington's disease

    NARCIS (Netherlands)

    Heemskerk-van den Berg, Willemien Antoinette

    2015-01-01

    Huntington’s disease (HD) is a progressive neurodegenerative disease with an autosomal, dominant mode of inheritance. Patients with HD suffer from dysphagia which can have serious consequences, such as weight loss, dehydration, and pneumonia leading to death. Many patients with HD die of aspiration

  19. Dysphagia in Huntington's disease

    NARCIS (Netherlands)

    Heemskerk-van den Berg, Willemien Antoinette

    2015-01-01

    Huntington’s disease (HD) is a progressive neurodegenerative disease with an autosomal, dominant mode of inheritance. Patients with HD suffer from dysphagia which can have serious consequences, such as weight loss, dehydration, and pneumonia leading to death. Many patients with HD die of aspiration

  20. Air Traffic Control Tools Assessment

    Directory of Open Access Journals (Sweden)

    Tomáš Noskievič

    2017-04-01

    Full Text Available Undoubtedly air transport in today’s world wouldn’t be able to exist without any air traffic control service. As the air transport has been coming through major changes and it has been expanding, it is assumed that its volume will be doubled in the next 15 years. Air traffic control uses strictly organised procedures to ensure safe course of air operations. With the skies covered with more airplanes every year, new tools must be introduced to allow the controllers to manage this rising amount of flying aircraft and to keep the air transport safe. This paper provides a comprehensive and organized material, which describes the newest tools and systems used by air traffic control officers. It proposes improvements for further research and development of ATC tools.

  1. 33 CFR 101.510 - Assessment tools.

    Science.gov (United States)

    2010-07-01

    ... MARITIME SECURITY: GENERAL Other Provisions § 101.510 Assessment tools. Ports, vessels, and facilities... may include: (a) DHS/TSA's vulnerability self-assessment tool located at http://www.tsa.gov/risk; and...); and (3) Navigation and Vessel Inspection Circular titled, “Security Guidelines for Facilities”, (NVIC...

  2. Causes of dysphagia among different age groups: a systematic review of the literature.

    Science.gov (United States)

    Roden, Dylan F; Altman, Kenneth W

    2013-12-01

    Dysphagia is a common problem that has the potential to result in severe complications such as malnutrition and aspiration pneumonia. Based on the complexity of swallowing, there may be many different causes. This article presents a systematic literature review to assess different comorbid disease associations with dysphagia based on age. The causes of dysphagia are different depending on age, affecting between 1.7% and 11.3% of the general population. Dysphagia can be a symptom representing disorders pertinent to any specialty of medicine. This review can be used to aid in the diagnosis of patients presenting with the complaint of dysphagia. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. [Efficacy of rehabilitation in oropharyngeal dysphagia].

    Science.gov (United States)

    Silva, Roberta Gonçalves da

    2007-01-01

    efficacy of rehabilitation in oropharyngeal dysphagia. In our country the practice of speech-language pathology in oropharyngeal dysphagia has increased significantly and, at this moment, deserves attention since practice needs to be based on scientific evidence. Therapeutic techniques and the outcome of rehabilitation in oropharyngeal dysphagia have been studied since the 70s, reaching its high point during the 80s and 90s. Few studies have investigated the efficacy of therapy in the rehabilitation of oropharyngeal dysphagia, the vast majority have tried to prove the effects of therapy on the dynamics of swallowing. In Brazil, the studies about oropharyngeal dysphagia have, in great part, investigated assessment procedures, and only a few have worried about rehabilitation. to present a critical analysis about the efficacy of rehabilitation in oropharyngeal dysphagia. this review of the literature indicates that non-randomized studies have compromised the results, once the casuistic of the researches are very heterogeneous--they include neurogenic and mechanical oropharyngeal dyshagia caused by different etiologies. Besides that, therapeutic programs which are used are not sufficiently described, compromising the reproduction of the methodology by other researchers. These results suggest the need for more randomized studies, which can be initially developed as case studies in order to exclude the control variables of therapy efficacy. Another suggestion is, as proposed by present researches, to use scales that can measure the impact of swallowing training in the nutritional and pulmonary condition of dysphagic patients. An important research area, related to the control of therapeutic efficacy and efficiency, are the studies that aim to establish the decrease in hospital and home care costs as a consequence of speech-language intervention with patients with oropharyngeal dyspahgia.

  4. The McGill ingestive skills assessment predicts time to death in an elderly population with neurogenic dysphagia: preliminary evidence.

    Science.gov (United States)

    Lambert, Heather C; Abrahamowicz, Michal; Groher, Michael; Wood-Dauphinee, Sharon; Gisel, Erika G

    2005-01-01

    The McGill Ingestive Skills Assessment (MISA) is a new assessment tool which quantifies the ingestive process by scoring a meal observation. The reliability and the construct validity of the MISA have been documented. However, establishment of the ability of the MISA to predict health outcomes related to feeding difficulties would support its applicability in research and in clinical settings. Seventy-three participants of a large-scale reliability and validity study were followed for up to 563 days following evaluation with the MISA. The date of the first pulmonary infection and the date and cause of death where applicable were obtained from medical records. Individuals with no incident of pulmonary infection and who were not deceased were "censored" at the date of followup. Survival analyses revealed that the MISA scores are predictive of death using a Cox proportional hazards model, and of time to pulmonary infection using a flexible model. Scores on the Solid Ingestion and Self-feeding scales are predictive of death using the Cox model, and the Texture Management scale is predictive of death using the flexible model. This effect remains statistically significant even when MISA scores are adjusted for the participant's age. These findings support the validity of the MISA for use with elderly individuals with neurogenic ingestive skill loss residing in long-term care facilities.

  5. Evolution of chronic dysphagia following treatment for head and neck cancer.

    Science.gov (United States)

    Nguyen, Nam P; Moltz, Candace C; Frank, Cheryl; Vos, Paul; Smith, Herbert J; Karlsson, Ulf; Nguyen, Ly M; Rose, Sue; Dutta, Suresh; Sallah, Sabah

    2006-04-01

    We would like to assess the evolution of chronic dysphagia (1 year or more) following treatment for head and neck cancer. Modified barium swallow (MBS) examinations were performed in cancer-free patients who complained of dysphagia following treatment for head and neck cancer. The severity of the dysphagia was graded on a scale of 1-7. Each patient had at least 2 MBS. Severity of dysphagia was compared between the first and last MBS study to determine whether the swallowing dysfunction had returned to normal. Patients with complaint of dysphagia and normal MBS also underwent a regular barium swallow to assess the structural integrity of the pharynx and esophagus. Between 1996 and 2001, 25 patients with dysphagia underwent repeat MBS following treatment. Swallowing dysfunction did not return to normal in the majority of the patients. At a median time of 26 months following treatment (range 15-82 months), only two patient (8%) had normalization of the swallowing. The severity of dysphagia decreased in eight patients (32%), remained unchanged in 12 patients (48%), and worsened in five patients (20%). Eight patients (32%) still had aspiration problems at 12-83 months following treatment. Six patients (24%) required dilation because of pharyngeal stenosis. Three patients who required dilation had improvement of the dysphagia severity. Chronic dysphagia is a relentless process possibly due to excessive scarring. Patients with chronic dysphagia are at risk of malnutrition, and aspiration. Management of chronic dysphagia requires a team approach with nutritional support, psychological counseling, dilation, and tube feedings when indicated.

  6. Observation as an Assessment Tool.

    Science.gov (United States)

    Nickell, Pat; Wilson, Angene

    1999-01-01

    Considers the use of observation in the classroom as a means of student assessment. Focuses on developing an observation instrument, the scoring criteria, and using progress-based rankings rather than static rankings. Provides an example teacher observation form. (CMK)

  7. PCATool: primary care assessment tool

    Directory of Open Access Journals (Sweden)

    Armando Henrique Norman

    2013-10-01

    Full Text Available A Revista Brasileira de Medicina de Família e Comunidade (RBMFC  encerra o ano de 2013 com uma edição em comemoração ao nascimento da Dra. Barbara Starfield em 18 de dezembro (18/12/1932 - 10/6/2011. A foto da capa, intitulada  “Desayuno en Buitrago de Lozoya” retrata a amizade entre Barbara Starfield, seu marido Neil “Tony” Holtzman e Juan Gérvas e Mercedes Pérez Fernández (autora da foto, na qual desfrutam e compartilham a vida à mesa. A mesa também faz referência a uma característica marcante de Starfield: a de nutriz (do latim nuctrix, que possui a capacidade de nutrir; que sustenta. Como  afirmou seu marido Tony: - “Ela fez isso por meio de sua pesquisa, sua paixão altruísta e sua orientação àqueles que se preocupam com as pessoas, a justiça e a verdade”1.O editorial especial para esta edição foi escrito pelo Dr. Juan Gérvas e reflete a importância de se avaliar a qualidade da atenção primária à saúde (APS a fim de que ela possa, continuamente,  se fortalecer. Em decorrência disso, todos os artigos desta edição versam sobre o Instrumento de Avaliação da Atenção Primária, em inglês Primary Care Assessment Tool (PCATool, sua validação, adaptação e aplicação para a APS2. Starfield e colaboradores desenvolveram, no The Johns Hopkins Populations Care Policy Center for the Underserved Populations, o PCATool, instrumento que permite mensurar a presença e a extensão dos atributos essenciais e derivados da APS3. Os quatro atributos essenciais da APS: a acesso de primeiro contato; b continuidade do cuidado; c abrangência  (comprehensiveness; e d coordenação dos cuidados são subcomponentes do acesso e, portanto, a qualidade dos serviços passa pela melhoria de estruturas e processos (efetividade que garantam o acesso tanto no nível individual – atendendo os indivíduos e suas necessidades em saúde – como no nível populacional, em que o acesso volta-se à dimensão ética da

  8. Cross-cultural adaptation of the Brazilian version of the Eating Assessment Tool - EAT-10.

    Science.gov (United States)

    Gonçalves, Maria Inês Rebelo; Remaili, Carla Bogossian; Behlau, Mara

    2013-12-16

    The Eating Assessment Tool (EAT-10) was conceptually developed in the United States from data collected from 482 patients, for use as a self-administered survey regarding risk identification of dysphagia and symptoms related to clinical response to treatment. The purpose of this study is to present the cultural equivalence of the Brazilian version of the EAT-10. The process followed the Scientific Advisory Committee of Medical Outcome Trust (SACMOT). The questionnaire was translated by two Brazilian bilingual speech-language pathologists, aware of the purpose of this study. A back translation was performed by a third Brazilian speech-language pathologist, bilingual and English teacher that had not participated in the previous stage. After comparing both translations, a final version of the questionnaire was produced and called Instrumento de Autoavaliação da Alimentação (EAT-10). It was administered to 107 adult inpatients of the Hospital São Paulo, cwith request for bedside clinical evaluation of swallow. During the process of translation and cultural adaptation, no item was modified and/or suppressed. The EAT-10 maintained the same structure as the original American English version with ten questions, of which three of functional domain, three of emotional domain and four of physical symptoms domain. The cultural equivalence of the Brazilian version of the EAT-10 was demonstrated, being a score of three points or above it the cutoff for dysphagia risk, also for the Brazilian population.

  9. Dysphagia after laparoscopic Nissen fundoplication

    DEFF Research Database (Denmark)

    Funch-Jensen, Peter; Jacobsen, Bo

    2007-01-01

    OBJECTIVE: To investigate the frequency and severity of dysphagia during the first 8 weeks after laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. So far, there have been no studies reporting data on day-to-day occurrence of dysphagia after laparoscopic fundoplication...... in a consecutive series of patients. This may explain why the frequency of dysphagia varies greatly in the literature (4-100%). MATERIAL AND METHODS: Forty consecutive patients, undergoing elective laparoscopic Nissen fundoplication, completed a standard dysphagia registration diary each day during the first 8...... weeks after surgery. Patients who preoperatively had suffered from dysphagia were excluded. Thus, none of the patients had dysphagia in the 2-month period before surgery. Ten patients undergoing elective cholecystectomy served as controls. Data were quantified, and a score value of 4 or more...

  10. [Geriatric assessment tools in Spanish Geriatric Departments].

    Science.gov (United States)

    Flores Ruano, Teresa; Cruz Jentoft, Alfonso J; González Montalvo, Juan Ignacio; López Soto, Alfonso; Abizanda Soler, Pedro

    2014-01-01

    Comprehensive Geriatric Assessment (CGA) is the main measurement tool used by Geriatricians. A 2000 survey demonstrated great variability in the tools used for CGA among Spanish Geriatric Departments. A new survey to detect 13-year trends in the use of CGA tools in our country is presented. Descriptive study using a structured questionnaire on the use of CGA tools in different levels of care sent to the Heads of 39 Spanish Geriatric Departments or Services (27 with postgraduate teaching in Geriatrics) during the first three months of 2013. The response rate was 97.4%. It was found that 78.4% (29 centers) used different tools depending on the level of care. Barthel and Lawton index were the most used functional assessment tools in all Departments and across all geriatric levels, although gait speed and Tinetti scale were frequently used in Day Hospital and Outpatient clinics. The Mini Mental State Exam and its Spanish version Mini Examen Cognoscitivo were the most used mental scales (97.4%), followed by tools for assessing depression-behavior (86.8%) and severity of cognitive impairment tools (84.2%). CGA tools were used in 43.2% of the emergency departments of the hospitals surveyed, being the most frequent. More than two-thirds (69.4%) of the Departments reported that their affiliated Primary Care centers used CGA tools, with the Barthel and Lawton again being indexes the most used. Most of the responding Departments considered that the main domains of CGA are functional, mental and social status. Nutrition, comorbidity, falls and pressure ulcers are other important domains. There is still a great variability in the CGA tools being used in Spanish Geriatric Departments, although there is a trend towards a greater use of Barthel index, greater adaptation of tools to each level of care, and increasing assessment of new domains like frailty, nutrition or comorbidity. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

  11. New risk assessment tools in the Netherlands

    NARCIS (Netherlands)

    Kraker, H. de; Douwes, M.

    2012-01-01

    In this paper an introduction to and description of the risk assessment tools that are freely available for companies in The Netherlands is given. It is explained in what way the tools can and should be used and how the level I checklist for physical load and the level II instruments are related. Th

  12. Air Traffic Management Cost Assessment Tool Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The Robust Analytics air traffic management cost assessment tool provides the comprehensive capability to analyze the impacts of NASA Airspace Systems Program (ASP)...

  13. POSTFUNDOPLICATION DYSPHAGIA CAUSES SIMILAR WATER INGESTION DYNAMICS AS ACHALASIA.

    Science.gov (United States)

    Dantas, Roberto Oliveira; Santos, Carla Manfredi; Cassiani, Rachel Aguiar; Alves, Leda Maria Tavares; Nascimento, Weslania Viviane

    2016-01-01

    - After surgical treatment of gastroesophageal reflux disease dysphagia is a symptom in the majority of patients, with decrease in intensity over time. However, some patients may have persistent dysphagia. - The objective of this investigation was to evaluate the dynamics of water ingestion in patients with postfundoplication dysphagia compared with patients with dysphagia caused by achalasia, idiopathic or consequent to Chagas' disease, and controls. - Thirty-three patients with postfundoplication dysphagia, assessed more than one year after surgery, together with 50 patients with Chagas' disease, 27 patients with idiopathic achalasia and 88 controls were all evaluated by the water swallow test. They drunk, in triplicate, 50 mL of water without breaks while being precisely timed and the number of swallows counted. Also measured was: (a) inter-swallows interval - the time to complete the task, divided by the number of swallows during the task; (b) swallowing flow - volume drunk divided by the time taken; (c) volume of each swallow - volume drunk divided by the number of swallows. - Patients with postfundoplication dysphagia, Chagas' disease and idiopathic achalasia took longer to ingest all the volume, had an increased number of swallows, an increase in interval between swallows, a decrease in swallowing flow and a decrease in water volume of each swallow compared with the controls. There was no difference between the three groups of patients. There was no correlation between postfundoplication time and the results. - It was concluded that patients with postfundoplication dysphagia have similar water ingestion dynamics as patients with achalasia.

  14. The challenges of managing dysphagia in brain-injured patients.

    Science.gov (United States)

    Mayer, Victoria

    2004-02-01

    Dysphagia, or the inability to swallow normally, is a feature of a number of neurological conditions. It is found in both paediatric and adult populations, but the scope of this article is limited to the adult neurogenic population. The normal swallow is a complex and highly coordinated activity, any part of which may be disturbed by neurological illness or injury. Assessment of dysphagia is normally undertaken by speech and language therapists in conjunction with the multidisciplinary team. A bedside screening assessment may be augmented by instrumental assessment, such as videofluoroscopy, in cases where silent aspiration of food or liquid into the lungs is suspected. Dysphagia is treated using a variety of strategies, depending on the presenting symptoms. Individuals with dysphagia following traumatic brain injury present with particular difficulties, relating to impairments of cognition, communication and behavioural control. A description of the normal swallow is presented below with a review of dysphagic disorders, assessment methods and management. This is followed by a case account of a young man with dysphagia subsequent to traumatic brain injury to highlight some of the difficulties which can be encountered in the management of dysphagia.

  15. Management of oropharyngeal neurogenic dysphagia in adults.

    Science.gov (United States)

    Miles, Anna; Allen, Jacqui E

    2015-12-01

    This article reviews recent literature in the management of neurogenic oropharyngeal dysphagia (OPD) including assessment processes and treatments, with a specific focus on OPD as a result of stroke and Parkinson's disease. A large number of high-quality systematic reviews were published that provide an excellent summary of current evidence across assessment and treatment of swallowing disorders. There is building interest and knowledge in technology in both the understanding and treatment of OPD including functional MRI, manometry, and noninvasive brain stimulation. Neurologic disorders demonstrate a high prevalence of OPD resulting in significant decrement to health and healthcare costs. Novel technologies were reported in assessment and tracking of dysphagia as well as emerging innovative therapeutic options.

  16. Exposure Assessment Tools by Lifestages and Populations

    Science.gov (United States)

    EPA ExpoBox is a toolbox for exposure assessors. Its purpose is to provide a compendium of exposure assessment and risk characterization tools that will present comprehensive step-by-step guidance and links to relevant exposure assessment data bases

  17. Automated Assessment in a Programming Tools Course

    Science.gov (United States)

    Fernandez Aleman, J. L.

    2011-01-01

    Automated assessment systems can be useful for both students and instructors. Ranking and immediate feedback can have a strongly positive effect on student learning. This paper presents an experience using automatic assessment in a programming tools course. The proposal aims at extending the traditional use of an online judging system with a…

  18. Designing Online Assessment Tools for Disengaged Youth

    Science.gov (United States)

    Brader, Andy; Luke, Allan; Klenowski, Val; Connolly, Stephen; Behzadpour, Adib

    2014-01-01

    This article reports on the development of online assessment tools for disengaged youth in flexible learning environments. Sociocultural theories of learning and assessment and Bourdieu's sociological concepts of capital and exchange were used to design a purpose-built content management system. This design experiment engaged participants in…

  19. Automated Assessment in a Programming Tools Course

    Science.gov (United States)

    Fernandez Aleman, J. L.

    2011-01-01

    Automated assessment systems can be useful for both students and instructors. Ranking and immediate feedback can have a strongly positive effect on student learning. This paper presents an experience using automatic assessment in a programming tools course. The proposal aims at extending the traditional use of an online judging system with a…

  20. Oropharyngeal dysphagia in myotonic dystrophy type 1: a systematic review.

    Science.gov (United States)

    Pilz, Walmari; Baijens, Laura W J; Kremer, Bernd

    2014-06-01

    A systematic review was conducted to investigate the pathophysiology of and diagnostic procedures for oropharyngeal dysphagia in myotonic dystrophy (MD). The electronic databases Embase, PubMed, and The Cochrane Library were used. The search was limited to English, Dutch, French, German, Spanish, and Portuguese publications. Sixteen studies met the inclusion criteria. Two independent reviewers assessed the methodological quality of the included articles. Swallowing assessment tools, the corresponding protocols, the studies' outcome measurements, and main findings are summarized and presented. The body of literature on pathophysiology of swallowing in dysphagic patients with MD type 1 remains scant. The included studies are heterogeneous with respect to design and outcome measures and hence are not directly comparable. More importantly, most studies had methodological problems. These are discussed in detail and recommendations for further research on diagnostic examinations for swallowing disorders in patients with MD type 1 are provided.

  1. Nutritional Aspects of Dysphagia Management.

    Science.gov (United States)

    Gallegos, C; Brito-de la Fuente, E; Clavé, P; Costa, A; Assegehegn, G

    This chapter describes the nutritional aspects of dysphagia management by starting with the definition of these two conditions (dysphagia and malnutrition) that share three main clinical characteristics: (a) their prevalence is very high, (b) they can lead to severe complications, and (c) they are frequently underrecognized and neglected conditions. From an anatomical standpoint, dysphagia can result from oropharyngeal and/or esophageal causes; from a pathophysiological perspective, dysphagia can be caused by organic or structural diseases (either benign or malignant) or diseases causing impaired physiology (mainly motility and/or perception disorders). This chapter gathers up-to-date information on the screening and diagnosis of oropharyngeal dysphagia, the consequences of dysphagia (aspiration pneumonia, malnutrition, and dehydration), and on the nutritional management of dysphagic patients. Concerning this last topic, this chapter reviews the rheological aspects of swallowing and dysphagia (including shear and elongational flows) and its influence on the characteristics of the enteral nutrition for dysphagia management (solid/semisolid foods and thickened liquids; ready-to-use oral nutritional supplements and thickening powders), with special focus on the real characteristics of the bolus after mixing with human saliva. © 2017 Elsevier Inc. All rights reserved.

  2. Electrodiagnostic methods for neurogenic dysphagia.

    Science.gov (United States)

    Ertekin, C; Aydogdu, I; Yüceyar, N; Tarlaci, S; Kiylioglu, N; Pehlivan, M; Celebi, G

    1998-08-01

    Swallowing mechanisms and neurogenic dysphagia have not been systematically studied by the EMG technique. It is desirable to evaluate neurogenic dysphagia for diagnostic and possibly for therapeutic purposes using electrophysiological methods. The following methods were described: mechanical upward/downward movements of the larynx were detected using a piezoelectric sensor, while submental integrated EMG activity was recorded during dry and wet swallowing. The EMG activity of cricopharyngeal muscle of the upper oesophageal sphincter was also recorded in some normal subjects and patients. Piecemeal deglutition and the dysphagia limit were determined in all patients to detect dysphagia objectively. In this study 75 normal subjects and 177 neurological patients with various degrees of dysphagia were investigated. Voluntarily triggered oropharyngeal swallowing was commonly pathological in the majority of patients, with or without overt dysphagia. The dysphagia limit appeared to be an objective measure of the degree of dysphagia in more than 90% of patients. Pathophysiological mechanisms were different in at least three groups of patients with neurogenic dysphagia. In the group of patients with muscular disorders, laryngeal elevators were involved while the CP-sphincter was intact. The second group included patients with the clinical signs of corticobulbar fibre involvement such as amyotrophic lateral sclerosis and pseudobulbar palsy. In these patients, there was incoordination between paretic laryngeal elevators and hyperreflexic CP-sphincter. In the third group (patients with Parkinson's disease), the swallowing reflex was delayed and prolonged. EMG methods described in the present study are very useful for the diagnosis of neurogenic dysphagia, objectively and quickly. They are important to understand the physiological mechanisms for deglutition and its disorders.

  3. Spontaneous swallowing frequency has potential to identify dysphagia in acute stroke.

    Science.gov (United States)

    Crary, Michael A; Carnaby, Giselle D; Sia, Isaac; Khanna, Anna; Waters, Michael F

    2013-12-01

    Spontaneous swallowing frequency has been described as an index of dysphagia in various health conditions. This study evaluated the potential of spontaneous swallow frequency analysis as a screening protocol for dysphagia in acute stroke. In a cohort of 63 acute stroke cases, swallow frequency rates (swallows per minute [SPM]) were compared with stroke and swallow severity indices, age, time from stroke to assessment, and consciousness level. Mean differences in SPM were compared between patients with versus without clinically significant dysphagia. Receiver operating characteristic curve analysis was used to identify the optimal threshold in SPM, which was compared with a validated clinical dysphagia examination for identification of dysphagia cases. Time series analysis was used to identify the minimally adequate time period to complete spontaneous swallow frequency analysis. SPM correlated significantly with stroke and swallow severity indices but not with age, time from stroke onset, or consciousness level. Patients with dysphagia demonstrated significantly lower SPM rates. SPM differed by dysphagia severity. Receiver operating characteristic curve analysis yielded a threshold of SPM≤0.40 that identified dysphagia (per the criterion referent) with 0.96 sensitivity, 0.68 specificity, and 0.96 negative predictive value. Time series analysis indicated that a 5- to 10-minute sampling window was sufficient to calculate spontaneous swallow frequency to identify dysphagia cases in acute stroke. Spontaneous swallowing frequency presents high potential to screen for dysphagia in acute stroke without the need for trained, available personnel.

  4. Spontaneous Swallowing Frequency [Has Potential to] Identify Dysphagia in Acute Stroke

    Science.gov (United States)

    Carnaby, Giselle D; Sia, Isaac; Khanna, Anna; Waters, Michael

    2014-01-01

    Background and Purpose Spontaneous swallowing frequency has been described as an index of dysphagia in various health conditions. This study evaluated the potential of spontaneous swallow frequency analysis as a screening protocol for dysphagia in acute stroke. Methods In a cohort of 63 acute stroke cases swallow frequency rates (swallows per minute: SPM) were compared to stroke and swallow severity indices, age, time from stroke to assessment, and consciousness level. Mean differences in SPM were compared between patients with vs. without clinically significant dysphagia. ROC analysis was used to identify the optimal threshold in SPM which was compared to a validated clinical dysphagia examination for identification of dysphagia cases. Time series analysis was employed to identify the minimally adequate time period to complete spontaneous swallow frequency analysis. Results SPM correlated significantly with stroke and swallow severity indices but not with age, time from stroke onset, or consciousness level. Patients with dysphagia demonstrated significantly lower SPM rates. SPM differed by dysphagia severity. ROC analysis yielded a threshold of SPM ≤ 0.40 which identified dysphagia (per the criterion referent) with 0.96 sensitivity, 0.68 specificity, and 0.96 negative predictive value. Time series analysis indicated that a 5 to 10 minute sampling window was sufficient to calculate spontaneous swallow frequency to identify dysphagia cases in acute stroke. Conclusions Spontaneous swallowing frequency presents high potential to screen for dysphagia in acute stroke without the need for trained, available personnel. PMID:24149008

  5. Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome

    Science.gov (United States)

    Broeg-Morvay, Anne; Meisterernst, Julia; Schlager, Markus; Mono, Marie-Luise; El-Koussy, Marwan; Kägi, Georg; Jung, Simon; Sarikaya, Hakan

    2016-01-01

    Background Reported frequency of post-stroke dysphagia in the literature is highly variable. In view of progress in stroke management, we aimed to assess the current burden of dysphagia in acute ischemic stroke. Methods We studied 570 consecutive patients treated in a tertiary stroke center. Dysphagia was evaluated by using the Gugging Swallowing Screen (GUSS). We investigated the relationship of dysphagia with pneumonia, length of hospital stay and discharge destination and compared rates of favourable clinical outcome and mortality at 3 months between dysphagic patients and those without dysphagia. Results Dysphagia was diagnosed in 118 of 570 (20.7%) patients and persisted in 60 (50.9%) at hospital discharge. Thirty-six (30.5%) patients needed nasogastric tube because of severe dysphagia. Stroke severity rather than infarct location was associated with dysphagia. Dysphagic patients suffered more frequently from pneumonia (23.1% vs. 1.1%, pdysphagia. At 3 months, dysphagic patients less often had a favourable outcome (35.7% vs. 69.7%; pdysphagia to be an independent predictor of discharge destination and institutionalization at 3 months, while severe dysphagia requiring tube placement was strongly associated with mortality. Conclusion Dysphagia still affects a substantial portion of stroke patients and may have a large impact on clinical outcome, mortality and institutionalization. PMID:26863627

  6. Postmyotomy dysphagia after laparoscopic surgery for achalasia

    Institute of Scientific and Technical Information of China (English)

    Yutaka Shiino; Ziad T. Awad; Gleb R. Haynatzki; Richard E. Davis; Ronald A. Hinder; Charles J. Filipi

    2003-01-01

    AIM: To determine predictive factors for postoperative dysphagia after laparoscopic myotomy for achalasia.METHODS: Logistic regression was used to investigate the possible association between the response (postoperative dysphagia, with two levels: none/mild and moderate/severe)and several plausible predictive factors.RESULTS: Eight patients experienced severe or moderate postoperative dysphagia. The logistic regression revealed that only the severity of preoperative dysphagia (with four levels; mild, moderate, severe, and liquid) was a marginally significant (P=0.0575) predictive factor for postoperative dysphagia.CONCLUSION: The severity of postoperative dysphagia is strongly associated with preoperative dysphagia. Preoperative symptomatology can significantly impact patient outcome.

  7. Modeling Languages: metrics and assessing tools

    OpenAIRE

    Fonte, Daniela; Boas, Ismael Vilas; Azevedo, José; Peixoto, José João; Faria, Pedro; Silva, Pedro; Sá, Tiago de, 1990-; Costa, Ulisses; da Cruz, Daniela; Henriques, Pedro Rangel

    2012-01-01

    Any traditional engineering field has metrics to rigorously assess the quality of their products. Engineers know that the output must satisfy the requirements, must comply with the production and market rules, and must be competitive. Professionals in the new field of software engineering started a few years ago to define metrics to appraise their product: individual programs and software systems. This concern motivates the need to assess not only the outcome but also the process and tools em...

  8. Clinical application of ICF key codes to evaluate patients with dysphagia following stroke.

    Science.gov (United States)

    Dong, Yi; Zhang, Chang-Jie; Shi, Jie; Deng, Jinggui; Lan, Chun-Na

    2016-09-01

    This study was aimed to identify and evaluate the International Classification of Functioning (ICF) key codes for dysphagia in stroke patients. Thirty patients with dysphagia after stroke were enrolled in our study. To evaluate the ICF dysphagia scale, 6 scales were used as comparisons, namely the Barthel Index (BI), Repetitive Saliva Swallowing Test (RSST), Kubota Water Swallowing Test (KWST), Frenchay Dysarthria Assessment, Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). Multiple regression analysis was performed to quantitate the relationship between the ICF scale and the other 7 scales. In addition, 60 ICF scales were analyzed by the least absolute shrinkage and selection operator (LASSO) method. A total of 21 ICF codes were identified, which were closely related with the other scales. These included 13 codes from Body Function, 1 from Body Structure, 3 from Activities and Participation, and 4 from Environmental Factors. A topographic network map with 30 ICF key codes was also generated to visualize their relationships. The number of ICF codes identified is in line with other well-established evaluation methods. The network topographic map generated here could be used as an instruction tool in future evaluations. We also found that attention functions and biting were critical codes of these scales, and could be used as treatment targets.

  9. Risk assessment meta tool LDRD final report.

    Energy Technology Data Exchange (ETDEWEB)

    Bouchard, Ann Marie; Osbourn, Gordon Cecil

    2006-12-01

    The goal of this project was to develop a risk analysis meta tool--a tool that enables security analysts both to combine and analyze data from multiple other risk assessment tools on demand. Our approach was based on the innovative self-assembling software technology under development by the project team. This technology provides a mechanism for the user to specify his intentions at a very high level (e.g., equations or English-like text), and then the code self-assembles itself, taking care of the implementation details. The first version of the meta tool focused specifically in importing and analyzing data from Joint Conflict and Tactical Simulation (JCATS) force-on-force simulation. We discuss the problem, our approach, technical risk, and accomplishments on this project, and outline next steps to be addressed with follow-on funding.

  10. A Tool To Assess Journal Price Discrimination.

    Science.gov (United States)

    Meyer, Richard W.

    2001-01-01

    The author designed an experiment to determine whether periodical price inflation might be dampened by electronic scholarship. This article discusses results of an econometric analysis of prices for 859 periodical titles for three consecutive years, and concludes with a description of an analytical tool that may be used to assess journal prices.…

  11. Assessment and Development of Software Engineering Tools

    Science.gov (United States)

    1991-01-16

    Assessment (REA) tool would advise a potential software reuser on the tradeoffs between reusing a RSC versus developing a brand new software product...of memberships in the key RSC reusability attributes; e.g., size, structure, or documentation, etc., all of which would be weighted by reuser

  12. Software Tools Used for Continuous Assessment

    Directory of Open Access Journals (Sweden)

    Corina SBUGHEA

    2016-04-01

    Full Text Available he present paper addresses the subject of continuous evaluation and of the IT tools that support it. The approach starts from the main concepts and methods used in the teaching process, according to the assessment methodology and, then, it focuses on their implementation in the Wondershare QuizCreator software.

  13. A Suite of Tools for Technology Assessment

    Science.gov (United States)

    2007-09-01

    Saden, Povinelli & Rosen, 1989). • This was a significant change in emphasis on the part of NASA, where technology had previously viewed as merely...Cost Analysis Symposium, April 13, 2005. A Suite of Tools for Technology Assessment 24 Bibliography - continued: • Sadin, Stanley T.; Povinelli

  14. Content validation of a Danish version of "The McGill Ingestive Skills Assessment" for dysphagia management

    DEFF Research Database (Denmark)

    Hansen, Tina; Lambert, H.C.; Faber, J.

    2011-01-01

    This study addresses the first steps in the cross-cultural adaptation of a Danish version of the McGill Ingestive Skills Assessment (MISA), which quantifies eating and drinking abilities by scoring a meal observation. The original Canadian MISA was translated and adapted into Danish (MISA...

  15. [Neurogenic dysphagia: physiology, physiopathology and rehabilitative treatment].

    Science.gov (United States)

    Patti, F; Emmi, N; Restivo, D A; Liberto, A; Pappalardo, A; Torre, L M; Reggio, A

    2002-01-01

    Swallowing is both a voluntary than a reflex function. It consist in transporting feeding from mouth to the stomach. Swallowing function occurs with very frequency during the day and needs complex neuromuscular coordination. Several neurologic diseases determine swallowing disorders. Dysphagia, is the difficulty in swallowing. In slight disorders, swallowing function is sufficiently compensated, symptoms are few or absent. Sometimes the patient is able to compensate and obtains a safe deglutition. Rehabilitation of swallowing disorders is based on the assessment of all symptoms and troubles causing dysphagia and on the improvement of the specific disabilities. Rehabilitation is aimed to make patient able for a safe oral feeding. We can use classic specific physiotherapy, compensatory movements of head and neck, electrostimulation, and the chemical myotomia by botulinum toxin injection.

  16. Current Evaluation of Upper Oesophageal Sphincter Opening in Dysphagia Practice: An International SLT Survey

    Science.gov (United States)

    Regan, Julie; Walshe, Margaret; McMahon, Barry P.

    2012-01-01

    Background: The assessment of adequate upper oesophageal sphincter (UOS) opening during swallowing is an integral component of dysphagia evaluation. Aims: To ascertain speech and language therapists' (SLTs) satisfaction with current methods for assessing UOS function in people with dysphagia and to identify challenges encountered by SLTs with UOS…

  17. Dysphagia due to tardive dyskinesia

    Directory of Open Access Journals (Sweden)

    Pookala S Bhat

    2010-01-01

    Full Text Available Tardive dyskinesia (TD, neuroleptic-induced delayed onset movement disorder, remains an enigmatic phenomenon and a therapeutic challenge. Only a few cases of dysphagia also have been reported in world literature and to the best knowledge of the authors no case of TD manifesting as isolated dysphagia has been reported so far from India. We report a case of TD consequent to prolonged exposure to typical neuroleptics, manifesting as isolated dysphagia who responded well to a combination of Quetiapine, Donepezil and Vit E.

  18. Dysphagia Post Subcortical and Supratentorial Stroke.

    Science.gov (United States)

    Wan, Ping; Chen, Xuhui; Zhu, Lequn; Xu, Shuangjin; Huang, Li; Li, Xiangcui; Ye, Qing; Ding, Ruiying

    2016-01-01

    Studies have recognized that the damage in the subcortical and supratentorial regions may affect voluntary and involuntary aspects of the swallowing function. The current study attempted to explore the dysphagia characteristics in patients with subcortical and supratentorial stroke. Twelve post first or second subcortical and supratentorial stroke patients were included in the study. The location of the stroke was ascertained by computed tomography and magnetic resonance imaging. The characteristics of swallowing disorder were assessed by video fluoroscopic swallowing assessment/fiberoptic endoscopic evaluation of swallowing. The following main parameters were analyzed: oral transit time, pharyngeal delay time, presence of cricopharyngeal muscle achalasia (CMA), distance of laryngeal elevation, the amounts of vallecular residue and pyriform sinus residue (PSR), and the extent of pharyngeal contraction. Eighty-three percent of the 12 patients were found suffering from pharyngeal dysphagia, with 50% having 50%-100% PSRs, 50% having pharyngeal delay, and 41.6% cases demonstrating CMA. Simple regression analysis showed PSRs were most strongly associated with CMA. Pharyngeal delay in the study can be caused by infarcts of basal ganglia/thalamus, infarcts of sensory tract, infarcts of swallowing motor pathways in the centrum semiovale, or a combination of the three. Subcortical and supratentorial stroke may result in pharyngeal dysphagia such as PSR and pharyngeal delay. PSR was mainly caused by CMA. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Marine Litter, Eutrophication and Noise Assessment Tools

    Science.gov (United States)

    Palazov, Atanas; Velcheva, Maya; Milkova, Tanya; Slabakova, Violeta; Marinova, Veselka

    2017-04-01

    MARLEN - Marine Litter, Eutrophication and Noise Assessment Tools is a project under the Programme BG02.03: Increased capacity for assessing and predicting environmental status in marine and inland waters, managed by Bulgarian Ministry of environment and waters and co-financed by the Financial Mechanism of the European Economic Area (EEA FM) 2009 - 2014. Project Beneficiary is the Institute of oceanology - Bulgarian Academy of Sciences with two partners: Burgas municipality and Bulgarian Black Sea Basin Directorate. Initial assessment of ecological state of Bulgarian marine waters showed lack of data for some descriptors of MSFD. The main goal of MARLEN is to build up tools for assessment of marine environment by implementing new technologies and best practices for addressing three main areas of interest with lack of marine data in particular: a) Marine litter detection and classification in coastal areas; b) Regular near real time surface water eutrophication monitoring on large aquatory; c) Underwater noise monitoring. Developed tools are an important source of real time, near real time and delay mode marine data for Bulgarian Black Sea waters. The partnership within the project increased capacity for environmental assessments and training of personnel and enhances collaboration between scientific institutes, regional and local authorities. Project results supported implementation of MSFD in Bulgarian marine waters for the benefit of coastal population, marine industry, tourism, marine research and marine spatial planning.

  20. Cough responsiveness in neurogenic dysphagia.

    Science.gov (United States)

    Smith, P E; Wiles, C M

    1998-03-01

    In neurogenic dysphagia a good cough is important for airway protection. If triggering of cough, or its effectiveness, is impaired this might result in an increased aspiration risk. Capsaicin, an agent which induces cough through sensory nerve stimulation, was used to test cough sensitivity in groups of patients with and without neurogenic dysphagia. On the basis of swallowing speed (ml/s) in a validated water test 28 alert neurological inpatients (16 women, aged 22-71 years) were classified into 13 with abnormal and 15 with normal swallowing (median swallowing speed 23% and 99%, median volume/swallow 43% and 106% of that predicted for age and sex respectively: pneurogenic dysphagia even after allowing for diagnostic category, the possible presence of a bulbar upper motor neuron lesion, or voluntary respiratory capacity. It is concluded that these patients with neurogenic dysphagia do not have a reduced sensitivity of cough triggering.

  1. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

    ... Stroke Heroes Among Us Difficulty Swallowing After Stroke (Dysphagia) Updated:Nov 15,2016 Excerpted and adapted from "Swallowing Disorders After a Stroke," Stroke Connection Magazine July/August ...

  2. Reliability and Validity of the Turkish Eating Assessment Tool (T-EAT-10).

    Science.gov (United States)

    Demir, Numan; Serel Arslan, Selen; İnal, Özgü; Karaduman, A Ayşe

    2016-10-01

    The purpose of this study was to test the reliability and validity of the Turkish Eating Assessment Tool (T-EAT-10) among patients with swallowing disorders. One hundred and five patients completed the T-EAT-10 and Functional Oral Intake Scale (FOIS). The internal consistency, test-retest reliability, and criterion validity of T-EAT-10 were investigated. The internal consistency was assessed using Cronbach's alpha. Intraclass correlation coefficient (ICC) value with 95 % confidence intervals was calculated for test-retest reliability. The criterion validity of the T-EAT-10 was determined by assessing the correlation between T-EAT-10 and FOIS. All the patients in the study completed the T-EAT-10 without assistance. The mean time to complete the instrument was 1.8 ± 0.9 min. The internal consistency of the T-EAT-10 was found to be high with 0.90 Cronbach's alpha for test and 0.91 Cronbach's alpha for retest reproducibility. No difference between the test and retest scores of the T-EAT-10 was found (p = 0.14). A negative, moderate correlation between T-EAT-10 and FOIS was detected (r = -0.365, p EAT-10 is a reliable and valid symptom-specific outcome tool for dysphagia in adult Turkish patients. It can be used in clinical practice and research.

  3. Pill swallowing by adults with dysphagia.

    Science.gov (United States)

    Carnaby-Mann, Giselle; Crary, Michael

    2005-11-01

    To evaluate differences in swallowing physiology and safety in patients with dysphagia between conventional tablets and a new method of tablet transportation, orally disintegrating technology (ODT) (RapiTab; Schwarz Pharma Inc, Milwaukee, Wis). The study observed a single group, crossover design. Outpatient clinic within an academic teaching hospital. A total of 36 adult dysphagic patients referred to the clinic. All subjects underwent simultaneous nasopharyngeal endoscopic evaluation, surface electromyographic (sEMG) measurement, and respiratory monitoring during swallowing. Subjects were evaluated swallowing the ODT and a conventional tablet formulation. Tablets were randomly and blindly presented to each subject. Subjects completed a preference survey subsequent to swallowing both tablets. Significant differences included greater sEMG amplitude and longer apneic duration when swallowing a conventional tablet compared with the ODT (Pswallow durations (Pswallows per tablet (Pswallow. On a postevaluation survey, patients reported that they preferred the ODT preparation for most of the parameters assessed. Patients with dysphagia frequently complain of trouble swallowing medication. In this study, an ODT formulation provided a method of delivery that required less effort to swallow, did not result in increased levels of airway compromise, and was preferred by dysphagic patients. The ODT medication delivery technology may provide benefit to adults with dysphagia in convenience, compliance, and accuracy of dosing.

  4. Mass Casualty Triage Performance Assessment Tool

    Science.gov (United States)

    2015-02-01

    tactical tasks for which Soldiers are supposed to be trained to complete and the lack of more precise measurement tools, one key gap identified for...between the wound and the heart) and elevate the wound above the level of the heart to slow the flow of blood to the wound. • Apply a clean...TERMS Assessment, Triage, Performance measurement , Feedback, Tasks-Collective, Brigade Combat Teams, Task analysis

  5. Evaluating the Psychometric Properties of the Eating Assessment Tool (EAT-10) Using Rasch Analysis.

    Science.gov (United States)

    Cordier, R; Joosten, A; Clavé, P; Schindler, A; Bülow, M; Demir, N; Arslan, S Serel; Speyer, R

    2017-04-01

    Early and reliable screening for oropharyngeal dysphagia (OD) symptoms in at-risk populations is important and a crucial first stage in effective OD management. The Eating Assessment Tool (EAT-10) is a commonly utilized screening and outcome measure. To date, studies using classic test theory methodologies report good psychometric properties, but the EAT-10 has not been evaluated using item response theory (e.g., Rasch analysis). The aim of this multisite study was to evaluate the internal consistency and structural validity and conduct a preliminary investigation of the cross-cultural validity of the EAT-10; floor and ceiling effects were also checked. Participants involved 636 patients deemed at risk of OD, from outpatient clinics in Spain, Turkey, Sweden, and Italy. The EAT-10 and videofluoroscopic and/or fiberoptic endoscopic evaluation of swallowing were used to confirm OD diagnosis. Patients with esophageal dysphagia were excluded to ensure a homogenous sample. Rasch analysis was used to investigate person and item fit statistics, response scale, dimensionality of the scale, differential item functioning (DIF), and floor and ceiling effect. The results indicate that the EAT-10 has significant weaknesses in structural validity and internal consistency. There are both item redundancy and lack of easy and difficult items. The thresholds of the rating scale categories were disordered and gender, confirmed OD, and language, and comorbid diagnosis showed DIF on a number of items. DIF analysis of language showed preliminary evidence of problems with cross-cultural validation, and the measure showed a clear floor effect. The authors recommend redevelopment of the EAT-10 using Rasch analysis.

  6. McNeill dysphagia therapy program: a case-control study.

    Science.gov (United States)

    Carnaby-Mann, Giselle D; Crary, Michael A

    2010-05-01

    To compare the effectiveness of the McNeill Dysphagia Therapy Program, a systematic exercise-based rehabilitation framework for swallowing remediation, with traditional swallowing therapy techniques paired with surface electromyography (sEMG) biofeedback. Matched case-control study. University medical center. Dysphagic patients referred to an outpatient swallowing therapy service. Cases were individually matched to 2 separate controls for age, sex, and primary medical diagnosis (N=24). Cases were patients with dysphagia who entered the McNeill Dysphagia Therapy Program from September 2006 to October 2008. Controls entered a traditional swallowing therapy program augmented with sEMG biofeedback (traditional therapy with biofeedback group) from February 1994 to June 1999. The primary outcome was the proportion of patients who improved clinical swallowing ability and functional oral intake. The secondary outcomes were the presence (or not) of tube feeding, physiologic change on instrumental swallowing studies, and occurrence of aspiration on posttreatment assessment. Case patients were more likely to demonstrate dysphagia recovery at posttreatment re-evaluation (adjusted odds ratio for dysphagia recovery=13.0 [95% CI, 1.27-63.89]; Mantel-Haenszel chi(2)=6.7; P=.009; relative risk reduction=.69). Dysphagia was reduced by 69% in the McNeill Dysphagia Therapy Program treatment group compared with the traditional therapy with biofeedback group. Both approaches facilitated improved swallowing function. The McNeill Dysphagia Therapy Program resulted in superior outcomes compared with traditional dysphagia therapy supplemented with sEMG biofeedback.

  7. Revisão analítica das escalas de disfagia Analytic review of dysphagia scales

    Directory of Open Access Journals (Sweden)

    Rubens Antonio Aissar Sallum

    2012-12-01

    orofaringeana (região cervical, ambas focadas em terapia nutricional. Para a avaliação motora baixa, a escala de Zaninotto e Youssef tem aplicação prática, e a DHI parece representar a ferramenta mais promissora na avaliação global da disfagia.INTRODUCTION: An efficient instrument for dysphagia measurement, easily reproducible and statistically consistent, should provide consistent data on the outcomes and follow-up of diseases with dysphagia. Existent proposals do not show a global coverage in the evaluation of this symptom. OBJECTIVE: To analyze the available dysphagia scales determining those that allow a more objective and statistically consistent evaluation, and not only a measurement tool. Also, witch of the them achieve a better quantification of the symptom and useful in the follow-up. METHOD: Searching descriptors in the database Pubmed: "dysphagia", "scale", "index", "score", 10 papers were selected published between 1995 and June 2012 with proposals of dysphagia scales. RESULTS: Most scales do not reach the requirements to be classified as a complete tool in the evaluation of any dysphagia. Many are specific to a single disease and few, which have a global assessment, have no statistical consistency. In oropharyngeal (cervical dysphagia, the FOIS and ASHA scales are the most often cited. In motor dysphagia (cervical, the Zaninotto and Youssef scale have extremely practical applicability, but both require statistical validation. Zaninotto´s seems to be more accurate by including more variables (dysphagia, chest pain and heartburn. The scales which cover the two forms of dysphagia (ASHA and DHI are extremely different regarding the goal of their evaluation. The DHI is a scale of recent publication, which examines the two types of dysphagia and has a well-structured statistical validation. Future important step would be testing this new proposal with a more expressive and representative sample, probably enshrining this new assessment tool. CONCLUSION: The most

  8. A software tool for ecosystem services assessments

    Science.gov (United States)

    Riegels, Niels; Klinting, Anders; Butts, Michael; Middelboe, Anne Lise; Mark, Ole

    2017-04-01

    The EU FP7 DESSIN project is developing methods and tools for assessment of ecosystem services (ESS) and associated economic values, with a focus on freshwater ESS in urban settings. Although the ESS approach has gained considerable visibility over the past ten years, operationalizing the approach remains a challenge. Therefore, DESSSIN is also supporting development of a free software tool to support users implementing the DESSIN ESS evaluation framework. The DESSIN ESS evaluation framework is a structured approach to measuring changes in ecosystem services. The main purpose of the framework is to facilitate the application of the ESS approach in the appraisal of projects that have impacts on freshwater ecosystems and their services. The DESSIN framework helps users evaluate changes in ESS by linking biophysical, economic, and sustainability assessments sequentially. It was developed using the Common International Classification of Ecosystem Services (CICES) and the DPSIR (Drivers, Pressures, States, Impacts, Responses) adaptive management cycle. The former is a standardized system for the classification of ESS developed by the European Union to enhance the consistency and comparability of ESS assessments. The latter is a well-known concept to disentangle the biophysical and social aspects of a system under study. As part of its analytical component, the DESSIN framework also integrates elements of the Final Ecosystem Goods and Services-Classification System (FEGS-CS) of the US Environmental Protection Agency (USEPA). As implemented in the software tool, the DESSIN framework consists of five parts: • In part I of the evaluation, the ecosystem is defined and described and the local stakeholders are identified. In addition, administrative details and objectives of the assessment are defined. • In part II, drivers and pressures are identified. Once these first two elements of the DPSIR scheme have been characterized, the claimed/expected capabilities of a

  9. [Dysphagia in Parkinson's Disease: Pathophysiology, Diagnosis and Therapy].

    Science.gov (United States)

    Suttrup, I; Warnecke, T

    2016-07-01

    Oropharyngeal and esophageal dysphagia are a frequent, but seldom diagnosed symptom of Parkinson's disease (PD). More than 80 % of patients with PD develop dysphagia during the course of their disease leading to a reduced quality of life, complicated medication intake, malnutrition and aspiration pneumonia, which is a major cause of death in PD. The underlying pathophysiology is poorly understood. Impaired dopaminergic and non-dopaminergic mechanisms of the cortical swallowing network as well as peripheral neuromuscular involvement have been suggested to contribute to its multifactorial genesis. Diagnostic screening methods include PD-specific questionnaires and a modified water test. Fiber optic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS), which complement each other, are the gold standard for evaluation of PD-related dysphagia. For evaluation of esophageal dysphagia, the high-resolution manometry (HRM) may be a helpful tool. In addition to dysphagia-specific treatment by speech and language therapists (SLTs), optimized dopaminergic medication is a meaningful therapeutic option. A promising novel method is intensive training of expiratory muscle strength (EMST). Deep brain stimulation does not seem to have a clinically relevant effect on swallowing function in PD. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Food Culture, Preferences and Ethics in Dysphagia Management.

    Science.gov (United States)

    Kenny, Belinda

    2015-11-01

    Adults with dysphagia experience difficulties swallowing food and fluids with potentially harmful health and psychosocial consequences. Speech pathologists who manage patients with dysphagia are frequently required to address ethical issues when patients' food culture and/ or preferences are inconsistent with recommended diets. These issues incorporate complex links between food, identity and social participation. A composite case has been developed to reflect ethical issues identified by practising speech pathologists for the purposes of illustrating ethical concerns in dysphagia management. The case examines a speech pathologist's role in supporting patient autonomy when patients and carers express different goals and values. The case presents a 68-year-old man of Australian/Italian heritage with severe swallowing impairment and strong values attached to food preferences. The case is examined through application of the dysphagia algorithm, a tool for shared decision-making when patients refuse dietary modifications. Case analysis revealed the benefits and challenges of shared decision-making processes in dysphagia management. Four health professional skills and attributes were identified as synonymous with shared decision making: communication, imagination, courage and reflection.

  11. Data Center IT Equipment Energy Assessment Tools: Current State of Commercial Tools, Proposal for a Future Set of Assessment Tools

    Energy Technology Data Exchange (ETDEWEB)

    Radhakrishnan, Ben D. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); National Univ., San Diego, CA (United States). School of Engineering

    2012-06-30

    This research project, which was conducted during the Summer and Fall of 2011, investigated some commercially available assessment tools with a focus on IT equipment to see if such tools could round out the DC Pro tool suite. In this research, the assessment capabilities of the various tools were compiled to help make “non-biased” information available to the public. This research should not be considered to be exhaustive on all existing vendor tools although a number of vendors were contacted. Large IT equipment OEM’s like IBM and Dell provide their proprietary internal automated software which does not work on any other IT equipment. However, found two companies with products that showed promise in performing automated assessments for IT equipment from different OEM vendors. This report documents the research and provides a list of software products reviewed, contacts and websites, product details, discussions with specific companies, a set of recommendations, and next steps. As a result of this research, a simple 3-level approach to an IT assessment tool is proposed along with an example of an assessment using a simple IT equipment data collection tool (Level 1, spreadsheet). The tool has been reviewed with the Green Grid and LBNL staff. The initial feedback has been positive although further refinement to the tool will be necessary. Proposed next steps include a field trial of at least two vendors’ software in two different data centers with an objective to prove the concept, ascertain the extent of energy and computational assessment, ease of installation and opportunities for continuous improvement. Based on the discussions, field trials (or case studies) are proposed with two vendors – JouleX (expected to be completed in 2012) and Sentilla.

  12. Dysphagia Rehabilitation in Japan.

    Science.gov (United States)

    Inoue, Makoto

    2015-01-01

    In Japan, one of the most common causes of death in elderly people is aspiration pneumonia. Maintenance of oral hygiene and feeding functions are important elements, especially in patients with dysphagia caused by stroke, neurological diseases, and after operations on the head and neck cancer, as well as in the elderly to prevent aspiration pneumonia. It should also be noted that not only oral health care and physical therapy related to feeding functions but also dental treatment is included in the clinical management during interventions whenever needed. On the other hand, for the patients and/or elderly in need of assistance in maintaining a safe diet, it is recommended that a specialized team comprising physicians, dentists, and speech therapists in functional rehabilitation observes meal conditions of the subjects and evaluates such factors as meal contents, posture during meals, usage of dishes and cutlery, meal times, status of consciousness, perception, and motivation. First, I will present the clinical interventions to those patients, which include oral health care, dental treatment, physical therapy and meal assistance, as well as team approaches in those circumstances. In addition, clinical and basic research results will be introduced, which are expected to foster the understanding of physiology in chewing and swallowing. These results are also expected to develop the clinical technology to maintain or recover the feeding functions.

  13. Oropharyngeal dysphagia in older persons – from pathophysiology to adequate intervention

    DEFF Research Database (Denmark)

    Wirth, Rainer; Beck, Anne Marie; Dziewas, Rainer

    2016-01-01

    Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why...... the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition......, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation...

  14. Oropharyngeal dysphagia in older persons – from pathophysiology to adequate intervention

    DEFF Research Database (Denmark)

    Wirth, Rainer; Beck, Anne Marie; Dziewas, Rainer

    2016-01-01

    Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why...... the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition......, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation...

  15. Dysphagia due to Multiple Esophageal Rings

    Directory of Open Access Journals (Sweden)

    Stephen N Sullivan

    1995-01-01

    Full Text Available A 27-year-old Saudi man with dysphagia due to multiple esophageal rings is reported and the literature reviewed. Dysphagia due to multiple esophageal rings is very rare. Only 15 cases have been reported. The patient is usually male and has had dysphagia for many years when presenting. The cause of the rings is unknown. Theories to explain dysphagia are that the rings are either congenital or an unusual manifestation of gastroesophageal reflux.

  16. Strengthening the foundations of proliferation assessment tools.

    Energy Technology Data Exchange (ETDEWEB)

    Rexroth, Paul E.; Saltiel, David H.; Rochau, Gary Eugene; Cleary, Virginia D.; Ng, Selena (AREVA NC, Paris, France); Greneche, Dominique (AREVA NC, Paris, France); Giannangeli, Don (Texas A& M University, College Station, TX); Charlton, William S. (Texas A& M University, College Station, TX); Ford, David (Texas A& M University, College Station, TX)

    2007-09-01

    Robust and reliable quantitative proliferation assessment tools have the potential to contribute significantly to a strengthened nonproliferation regime and to the future deployment of nuclear fuel cycle technologies. Efforts to quantify proliferation resistance have thus far met with limited success due to the inherent subjectivity of the problem and interdependencies between attributes that lead to proliferation resistance. We suggest that these limitations flow substantially from weaknesses in the foundations of existing methodologies--the initial data inputs. In most existing methodologies, little consideration has been given to the utilization of varying types of inputs--particularly the mixing of subjective and objective data--or to identifying, understanding, and untangling relationships and dependencies between inputs. To address these concerns, a model set of inputs is suggested that could potentially be employed in multiple approaches. We present an input classification scheme and the initial results of testing for relationships between these inputs. We will discuss how classifying and testing the relationship between these inputs can help strengthen tools to assess the proliferation risk of nuclear fuel cycle processes, systems, and facilities.

  17. Cryostimulation improves recovery from oropharyngeal dysphagia after stroke.

    Science.gov (United States)

    Zart, Patrícia; Levy, Deborah Salle; Bolzan, Geovana de Paula; Mancopes, Renata; da Silva, Ana Maria Toniolo

    2013-01-01

     Stroke is considered one of the most frequent neurological causes of oropharyngeal dysphagia.  To determine the effect of cryostimulation on oropharyngeal sensitivity and, subsequently, on the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke.  Clinical and experimental study. The study enrolled 7 adult subjects, 6 men and 1 woman ranging from 28 to 64 years of age, with a diagnosis of stroke and current oropharyngeal dysphagia without any other underlying disease. The selected subjects underwent speech-language pathology evaluation and videofluoroscopic assessment of the dysphagia. The subjects were then treated with cryostimulation consisting of 10 applications to each structure (anterior faucial pillar, posterior oropharyngeal wall, soft palate, and back tongue) 3 times a day (for a total of 30 daily applications per structure) for 4 consecutive days. The patients were then re-evaluated based on the same criteria. The pre- and post-cryostimulation results of the clinical and videofluoroscopic evaluations were analyzed descriptively and statistically using Student's t-test and Fisher's exact test.  Cryostimulation had beneficial effects on oropharyngeal sensitivity in 6 of the 7 subjects. There was also a significant improvement in swallowing and in the premature escape in six subjects.  Cryostimulation increased sensitivity and subsequently improved the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. These effects were evident by both speech-language pathology and videofluoroscopic evaluation.

  18. Cryostimulation improves recovery from oropharyngeal dysphagia after stroke

    Directory of Open Access Journals (Sweden)

    Silva, Ana Maria Toniolo da

    2013-01-01

    Full Text Available Introduction: Stroke is considered one of the most frequent neurological causes of oropharyngeal dysphagia. Aim: To determine the effect of cryostimulation on oropharyngeal sensitivity and, subsequently, on the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. Methods: Clinical and experimental study. The study enrolled 7 adult subjects, 6 men and 1 woman ranging from 28 to 64 years of age, with a diagnosis of stroke and current oropharyngeal dysphagia without any other underlying disease. The selected subjects underwent speech-language pathology evaluation and videofluoroscopic assessment of the dysphagia. The subjects were then treated with cryostimulation consisting of 10 applications to each structure (anterior faucial pillar, posterior oropharyngeal wall, soft palate, and back tongue 3 times a day (for a total of 30 daily applications per structure for 4 consecutive days. The patients were then re-evaluated based on the same criteria. The pre- and post-cryostimulation results of the clinical and videofluoroscopic evaluations were analyzed descriptively and statistically using Student's t-test and Fisher's exact test. Results: Cryostimulation had beneficial effects on oropharyngeal sensitivity in 6 of the 7 subjects. There was also a significant improvement in swallowing and in the premature escape in six subjects. Conclusion: Cryostimulation increased sensitivity and subsequently improved the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. These effects were evident by both speech-language pathology and videofluoroscopic evaluation.

  19. Wound assessment tools and nurses' needs: an evaluation study.

    Science.gov (United States)

    Greatrex-White, Sheila; Moxey, Helen

    2015-06-01

    The purpose of this study was to ascertain how well different wound assessment tools meet the needs of nurses in carrying out general wound assessment and whether current tools are fit for purpose. The methodology employed was evaluation research. In order to conduct the evaluation, a literature review was undertaken to identify the criteria of an optimal wound assessment tool which would meet nurses' needs. Several freely available wound assessment tools were selected based on predetermined inclusion and exclusion criteria and an audit tool was developed to evaluate the selected tools based on how well they met the criteria of the optimal wound assessment tool. The results provide a measure of how well the selected wound assessment tools meet the criteria of the optimal wound assessment tool. No tool was identified which fulfilled all the criteria, but two (the Applied Wound Management tool and the National Wound Assessment Form) met the most criteria of the optimal tool and were therefore considered to best meet nurses' needs in wound assessment. The study provides a mechanism for the appraisal of wound assessment tools using a set of optimal criteria which could aid practitioners in their search for the best wound assessment tool.

  20. Collaborative Assessment Tool (CAT) - Assessing scientific practices in introductory physics

    Science.gov (United States)

    Irving, Paul

    2017-01-01

    An important learning goal of Projects and Practices in Physics (P3) , the transformed introductory mechanics course at Michigan State University, is the development of scientific practices. The design team, as part of the P3 course construction, made clear attempts to assess learning goals that can often be perceived as being a part of the hidden curriculum or considered difficult to assess (e.g., learning to work productively in a group) by developing a collaborative assessment tool (CAT). The CAT is a formative assessment tool that provides students with a numerical grade for how they participated in their learning group on a weekly basis while also providing feedback in the form of written commentary and suggestions on how they might improve at a particular collaborative practice. In this presentation, we demonstrate the CAT tool from two perspectives: 1) how the CAT tool is used within the P3 context and 2) how the formative feedback has affected changes in student interactions in class. We will present the case studies of 3 students who had differing reactions to the feedback they received. We will explore the role the feedback had in their interactions over a four-week period from an in-class perspective and a reflected perspective through interviews and observations. The analysis will also be presented from a tutor and group perspective, which will highlight the affordances the CAT can have in creating a productive learning group. The research on the CAT shows promise in encouraging growth in students' collaborative skills, but this research is still in its infancy and needs to be expanded to include different contexts.

  1. Wound assessment tools and nurses’ needs: an evaluation study

    OpenAIRE

    Greatrex-White, Sheila; Moxey, Helen

    2013-01-01

    The purpose of this study was to ascertain how well different wound assessment tools meet the needs of nurses in carrying out general wound assessment and whether current tools are fit for purpose. The methodology employed was evaluation research. In order to conduct the evaluation, a literature review was undertaken to identify the criteria of an optimal wound assessment tool which would meet nurses’ needs. Several freely available wound assessment tools were selected based on predetermin...

  2. [Dysphagia management of acute and long-term critically ill intensive care patients].

    Science.gov (United States)

    Zielske, J; Bohne, S; Axer, H; Brunkhorst, F M; Guntinas-Lichius, O

    2014-10-01

    Dysphagia is a severe complication in critically ill patients and affects more than half the patients in an intensive care unit. Dysphagia also has a strong impact on morbidity and mortality. Risk factors for the development of dysphagia are neurological diseases, age >55-70 years, intubation >7 days and sepsis. With increasing numbers of long-term survivors chronic dysphagia is becoming an increasing problem. There is not much knowledge on the influence of specific diseases, including the direct impact of sepsis on the development of dysphagia. Fiberoptic evaluation of swallowing is a standardized tool for bedside evaluation, helping to plan swallowing training during the acute phase and to decrease the rate of chronic dysphagia. For evaluation of chronic dysphagia even more extensive diagnostic tools as well as several options of stepwise rehabilitation using restitution, compensation and adaption strategies for swallowing exist. Currently it seems that these options are not being sufficiently utilized. In general, there is a need for controlled clinical trials analyzing specific swallowing rehabilitation concepts for former critically ill patients and long-term survivors.

  3. Evaluation of dysphagia risk, nutritional status and caloric intake in elderly patients with Alzheimer's

    Science.gov (United States)

    Goes, Vanessa Fernanda; Mello-Carpes, Pâmela Billig; de Oliveira, Lilian Oliveira; Hack, Jaqueline; Magro, Marcela; Bonini, Juliana Sartori

    2014-01-01

    Objective to evaluate the risk of dysphagia and its relationship with the stage of Alzheimer's Disease, as well as the relationship between the risk of dysphagia and nutritional status and caloric intake in elderly people with Alzheimer's disease. Methods the sample consisted of 30 subjects of both genders with probable Alzheimer's disease. The stage of the disease, nutritional status, energy intake, and risk of dysphagia were assessed. Results it was found that increased risk of dysphagia is associated with the advance in the stages of Alzheimer's disease and that even patients in the early stages of disease have a slight risk of developing dysphagia. No association was found between nutritional status and the risk of dysphagia. High levels of inadequate intake of micronutrients were also verified in the patients. Conclusion an association between dysphagia and the development of Alzheimer's disease was found. The results indicate the need to monitor the presence of dysphagia and the micronutrient intake in patients with Alzheimer's disease. PMID:26107841

  4. Evaluation of dysphagia risk, nutritional status and caloric intake in elderly patients with Alzheimer's

    Directory of Open Access Journals (Sweden)

    Vanessa Fernanda Goes

    2014-04-01

    Full Text Available OBJECTIVE: to evaluate the risk of dysphagia and its relationship with the stage of Alzheimer's Disease, as well as the relationship between the risk of dysphagia and nutritional status and caloric intake in elderly people with Alzheimer's disease.METHODS: the sample consisted of 30 subjects of both genders with probable Alzheimer's disease. The stage of the disease, nutritional status, energy intake, and risk of dysphagia were assessed.RESULTS: it was found that increased risk of dysphagia is associated with the advance in the stages of Alzheimer's disease and that even patients in the early stages of disease have a slight risk of developing dysphagia. No association was found between nutritional status and the risk of dysphagia. High levels of inadequate intake of micronutrients were also verified in the patients.CONCLUSION: an association between dysphagia and the development of Alzheimer's disease was found. The results indicate the need to monitor the presence of dysphagia and the micronutrient intake in patients with Alzheimer's disease.

  5. Conceptual assessment tool for advanced undergraduate electrodynamics

    Directory of Open Access Journals (Sweden)

    Charles Baily

    2017-09-01

    Full Text Available As part of ongoing investigations into student learning in advanced undergraduate courses, we have developed a conceptual assessment tool for upper-division electrodynamics (E&M II: the Colorado UppeR-division ElectrodyNamics Test (CURrENT. This is a free response, postinstruction diagnostic with 6 multipart questions, an optional 3-question preinstruction test, and accompanying grading rubrics. The instrument’s development was guided by faculty-consensus learning goals and research into common student difficulties. It can be used to gauge the effectiveness of transformed pedagogy, and to gain insights into student thinking in the covered topic areas. We present baseline data representing 500 students across 9 institutions, along with validity, reliability, and discrimination measures of the instrument and scoring rubric.

  6. [The Determinants of Dysphagia in Patients With Stroke During Hospitalized Rehabilitation].

    Science.gov (United States)

    Szu, Li-Yun; Hsieh, Suh-Ing; Tseng, Su-Mei; Huang, Tzu-Hsin

    2017-06-01

    Stroke was the third leading cause of death in Taiwan in 2014. A study found that 53.61% of stroke patients suffered from dysphagia disorder during the rehabilitation phase, which may result in lung aspiration and death. The determinants of dysphagia among nationally hospitalized-rehabilitation stroke patients have not been explored comprehensively. To explore the incidence of dysphagia among hospitalized-rehabilitation stroke patients and the related determinants of dysphagia. This descriptive and correlational research design employed a convenience sample of 130 hospitalized stroke patients from rehabilitation wards at a northern regional hospital in Taiwan. A questionnaire and functional assessment were used to collect data. Instruments used included personal and clinical characteristics data questionnaire, the National Institute of Health Stroke Scale (NIHSS), Barthel Index, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Standardization Swallowing Assessment (SSA), and Acute Stroke Dysphagia Screening (ASDS). Data analyses contained descriptive statistics and logistic regression. The incidence of stroke dysphagia was 63.8% (SSA) and 64.6% (ASDS), respectively. Age, marital status, stroke site, stroke severity (NIHSS), and cognitive status (MMSE) were identified as significant determinants of dysphagia in bivariate logistic regression, whereas stroke severity and cognitive status were identified as significant independent determinants of dysphagia in multivariate logistic regression. Two-thirds of the participant sample were affected by dysphagia, for which NIHSS and cognitive status were identified as significant determinants. Thus, nurses may conduct early screening for high risk populations based on patients' clinical characteristics in order to reduce aspiration pneumonia problems and to improve the quality of clinical care for dysphagia patients.

  7. Evaluation of neurogenic dysphagia in Iraqi patients with acute stroke.

    Science.gov (United States)

    Hasan, Zeki N; Al-Shimmery, Ehsan K; Taha, Mufeed A

    2010-04-01

    To clinically assess neurogenic dysphagia, and to correlate its presence with demographic features, different stroke risk factors, anatomical arterial territorial stroke types, and pathological stroke types. Seventy-two stroke inpatients were studied between July 2007 and February 2008, at the Departments of Medicine and Neurology at Al-Yarmouk Teaching Hospital, Baghdad, and Rizgary Teaching Hospital, Erbil, Iraq. All patients were assessed using the Mann Assessment of Swallowing Ability score (MASA), Modified Rankin Scale, and the Stroke Risk Scorecard. All patients were reassessed after one month. There were 40 males and 32 females. Sixty-eight patients had ischemic stroke, and 4 had primary intracerebral hemorrhage (ICH). According to the MASA score, 55% of anterior circulation stroke (ACS) cases were associated with dysphasia, and 91% of lateral medullary syndrome cases were associated with dysphagia. Fifty-six percent of ACS dysphagic cases improved within the first month. Forty percent of dysphagic patients died in the one month follow up period, and in most, death was caused by aspiration pneumonia. We observed no significant differences regarding demographic features of dysphagia. Dysphagia can be an indicator of the severity of stroke causing higher mortality and morbidity in affected patients. It was not related to the stroke risk factors and the type of stroke. It is essential from a prognostic point of view to assess swallowing, and to treat its complications early.

  8. A Descriptive Investigation of Dysphagia in Adults with Intellectual Disabilities

    Science.gov (United States)

    Chadwick, Darren D.; Jolliffe, J.

    2009-01-01

    Background: Dysphagia has rarely been investigated in adults with intellectual disabilities (ID) despite being a serious condition affecting health and quality of life. Method: This study collected information about 101 adults with ID, living in community settings, referred for an assessment of their eating and drinking. Ninety-nine people were…

  9. Dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Nam P. [Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, VA North Texas Health Care System, Radiation Oncology Service (140), 4500 S, Lancaster Road, Dallas, TX 72516 (United States)]. E-mail: NamPhong.Nguyen@med.va.gov; Moltz, Candace C. [Audiology and Speech Pathology Service (126), VA North Texas Health Care System, Dallas, TX 75216 (United States); Frank, Cheryl [Audiology and Speech Pathology Service (126), VA North Texas Health Care System, Dallas, TX 75216 (United States); Karlsson, Ulf [Department of Radiation Oncology, East Carolina University, Greenville, NC 27858 (United States); Nguyen, Phuc D. [Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, VA North Texas Health Care System, Radiation Oncology Service (140), 4500 S, Lancaster Road, Dallas, TX 72516 (United States); Vos, Paul [Department of Biostatistics, East Carolina University, Greenville, NC 27858 (United States); Smith, Herbert J. [Radiology Service, VA North Texas Health Care System, Dallas, TX 75216 (United States); Dutta, Suresh [Department of Radiation Oncology, University of Southern California, Los Angeles, CA 90033 (United States); Nguyen, Ly M. [Public Health School, University of Michigan, Ann Arbor, MI 48109 (United States); Lemanski, Claire [Department of Radiation Oncology, Val D' Aurelle, Montpellier (France); Chan, Wayne [Radiation Oncology Service, VAMC, Jackson, MS 39216 (United States); Sallah, Sabah [Division of Hematology/Oncology Research, Novo Nordisk, Athens (Greece)

    2006-09-15

    Objective: The purpose of the study is to evaluate dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer, and particularly the aspiration risk because of its potential life-threatening consequence. Materials and methods: We reviewed retrospectively the modified barium swallow (MBS) results in 110 patients who complained of dysphagia following chemoradiation (57) and postoperative radiation (53) of their head and neck cancer. Patients were selected if they were cancer free at the time of the swallowing study. Dysphagia severity was graded on a scale of 1-7. Patients were grouped according to the dysphagia severity: mild (grades 2-3), moderate (grades 4-5), and severe (grades 6-7). Results: Mean and median dysphagia grades were 4.84/5 and 4.12/4 for chemoradiation and postoperative radiation respectively. The mean difference between the two groups is statistically significant (p = 0.02). Mild dysphagia occurred in 13 patients (22%) of the chemoradiation group and 17 (32%) of the postoperative group. Corresponding number for the moderate group was 25 (43%) and 25 (48%), respectively. Severe dysphagia was significant in the chemoradiation group (34%) compared to the postoperative group (19%). However, the difference was not statistically significant (p = 0.29). There was a higher proportion of patients with large tumor (T3-T4) in the chemoradiation group who developed severe dysphagia. Conclusion: Dysphagia remained a significant morbidity of chemoradiation and postoperative radiation for head and neck cancer. Dysphagia may be more severe in the chemoradiation group because of the higher proportion of patients with large tumor, the high radiation dose, and a high number of oropharyngeal tumors. Aspiration occurred in both groups. Diagnostic studies such as MBS should be part of future head and neck cancer prospective studies to assess the prevalence of aspiration, as it may be silent.

  10. Student Online Readiness Assessment Tools: A Systematic Review Approach

    Science.gov (United States)

    Farid, Alem

    2014-01-01

    Although there are tools to assess student's readiness in an "online learning context," little is known about the "psychometric" properties of the tools used or not. A systematic review of 5107 published and unpublished papers identified in a literature search on student online readiness assessment tools between 1990 and…

  11. Dysphagia assessment and care with nutritional support in patients with stroke%脑卒中患者吞咽障碍评估与营养支持的护理配合

    Institute of Scientific and Technical Information of China (English)

    彭亚利

    2014-01-01

    目的:探讨脑卒中患者吞咽障碍评估和不同方式营养支持护理对患者的影响。方法对212例急性脑卒中患者进行吞咽障碍评估,将符合吞咽障碍标准的87患者随机分成观察组和对照组,观察组44例进行肠内与肠外贯序营养支持,对照组43例给予完全肠外营养支持,比较2组患者治疗后的影响指标与并发症发生情况。结果营养支持3周后,观察组血清总蛋白(67.8±2.1)g/L、血清白蛋白(37.6±1.8)g/L、血红蛋白(129.8±13.8)g/L ,计数均高于对照组( P<0.05);观察组并发症发生率(27.27%)和病死率(2.27%)均明显低于对照组的48.48%、13.95%( P<0.05)。结论肠内与肠外贯序营养支持对脑卒中伴有吞咽障碍的患者护理效果显著,能够明显改善患者的营养状况,降低并发症的发生率,有利于患者疾病的康复。%Objective To investigate the effect of dysphagia assessment and nutritional support different ways of care for stroke patients.Methods Totally 212 cases of acute stroke patients with dysphagia assessment criteria complicated with dys-phagia ,87 patients were randomly divided into observation group and control group ,44 cases of the observation group were given sequential enteral and parenteral nutrition support ,and 43 patients in the control group were given total parenteral nutri-tional support ,the occurrence of impact indicators with complications in the two groups were compared.Results After 3 weeks of nutritional support in observation group ,serum total protein (67.8 ± 2.1) g/L ,serum albumin (37.6 ± 1.8) g/L ,hemoglo-bin (129.8 ± 13.8) g/L were higher than those of control group (P< 0.05);complication rate (27.27% ) and mortality (2.27% ) in observation group were significantly lower than those in control group (48.48% ,13.95% , P<0.05).Conclusion The care effect of sequential enteral and parenteral nutrition support for stroke patients with

  12. Self-reported dysphagia and its correlates within a prevalent population of people with Parkinson's disease.

    Science.gov (United States)

    Walker, Richard W; Dunn, Janet R; Gray, William K

    2011-03-01

    Many people with Parkinson's disease (PD) experience dysphagia; however, the prevalence of dysphagia in people with PD is unknown. We studied a prevalent population of PD cases. All of those who consented to participate were assessed for anxiety, depression, cognitive function, and quality of life using standard rating scales. Anyone who answered "yes" to either one of the two questions: Do you have difficulty swallowing food/liquid or tablets? and Do you cough after eating/drinking? was considered to have dysphagia. Question 7 of the Unified Parkinson's Disease Rating Scale (UPDRS) was also used to identify dysphagia. Of 106 prevalent PD cases, 75 (38 males) patients consented to examination and assessment. The prevalence of dysphagia was 32.0% (n=24; 11 males). Using the response to UPDRS Question 7 as an indicator of the impact of swallowing problems on the patient, there were significant correlations with cognitive function, anxiety, depression, quality of life, and UPDRS-reported gait disturbance, postural instability and problems with falling. There was no correlation with disease duration, age, or gender. Almost one third of the participants reported dysphagia. There was a strong correlation between dysphagia and gross motor skills; patients reporting such problems should be screened for swallowing problems. © Springer Science+Business Media, LLC 2010

  13. Dysphagia is a common and serious problem for adults with mental illness: a systematic review.

    Science.gov (United States)

    Aldridge, Kristy J; Taylor, Nicholas F

    2012-03-01

    Adults with mental illness may experience a higher incidence of dysphagia and choking due to factors such as medication side effects and behavioural abnormalities. The aim of this study was to determine the frequency of dysphagia and the most effective interventions for this population. Studies published up to August 2010 were sought via a comprehensive electronic database search (CINAHL, PsycINFO, MEDLINE, PubMed, Cochrane, and Embase). Studies reporting dysphagia frequency or dysphagia intervention outcomes in adults with mental illness were included. Two reviewers independently assessed study eligibility and quality, and the results were synthesised descriptively. Ten studies were identified, each describing dysphagia frequency or death due to choking asphyxiation. No studies evaluating intervention effectiveness were identified. Study quality was limited by subjective assessment of outcomes. Six studies presented dysphagia frequencies ranging from 9 to 42% in varying subgroups. Four studies presented the frequency of choking asphyxiation death, including a large survey that concluded that adults with organic mental illness were 43 times more likely to die of this cause than the general population. Dysphagia is a common and significant cause of morbidity and mortality in adults with mental illness and our review found that there is a lack of studies evaluating the effectiveness of intervention techniques.

  14. Ultrasonography - A viable tool for airway assessment

    Directory of Open Access Journals (Sweden)

    Preethi B Reddy

    2016-01-01

    Full Text Available Background and Aims: Accurate prediction of the Cormack-Lehane (CL grade preoperatively can help in better airway management of the patient during induction of anaesthesia. Our aim was to determine the utility of ultrasonography in predicting CL grade. Methods: We studied 100 patients undergoing general endotracheal anaesthesia. Mallampati (MP class, thyromental distance (TMD and sternomental distance (SMD were noted. Ultrasound measurements of the anterior neck soft tissue thickness at the level of the hyoid (ANS-Hyoid, anterior neck soft tissue thickness at the level of the vocal cords (ANS-VC and ratio of the depth of the pre-epiglottic space (Pre-E to the  distance from the epiglottis to the mid-point of the distance between the vocal cords (E-VC were obtained. CL grade was noted during intubation. Chi-square test was employed to determine if there was any statistical difference in the measurements of patients with different CL grades. Sensitivity, specificity, positive predictive value (PPV, negative predictive value (NPV and accuracy were calculated for the various parameters. Results: The incidence of difficult intubation was 14%. An ANS-VC >0.23 cm had a sensitivity of 85.7% in predicting a CL Grade of 3 or 4, which was higher than that of MP class, TMD and SMD. However, the specificity, PPV and accuracy were lower than the physical parameters. The NPV was comparable. Conclusion: Ultrasound is a useful tool in airway assessment. ANS-VC >0.23 cm is a potential predictor of difficult intubation. ANS-Hyoid is not indicative of difficult intubation. The ratio Pre-E/E-VC has a low to moderate predictive value.

  15. Ultrasonography - A viable tool for airway assessment

    Science.gov (United States)

    Reddy, Preethi B; Punetha, Pankaj; Chalam, Kolli S

    2016-01-01

    Background and Aims: Accurate prediction of the Cormack-Lehane (CL) grade preoperatively can help in better airway management of the patient during induction of anaesthesia. Our aim was to determine the utility of ultrasonography in predicting CL grade. Methods: We studied 100 patients undergoing general endotracheal anaesthesia. Mallampati (MP) class, thyromental distance (TMD) and sternomental distance (SMD) were noted. Ultrasound measurements of the anterior neck soft tissue thickness at the level of the hyoid (ANS-Hyoid), anterior neck soft tissue thickness at the level of the vocal cords (ANS-VC) and ratio of the depth of the pre-epiglottic space (Pre-E) to the distance from the epiglottis to the mid-point of the distance between the vocal cords (E-VC) were obtained. CL grade was noted during intubation. Chi-square test was employed to determine if there was any statistical difference in the measurements of patients with different CL grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated for the various parameters. Results: The incidence of difficult intubation was 14%. An ANS-VC >0.23 cm had a sensitivity of 85.7% in predicting a CL Grade of 3 or 4, which was higher than that of MP class, TMD and SMD. However, the specificity, PPV and accuracy were lower than the physical parameters. The NPV was comparable. Conclusion: Ultrasound is a useful tool in airway assessment. ANS-VC >0.23 cm is a potential predictor of difficult intubation. ANS-Hyoid is not indicative of difficult intubation. The ratio Pre-E/E-VC has a low to moderate predictive value. PMID:27942053

  16. [Videofluoroscopy study of swallowing in neurogenic dysphagia].

    Science.gov (United States)

    Avdiunina, I A; Popova, L M; Dokuchaeva, N V; Bragina, L K; Dokuchaeva, N F

    2000-01-01

    Videofluoroscopy (VFS) was for the first time used for examining swallowing in 49 patients with nervous diseases. Disturbances in each phase of swallowing act are analyzed with evaluation of the time parameters and defects, causes of aspiration in neurogenic dysphagia are discussed, and cricopharyngeal insufficiency is described. Neurogenic dysphagia is characterized by a combination of disorders which determine the degree of dysphagia. The most severe swallowing disorders were observed in patients with multiple foci in the brain stem and in diphtheritic polyneuropathies. The authors conclude that VFS is the optimal method for the diagnosis of neurogenic dysphagia.

  17. Oral vs. pharyngeal dysphagia: surface electromyography randomized study.

    Science.gov (United States)

    Vaiman, Michael; Nahlieli, Oded

    2009-05-21

    A clear differential diagnosis between oral and pharyngeal dysphagia remains an unsolved problem. Disorders of the oral cavity are frequently overlooked when dysphagia/odybophagia complaints are assessed. Surface electromyographic (sEMG) studies were performed on randomly assigned patients with oral and pharyngeal pathology to evaluate their dysphagia complaints for the sake of differential diagnosis. Parameters evaluated during swallowing for patients after dental surgery (1: n = 62), oral infections (2: n = 49), acute tonsillitis (3: n = 66) and healthy controls (4: n = 50) included timing and amplitude of sEMG activity of masseter, infrahyoid and submental muscles. The duration of swallows and drinking periods was significantly increased in dental patients and was normal in patients with tonsillitis. The electric activity of masseter was significantly lower in Groups 1 and 2 in comparison with the patients with tonsillitis and controls. The submental and infrahyoid activity was normal in dental patients but infrahyoid activity in patients with tonsillitis was high. Dysphagia following dental surgery or oral infections does not affect pharynx and submental muscles and has clear sEMG signs: increased duration of a single swallow, longer drinking time, low activity of the masseter, and normal range of submental activity. Patients with tonsillitis present hyperactivity of infrahyoid muscles. These data could be used for evaluation of symptoms when differential dental/ENT diagnosis is needed.

  18. Oral vs. pharyngeal dysphagia: surface electromyography randomized study

    Directory of Open Access Journals (Sweden)

    Nahlieli Oded

    2009-05-01

    Full Text Available Abstract Background A clear differential diagnosis between oral and pharyngeal dysphagia remains an unsolved problem. Disorders of the oral cavity are frequently overlooked when dysphagia/odybophagia complaints are assessed. Surface electromyographic (sEMG studies were performed on randomly assigned patients with oral and pharyngeal pathology to evaluate their dysphagia complaints for the sake of differential diagnosis. Methods Parameters evaluated during swallowing for patients after dental surgery (1: n = 62, oral infections (2: n = 49, acute tonsillitis (3: n = 66 and healthy controls (4: n = 50 included timing and amplitude of sEMG activity of masseter, infrahyoid and submental muscles. Results The duration of swallows and drinking periods was significantly increased in dental patients and was normal in patients with tonsillitis. The electric activity of masseter was significantly lower in Groups 1 and 2 in comparison with the patients with tonsillitis and controls. The submental and infrahyoid activity was normal in dental patients but infrahyoid activity in patients with tonsillitis was high. Conclusion Dysphagia following dental surgery or oral infections does not affect pharynx and submental muscles and has clear sEMG signs: increased duration of a single swallow, longer drinking time, low activity of the masseter, and normal range of submental activity. Patients with tonsillitis present hyperactivity of infrahyoid muscles. These data could be used for evaluation of symptoms when differential dental/ENT diagnosis is needed.

  19. Psychometric Properties of Questionnaires on Functional Health Status in Oropharyngeal Dysphagia: A Systematic Literature Review

    Science.gov (United States)

    Speyer, Renée; Cordier, Reinie; Kertscher, Berit; Heijnen, Bas J

    2014-01-01

    Introduction. Questionnaires on Functional Health Status (FHS) are part of the assessment of oropharyngeal dysphagia. Objective. To conduct a systematic review of the literature on the psychometric properties of English-language FHS questionnaires in adults with oropharyngeal dysphagia. Methods. A systematic search was performed using the electronic databases Pubmed and Embase. The psychometric properties of the questionnaires were determined based on the COSMIN taxonomy of measurement properties and definitions for health-related patient-reported outcomes and the COSMIN checklist using preset psychometric criteria. Results. Three questionnaires were included: the Eating Assessment Tool (EAT-10), the Swallowing Outcome after Laryngectomy (SOAL), and the Self-report Symptom Inventory. The Sydney Swallow Questionnaire (SSQ) proved to be identical to the Modified Self-report Symptom Inventory. All FHS questionnaires obtained poor overall methodological quality scores for most measurement properties. Conclusions. The retrieved FHS questionnaires need psychometric reevaluation; if the overall methodological quality shows satisfactory improvement on most measurement properties, the use of the questionnaires in daily clinic and research can be justified. However, in case of insufficient validity and/or reliability scores, new FHS questionnaires need to be developed using and reporting on preestablished psychometric criteria as recommended in literature. PMID:24877095

  20. Psychometric properties of questionnaires on functional health status in oropharyngeal dysphagia: a systematic literature review.

    Science.gov (United States)

    Speyer, Renée; Cordier, Reinie; Kertscher, Berit; Heijnen, Bas J

    2014-01-01

    Questionnaires on Functional Health Status (FHS) are part of the assessment of oropharyngeal dysphagia. To conduct a systematic review of the literature on the psychometric properties of English-language FHS questionnaires in adults with oropharyngeal dysphagia. A systematic search was performed using the electronic databases Pubmed and Embase. The psychometric properties of the questionnaires were determined based on the COSMIN taxonomy of measurement properties and definitions for health-related patient-reported outcomes and the COSMIN checklist using preset psychometric criteria. Three questionnaires were included: the Eating Assessment Tool (EAT-10), the Swallowing Outcome after Laryngectomy (SOAL), and the Self-report Symptom Inventory. The Sydney Swallow Questionnaire (SSQ) proved to be identical to the Modified Self-report Symptom Inventory. All FHS questionnaires obtained poor overall methodological quality scores for most measurement properties. The retrieved FHS questionnaires need psychometric reevaluation; if the overall methodological quality shows satisfactory improvement on most measurement properties, the use of the questionnaires in daily clinic and research can be justified. However, in case of insufficient validity and/or reliability scores, new FHS questionnaires need to be developed using and reporting on preestablished psychometric criteria as recommended in literature.

  1. The lived experience of dysphagia following non-surgical treatment for head and neck cancer.

    Science.gov (United States)

    Nund, Rebecca L; Ward, Elizabeth C; Scarinci, Nerina A; Cartmill, Bena; Kuipers, Pim; Porceddu, Sandro V

    2014-06-01

    The prevalence and severity of dysphagia in people treated non-surgically for primary head and neck cancer (HNC) is well documented. However, few studies have looked beyond the physiological impairment to explore the lived experience of dysphagia in the post-treatment period of HNC. The current study adopted a person-centred, qualitative approach to describe the experiences of people living with dysphagia in the months and years following non-surgical treatment for HNC. Using maximum variation sampling, 24 participants who had undergone radiotherapy treatment for HNC were recruited. Individual interviews were conducted to explore the impact of dysphagia on participants' everyday lives. The themes identified included: (1) physical changes related to swallowing; (2) emotions evoked by living with dysphagia; (3) altered perceptions and changes in appreciation of food; and (4) personal and lifestyle impacts. The data revealed the breadth and significance of the impact of dysphagia on the lives of people treated curatively for HNC. Assessment and management in the post-treatment period must be sufficiently holistic to address both the changing physical states and the psychosocial needs of people with dysphagia following HNC. Rehabilitation services which focus only on impairment-based management will fail to fully meet the support needs of this clinical population.

  2. [Seamless community coordination of rehabilitation nutrition care management in patients with Dysphagia].

    Science.gov (United States)

    Wakabayashi, Hidetaka

    2010-12-01

    Community coordination is necessary in nutrition care management and dysphagia rehabilitation, because they are not completed in one hospital or facility. For seamless community coordination of rehabilitation nutrition care management in patients with dysphagia, it is useful to define why, who, when, where, what, and how. Common communication materials of nutrition support team and dysphagia rehabilitation made by Kanagawa society of dysphagia rehabilitation is effective in promoting community coordination. In qualitative research for participants in community nutrition support team at Yokohama south area, two issues were emerged: strengthening collaboration of the community nutrition support team including visiting medical staffs and offering opportunity to learn clinical nutrition and dysphagia rehabilitation. Concept of rehabilitation nutrition is also useful for community coordination. Rehabilitation nutrition is to assess with the International Classification of Functioning, Disability and Health including nutrition status and to practice rehabilitation nutrition care plan under adequate prognosis prediction. It is not enough for patients with dysphagia to coordinate only clinical nutrition or rehabilitation. Seamless community coordination of rehabilitation nutrition care management is important for patients with dysphagia to improve their activities of daily living and quality of life.

  3. Jaw-opening force test to screen for Dysphagia: preliminary results.

    Science.gov (United States)

    Hara, Koji; Tohara, Haruka; Wada, Satoko; Iida, Takatoshi; Ueda, Koichiro; Ansai, Toshihiro

    2014-05-01

    To assess the jaw-opening force test (JOFT) for dysphagia screening. Criterion standard. University dental hospital. Patients complaining of dysphagia (N=95) and with symptoms of dysphagia with chronic underlying causes (mean age ± SD, 79.3±9.61y; range, 50-94y; men: n=49; mean age ± SD, 77.03±9.81y; range, 50-94y; women: n=46; mean age ± SD, 75.42±9.73y; range, 51-93y) admitted for treatment between May 2011 and December 2012 were included. None. All patients were administered the JOFT and underwent fiberoptic endoscopic evaluation of swallowing (FEES). The mean jaw-opening strength was compared with aspiration (ASP) and pharyngeal residue observations of the FEES, which was used as the criterion standard. A receiver operating characteristic (ROC) curve analysis was performed. Forces of ≤3.2kg for men and ≤4kg for women were appropriate cutoff values for predicting ASP with a sensitivity and specificity of .57 and .79 for men and .93 and .52 for women, respectively. Based on the ROC analyses for predicting pharyngeal residue, forces of ≤5.3kg in men and ≤3.9kg in women were appropriate cutoff values, with a sensitivity and specificity of .80 and .88 for men and .83 and .81 for women, respectively. The JOFT could be a useful screening tool for predicting pharyngeal residue and could provide useful information to aid in the referral of patients for further diagnostic imaging testing. However, given its low sensitivity to ASP the JOFT should be paired with other screening tests that predict ASP. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. Assessment Tools' Indicators for Sustainability in Universities: An Analytical Overview

    Science.gov (United States)

    Alghamdi, Naif; den Heijer, Alexandra; de Jonge, Hans

    2017-01-01

    Purpose: The purpose of this paper is to analyse 12 assessment tools of sustainability in universities and develop the structure and the contents of these tools to be more intelligible. The configuration of the tools reviewed highlight indicators that clearly communicate only the essential information. This paper explores how the theoretical…

  5. 77 FR 28894 - Maritime Vulnerability Self-Assessment Tool

    Science.gov (United States)

    2012-05-16

    ... SECURITY Transportation Security Administration Maritime Vulnerability Self-Assessment Tool AGENCY: Transportation Security Administration, DHS. ACTION: Notice of removal of TSA's maritime vulnerability self... Self-Assessment Risk Module (TMSARM), developed to support the United States Coast Guard's...

  6. The influence of tracheotomy tubes on the swallowing frequency in neurogenic dysphagia.

    Science.gov (United States)

    Seidl, Rainer O; Nusser-Müller-Busch, Ricki; Ernst, Arne

    2005-03-01

    To compare the swallowing frequency in patients with neurogenic dysphagia with or without tracheotomy tubes (TT) to assess the underlying mechanisms of dysphagia to improve rehabilitation strategies. Prospective study, 10 patients (64 +/- 7 years) with neurogenic dysphagia. Glasgow Coma Scale (GCS) less than 8 points, tracheotomy due to the dysphagia 2 weeks before the examination. The swallowing frequency (1 or less over 5 min) was assessed over 5 consecutive days with or without TT. The swallowing frequency increased after removal of the TT. These findings did not influence the GCS or the Coma Remission Scale. Over a 5-day period, the frequency of swallowing was increased. TTs decisively influence the swallowing behavior of vegetative patients. This phenomenon could be based on an improved sensitivity under re-established physiological expiration. We strongly favor removing the TT or deflating the cuff of the TT under therapeutic conditions in a rehabilitation therapy setting.

  7. People with intellectual disabilities and dysphagia.

    Science.gov (United States)

    Robertson, Janet; Chadwick, Darren; Baines, Susannah; Emerson, Eric; Hatton, Chris

    2017-03-12

    Dysphagia (difficulties in eating, drinking or swallowing) is associated with serious health complications and psychosocial sequelae. This review aims to summarise the state of the evidence regarding dysphagia in people with intellectual disabilities (excluding prevalence), identify gaps in the evidence base and highlight future research priorities. Studies published from 1 January 1990 to 19 July 2016 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests and cross citations. Studies were reviewed narratively in relation to identified themes. A total of 35 studies were included in the review. Themes identified were as follows: health conditions associated with dysphagia; mortality; health service use; practice and knowledge in supporting people with intellectual disabilities and dysphagia; intervention effectiveness and quality of life. Dysphagia is associated with respiratory infections and choking and may be under-recognised. Silent aspiration is common and may go unnoticed. Management practices exist, but there are few intervention studies and no randomised controlled trials (RCTs), and hence, the effectiveness of these is currently unclear. Dysphagia is a key concern in relation to people with intellectual disabilities. There is urgent need for research on the management of dysphagia in people with intellectual disabilities, including mealtime support offered, positioning, dietary modification and impact on wellbeing. Implications for Rehabilitation Dysphagia is common in people with intellectual disabilities, associated with serious health risks and may be under-recognised. Caregivers of people with intellectual disabilities should be educated about dysphagia. There is an urgent need for research on improving the management of dysphagia in people with intellectual disabilities. Improved recognition and management of dysphagia may reduce the occurrence of associated health conditions and reduce hospital admissions and premature death

  8. Advanced REACH tool: A Bayesian model for occupational exposure assessment

    NARCIS (Netherlands)

    McNally, K.; Warren, N.; Fransman, W.; Entink, R.K.; Schinkel, J.; Van Tongeren, M.; Cherrie, J.W.; Kromhout, H.; Schneider, T.; Tielemans, E.

    2014-01-01

    This paper describes a Bayesian model for the assessment of inhalation exposures in an occupational setting; the methodology underpins a freely available web-based application for exposure assessment, the Advanced REACH Tool (ART). The ART is a higher tier exposure tool that combines disparate sourc

  9. A comprehensive pain assessment tool (COMPAT) for chronic pancreatitis

    DEFF Research Database (Denmark)

    Teo, Keng Lik; Johnson, M H; Drewes, A M

    2017-01-01

    BACKGROUND/OBJECTIVES: Chronic pancreatitis (CP) pain is challenging to treat. Treatment selection is hampered by there being no validated pain assessment tool that accounts for the complexity of CP pain and its underlying mechanisms. This study aims to develop a comprehensive pain assessment tool...

  10. A quality assessment tool for markup-based clinical guidelines.

    Science.gov (United States)

    Shalom, Erez; Shahar, Yuval; Taieb-Maimon, Meirav; Lunenfeld, Eitan

    2008-11-06

    We introduce a tool for quality assessment of procedural and declarative knowledge. We developed this tool for evaluating the specification of mark-up-based clinical GLs. Using this graphical tool, the expert physician and knowledge engineer collaborate to perform scoring, using pre-defined scoring scale, each of the knowledge roles of the mark-ups, comparing it to a gold standard. The tool enables scoring the mark-ups simultaneously at different sites by different users at different locations.

  11. Nursing Assessment Tool for People With Liver Cirrhosis

    OpenAIRE

    GIMENES, Fernanda Raphael Escobar; Reis, Renata Karina; da Silva, Patrícia Costa dos Santos; Silva,Ana Elisa Bauer de Camargo; Atila, Elisabeth

    2015-01-01

    The aim of this study was to describe the process of developing a nursing assessment tool for hospitalized adult patients with liver cirrhosis. A descriptive study was carried out in three stages. First, we conducted a literature review to develop a data collection tool on the basis of the Conceptual Model of Wanda Horta. Second, the data collection tool was assessed through an expert panel. Third, we conducted the pilot testing in hospitalized patients. Most of the comments offered by the pa...

  12. Defining and Measuring Dysphagia Following Stroke

    Science.gov (United States)

    Daniels, Stephanie K.; Schroeder, Mae Fern; DeGeorge, Pamela C.; Corey, David M.; Foundas, Anne L.; Rosenbek, John C.

    2009-01-01

    Purpose: To continue the development of a quantified, standard method to differentiate individuals with stroke and dysphagia from individuals without dysphagia. Method: Videofluoroscopic swallowing studies (VFSS) were completed on a group of participants with acute stroke (n = 42) and healthy age-matched individuals (n = 25). Calibrated liquid…

  13. Oropharyngeal Dysphagia in a Community-Based Elderly Cohort: the Korean Longitudinal Study on Health and Aging

    Science.gov (United States)

    Yang, Eun Joo; Kim, Mi Hyun; Lim, Jae-young

    2013-01-01

    This study was conducted to investigate the prevalence of dysphagia and evaluated the association of dysphagia and activities of daily living in a geriatric population residing in an independent-living facility in Korea. Korean men and women 65-yr and older living in a single, typical South Korean city (n=415) were enrolled in the Korean Longitudinal Study on Health and Aging study. Dysphagia was assessed using the Standardized Swallowing Assessment. Data were collected on activities of daily living (ADL), instrumental ADL (IADL), and medical history and laboratory. The overall prevalence of dysphagia in the random sample was 33.7% (95% CI, 29.1-38.4), including 39.5% in men and 28.4% in women. The identified risk factors for dysphagia were men (OR, 3.6, P=0.023), history of stroke (OR, 2.7, P=0.042) and presence of major depressive disorder (OR, 3.0, P=0.022). Dysphagia was associated with impairment in IADL domains of preparing meals and taking medicine (P=0.013 and P=0.007, respectively). This is the first published report of the prevalence of dysphagia in older community-dwelling Koreans. Dysphagia is a common problem among elderly people that limits some IADL domains. PMID:24133362

  14. Assessment Methods and Tools for Architectural Curricula

    Science.gov (United States)

    Marriott, Christine A.

    2012-01-01

    This research explores the process of assessment within the arena of architectural education by questioning traditional assessment practices and probing into the conditions that necessitate change. As architectural educators we have opened our studios to digital technologies for the purposes of design and representation, but how do we measure and…

  15. The challenges of dysphagia management and rehabilitation after extensive thermal burn injury: a complex case.

    Science.gov (United States)

    Rumbach, Anna F; Ward, Elizabeth C; Cornwell, Petrea L; Bassett, Lynell V; Muller, Michael J

    2009-01-01

    The role of the speech pathologist in the burns population is still emerging, with detailed discussion of the assessment and management of dysphagia limited to date. This report describes the case of a 60-year-old man who developed severe contractures of the head and neck and oropharyngeal dysphagia after sustaining 53.5% deep partial- and full-thickness burns. Although some aspects of rehabilitation were confounded by a preexisting mild intellectual disability, the patient was able to participate in an intensive regimen of active and passive exercise to rehabilitate his oropharyngeal dysphagia. Significant oral contractures remained; however, the patient was discharged without tracheostomy and consuming a texture-modified diet with no signs of aspiration. To our knowledge, this is one of a small handful of reports that document speech pathology management of the burns population, and a first that identifies and outlines specific characteristics of, and rehabilitation strategies for, dysphagia in a burned individual.

  16. Development of a sustainability assessment tool for office buildings

    OpenAIRE

    Barbosa, José Amarilio; Mateus, Ricardo; Bragança, L.

    2012-01-01

    The few available sustainability assessment tools applicable in Portugal are oriented for residential buildings. Nevertheless, the impacts of office buildings have been rising mainly due to an increase in the energy consumption for cooling and heating. This way, due to the growing environmental impact of office buildings, the development of Build-ing Sustainability Assessment (BSA) tools to assess the sustainability of this type of buildings is necessary and important to guide and to boost th...

  17. Correlations of clinical assessment tools with written examinations.

    Science.gov (United States)

    Choi, Eun Jeong; Sunwoo, Sung

    2009-03-01

    Despite the goal of medical education, which is 'training to be a primary care physician,' only written examinations (WEs) generally have been used to assess medical student ability. We assessed clinical competence using the CPX (clinical performance examination), PA (portfolio assessment), VMA (video-monitoring assessment), CGD (case group discussion), and PCP (primary clinical practice) during students' clerkships in family medicine and correlated these clinical assessment tools with WEs. Also, we correlated these tools with each other to determine the feasibility of each as a replacement of the other tools. Thirty-nine fourth year students at University of Ulsan College of Medicine took part in their clerkship in family medicine for 2 weeks during the first session of 2005. They took 1 CPX, 2 VMAs, 6 CGDs, and 2 PCPs and were required to submit their portfolios at the end of the clerkship. We evaluated the correlations of these tools and WEs by the overall scores of each class year and in each subject. The CPX, VMA, and PCP showed no significant correlation,while PA showed strong correlation with 4th year students' overall WEs. The CGD showed strong correlation with all overall scores and with almost all subjects. In addition, the PA correlated significantly with CGD. New clinical assessment tools, such as CPX, PA, and VMA, have no significant correlation with WE, even though these tools closely correspond with real clinical practice. Therefore, these tools should be considered as complementary instruments to better assess clinical competence.

  18. Durability, adaptability and energy conservation (DAEC) assessment tool

    Energy Technology Data Exchange (ETDEWEB)

    Langford, D.A.; Macleod, I.; Dimitrijevic, B. [University of Strathclyde, Glasgow (United Kingdom). Dept. of Civil Engineering; Maver, T.W. [University of Strathclyde, Glasgow (United Kingdom). Dept. of Architecture and Building

    2002-07-01

    This paper presents an evaluation tool for assessing the durability, adaptability and energy conservation of existing buildings and new building designs - DAEC Tool. The tool is one of the outcomes of the research project 'Sustainability of Buildings: Durability, Adaptability and Energy Conservation'. The paper examines the issues which were the basis for developing the metrics, and the application of the DAEC Tool in the evaluation of selected higher education buildings and a new building design for a community hospital. The paper explains how the DAEC Tool can be used in building design and building management. (author)

  19. Detecting signs of dysphagia in patients with Alzheimer's disease with oral feeding in daily life.

    Science.gov (United States)

    Sato, Emiko; Hirano, Hirohiko; Watanabe, Yutaka; Edahiro, Ayako; Sato, Kazumichi; Yamane, Genyuki; Katakura, Akira

    2014-07-01

    It is important to understand dysphagia in patients with dementia, as it is associated with malnutrition and aspiration pneumonia. Particularly in patients with Alzheimer's disease (AD), mortality from pneumonia is high and accounts for 70% of the causes of death. However, the standard swallowing tests are often difficult to use for patients with dementia, and methods to assess daily swallowing function are required. Therefore, the purpose of the present study was to identify signs of dysphagia in AD patients in daily life. A total of 155 AD patients underwent evaluation of their swallowing function (modified water swallowing test), oral status (residual teeth, occlusal contacts), oral functions (lips function, tongue function, rinsing and gargling ability), vital functions (Barthel Index, Vitality Index), nutritional status (serum albumin, body mass index), cognitive function and neurological signs (Mini-Mental State Examination, Clinical Dementia Rating, limb contractures), and diet-related assessments (storing food in the mouth, stuffing food into the mouth, appetite, caloric intake). The severity of AD was significantly associated with swallowing function (P dysphagia was "rinsing ability" (P = 0.001, odds ratio 4.8, 95% confidence interval 1.9-12.1). The factors that affect swallowing function in AD patients were examined. The swallowing function of severe AD patients was poor, and an association between AD and dysphagia was shown. Defective rinsing ability was identified as a risk factor for dysphagia. Therefore, observation of daily rinsing ability appears to be useful to identify signs of dysphagia in AD patients. © 2013 Japan Geriatrics Society.

  20. Sarcopenia is an independent risk factor of dysphagia in hospitalized older people.

    Science.gov (United States)

    Maeda, Keisuke; Akagi, Junji

    2016-04-01

    Sarcopenia can cause varying physical function disorders, including dysphagia. Malnutrition, a potential result of dysphagia, can also cause sarcopenia. However, the association between sarcopenia and dysphagia is not fully understood, despite evidence suggesting correlations between deglutition disorders and degenerative loss of muscle mass. The present study investigated the prevalence of dysphagia among patients with sarcopenia, and the association between the two conditions. We included 224 older adults (mean age 82.5 ± 8.4 years; 37.9% men). Individuals who had a stroke or other diseases that could directly cause dysphagia were excluded. Logistic regression analyses were carried out after adjusting for potential causes of sarcopenia, including malnutrition, a low activity of daily living levels and aging, to investigate the relationship between the skeletal muscle index (SMI), prevalence of sarcopenia diagnosed based on a low SMI and grip strength, and swallowing functions. The Mini-Nutritional Assessment short form was used to assess their nutritional status, and the Barthel Index was used to evaluate their activities of daily living. The prevalences of sarcopenia and dysphagia were 76.8% and 30.0%, respectively. Multivariate analysis showed that Barthel Index, SMI and presence of sarcopenia were significant independent factors for the prevalence of dysphagia, after adjusting for sex, age and nutritional status. Furthermore, subgroup analysis showed that SMI in males, and both hand-grip strength and SMI in females were lower in dysphagic subjects than in non-dysphagic subjects (P ≤ 0.01). Sarcopenia was an independent risk factor for dysphagia among older individuals. However, further studies are required to define causality. © 2015 Japan Geriatrics Society.

  1. Analysis of Alternatives for Risk Assessment Methodologies and Tools

    Energy Technology Data Exchange (ETDEWEB)

    Nachtigal, Noel M. [Sandia National Lab. (SNL-CA), Livermore, CA (United States). System Analytics; Fruetel, Julia A. [Sandia National Lab. (SNL-CA), Livermore, CA (United States). Systems Research and Analysis; Gleason, Nathaniel J. [Sandia National Lab. (SNL-CA), Livermore, CA (United States). Systems Research and Analysis; Helms, Jovana [Sandia National Lab. (SNL-CA), Livermore, CA (United States). Systems Research and Analysis; Imbro, Dennis Raymond [Sandia National Lab. (SNL-CA), Livermore, CA (United States). Systems Research and Analysis; Sumner, Matthew C. [Sandia National Lab. (SNL-CA), Livermore, CA (United States). Systems Research and Analysis

    2013-10-01

    The purpose of this document is to provide a basic overview and understanding of risk assessment methodologies and tools from the literature and to assess the suitability of these methodologies and tools for cyber risk assessment. Sandia National Laboratories (SNL) performed this review in support of risk modeling activities performed for the Stakeholder Engagement and Cyber Infrastructure Resilience (SECIR) division of the Department of Homeland Security (DHS) Office of Cybersecurity and Communications (CS&C). The set of methodologies and tools covered in this document is not intended to be exhaustive; instead, it focuses on those that are commonly used in the risk assessment community. The classification of methodologies and tools was performed by a group of analysts with experience in risk analysis and cybersecurity, and the resulting analysis of alternatives has been tailored to address the needs of a cyber risk assessment.

  2. Clinical reasoning in nursing: teaching strategies and assessment tools

    Directory of Open Access Journals (Sweden)

    Emília Campos de Carvalho

    Full Text Available ABSTRACT Objective: To present the concept and development of teaching strategies and the assessment tools regarding clinical reasoning for accurate practice. Method: This is a theoretical reflection based on scientific studies. Results: Comprehension of the essential concepts of the thought process and its articulation with the different teaching strategies and the assessment tools which has allowed presenting ways to improve the process of diagnostic or therapeutic clinical reasoning. Conclusion: The use of new strategies and assessment tools should be encouraged in order to contribute to the development of skills that lead to safe and effective decision making.

  3. Assessment of Available Numerical Tools for Dynamic Mooring Analysis

    DEFF Research Database (Denmark)

    Thomsen, Jonas Bjerg; Eskilsson, Claes; Ferri, Francesco

    This report covers a preliminary assessment of available numerical tools to be used in upcoming full dynamic analysis of the mooring systems assessed in the project _Mooring Solutions for Large Wave Energy Converters_. The assessments tends to cover potential candidate software and subsequently c...

  4. Comparative Testing for Corporate Impact Assessment Tools

    DEFF Research Database (Denmark)

    Farsang, Andrea; Reisch, Lucia A.

    Environmental and social pressures have increased substantially over the few last decades, and have been accompanied by growing political pressure (e.g., mandatory economic, environmental, social, and governance reporting) and respective societal demands (e.g., critical media reports). Companies...... are increasingly challenged to be ready to respond to these demands. This paper critically examines the following question: To what extent do the measurement tools currently available, in practice and in literature, effectively measure companies’ impact on sustainable development goals (SDGs)? The focus issues...... of our study are: poverty, water and sanitation, education, food and agriculture, climate change, and human rights in three industries, namely: footwear, coffee, and paper and pulp. The paper develops a protocol for the selection and quantification of indicators that can be used in selecting...

  5. Impact assessment as a design tool

    DEFF Research Database (Denmark)

    Lyhne, Ivar

    Research and development (R&D) programmes constitute a pivotal arena for shaping technologies of the future. In order to make qualified decisions, R&D programmes ought to be subject to impact assessment (IA). It seems, however, that only a few countries have developed a systematic practice. One...

  6. Current established risk assessment methodologies and tools

    NARCIS (Netherlands)

    Ionita, Dan; Hartel, Pieter; Pieters, Wolter; Wieringa, Roel

    2013-01-01

    The technology behind information systems evolves at an exponential rate, while at the same time becoming more and more ubiquitous. This brings with it an implicit rise in the average complexity of systems as well as the number of external interactions. In order to allow a proper assessment of the

  7. Voice Recognition: A New Assessment Tool?

    Science.gov (United States)

    Jones, Darla

    2005-01-01

    This article presents the results of a study conducted in Anchorage, Alaska, that evaluated the accuracy and efficiency of using voice recognition (VR) technology to collect oral reading fluency data for classroom-based assessments. The primary research question was as follows: Is voice recognition technology a valid and reliable alternative to…

  8. Tools for climate change adaptation in water management - inventory and assessment of methods and tools

    NARCIS (Netherlands)

    Ludwig, F.; Swart, R.

    2010-01-01

    This report summarizes an inventory of methods and tools for assessing climate change impacts, vulnerability and adaptation options, focusing on the water sector. Two questions are central: What are the opportunities for international applications of Dutch methods and tools? And: Which methods and t

  9. The development of a post occupancy evaluation tool for primary schools: learner comfort assessment tool (LCAT)

    CSIR Research Space (South Africa)

    Motsatsi, L

    2015-12-01

    Full Text Available in order to facilitate teaching and learning. The aim of this study was to develop a Post Occupational Evaluation (POE) tool to assess learner comfort in relation to indoor environmental quality in the classroom. The development of POE tool followed a...

  10. Tools for Assessing Readability of Statistics Teaching Materials

    Science.gov (United States)

    Lesser, Lawrence; Wagler, Amy

    2016-01-01

    This article provides tools and rationale for instructors in math and science to make their assessment and curriculum materials (more) readable for students. The tools discussed (MSWord, LexTutor, Coh-Metrix TEA) are readily available linguistic analysis applications that are grounded in current linguistic theory, but present output that can…

  11. Evaluating IMU communication skills training programme: assessment tool development.

    Science.gov (United States)

    Yeap, R; Beevi, Z; Lukman, H

    2008-08-01

    This article describes the development of four assessment tools designed to evaluate the communication skills training (CST) programme at the International Medical University (IMU). The tools measure pre-clinical students' 1) perceived competency in basic interpersonal skills, 2) attitude towards patient-centred communication, 3) conceptual knowledge on doctor-patient communication, and 4) acceptance of the CST programme.

  12. Tools for Assessing Readability of Statistics Teaching Materials

    Science.gov (United States)

    Lesser, Lawrence; Wagler, Amy

    2016-01-01

    This article provides tools and rationale for instructors in math and science to make their assessment and curriculum materials (more) readable for students. The tools discussed (MSWord, LexTutor, Coh-Metrix TEA) are readily available linguistic analysis applications that are grounded in current linguistic theory, but present output that can…

  13. GIS Technology: Resource and Habitability Assessment Tool Project

    Data.gov (United States)

    National Aeronautics and Space Administration — This is a one-year project to apply a GIS analysis tool to new orbital data for lunar resource assessment and martian habitability identification.  We used...

  14. Development and psychometric testing of the nursing culture assessment tool.

    Science.gov (United States)

    Kennerly, Susan M; Yap, Tracey L; Hemmings, Annette; Beckett, Gulbahar; Schafer, John C; Borchers, Andrea

    2012-11-01

    A valid and reliable nursing culture assessment tool aimed at capturing general aspects of nursing culture is needed for use in health care settings to assess and then reshape indicated troubled areas of the nursing culture. This article summarizes the Nursing Culture Assessment Tool's (NCAT) development and reports on a cross-sectional, exploratory investigation of its psychometric properties. The research aims were to test the tool's psychometric properties; discover its dimensionality; and refine the item structure to best represent the construct of nursing culture, an occupational subset of organizational culture. Empirical construct validity was tested using a sample of licensed nurses and nursing assistants (n = 340). Exploratory and confirmatory factor analysis (CFA) and logistical regression yielded a 6-factor, 19-item solution. Evidence supports the tool's validity for assessing nursing culture as a basis for shaping the culture into one that supports change, thereby accelerating, improving, and advancing nursing best practices and care outcomes.

  15. Clinical reasoning in nursing: teaching strategies and assessment tools

    National Research Council Canada - National Science Library

    Emília Campos de Carvalho; Ana Railka de Souza Oliveira-Kumakura; Sheila Coelho Ramalho Vasconcelos Morais

    2017-01-01

    Results: Comprehension of the essential concepts of the thought process and its articulation with the different teaching strategies and the assessment tools which has allowed presenting ways to improve...

  16. Risk Informed Design Using Integrated Vehicle Rapid Assessment Tools Project

    Data.gov (United States)

    National Aeronautics and Space Administration — A successful proof of concept was performed in FY 2012 integrating the Envision tool for parametric estimates of vehicle mass and the Rapid Response Risk Assessment...

  17. CogGauge (A Cognitive Assessment Tool) Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The Cognitive Gauge (CogGauge) tool aims to develop a portable gaming application that assesses cognitive state of astronaut crew members with the goal of...

  18. The development and demonstration of the metric assessment tool

    Science.gov (United States)

    Campbell, Cynthia A.; Gutterman, Gregory M.

    1993-09-01

    This study reflects the development and demonstration of the metric assessment tool. The purpose of the tool was to provide individuals the means to assess metrics and make improvements to the process measurement. The tool was developed using two critical attributes: customer satisfaction and process improvement. Once the tool was developed, a metric assessment process was designed to demonstrate the tool. Two metrics were selected from the Aeronautical Systems Center (ASC) and individuals with a working knowledge of the metric and process were selected for the demonstrations. Using a group support system at Armstrong Laboratory, Wright Patterson AFB, the group was asked to identify behaviors which might be motivated from the metric. Once the behaviors were identified, the group evaluated the behaviors against the critical attributes. From this assessment, behaviors were placed on the metric assessment tool. This tool clearly identified deficient behaviors and how they might distort the process measurement. From this information, the group was asked to generate improvement actions which would serve to eliminate or control deficient behaviors. With the elimination or control of deficient behaviors, the process measurement is improved and the organizational objective is better served.

  19. Dysphagia and nutritional status at the time of hospital admission for ischemic stroke.

    Science.gov (United States)

    Crary, Michael A; Carnaby-Mann, Giselle D; Miller, Leslie; Antonios, Nader; Silliman, Scott

    2006-01-01

    Dysphagia and poor nutritional status occur frequently after stroke; however, potential associations between them are unknown. We evaluated potential associations between dysphagia and poor nutritional status in patients with acute ischemic stroke. Potential associations between these outcomes and more global stroke severity measures were also assessed. In all, 76 patients with acute ischemic stroke were recruited on admission to the dedicated stroke department of an academic medical center. All patients were assessed with a clinical swallowing evaluation, Functional Oral Intake Scale, Mini Nutritional Assessment, body mass index, percent body fat, National Institutes of Health Stroke Scale, modified Rankin Scale, and modified Barthel Index. Associations were evaluated among dysphagia, nutrition, and stroke severity measures. On clinical examination 52.6% of study patients demonstrated dysphagia and 26.3% were identified with poor nutritional status. Dysphagia, based on clinical assessment, was associated with stroke severity (National Institutes of Health Stroke Scale, odds ratio [OR] 4.6, 95% confidence interval [CI] 1.6-13.1; modified Rankin Scale, OR 12.3, 95% CI 3.2-47.4) and with functional oral intake (OR 29.2, 95% CI 8.4-101.8), but not with measures of nutritional status (Mini Nutritional Assessment, OR 1.0, 95% CI 0.4-2.8). Nutritional measures did not correlate with swallowing or stroke severity measures. Dysphagia and poor nutritional status are prevalent in patients with acute ischemic stroke, however, they are not associated with each other at the time of hospital admission. Furthermore, dysphagia, but not nutritional status, is associated with stroke severity measures.

  20. Posterior mediastinal melanoma causing severe dysphagia: A case report

    Directory of Open Access Journals (Sweden)

    Meacci Elisa

    2008-09-01

    Full Text Available Abstract Introduction We describe an original case of progressive severe dysphagia caused by a posterior mediastinal metastatic melanoma of unknown origin. To the best of our knowledge, such an event has never been described before in the literature. Case presentation A progressive severe dysphagia case is reported induced by a melanoma of unknown origin (metastatic to a posterior mediastinal lymph node. At the time of diagnosis, the lesion appeared as a large posterior mediastinal mass mimicking a neurogenic tumour with oesophageal involvement. After complete resection, pathological assessment of the tumour by immunohistochemistry was consistent with nodal metastatic melanoma. Conclusion This report of a posterior mediastinal lymph node melanoma is unique. The nodal origin is definitely unusual: a primary melanoma should always be carefully ruled out. In fact no other evidence, a part from the absence of the tumour elsewhere, can support the diagnosis of a primary nodal melanoma.

  1. The Development and Demonstration of The Metric Assessment Tool

    Science.gov (United States)

    1993-09-01

    motivate continuous improvement and likewise quality. Attributen of MNaninafui Metrica Section Overview. The importance of metrics cannot be overstated...some of the attributes of meaningful measures discussed earlier in this chapter. The Metrica Handbook. This guide is utilized by a variety of Air...Metric Assessment Tool. 3-8 Metrica Belaction The metric assessment tool was designed to apply to any type of metric. Two criteria were established for

  2. Dysphagia

    African Journals Online (AJOL)

    evaluations, treatments and rehabilitation options available to patients with ... control via the cortical and subcortical areas of the brain. Once sensory .... compensatory strategies. Contrary to ... Dysarthria. Speech .... Modify rate of delivery.

  3. Dysphagia

    Science.gov (United States)

    ... Wexler Medical Center ( 2/27/2017 ) The dyslexia paradox: Differences in how the brain adapts to sights ... gov More Info Follow us on Contact Us Privacy Accessibility Freedom of Information Act Website Policies Free ...

  4. Treatment for dysphagia (swallowing difficulties) in hereditary ataxia.

    Science.gov (United States)

    Vogel, Adam P; Keage, Megan J; Johansson, Kerstin; Schalling, Ellika

    2015-11-13

    Hereditary ataxias are a heterogeneous group of disorders resulting in progressive inco-ordination. Swallowing impairment, also known as dysphagia, is a common and potentially life threatening sequel of disease progression. The incidence and nature of dysphagia in these conditions is largely unknown. The loss of an effective and safe swallow can dramatically affect the health and well-being of an individual. Remediation of difficulties of eating and drinking is an important goal in the clinical care of people with hereditary ataxia. To assess the effects of interventions for swallowing impairment (dysphagia) in people with hereditary ataxias. We searched the Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL Plus, PsycINFO, and the Education Resources Information Center (ERIC) on 14 September 2015. We also searched Linguistics and Language Behavior Abstracts (LLBA), Dissertation Abstracts, and Trials Registries on 24 September 2015. We considered all randomised controlled trials (RCTs) and quasi-RCTs that compared treatments for hereditary ataxia with placebo or no treatment. We only included studies measuring dysphagia. Three review authors (ES, KJ, MK) independently screened all titles and abstracts. In the event of any disagreement or uncertainty over the inclusion of a particular paper, the review authors planned to meet and reach consensus. We identified no RCTs from the 519 titles and abstracts screened. We excluded papers primarily for not including participants with a hereditary ataxia (that is, being focused on other neurological conditions), being theoretical reviews rather than intervention studies, or being neither randomised nor quasi-randomised trials.We identified five papers of various design that described treatment for dysphagia, or improvement to swallow as a by-product of treatment, in people with hereditary ataxia. None of these studies were RCTs or

  5. Functional magnetic resonance imaging study on dysphagia after unilateral hemispheric stroke: a preliminary study.

    Science.gov (United States)

    Li, S; Luo, C; Yu, B; Yan, B; Gong, Q; He, C; He, L; Huang, X; Yao, D; Lui, S; Tang, H; Chen, Q; Zeng, Y; Zhou, D

    2009-12-01

    Swallowing dysfunction is common and disabling after acute stroke; however, the mechanism of dysphagia or recovery of swallowing from dysphagia remains uncertain. The purpose of this study was to explore cerebral activation of swallowing in dysphagia using functional MRI (fMRI) to compare the functional anatomy of swallowing in unilateral hemispheric stroke patients and healthy adults. In total, five left hemispheric stroke patients with dysphagia, five right hemispheric stroke patients with dysphagia and 10 healthy controls were examined with event related fMRI while laryngeal swallow related movements were recorded. Data were processed using the general linear model. A multifocal cerebral representation of swallowing was identified predominantly in the left hemisphere, in a bilateral and asymmetrical manner. Cerebral activation during swallowing tasks was localised to the precentral, postcentral and anterior cingulate gyri, insula and thalamus in all groups. Activation of volitional swallowing in dysphagic unilateral hemispheric stroke patients might require reorganisation of the dominant hemispheric motor cortex, or a compensatory shift in activation to unaffected areas of the hemisphere. The results indicate that unilateral stroke of either cerebral hemisphere can produce dysphagia. Effective recovery is associated with cerebral activation related to cortical swallowing representation in the compensating or recruited areas of the intact hemisphere. Functional MRI is a useful method for exploring the spatial localisation of changes in neuronal activity during tasks that may be related to recovery. Therefore, the subsequent information gleaned from changes in neural plasticity could be useful for assessing the prognosis of dysphagic stroke.

  6. A common assessment tool in inflammatory rheumatisms

    Directory of Open Access Journals (Sweden)

    Dan Nemeş

    2010-06-01

    Full Text Available Aims: Once the biologic therapies have been used, the present-day medicine trend is to homogenize the treatment of the inflammatory autoimmune rheumatic diseases, meaning rheumatoid arthritis (RA, ankylosing spondylitis (AS, psoriatic arthritis (PsA and systemic lupus erythematosus (SLE. But, there is still the need to find out a common assessment instrument for this pathology.Methods:The study included 120 patients (40 patients with RA, 40 patients with AS, 20 patients with PsA and 20 patients with SLE. They were assessed at the beginning and at the end of the study period by using both DAS (Disease Activity Score and HAQ (Health Assessment Questionnaire scales. BASDAI (Bath AS Disease Activity Index was used for AS patients and SLEDAI (SLE Disease Activity Index for SLE patients. Results: The RA patients had significant improvements regarding both DAS and HAQ scores (DAS mean score was initially 4.49 and finally 3.75; HAQ mean score was initially 1.78 and finally 2.15; p<0.05. Important improvements were registered in AS patients (DAS mean score was initially 5.25 and finally 4.02; HAQ mean score was initially 2.24 and finally 2.57; BASDAI mean score was initially 4.28 and finally 3.21; p<0.05, in PsA patients (DAS mean score was initially 7.32 and finally 5.15; HAQ mean score was initially 2.1 and finally 2.51; p<0.05 and in SLE patients (DAS mean score was initially 4.4 and finally 3.45; HAQ mean score was initially 1.9 and finally 2.4; SLEDAI mean score was initially 24.7 and finally 12.5; p<0.05.Conclusions:Having in view that the DAS scale analyses complex aspects (clinical activity of the disease, its inflammatory lab evidence, patient’s general health status, as well as its good correlation to other specific disease scales, it can be used as a more widely assessment instrument in the autoimmune inflammatory rheumatisms.

  7. Computational Tools to Assess Turbine Biological Performance

    Energy Technology Data Exchange (ETDEWEB)

    Richmond, Marshall C.; Serkowski, John A.; Rakowski, Cynthia L.; Strickler, Brad; Weisbeck, Molly; Dotson, Curtis L.

    2014-07-24

    Public Utility District No. 2 of Grant County (GCPUD) operates the Priest Rapids Dam (PRD), a hydroelectric facility on the Columbia River in Washington State. The dam contains 10 Kaplan-type turbine units that are now more than 50 years old. Plans are underway to refit these aging turbines with new runners. The Columbia River at PRD is a migratory pathway for several species of juvenile and adult salmonids, so passage of fish through the dam is a major consideration when upgrading the turbines. In this paper, a method for turbine biological performance assessment (BioPA) is demonstrated. Using this method, a suite of biological performance indicators is computed based on simulated data from a CFD model of a proposed turbine design. Each performance indicator is a measure of the probability of exposure to a certain dose of an injury mechanism. Using known relationships between the dose of an injury mechanism and frequency of injury (dose–response) from laboratory or field studies, the likelihood of fish injury for a turbine design can be computed from the performance indicator. By comparing the values of the indicators from proposed designs, the engineer can identify the more-promising alternatives. We present an application of the BioPA method for baseline risk assessment calculations for the existing Kaplan turbines at PRD that will be used as the minimum biological performance that a proposed new design must achieve.

  8. Neurogenic [corrected] and oropharyngeal dysphagia.

    Science.gov (United States)

    Rofes, Laia; Clavé, Pere; Ouyang, Ann; Scharitzer, Martina; Pokieser, Peter; Vilardell, Natalia; Ortega, Omar

    2013-10-01

    Oropharyngeal dysphagia (OD) is a swallowing disorder caused by congenital abnormalities and structural damage and disease-associated damage of the oral cavity, pharynx, and upper esophageal sphincter. Patients with OD lack the protective mechanisms necessary for effective swallowing, exhibiting difficulty controlling food in the mouth and initiating a swallow, leading to choking, coughing, and nasal regurgitation. OD is a major risk factor for malnutrition, dehydration, and aspiration pneumonia. The following on OD includes commentaries on the application of simulation of oropharyngeal transient receptor potential vanilloid 1 (TRPV1) and maneuvers like the Shaker exercise to improve the safety and efficacy of swallow in OD patients; the prevalence of esophageal pathologies in OD patients and the need to evaluate the esophagus, esophagogastric junction, and stomach; and strategies for clinical screening to detect OD and aspiration among high-risk patients and to improve oral health care, maintain nutrition and hydration, and prevent aspiration pneumonia. © 2013 New York Academy of Sciences.

  9. Simulation tools for robotics research and assessment

    Science.gov (United States)

    Fields, MaryAnne; Brewer, Ralph; Edge, Harris L.; Pusey, Jason L.; Weller, Ed; Patel, Dilip G.; DiBerardino, Charles A.

    2016-05-01

    The Robotics Collaborative Technology Alliance (RCTA) program focuses on four overlapping technology areas: Perception, Intelligence, Human-Robot Interaction (HRI), and Dexterous Manipulation and Unique Mobility (DMUM). In addition, the RCTA program has a requirement to assess progress of this research in standalone as well as integrated form. Since the research is evolving and the robotic platforms with unique mobility and dexterous manipulation are in the early development stage and very expensive, an alternate approach is needed for efficient assessment. Simulation of robotic systems, platforms, sensors, and algorithms, is an attractive alternative to expensive field-based testing. Simulation can provide insight during development and debugging unavailable by many other means. This paper explores the maturity of robotic simulation systems for applications to real-world problems in robotic systems research. Open source (such as Gazebo and Moby), commercial (Simulink, Actin, LMS), government (ANVEL/VANE), and the RCTA-developed RIVET simulation environments are examined with respect to their application in the robotic research domains of Perception, Intelligence, HRI, and DMUM. Tradeoffs for applications to representative problems from each domain are presented, along with known deficiencies and disadvantages. In particular, no single robotic simulation environment adequately covers the needs of the robotic researcher in all of the domains. Simulation for DMUM poses unique constraints on the development of physics-based computational models of the robot, the environment and objects within the environment, and the interactions between them. Most current robot simulations focus on quasi-static systems, but dynamic robotic motion places an increased emphasis on the accuracy of the computational models. In order to understand the interaction of dynamic multi-body systems, such as limbed robots, with the environment, it may be necessary to build component

  10. Developing and Validating a New Classroom Climate Observation Assessment Tool.

    Science.gov (United States)

    Leff, Stephen S; Thomas, Duane E; Shapiro, Edward S; Paskewich, Brooke; Wilson, Kim; Necowitz-Hoffman, Beth; Jawad, Abbas F

    2011-01-01

    The climate of school classrooms, shaped by a combination of teacher practices and peer processes, is an important determinant for children's psychosocial functioning and is a primary factor affecting bullying and victimization. Given that there are relatively few theoretically-grounded and validated assessment tools designed to measure the social climate of classrooms, our research team developed an observation tool through participatory action research (PAR). This article details how the assessment tool was designed and preliminarily validated in 18 third-, fourth-, and fifth-grade classrooms in a large urban public school district. The goals of this study are to illustrate the feasibility of a PAR paradigm in measurement development, ascertain the psychometric properties of the assessment tool, and determine associations with different indices of classroom levels of relational and physical aggression.

  11. [Cancer cachexia assessment: new tools for oncologists.

    Science.gov (United States)

    Serpe, Roberto; Demurtas, Laura; Puzzoni, Marco; Madeddu, Clelia; Scartozzi, Mario

    2016-10-01

    The cancer anorexia-cachexia syndrome (CACS) is considered a multifactorial syndrome that leads a general decline of the cancer patient conditions, prognosis and survival, and characterized by progressive loss of body mass and functional impairment, due to marked energy metabolism imbalance and immunological disorders. It is the cause of death in almost one out of five advanced cancer patients. CACS is also accompanied with loss of quality of life, reduced response and tolerance to anticancer therapies and affected outcome. This condition arises by acute-chronic inflammation, hypercatabolism and resulting in an increased energy expenditure, anorexia and negative caloric balance. Although the international scientific community has reached some important findings in last years regarding CACS, a precise definition agreement for CACS in order to a precise patients assessment is still lacking. In light of the advances in pathogenesis and evaluation of CACS, as well as those reached in the therapy, this review aims to draft a list of key points that could be useful for the oncologist to recognize the different signs and symptoms of this syndrome, in order to evaluate and stage the cancer patients in attempt to target an early multimodal pharmacological-nutritional treatment strategy to improve his outcome and his quality of life.

  12. Tools in the assessment of sarcopenia

    Science.gov (United States)

    Cooper, C; Fielding, R; Visser, M; van Loon, LJ; Rolland, Y; Orwoll, E; Reid, K; Boonen, S; Dere, W; Epstein, S; Mitlak, B; Tsouderos, Y; Sayer, AA; Rizzoli, R; Reginster, JY; Kanis, JA

    2013-01-01

    Summary This review provides a framework for development of an operational definition of sarcopenia and of the potential endpoints that might be adopted in clinical trials among older adults. Introduction While the clinical relevance of sarcopenia is widely recognized, there is currently no universally accepted definition of the disorder. The development of interventions to alter the natural history of sarcopenia also requires consensus on the most appropriate endpoints for determining outcomes of clinical importance which might be utilised in intervention studies. Methods and results We review current approaches to the definition of sarcopenia, and the methods used for the assessment of various aspects of physical function in older people. The potential endpoints of muscle mass, muscle strength, muscle power and muscle fatigue, as well as the relationships between them, are explored with reference to the availability and practicality of the available methods for measuring these endpoints in clinical trials. Conclusions Based on current evidence, none of the four potential outcomes in question is sufficiently comprehensive to recommend as a uniform single outcome in randomised clinical trials. We propose that sarcopenia may be optimally defined (for the purposes of clinical trial inclusion criteria, as well as epidemiological studies) using a combination of measures of muscle mass and physical performance. The choice of outcome measures for clinical trials in sarcopenia is more difficult; co-primary outcomes, tailored to the specific intervention in question, may be the best way forward in this difficult but clinically important area. PMID:23842964

  13. Physical function assessment tools in pediatric rheumatology

    Directory of Open Access Journals (Sweden)

    Onel Karen B

    2008-06-01

    Full Text Available Abstract Pediatric rheumatic diseases with predominant musculoskeletal involvement such as juvenile idiopathic arthritis (JIA and juvenile dermatomyositis(JDM can cause considerable physical functional impairment and significantly affect the children's quality of life (QOL. Physical function, QOL, health-related QOL (HRQOL and health status are personal constructs used as outcomes to estimate the impact of these diseases and often used as proxies for each other. The chronic, fluctuating nature of these diseases differs within and between patients, and complicates the measurement of these outcomes. In children, their growing needs and expectations, limited use of age-specific questionnaires, and the use of proxy respondents further influences this evaluation. This article will briefly review the different constructs inclusive of and related to physical function, and the scales used for measuring them. An understanding of these instruments will enable assessment of functional outcome in clinical studies of children with rheumatic diseases, measure the impact of the disease and treatments on their lives, and guide us in formulating appropriate interventions.

  14. Development of ecohydrological assessment tool and its application

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    The development of Hydro-Informatic Modelling System (HIMS) provides an integrated platform for hydrological simulation. To extend the application of HIMS, an ecohydrological modeling system named ecohydrological assessment tool (EcoHAT) has been developed. Integrating parameter-management tools, RS (remote sensing) inversion tools, module-design tools and GIS analysis tools, the EcoHAT provides an integrated tool to simulate ecohydrological processes on regional scale, which develops a new method on sustainable use of water. EcoHAT has been applied to several case studies, such as, the Yellow River Basin, the acid deposition area in Guizhou province and the riparian catchment of Guanting reservoir in Beijing. Results prove that EcoHAT can efficiently simulate and analysis the ecohydrological processes on regional scale and provide technical support to integrated water resources management on basin scale.

  15. Development of ecohydrological assessment tool and its application

    Institute of Scientific and Technical Information of China (English)

    LIU ChangMing; YANG ShengTian; WEN ZhiQun; WANG XueLei; WANG YuJuan; LI Qian; SHENG HaoRan

    2009-01-01

    The development of Hydro-Informatic Modelling System (HIMS) provides an integrated platform for hydrological simulation. To extend the application of HIMS, an ecohydrological modeling system named ecohydrological assessment tool (EcoHAT) has been developed, integrating parameter-management tools, RS (remote sensing) inversion tools, module-design tools and GIS analysis tools, the EcoHAT provides an integrated tool to simulate ecohydrological processes on regional scale, which develops a new method on sustainable use of water. EcoHAT has been applied to several case studies,such as, the Yellow River Basin, the acid deposition area in Guizhou province and the riparian catchment of Guanting reservoir in Beijing. Results prove that EcoHAT can efficiently simulate and analysis the ecohydrological processes on regional scale and provide technical support to integrated water resources management on basin scale.

  16. Feeding and Swallowing Disorders (Dysphagia) in Children

    Science.gov (United States)

    ... for the Public / Speech, Language and Swallowing / Swallowing Feeding and Swallowing Disorders (Dysphagia) in Children What are ... children with feeding and swallowing disorders ? What are feeding and swallowing disorders? Feeding disorders include problems gathering ...

  17. [Dysphagia: Forestier and Rotes Querol disease].

    Science.gov (United States)

    Cruz-Ruiz, M A; López-Saúz, M; Padierna-Luna, J L; García-Pescador, D; Franco-Grande, M A; Núñez-Sánchez, A

    2008-01-01

    Inside of the study of Dysphagia, until 38% of the greater patients of 50 years, they present/display cervical Osteophytes like cause of Dysphagia; frequently I diagnose passes for the methods of radiology and endoscopy unnoticed. The disease of Forestier and Rotes better well known Querol or like skeletal hiperostosis diffuse idiophatic it is characterized by the formation of spinal and cervical Osteophytes, ossification of ligaments and muscles for vetebrates of the cervical column. Frequently it produces affectation to medullar that it can pronounce like Dysphagia and crosstalk. We presented/displayed the case of a patient of 78 years with chronic pneumopathy, that presents/displays Dysphagia and progressive crosstalk with pondered loss, in where radiology of the cervical column they show cervical osteofitos with espondilolistesis, rectification of the cervical lordosis and diminution of the intersomatic spaces that they compress the trachea and column of air and an extrinsic compression below the cricopharyngeal is documented by endoscopy.

  18. The readability of online breast cancer risk assessment tools.

    Science.gov (United States)

    Cortez, Sarah; Milbrandt, Melissa; Kaphingst, Kimberly; James, Aimee; Colditz, Graham

    2015-11-01

    Numerous breast cancer risk assessment tools that allow users to input personal risk information and obtain a personalized breast cancer risk estimate are available on the Internet. The goal of these tools is to increase screening awareness and identify modifiable health behaviors; however, the utility of this risk information is limited by the readability of the material. We undertook this study to assess the overall readability of breast cancer risk assessment tools and accompanying information, as well as to identify areas of suggested improvement. We searched for breast cancer risk assessment tools, using five search terms, on three search engines. All searches were performed on June 12, 2014. Sites that met inclusion criteria were then assessed for readability using the suitability assessment of materials (SAM) and the SMOG readability formula (July 1, 2014–January 31, 2015). The primary outcomes are the frequency distribution of overall SAM readability category (superior, adequate, or not suitable) and mean SMOG reading grade level. The search returned 42 sites were eligible for assessment, only 9 (21.4 %) of which achieved an overall SAM superior rating, and 27 (64.3 %) were deemed adequate. The average SMOG reading grade level was grade 12.1 (SD 1.6, range 9–15). The readability of breast cancer risk assessment tools and the sites that host them is an important barrier to risk communication. This study demonstrates that most breast cancer risk assessment tools are not accessible to individuals with limited health literacy skills. More importantly, this study identifies potential areas of improvement and has the potential to heighten a physician’s awareness of the Internet resources a patient might navigate in their quest for breast cancer risk information.

  19. SIMPATO-The safety impact assessment tool of interactive

    NARCIS (Netherlands)

    Noort, M. van; Bakri, T.; Fahrenkrog, F.; Dobberstein, J.

    2015-01-01

    One step in the development of safety oriented Advanced Driver Assistance Systems (ADAS) is an ex ante assessment of the expected safety impacts. This requires a careful analysis combining models and data from various sources. This paper describes the Safety IMPact Assessment Tool, called SIMPATO, t

  20. Exposure Assessment Tools by Lifestages and Populations - General Population

    Science.gov (United States)

    EPA ExpoBox is a toolbox for exposure assessors. Its purpose is to provide a compendium of exposure assessment and risk characterization tools that will present comprehensive step-by-step guidance and links to relevant exposure assessment data bases

  1. Exposure Assessment Tools by Lifestages and Populations - Lifestages

    Science.gov (United States)

    EPA ExpoBox is a toolbox for exposure assessors. Its purpose is to provide a compendium of exposure assessment and risk characterization tools that will present comprehensive step-by-step guidance and links to relevant exposure assessment data bases

  2. Exposure Assessment Tools by Lifestages and Populations - Occupational Workers

    Science.gov (United States)

    EPA ExpoBox is a toolbox for exposure assessors. Its purpose is to provide a compendium of exposure assessment and risk characterization tools that will present comprehensive step-by-step guidance and links to relevant exposure assessment data bases

  3. Exposure Assessment Tools by Lifestages and Populations - Residential Consumers

    Science.gov (United States)

    EPA ExpoBox is a toolbox for exposure assessors. Its purpose is to provide a compendium of exposure assessment and risk characterization tools that will present comprehensive step-by-step guidance and links to relevant exposure assessment data bases

  4. Psychometric Testing of the Gordon Facial Muscle Weakness Assessment Tool

    Science.gov (United States)

    Gordon, Shirley C.; Blum, Cynthia Ann; Parcells, Dax Andrew

    2010-01-01

    School nurses may be the first health professionals to assess the onset of facial paralysis/muscle weakness in school-age children. The purpose of this study was to test the psychometric properties of the Gordon Facial Muscle Weakness Assessment Tool (GFMWT) developed by Gordon. Data were collected in two phases. In Phase 1, 4 content experts…

  5. Validation of a clinical assessment tool for spinal anaesthesia.

    LENUS (Irish Health Repository)

    Breen, D

    2011-07-01

    There is a need for a procedure-specific means of assessment of clinical performance in anaesthesia. The aim of this study was to devise a tool for assessing the performance of spinal anaesthesia, which has both content and construct validity.

  6. School Websites as a Novel Internationalization Assessment Tool

    Science.gov (United States)

    Yemini, Miri; Cohen, Anat

    2016-01-01

    This article presents a case study on internationalization assessment. The international, intercultural and global dimensions at the school level are examined, focusing on the case of one particular secondary school in Israel. A novel, practical assessment tool is presented for the measurement of internationalization intensity and scope at the…

  7. Customizable tool for ecological data entry, assessment, monitoring, and interpretation

    Science.gov (United States)

    The Database for Inventory, Monitoring and Assessment (DIMA) is a highly customizable tool for data entry, assessment, monitoring, and interpretation. DIMA is a Microsoft Access database that can easily be used without Access knowledge and is available at no cost. Data can be entered for common, nat...

  8. Using Tree Diagrams as an Assessment Tool in Statistics Education

    Science.gov (United States)

    Yin, Yue

    2012-01-01

    This study examines the potential of the tree diagram, a type of graphic organizer, as an assessment tool to measure students' knowledge structures in statistics education. Students' knowledge structures in statistics have not been sufficiently assessed in statistics, despite their importance. This article first presents the rationale and method…

  9. Using Tree Diagrams as an Assessment Tool in Statistics Education

    Science.gov (United States)

    Yin, Yue

    2012-01-01

    This study examines the potential of the tree diagram, a type of graphic organizer, as an assessment tool to measure students' knowledge structures in statistics education. Students' knowledge structures in statistics have not been sufficiently assessed in statistics, despite their importance. This article first presents the rationale and method…

  10. Validation of a new assessment tool for qualitative research articles

    DEFF Research Database (Denmark)

    Schou, Lone; Høstrup, Helle; Lyngsø, Elin Egholm

    2012-01-01

    schou l., høstrup h., lyngsø e.e., larsen s. & poulsen i. (2011) Validation of a new assessment tool for qualitative research articles. Journal of Advanced Nursing00(0), 000-000. doi: 10.1111/j.1365-2648.2011.05898.x ABSTRACT: Aim.  This paper presents the development and validation of a new...... assessment tool for qualitative research articles, which could assess trustworthiness of qualitative research articles as defined by Guba and at the same time aid clinicians in their assessment. Background.  There are more than 100 sets of proposals for quality criteria for qualitative research. However, we...... is the Danish acronym for Appraisal of Qualitative Studies. Phase 1 was to develop the tool based on a literature review and on consultation with qualitative researchers. Phase 2 was an inter-rater reliability test in which 40 health professionals participated. Phase 3 was an inter-rater reliability test among...

  11. The Nursing Experience of Assessment and Nutritional Support for the Patients with Stroke Dysphagia%脑卒中患者吞咽障碍评估和营养支持护理体会

    Institute of Scientific and Technical Information of China (English)

    陈丽玲

    2014-01-01

    Objective:To investigate patients with stroke dysphagia assessment and nursing methods of nutritional support.Method:74 cases of stroke patients from August 2013 to January 2014 in our hospital were selected,74 patients were randomly divided into the study group and the control group,37 cases in each group.They were all assessed,the study group was used enteral nutrition care methods,the control group was used parenteral nutrition care methods,the two groups of patients care effect was compared.Result:The index of albumin,total protein and hemoglobin in study group of patients were significantly higher than those in the control group(P<0.05).The complication rate was 5.4%in the study group,in the control group was 8.1%.Conclusion:Based on the assessment of dysphagia in patients with stroke,and take enteral nutrition support methods can improve the effect,reduce the incidence of complications,promote good rehabilitation.%目的:探讨脑卒中患者吞咽障碍评估以及营养支持的护理方法。方法:选择2013年8月-2014年1月笔者所在医院收治的脑卒中患者74例,将74例患者随机分为研究组和对照组,每组37例。均进行评估,对研究组患者主要采用肠内营养支持的护理方法,对照组患者主要采用肠外营养支持护理方法,对比两组患者的护理效果。结果:研究组患者的白蛋白、总蛋白以及血红蛋白等的指标明显高于对照组(P<0.05)。研究组患者并发症发生率为5.4%,对照组患者并发症发生率为8.1%。结论:通过对脑卒中患者吞咽障碍进行评估,并且采取肠内营养支持的方法,能够提高营养支持的效果,减少并发症的发生率,促进患者的良好康复。

  12. ECTA/DaSy Framework Self-Assessment Comparison Tool

    Science.gov (United States)

    Center for IDEA Early Childhood Data Systems (DaSy), 2016

    2016-01-01

    The Self-Assessment Comparison (SAC) Tool is for state Part C and Section 619/Preschool programs to use to assess changes in the implementation of one or more components of the ECTA System Framework and/or subcomponenets of the DaSy Data System Framework. It is a companion to the ECTA/DaSy Framework Self-Assessment. Key features of the SAC are…

  13. systemic assessment as a new tool for assessing students learning ...

    African Journals Online (AJOL)

    IICBA01

    aim of the systemic assessment (SA) of learners in heterocyclic chemistry is to introduce an efficient .... We experiment some of these questions successfully on our 3ed year ..... Type [V]: Systemic Synthesis Questions [SSynQs]: (6, 11).

  14. Teamwork Assessment Tools in Modern Surgical Practice: A Systematic Review

    Science.gov (United States)

    Whittaker, George; Abboudi, Hamid; Khan, Muhammed Shamim; Dasgupta, Prokar; Ahmed, Kamran

    2015-01-01

    Introduction. Deficiencies in teamwork skills have been shown to contribute to the occurrence of adverse events during surgery. Consequently, several teamwork assessment tools have been developed to evaluate trainee nontechnical performance. This paper aims to provide an overview of these instruments and review the validity of each tool. Furthermore, the present paper aims to review the deficiencies surrounding training and propose several recommendations to address these issues. Methods. A systematic literature search was conducted to identify teamwork assessment tools using MEDLINE (1946 to August 2015), EMBASE (1974 to August 2015), and PsycINFO (1806 to August 2015) databases. Results. Eight assessment tools which encompass aspects of teamwork were identified. The Nontechnical Skills for Surgeons (NOTSS) assessment was found to possess the highest level of validity from a variety of sources; reliability and acceptability have also been established for this tool. Conclusions. Deficits in current surgical training pathways have prompted several recommendations to meet the evolving requirements of surgeons. Recommendations from the current paper include integration of teamwork training and assessment into medical school curricula, standardised formal training of assessors to ensure accurate evaluation of nontechnical skill acquisition, and integration of concurrent technical and nontechnical skills training throughout training. PMID:26425732

  15. Teamwork Assessment Tools in Modern Surgical Practice: A Systematic Review.

    Science.gov (United States)

    Whittaker, George; Abboudi, Hamid; Khan, Muhammed Shamim; Dasgupta, Prokar; Ahmed, Kamran

    2015-01-01

    Introduction. Deficiencies in teamwork skills have been shown to contribute to the occurrence of adverse events during surgery. Consequently, several teamwork assessment tools have been developed to evaluate trainee nontechnical performance. This paper aims to provide an overview of these instruments and review the validity of each tool. Furthermore, the present paper aims to review the deficiencies surrounding training and propose several recommendations to address these issues. Methods. A systematic literature search was conducted to identify teamwork assessment tools using MEDLINE (1946 to August 2015), EMBASE (1974 to August 2015), and PsycINFO (1806 to August 2015) databases. Results. Eight assessment tools which encompass aspects of teamwork were identified. The Nontechnical Skills for Surgeons (NOTSS) assessment was found to possess the highest level of validity from a variety of sources; reliability and acceptability have also been established for this tool. Conclusions. Deficits in current surgical training pathways have prompted several recommendations to meet the evolving requirements of surgeons. Recommendations from the current paper include integration of teamwork training and assessment into medical school curricula, standardised formal training of assessors to ensure accurate evaluation of nontechnical skill acquisition, and integration of concurrent technical and nontechnical skills training throughout training.

  16. Teamwork Assessment Tools in Modern Surgical Practice: A Systematic Review

    Directory of Open Access Journals (Sweden)

    George Whittaker

    2015-01-01

    Full Text Available Introduction. Deficiencies in teamwork skills have been shown to contribute to the occurrence of adverse events during surgery. Consequently, several teamwork assessment tools have been developed to evaluate trainee nontechnical performance. This paper aims to provide an overview of these instruments and review the validity of each tool. Furthermore, the present paper aims to review the deficiencies surrounding training and propose several recommendations to address these issues. Methods. A systematic literature search was conducted to identify teamwork assessment tools using MEDLINE (1946 to August 2015, EMBASE (1974 to August 2015, and PsycINFO (1806 to August 2015 databases. Results. Eight assessment tools which encompass aspects of teamwork were identified. The Nontechnical Skills for Surgeons (NOTSS assessment was found to possess the highest level of validity from a variety of sources; reliability and acceptability have also been established for this tool. Conclusions. Deficits in current surgical training pathways have prompted several recommendations to meet the evolving requirements of surgeons. Recommendations from the current paper include integration of teamwork training and assessment into medical school curricula, standardised formal training of assessors to ensure accurate evaluation of nontechnical skill acquisition, and integration of concurrent technical and nontechnical skills training throughout training.

  17. Got Graphs? An Assessment of Data Visualization Tools

    Science.gov (United States)

    Schaefer, C. M.; Foy, M.

    2015-01-01

    Graphs are powerful tools for simplifying complex data. They are useful for quickly assessing patterns and relationships among one or more variables from a dataset. As the amount of data increases, it becomes more difficult to visualize potential associations. Lifetime Surveillance of Astronaut Health (LSAH) was charged with assessing its current visualization tools along with others on the market to determine whether new tools would be useful for supporting NASA's occupational surveillance effort. It was concluded by members of LSAH that the current tools hindered their ability to provide quick results to researchers working with the department. Due to the high volume of data requests and the many iterations of visualizations requested by researchers, software with a better ability to replicate graphs and edit quickly could improve LSAH's efficiency and lead to faster research results.

  18. Requirements for water assessment tools: An automotive industry perspective

    Directory of Open Access Journals (Sweden)

    Sherry A. Mueller

    2015-03-01

    Full Text Available Water availability is one of the greatest global sustainability challenges. Water is not available in adequate quantity and quality in many areas and water shortfalls are expected to increase. Businesses are facing water-related challenges due to inadequate water availability and poor resource management. Identifying and quantifying impacts is key to enabling companies to make effective management decisions. Several water assessment tools have been developed to help companies understand the complex nature of water challenges; however, there remain significant gaps in the datasets and inconsistencies in measurement and reporting of geographic water shortfalls. There is a need for more complete datasets containing information on water withdrawal and discharge, freshwater availability and depletion (spatially and temporally, water quality monitoring, reuse and recycling. We discuss four of the available water assessment tools (Global Water Tool, India Water Tool, Water Risk Filter and Aqueduct and highlight those elements most critical to water-related business decisions.

  19. Teamwork Assessment Tools in Modern Surgical Practice: A Systematic Review

    OpenAIRE

    George Whittaker; Hamid Abboudi; Muhammed Shamim Khan; Prokar Dasgupta; Kamran Ahmed

    2015-01-01

    Introduction. Deficiencies in teamwork skills have been shown to contribute to the occurrence of adverse events during surgery. Consequently, several teamwork assessment tools have been developed to evaluate trainee nontechnical performance. This paper aims to provide an overview of these instruments and review the validity of each tool. Furthermore, the present paper aims to review the deficiencies surrounding training and propose several recommendations to address these issues. Methods. A s...

  20. Survey of Ambient Air Pollution Health Risk Assessment Tools.

    Science.gov (United States)

    Anenberg, Susan C; Belova, Anna; Brandt, Jørgen; Fann, Neal; Greco, Sue; Guttikunda, Sarath; Heroux, Marie-Eve; Hurley, Fintan; Krzyzanowski, Michal; Medina, Sylvia; Miller, Brian; Pandey, Kiran; Roos, Joachim; Van Dingenen, Rita

    2016-09-01

    Designing air quality policies that improve public health can benefit from information about air pollution health risks and impacts, which include respiratory and cardiovascular diseases and premature death. Several computer-based tools help automate air pollution health impact assessments and are being used for a variety of contexts. Expanding information gathered for a May 2014 World Health Organization expert meeting, we survey 12 multinational air pollution health impact assessment tools, categorize them according to key technical and operational characteristics, and identify limitations and challenges. Key characteristics include spatial resolution, pollutants and health effect outcomes evaluated, and method for characterizing population exposure, as well as tool format, accessibility, complexity, and degree of peer review and application in policy contexts. While many of the tools use common data sources for concentration-response associations, population, and baseline mortality rates, they vary in the exposure information source, format, and degree of technical complexity. We find that there is an important tradeoff between technical refinement and accessibility for a broad range of applications. Analysts should apply tools that provide the appropriate geographic scope, resolution, and maximum degree of technical rigor for the intended assessment, within resources constraints. A systematic intercomparison of the tools' inputs, assumptions, calculations, and results would be helpful to determine the appropriateness of each for different types of assessment. Future work would benefit from accounting for multiple uncertainty sources and integrating ambient air pollution health impact assessment tools with those addressing other related health risks (e.g., smoking, indoor pollution, climate change, vehicle accidents, physical activity).

  1. Breast clinic triage tool: telephone assessment of new referrals.

    Science.gov (United States)

    Cusack, Leila; Brennan, Meagan; Weissenberg, Leisha; Moore, Katrina

    2012-04-01

    Efficient systems to triage increasing numbers of new referrals to breast clinics are needed, to optimise the management of patients with cancer and benign disease. A tool was developed to triage the urgency of referrals and allocate the most appropriate clinician consultation (surgeon or breast physician (BP)). 259 consecutive new referrals were triaged using the tool. 100% new cancers and 256 (98.8%) referrals overall were triaged to both appropriate category of urgency and the appropriate clinician. This triage tool provides a simple method for assessing new referrals to a breast clinic and can be easily delivered by trained administrative staff by telephone.

  2. Quality of life in oncological patients with oropharyngeal dysphagia: validity and reliability of the Dutch version of the MD Anderson Dysphagia Inventory and the Deglutition Handicap Index.

    Science.gov (United States)

    Speyer, Renée; Heijnen, Bas J; Baijens, Laura W; Vrijenhoef, Femke H; Otters, Elsemieke F; Roodenburg, Nel; Bogaardt, Hans C

    2011-12-01

    Quality of life is an important outcome measurement in objectifying the current health status or therapy effects in patients with oropharyngeal dysphagia. In this study, the validity and reliability of the Dutch version of the Deglutition Handicap Index (DHI) and the MD Anderson Dysphagia Inventory (MDADI) have been determined for oncological patients with oropharyngeal dysphagia. At Maastricht University Medical Center, 76 consecutive patients were selected and asked to fill in three questionnaires on quality of life related to oropharyngeal dysphagia (the SWAL-QOL, the MDADI, and the DHI) as well as a simple one-item visual analog Dysphagia Severity Scale. None of the quality-of-life questionnaires showed any floor or ceiling effect. The test-retest reliability of the MDADI and the Dysphagia Severity Scale proved to be good. The test-retest reliability of the DHI could not be determined because of insufficient data, but the intraclass correlation coefficients were rather high. The internal consistency proved to be good. However, confirmatory factor analysis could not distinguish the underlying constructs as defined by the subscales per questionnaire. When assessing criterion validity, both the MDADI and the DHI showed satisfactory associations with the SWAL-QOL (reference or gold standard) after having removed the less relevant subscales of the SWAL-QOL. In conclusion, when assessing the validity and reliability of the Dutch version of the DHI or the MDADI, not all psychometric properties have been adequately met. In general, because of difficulties in the interpretation of study results when using questionnaires lacking sufficient psychometric quality, it is recommended that researchers strive to use questionnaires with the most optimal psychometric properties.

  3. Framework for Detailed Comparison of Building Environmental Assessment Tools

    Directory of Open Access Journals (Sweden)

    Ola Eriksson

    2013-01-01

    Full Text Available Understanding how Building Environmental Assessments Tools (BEATs measure and define “environmental” building is of great interest to many stakeholders, but it is difficult to understand how BEATs relate to each other, as well as to make detailed and systematic tool comparisons. A framework for comparing BEATs is presented in the following which facilitates an understanding and comparison of similarities and differences in terms of structure, content, aggregation, and scope. The framework was tested by comparing three distinctly different assessment tools; LEED-NC v3, Code for Sustainable Homes (CSH, and EcoEffect. Illustrations of the hierarchical structure of the tools gave a clear overview of their structural differences. When using the framework, the analysis showed that all three tools treat issues related to the main assessment categories: Energy and Pollution, Indoor Environment, and Materials and Waste. However, the environmental issues addressed, and the parameters defining the object of study, differ and, subsequently, so do rating, results, categories, issues, input data, aggregation methodology, and weighting. This means that BEATs measure “environmental” building differently and push “environmental” design in different directions. Therefore, tool comparisons are important, and the framework can be used to make these comparisons in a more detailed and systematic way.

  4. Occupational Exposure Assessment of Nanomaterials using Control Banding Tools

    DEFF Research Database (Denmark)

    Liguori, Biase

    , the assessment of conventional chemicals is well established with clear definition of which metric to use (generally mass concentration). For nanoparticles the assessment procedures are not defined yet and there is debate on which metric should be used (e.g., mass, surface, size-number distribution). Similarly......, chemical reactions, and potential mixing and interaction between the nanomaterial and the background aerosol). Moreover, there are no extensive historical data for comparison and model calibration. Nevertheless, as it is illustrated throughout this thesis, application of modelling for occupational exposure....... In addition, several Control Banding (CB) tools for estimating the exposure to nanomaterials have been developed. An evaluation of current CB tools showed that they are all meant for a qualitative or semi-quantitative exposure assessment of nanomaterials. Two of these tools, NanoSafer and Stoffenmanager Nano...

  5. Performance Analysis of the Capability Assessment Tool for Sustainable Manufacturing

    Directory of Open Access Journals (Sweden)

    Enda Crossin

    2013-08-01

    Full Text Available This paper explores the performance of a novel capability assessment tool, developed to identify capability gaps and associated training and development requirements across the supply chain for environmentally-sustainable manufacturing. The tool was developed to assess 170 capabilities that have been clustered with respect to key areas of concern such as managing energy, water, material resources, carbon emissions and waste as well as environmental management practices for sustainability. Two independent expert teams used the tool to assess a sample group of five first and second tier sports apparel and footwear suppliers within the supply chain of a global sporting goods manufacturer in Asia. The paper addresses the reliability and robustness of the developed assessment method by formulating the expected links between the assessment results. The management practices of the participating suppliers were shown to be closely connected to their performance in managing their resources and emissions. The companies’ initiatives in implementing energy efficiency measures were found to be generally related to their performance in carbon emissions management. The suppliers were also asked to undertake a self-assessment by using a short questionnaire. The large gap between the comprehensive assessment and these in-house self-assessments revealed the suppliers’ misconceptions about their capabilities.

  6. [Surface electromyographic activities of submental muscles among stroke patients with dysphagia].

    Science.gov (United States)

    Xiao, Ling-jun; Xue, Jing-jing; Yan, Tie-bin; Wu, Shao-ling

    2013-06-18

    To explore the swallowing functions of stroke patients with dysphagia. A total of 41 subjects were recruited.There were 15 stroke patients with dysphagia, 12 stroke patients without swallowing disorders and 14 age-and gender-matched healthy controls.Surface electromyography (sEMG) was employed over the suprahyoid muscle group.Single swallow was applied twice with 5 and 10 ml of thin liquid barium as well as 5 and 10 ml of paste barium.The duration, average amplitude of sEMG and peak amplitude of submental muscle contraction were compared among three groups.Three-way analysis of variance (ANOVA) was performed. No significant differences existed in the general data among three groups (P > 0.05).However, all volumes, consistencies and durations [ (1.38 ± 0.21), (1.66 ± 0.30), (1.46 ± 0.24), (1.78 ± 0.28) s] were significantly longer for the group of dysphagia patients than for those without dysphagia and healthy subjects (P 0.05). As a simple and useful tool, sEMG is feasible for evaluating swallowing function and quantifying the strength of swallowing muscles in post-stroke patients with dysphagia.

  7. SYSTEMIC ASSESSMENT [SA] AS A TOOL TO ASSESS STUDENT ...

    African Journals Online (AJOL)

    Temechegn

    In inorganic chemistry the usual descriptions of inorganic reactions by chemical equations, represents ... chemical properties of some sodium compounds are included. This module is ... Selected contents of defined theme ..... assessing high School students' meaningful understanding of organic reactions, J. Chem. Educ.

  8. The music therapy assessment tool in Alzheimer's patients.

    Science.gov (United States)

    Glynn, N J

    1992-01-01

    1. Empirical research is needed to evaluate immediate and sustained physiological, psychological, and psychosocial therapeutic effects, if any, of music therapy on behavioral patterns of elderly institutionalized Alzheimer's patients. 2. The Music Therapy Assessment Tool (MTAT) was specifically designed and developed to assess the effects of music therapy on behavioral patterns of Alzheimer's disease patients. 3. Preliminary testing of the MTAT suggests that it has fairly high internal consistency and inter-rater reliability and warrants consideration as a research tool. 4. Musical intervention included familiar music to facilitate communication and socialization, ethnic and nostalgic music to stimulate reminiscence, and melodies with distinctive rhythmic patterns to enhance movement and behavioral repatterning.

  9. Risk Assessment in Fractured Clayey Tills - Which Modeling Tools?

    DEFF Research Database (Denmark)

    Chambon, Julie Claire Claudia; Bjerg, Poul Løgstrup; Binning, Philip John

    2012-01-01

    assessment is challenging and the inclusion of the relevant processes is difficult. Furthermore the lack of long-term monitoring data prevents from verifying the accuracy of the different conceptual models. Further investigations based on long-term data and numerical modeling are needed to accurately......The article presents different tools available for risk assessment in fractured clayey tills and their advantages and limitations are discussed. Because of the complex processes occurring during contaminant transport through fractured media, the development of simple practical tools for risk...

  10. Bedside screening to detect oropharyngeal dysphagia in patients with neurological disorders: an updated systematic review.

    Science.gov (United States)

    Kertscher, Berit; Speyer, Renée; Palmieri, Maria; Plant, Chris

    2014-04-01

    Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may le to outcomes of aspiration pneumonia ranging from hospitalization to death. Therefore, an early identification of risk followed by an accurate diagnosis of oropharyngeal dysphagia is fundamental. This systematic review provides an update of currently available bedside screenings to identify oropharyngeal dysphagia in neurological patients. An electronic search was carried out in the databases PubMed, Embase, CINAHL, and PsychInfo (formerly PsychLit), and all hits from 2008 up to December 2012 were included in the review. Only studies with sufficient methodological quality were considered, after which the psychometric characteristics of the screening tools were determined. Two relevant bedside screenings were identified, with a minimum sensitivity and specificity of ≥70 and ≥60 %, respectively.

  11. GEOGLAM Crop Monitor Assessment Tool: Developing Monthly Crop Condition Assessments

    Science.gov (United States)

    McGaughey, K.; Becker Reshef, I.; Barker, B.; Humber, M. L.; Nordling, J.; Justice, C. O.; Deshayes, M.

    2014-12-01

    The Group on Earth Observations (GEO) developed the Global Agricultural Monitoring initiative (GEOGLAM) to improve existing agricultural information through a network of international partnerships, data sharing, and operational research. This presentation will discuss the Crop Monitor component of GEOGLAM, which provides the Agricultural Market Information System (AMIS) with an international, multi-source, and transparent consensus assessment of crop growing conditions, status, and agro-climatic conditions likely to impact global production. This activity covers the four primary crop types (wheat, maize, rice, and soybean) within the main agricultural producing regions of the AMIS countries. These assessments have been produced operationally since September 2013 and are published in the AMIS Market Monitor Bulletin. The Crop Monitor reports provide cartographic and textual summaries of crop conditions as of the 28th of each month, according to crop type. This presentation will focus on the building of international networks, data collection, and data dissemination.

  12. Observational gait assessment tools in paediatrics--a systematic review.

    Science.gov (United States)

    Rathinam, Chandrasekar; Bateman, Andrew; Peirson, Janet; Skinner, Jane

    2014-06-01

    Instrumented gait analysis (IGA) is an expensive technique used to objectively detect gait abnormalities in children. Observational gait assessment is considered as a cost effective alternate for IGA in regular clinical practice. This article is aimed at systematically reviewing the available paediatric gait analysis tools and examines their reliability and validity compared to IGA. This review also examines the structure of these tools, their clinical use and limitations. Articles were searched from PubMed, CINHL, AMED, BNI, EMBASE, PEDro and Cochrane library from the earliest record on the database to December 2012. Hand searches were carried out in a few journals. Studies that examined children's gait using a structured assessment tool were included and analysed for their quality, reliability and validity. Pre-established criteria were used to judge the quality of methodology and reliability and validity. Five observational gait tools for children with Cerebral Palsy (CP) and one for children with Downs Syndrome were identified. Nine studies related to children with CP were enrolled for this review. None of the tools have accomplished the level of IGA's consistency. Edinburgh Visual Gait Score (EVGS) was found to have better reliability and validity than the other tools. Very limited studies were available for most of the gait assessment tools therefore their clinical use cannot be judged based on the existing evidence. EVGS was found to have better concurrent validity and reliability and it should be considered to assess CP gait in regular practice. Future work to investigate the use of low cost technology to improve observers' accuracy of EVGS is suggested.

  13. Long-Term Results of External Upper Esophageal Sphincter Myotomy for Oropharyngeal Dysphagia

    Science.gov (United States)

    David, Eric F.; Klinkenberg-Knol, Elly C.; Mahieu, Hans F.

    2009-01-01

    The aim of this work was to assess the efficacy of external myotomy of the upper esophageal sphincter (UES) for oropharyngeal dysphagia. In the period 1991–2006, 28 patients with longstanding dysphagia and/or aspiration problems of different etiologies underwent UES myotomy as a single surgical treatment. The main symptoms were difficulties in swallowing of a solid-food bolus, aspiration, and recurrent incidents of solid-food blockages. Pre- and postoperative manometry and videofluoroscopy were used to assess deglutition and aspiration. Outcome was defined as success in the case of complete relief or marked improvement of dysphagia and aspiration and as failure in the case of partial improvement or no improvement. Initial results showed success in 21 and failure in 7 patients. The best outcomes were observed in patients with dysphagia of unknown origin, noncancer-related iatrogenic etiology, and neuromuscular disease. No correlation was found between preoperative constrictor pharyngeal muscle activity and success rate. After follow-up of more than 1 year, 20 patients were marked as success and 3 as failure. All successful patients had full oral intake with a normal bolus consistency without clinically significant aspiration. We conclude that in select cases of oropharyngeal dysphagia success may be achieved by UES myotomy with restoration of oral intake of normal bolus consistency. PMID:19760460

  14. Orotracheal intubation and dysphagia: comparison of patients with and without brain damage

    Directory of Open Access Journals (Sweden)

    Aline Rodrigues Padovani

    2008-09-01

    Full Text Available Objectives: To compare the swallowing and feeding abilities in extubated patients with and without brain injury. Methods: A retrospective study including 44 patients aged 20 to 50 years submitted to prolonged orotracheal intubation (> 48 hours. Two groups were analyzed: Group 1 composed of nontraumatic brain injury patients, and Group 2 composed of patients with traumatic brain injury. Two scales for characterization of functional swallowing and feeding abilities were used to compare both groups; the levels of alertness, awareness and patient collaboration were also assessed. Rresults: The groups were equal in age, number and time of orotracheal intubation and extubation on the date of the assessment. Regarding the speech and language diagnosis, Group 1 presented higher percentage of functional swallowing and mild dysphagia, while Group 2 showed higher rates of moderate to severe dysphagia and severe dysphagia. The Functional Oral Intake Scale average was higher in Group 1. In addition, the injured brain group was sleepier, less collaborative and had less contact in the first evaluation. Cconclusions: In this study, patients who underwent prolonged orotracheal intubation had dysphagia in different degrees, but the patients with brain injury presented more frequent and severe disorder. Thus, this study suggested that orotracheal intubation cannot be considered as the single factor causing dysphagia, especially in neurological patients. Moreover, some cognitive factors may influence the possibility of providing oral feeding.

  15. [Relationship between dysphagia and malnutritition in patients over 65 years of age].

    Science.gov (United States)

    Galán Sánchez-Heredero, María José; Santander Vaquero, Cecilio; Cortázar Sáez, Milagros; de la Morena López, Felipe; Susi García, Rosario; Martínez Rincón, María Del Carmen

    2014-01-01

    The main objective of this study was to understand the relationship between oropharyngeal dysphagia, nutritional risk factors and functional impairment in the elderly (>65y) admitted to a medical-surgical hospital unit. Secondary objectives were to determine the prevalence of oropharyngeal dysphagia, the nutritional status and their functional capacity. A cross-sectional observational study was performed. It included patients over 65 years of age admitted to the Gastroenterology-Urology Department in La Princesa University Hospital (Madrid, Spain) during the months of February and March. The following variables were recorded: age, sex, body mass index, family support, diagnosis, comorbidity, oropharyngeal dysphagia (EAT-10 and volume-viscosity evaluation method), malnutrition (Mininutritional Assessment) and functional capacity (Barthel index). A total of 167 patients were recruited, with 30.8% and 15.4% prevalence of dysphagia and malnutrition, respectively. Prevalence of malnutrition increased to 75% in patients with oropharyngeal dysphagia. The logistic regression analysis showed how conditions as low score on the Barthel index (OR 0.97 [95% CI, 0.95-0.99]), comorbidity (OR 7.98 [CI 95%, 3.09-20.61]) and dysphagia (OR 4.07 [CI 95%, 1.57-10.52]) were associated with a greater likelihood of suffering malnutrition. Oropharyngeal dysphagia is one of the most underdiagnosed and underestimated conditions among elderly patients and one that has a greater effect on their nutritional status. Accordingly, we suggest using established diagnostic methods with a multidisciplinary team collaboration for its early detection. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  16. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke

    Directory of Open Access Journals (Sweden)

    Jalal Bakhtiyari

    2015-10-01

    Full Text Available Background: Dysphagia is common after stroke. The onset time of swallowing rehabilitation following stroke has an important role in the recovery of dysphagia and preventing of its complications, but it was either highly variable or was not stated in previous trials. The aim of this study was investigation effects of onset time of swallowing therapy on recovery from dysphagia following stroke.Methods: Sixty dysphagia patients due to stroke range of age 60-74 (67.1 ± 3.8, participated in this randomized clinical trial study. The patients allocated in Early, Medium and Late groups, on the base of initiation of swallowing therapy after the stroke. After basic clinical and video fluoroscopic swallowing study assessments, traditional swallowing therapy was initiated 3 times per week for 3 months. The outcome measures were North-Western dysphagia patient check sheet, functional oral intake scale, video fluoroscopy, and frequency of pneumonia. Statistical analysis was done by repeated measure ANOVA, Bonferroni and χ2 tests.Results: Three groups of patients in terms of demographic and clinical characteristics were similar in the pre-treatment P > 0.050. Onset time of swallowing therapy after stroke was effective on swallowing recovery on the main outcome variables. So that in first group patients, recovery was rather than other groups P < 0.050. Furthermore, the frequency of pneumonia in the early group was less than other groups and in the early group no patients experienced pneumonia P = 0.002.Conclusion: Our data suggested that early interventions for dysphagia in stroke have an important role in recovery from dysphagia and prevention of complications like aspiration pneumonia.

  17. Psychometric characteristics of health-related quality-of-life questionnaires in oropharyngeal dysphagia.

    Science.gov (United States)

    Timmerman, Angelique A; Speyer, Renée; Heijnen, Bas J; Klijn-Zwijnenberg, Iris R

    2014-04-01

    Dysphagia can have severe consequences for the patient's health, influencing health-related quality of life (HRQoL). Sound psychometric properties of HRQoL questionnaires are a precondition for assessing the impact of dysphagia, the focus of this study, resulting in recommendations for the appropriate use of these questionnaires in both clinical practice and research contexts. We performed a systematic review starting with a search for and retrieval of all full-text articles on the development of HRQoL questionnaires related to oropharyngeal dysphagia and/or their psychometric validation from the electronic databases PubMed and Embase published up to June 2011. Psychometric properties were judged according to quality criteria proposed for health status questionnaires. Eight questionnaires were included in this study. Four are aimed solely at HRQoL in oropharyngeal dysphagia: the deglutition handicap index (DHI), dysphagia handicap index (DHI'), M.D. Anderson Dysphagia Inventory (MDADI), and SWAL-QOL, while the EDGQ, EORTC QLQ-STO 22, EORTC QLQ-OG 25 and EORTC QLQ-H&N35 focus on other primary diseases resulting in dysphagia. The psychometric properties of the DHI, DHI', MDADI, and SWAL-QOL were evaluated. For appropriate applicability of HRQoL questionnaires, strong scores on the psychometric criteria face validity, criterion validity, and interpretability are prerequisites. The SWAL-QOL has the strongest ratings for these criteria, while the DHI' is the most easy to apply given its 25 items and the use of a uniform scoring format. For optimal use of HRQoL questionnaires in diverse settings, it is necessary to combine psychometric and utility approaches.

  18. The incidence of dysphagia in patients receiving cerebral reperfusion therapy poststroke.

    Science.gov (United States)

    Ribeiro, Priscila W; Cola, Paula C; Gatto, Ana R; da Silva, Roberta G; Luvizutto, Gustavo J; Braga, Gabriel P; Schelp, Arthur O; de Arruda Henry, Maria A C; Bazan, Rodrigo

    2014-07-01

    The high prevalence of dysphagia after stroke leads to increased mortality, and cerebral reperfusion therapy has been effective in reducing neurologic deficits. The aim of this study was to investigate the severity and evolution of dysphagia and the occurrence of pneumonia in patients submitted to cerebral reperfusion therapy. Seventy ischemic stroke patients were evaluated. Of these, 35 patients (group 1) were submitted to cerebral reperfusion therapy and 35 (group 2) did not receive thrombolytic treatment. The following were evaluated: severity of dysphagia by means of videofluoroscopy, evolution of oral intake rate by means of the Functional Oral Intake Scale, and the occurrence of pneumonia by international protocol. The relation between the severity of dysphagia and the occurrence of pneumonia with the treatment was evaluated through the chi-square test; the daily oral intake rate and its relation to the treatment were assessed by the Mann-Whitney test and considered significant if P is less than .05. The moderate and severe degrees of dysphagia were more frequent (P=.013) among the patients who were not submitted to cerebral reperfusion therapy. The daily oral intake evolved independently of the treatment type, without statistical significance when compared between the groups, whereas pneumonia occurred more frequently in group 2 (28%) in relation to group 1 (11%) and was associated with the worst degrees of dysphagia (P=.045). We can conclude that there is improvement in the oral intake rate in both groups, with lower severity of dysphagia and occurrence of pneumonia in ischemic stroke patients submitted to cerebral reperfusion therapy. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Web-based teaching tool incorporating peer assessment and self-assessment

    DEFF Research Database (Denmark)

    McEvoy, Fintan; McEvoy, Peter M.; Svalastoga, Eiliv L.

    2010-01-01

    OBJECTIVE. Our objective was to create an electronic learning tool that incorporates the pedagogic advantages of peer assessment and self-assessment into report-generating skills. CONCLUSION. The tool was created using Web programming software. It was tested with 12 veterinary students and provided...

  20. Integrated assessment of marine biodiversity status using a prototype indicator-based assessment tool

    DEFF Research Database (Denmark)

    Andersen, Jesper H; Dahl, Karsten; Göke, Cordula

    2014-01-01

    at an incorrect spatial scale and/or poorly integrated with existing marine environmental monitoring efforts. The objective of this Method Paper is to introduce and describe a simple tool for integrated assessment of biodiversity status based on the HELCOM Biodiversity Assessment Tool (BEAT), where interim...

  1. Dysphagia in acute stroke: Correlation with stroke subtype, vascular territory and in-hospital respiratory morbidity and mortality

    Directory of Open Access Journals (Sweden)

    Sundar Uma

    2008-01-01

    Full Text Available Aims: The study aimed at correlation of post-stroke dysphagia with area and volume of infarct/ bleed, and with subsequent in-hospital respiratory morbidity and mortality. Materials and Methods: 50 patients of acute stroke were serially recruited. Standard Staff swallowing assessment was performed within 24 hours of admission along with pulse oximetry. Ischemic strokes were classified as per OCPS registry. In-hospital respiratory morbidity and mortality, mode of nutrition and disability status at discharge were noted. Results: 21/50 (42% patients had post-stroke dysphagia during their hospital course. Among infarcts, Total Anterior Circulation Infarcts (TACI had 100% incidence of dysphagia, followed by Partial Anterior Circulation Infarcts (PACI-36%, Posterior Circulation infarcts (POCI-33%, and Lacunar infarcts (LACI-18%. 67% of hemorrhages had post-stroke dysphagia. Staff swallowing assessment had a sensitivity and specificity of 75% and 73% respy., for predicting respiratory morbidity. The corresponding figures for Pulse oximetry were 79% and 91%.

  2. Use of formative assessment as an educational tool.

    Science.gov (United States)

    Jain, Vaishali; Agrawal, Vandana; Biswas, Shubho

    2012-01-01

    Though formative assessments are popular in medical education, but data to establish their educational benefits are lacking. This study was conducted to determine whether participation and performance of MBBS students in regular formative assessments are associated with positive outcomes and has measurable effects on learning. One hundred and fifty MBBS students of semester II attending Biochemistry classes were studied by dividing into two groups till the completion of a topic. End-of-topic summative assessment marks were analysed with respect to the effect of participation and performance in formative assessments. Participation in formative assessments had a statistically significant positive relationship with summative assessment marks. Mean difference in formative and summative assessment marks for group that participated in formative assessments is 1.6 (95% CI = 0.9-2.4, p assessment marks for two groups is 3.4 (95% CI = 2.3-4.6, p Assessment for two groups is 1.2 (95% CI = 0.7-1.6, p assessment not only assesses students' achievements but it also enables students to recognise the areas in which they are having difficulty and to concentrate their future efforts on those areas. Adequate frequency of formative assessment with immediate feedback is beneficial as it stimulates meaningful and multifaceted learning. The results of this study encourage the use of formative assessment as an educational tool in all MBBS subjects for they have significant positive effects on learning.

  3. Creation of complexity assessment tool for patients receiving home care

    Directory of Open Access Journals (Sweden)

    Maria Leopoldina de Castro Villas Bôas

    2016-06-01

    Full Text Available Abstract OBJECTIVE To create and validate a complexity assessment tool for patients receiving home care from a public health service. METHOD A diagnostic accuracy study, with estimates for the tool's validity and reliability. Measurements of sensitivity and specificity were considered when producing validity estimates. The resulting tool was used for testing. Assessment by a specialized team of home care professionals was used as the gold standard. In the tool's reliability study, the authors used the Kappa statistic. The tool's sensitivity and specificity were analyzed using various cut-off points. RESULTS On the best cut-off point-21-with the gold standard, a sensitivity of 75.5% was obtained, with the limits of confidence interval (95% at 68.3% and 82.8% and specificity of 53.2%, with the limits of confidence interval (95% at 43.8% and 62.7%. CONCLUSION The tool presented evidence of validity and reliability, possibly helping in service organization at patient admission, care type change, or support during the creation of care plans.

  4. Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study.

    Science.gov (United States)

    Brodsky, Martin B; Huang, Minxuan; Shanholtz, Carl; Mendez-Tellez, Pedro A; Palmer, Jeffrey B; Colantuoni, Elizabeth; Needham, Dale M

    2017-03-01

    Nearly 60% of patients who are intubated in intensive care units (ICUs) experience dysphagia after extubation, and approximately 50% of them aspirate. Little is known about dysphagia recovery time after patients are discharged from the hospital. To determine factors associated with recovery from dysphagia symptoms after hospital discharge for acute respiratory distress syndrome (ARDS) survivors who received oral intubation with mechanical ventilation. This is a prospective, 5-year longitudinal cohort study involving 13 ICUs at four teaching hospitals in Baltimore, Maryland. The Sydney Swallowing Questionnaire (SSQ), a 17-item visual analog scale (range, 0-1,700), was used to quantify patient-perceived dysphagia symptoms at hospital discharge, and at 3, 6, 12, 24, 36, 48, and 60 months after ARDS. An SSQ score greater than or equal to 200 was used to indicate clinically important dysphagia symptoms at the time of hospital discharge. Recovery was defined as an SSQ score less than 200, with a decrease from hospital discharge greater than or equal to 119, the reliable change index for SSQ score. Fine and Gray proportional subdistribution hazards regression analysis was used to evaluate patient and ICU variables associated with time to recovery accounting for the competing risk of death. Thirty-seven (32%) of 115 patients had an SSQ score greater than or equal to 200 at hospital discharge; 3 died before recovery. All 34 remaining survivors recovered from dysphagia symptoms by 5-year follow-up, 7 (23%) after 6 months. ICU length of stay was independently associated with time to recovery, with a hazard ratio (95% confidence interval) of 0.96 (0.93-1.00) per day. One-third of orally intubated ARDS survivors have dysphagia symptoms that persist beyond hospital discharge. Patients with a longer ICU length of stay have slower recovery from dysphagia symptoms and should be carefully considered for swallowing assessment to help prevent complications related to dysphagia.

  5. Correlating Computed Tomography Perfusion Changes in the Pharyngeal Constrictor Muscles During Head-and-Neck Radiotherapy to Dysphagia Outcome

    Energy Technology Data Exchange (ETDEWEB)

    Truong, Minh Tam, E-mail: mitruong@bu.edu [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Department of Radiology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Lee, Richard [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Saito, Naoko [Department of Radiology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Qureshi, Muhammad M. [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Ozonoff, Al [Department of Biostatistics, Boston University School of Public Health, Boston, MA (United States); Romesser, Paul B. [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Wang, Jimmy; Sakai, Osamu [Department of Radiology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States)

    2012-02-01

    Purpose: To measure changes in perfusion of the pharyngeal constrictor muscles (PCM) using CT perfusion (CTP) imaging during a course of definitive radiotherapy (RT) in head-and-neck cancer (HNC) patients and correlate with dysphagia outcome after RT. Methods and Materials: Fifteen HNC patients underwent CTP imaging of the PCM at baseline and Weeks 2, 4, and 6 during RT and 6 weeks after RT. Blood flow and blood volume were measured in the PCM, and percentage change from baseline scan was determined. A single physician-based assessment of dysphagia was performed every 3 months after RT using the Common Terminology Criteria for Adverse Events, version 3.0 grading system. Results: With a median follow-up of 28 months (range, 6-44 months), Grade 3 dysphagia was present in 7 of 15 patients, and 8 patients experienced Grade 0-2 dysphagia. The CTP parameters at Week 2 of RT demonstrated an increase in mean PCM blood flow of 161.9% vs. 12.3% (p = 0.007) and an increase in mean PCM blood volume of 96.6% vs. 8.7% (p = 0.039) in patients with 6-month post-RT Grade 3 dysphagia and Grade 0-2 dysphagia, respectively. On multivariate analysis, when adjusting for smoking history, tumor volume, and baseline dysphagia status, an increase in blood flow in the second week of RT was significant for 3- and 6-month Grade 3 dysphagia (p < 0.05). Conclusions: Perfusion changes in the PCM during Week 2 of RT in the PCM may predict the severity of dysphagia after HNC RT.

  6. Oral conditions and dysphagia in Japanese, community-dwelling middle- and older- aged adults, independent in daily living

    Science.gov (United States)

    Inui, Akinari; Takahashi, Ippei; Kurauchi, Sizuka; Soma, Yuki; Oyama, Toshiaki; Tamura, Yoshihiro; Noguchi, Takao; Murashita, Kouichi; Nakaji, Shigeyuki; Kobayashi, Wataru

    2017-01-01

    Purpose Prevention, early detection and effective rehabilitation of dysphagia are important issues to be considered in an aging society. Previous studies have shown conflicting findings regarding the association between dysphagia and its potential risk factors, including age, malnutrition, oral conditions, lifestyle and medical history. Herein, we assessed the prevalence and association of dysphagia with potential risk factors in 50- to 79-year-old adults dwelling in a community in Japan. Patients and methods In this study, there were 532 participants (185 males and 347 females). Participants who responded positively to the question “Do you sometimes choke on drinks/food such as tea and soup?” or those who presented with abnormal repetitive saliva swallowing test findings were diagnosed with dysphagia. The data collected from these participants included the following: number of teeth, occurrence of oral dryness, age, body mass index, serum albumin concentration, smoking, drinking and exercise habits, presence of diseases, such as diabetes mellitus and hypertension, and questions from the Mini–Mental State Examination. Results Dysphagia was observed in 33 males (17.8%) and 76 females (21.9%). To explore the effect of the potential risk factors on the prevalence of dysphagia, a model was built by multivariate logistic regression analysis. Using the forced entry method, oral dryness (odds ratio [OR] =3.683 and P=0.003 in males; OR =1.797 and P=0.032 in females) and the number of teeth (OR =0.946 and P=0.038 in males) were found to be significantly related to dysphagia. Conclusion This cross-sectional study demonstrated associations between oral conditions and dysphagia. Factors such as oral dryness and number of teeth may contribute to dysphagia more so than aging, lifestyle and comorbidity in community-dwelling adults over the age of 50. PMID:28352164

  7. Assessment of patient safety culture: what tools for medical students?

    Science.gov (United States)

    Chaneliere, M; Jacquet, F; Occelli, P; Touzet, S; Siranyan, V; Colin, C

    2016-09-29

    The assessment of patient safety culture refers mainly to surveys exploring the perceptions of health professionals in hospitals. These surveys have less relevance when considering the assessment of the patient safety culture of medical students, especially at university or medical school. They are indeed not fully integrated in care units and constitute a heterogeneous population. This work aimed to find appropriate assessment tools of the patient safety culture of medical students. Systematic review of the literature. Surveys related to a care unit were excluded. A typology of the patient safety culture of medical students was built from the included surveys. Eighteen surveys were included. In our typology of patient safety culture of medical students (15 dimensions), the number of dimensions explored by survey (n) ranged from 1 to 12, with 6 "specialized" tools (n ≤ 4) and 12 "global" tools (N ≥ 5). These surveys have explored: knowledge about patient safety, acknowledgment of the inevitability of human error, the lack of skills as the main source of errors, the errors reporting systems, disclosure of medical errors to others health professionals or patients, teamwork and patient involvement to improve safety in care. We recommend using Wetzel's survey for making an overall assessment of the patient safety culture of medical students at university. In a specific purpose-e.g. to assess an educational program on medical error disclosure-the authors recommend to determine which dimensions of patient safety will be taught, to select the best assessment tool. Learning on patient safety should however be considered beyond the university. International translations of tools are required to create databases allowing comparative studies.

  8. An assessment tool for developing healthcare managerial skills and roles.

    Science.gov (United States)

    Guo, Kristina L

    2003-01-01

    This article is based on a study to identify, and by doing so help develop, the skills and roles of senior-level healthcare managers related to the needs of the current healthcare environment. To classify these roles and skills, a qualitative study was conducted to examine the literature on forces in the healthcare environment and their impact on managers. Ten senior managers were interviewed, revealing six roles as the most crucial to their positions along with the skills necessary to perform those roles. A pilot study was conducted with these senior managers to produce a final assessment tool. This assessment tool helps managers to identify strengths and weaknesses, develop in deficient areas, and promote competence in all areas as demanded by the market and organization. This tool can be used by organizations in the recruitment process and in the training process.

  9. [Medication-induced dysphagia : A review].

    Science.gov (United States)

    Schwemmle, C; Jungheim, M; Miller, S; Kühn, D; Ptok, M

    2015-07-01

    As a highly differentiated physiological process, swallowing may be affected by a variety of confounding factors. Primarily described are swallowing disorders caused by mechanical anatomic changes (e. g., alteration of the cervical spine, goiter), surgery for head and neck tumors, thyroid abnormalities, and neuromuscular disorders. Age-related cerebral neurological and blood vessel-associated changes can also cause dysphagia (so-called presbyphagia) or worsen the condition.Medication-associated dysphagia is recognized far less frequently, not paid due attention, or accepted in silence; particularly in older patients. Furthermore, pharmacological interference of different medications is frequently inadequately considered, particularly in the case of polypharmacy.Initial treatment of medication-induced dysphagia includes a critical review of medication status, with the aim of reducing/discontinuing the causative medication by giving precise instructions regarding its administration; as well as antacid medication, diet, and professional oral stimulation or swallowing training.To date, medication-induced dysphagia has not occupied the focus of physicians and therapists. This is despite the fact that many active agents can have a negative effect on swallowing and medication-induced dysphagia caused by polypharmacy is not uncommon, particularly in old age. This article presents an overview of the different classes of drugs in terms of their direct or indirect negative effects on the swallowing function.

  10. 48 CFR 1323.705 - Electronic products environmental assessment tool.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Electronic products... COMMERCE SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES... Products and Services 1323.705 Electronic products environmental assessment tool. The procedures...

  11. Developing a Quantitative Tool for Sustainability Assessment of HEIs

    Science.gov (United States)

    Waheed, Bushra; Khan, Faisal I.; Veitch, Brian

    2011-01-01

    Purpose: Implementation of a sustainability paradigm demands new choices and innovative ways of thinking. The main objective of this paper is to provide a meaningful sustainability assessment tool for make informed decisions, which is applied to higher education institutions (HEIs). Design/methodology/approach: The objective is achieved by…

  12. Assessing Educational Processes Using Total-Quality-Management Measurement Tools.

    Science.gov (United States)

    Macchia, Peter, Jr.

    1993-01-01

    Discussion of the use of Total Quality Management (TQM) assessment tools in educational settings highlights and gives examples of fishbone diagrams, or cause and effect charts; Pareto diagrams; control charts; histograms and check sheets; scatter diagrams; and flowcharts. Variation and quality are discussed in terms of continuous process…

  13. USING ONLINE ASSESSMENT AS A TOOL FOR LEARNING

    Directory of Open Access Journals (Sweden)

    Coculescu Cristina

    2009-05-01

    Full Text Available The use of information and communication technologies in education offers new means of evaluation and examination. e-Testing is a valuable evaluation tool that teachers can use during final exams and students can exploit for self-assessment, in order to g

  14. Building Assessment Tools Aligned with Grade-Level Outcomes

    Science.gov (United States)

    Martin, Caryl; Horton, Mel L.; Tarr, Susan J.

    2015-01-01

    This article focuses on the development of assessment tools to enhance the acquisition of the grade-level outcomes developed in the K-12 curriculum. Physical education is one of the few educational programs that does not have a multitude of available state and national tests to measure student progress. This distinction has been both a strength…

  15. Analysis of Online Quizzes as a Teaching and Assessment Tool

    Science.gov (United States)

    Salas-Morera, Lorenzo; Arauzo-Azofra, Antonio; García-Hernández, Laura

    2012-01-01

    This article deals with the integrated use of online quizzes as a teaching and assessment tool in the general program of the subject Proyectos in the third course of Ingeniero Técnico en Informática de Gestión over five consecutive years. The research undertaken aimed to test quizzes effectiveness on student performance when used, not only as an…

  16. An advanced tool for Preventive Voltage Security Assessment

    OpenAIRE

    Van Cutsem, Thierry; Capitanescu, Florin; Moors, Cédric; Lefebvre, Daniel; Sermanson, Vincent

    2000-01-01

    This paper deals with methods for the preventive assessment of voltage security with respect to contingencies. We describe a computing tool for the determination of secure operation limits, together with methods for contingency filtering. Examples from two very different real-life systems are provided. We outline extensions in the field of preventive control. Peer reviewed

  17. Developing a Quantitative Tool for Sustainability Assessment of HEIs

    Science.gov (United States)

    Waheed, Bushra; Khan, Faisal I.; Veitch, Brian

    2011-01-01

    Purpose: Implementation of a sustainability paradigm demands new choices and innovative ways of thinking. The main objective of this paper is to provide a meaningful sustainability assessment tool for make informed decisions, which is applied to higher education institutions (HEIs). Design/methodology/approach: The objective is achieved by…

  18. Econometric Assessment of "One Minute" Paper as a Pedagogic Tool

    Science.gov (United States)

    Das, Amaresh

    2010-01-01

    This paper makes an econometric testing of one-minute paper used as a tool to manage and assess instruction in my statistics class. One of our findings is that the one minute paper when I have tested it by using an OLS estimate in a controlled Vs experimental design framework is found to statistically significant and effective in enhancing…

  19. Evaluation of TENCompetence proof of concept assessment tools

    NARCIS (Netherlands)

    Petrov, Milen; Aleksieva-Petrova, Adelina; Stefanov, Krassen; Schoonenboom, Judith; Miao, Yongwu

    2008-01-01

    Petrov, M., Aleksieva-Petrova, A., Stefanov, K., Schoonenboom, J., & Miao, Y. (2008). Evaluation of TENCompetence proof of concept assessment tools. In H. W. Sligte & R. Koper (Eds.). Proceedings of the 4th TENCompetence Open Workshop. Empowering Learners for Lifelong Competence Development: pedagog

  20. An implementation evaluation of a qualitative culture assessment tool.

    Science.gov (United States)

    Tappin, D C; Bentley, T A; Ashby, L E

    2015-03-01

    Safety culture has been identified as a critical element of healthy and safe workplaces and as such warrants the attention of ergonomists involved in occupational health and safety (OHS). This study sought to evaluate a tool for assessing organisational safety culture as it impacts a common OHS problem: musculoskeletal disorders (MSD). The level of advancement across nine cultural aspects was assessed in two implementation site organisations. These organisations, in residential healthcare and timber processing, enabled evaluation of the tool in contrasting settings, with reported MSD rates also high in both sectors. Interviews were conducted with 39 managers and workers across the two organisations. Interview responses and company documentation were compared by two researchers to the descriptor items for each MSD culture aspect. An assignment of the level of advancement, using a five stage framework, was made for each aspect. The tool was readily adapted to each implementation site context and provided sufficient evidence to assess their levels of advancement. Assessments for most MSD culture aspects were in the mid to upper levels of advancement, although the levels differed within each organisation, indicating that different aspects of MSD culture, as with safety culture, develop at a different pace within organisations. Areas for MSD culture improvement were identified for each organisation. Reflections are made on the use and merits of the tool by ergonomists for addressing MSD risk.

  1. Evaluation of TENCompetence proof of concept assessment tools

    NARCIS (Netherlands)

    Petrov, Milen; Aleksieva-Petrova, Adelina; Stefanov, Krassen; Schoonenboom, Judith; Miao, Yongwu

    2008-01-01

    Petrov, M., Aleksieva-Petrova, A., Stefanov, K., Schoonenboom, J., & Miao, Y. (2008). Evaluation of TENCompetence proof of concept assessment tools. In H. W. Sligte & R. Koper (Eds.). Proceedings of the 4th TENCompetence Open Workshop. Empowering Learners for Lifelong Competence Development: pedagog

  2. Analysis of the level of Dysphagia, anxiety, and nutritional status before and after speech therapy in patients with stroke.

    Science.gov (United States)

    Drozdz, Daniela; Mancopes, Renata; Silva, Ana Maria Toniolo; Reppold, Caroline

    2014-04-01

     The rehabilitation in oropharyngeal dysphagia evidence-based implies the relationship between the interventions and their results.  Analyze level of dysphagia, oral ingestion, anxiety levels and nutritional status of patients with stroke diagnosis, before and after speech therapy.  Clinical assessment of dysphagia partially using the Protocol of Risk Assessment for Dysphagia (PARD), applying the scale Functional Oral Intake Scale for Dysphagia in Stroke Patients (FOIS), Beck Anxiety Inventory (BAI) and the Mini Nutritional Assessment MNA(®). The sample consisted of 12 patients, mean age of 64.6 years, with a medical diagnosis of hemorrhagic and ischemic stroke and without cognitive disorders. All tests were applied before and after speech therapy (15 sessions). Statistical analysis was performed using the chi-square test or Fisher's exact test, McNemar's test, Bowker's symmetry test and Wilcoxon's test.  During the pre-speech therapy assessments, 33.3% of patients had mild to moderate dysphagia, 88.2% did not receive food orally, 47.1% of the patients showed malnutrition and 35.3% of patients had mild anxiety level. After the therapy sessions, it was found that 33.3% of patients had mild dysphagia, 16.7% were malnourished and 50% of patients had minimal level of anxiety.   There were statistically significant evolution of the level of dysphagia (p = 0.017) and oral intake (p = 0.003) post-speech therapy. Although not statistically significant, there was considerable progress in relation to the level of anxiety and nutritional status.

  3. Developing a tool for assessing competency in root cause analysis.

    Science.gov (United States)

    Gupta, Priyanka; Varkey, Prathibha

    2009-01-01

    Root cause analysis (RCA) is a tool for identifying the key cause(s) contributing to a sentinel event or near miss. Although training in RCA is gaining popularity in medical education, there is no published literature on valid or reliable methods for assessing competency in the same. A tool for assessing competency in RCA was pilot tested as part of an eight-station Objective Structured Clinical Examination that was conducted at the completion of a three-week quality improvement (QI) curriculum for the Mayo Clinic Preventive Medicine and Endocrinology fellowship programs. As part of the curriculum, fellows completed a QI project to enhance physician communication of the diagnosis and treatment plan at the end of a patient visit. They had a didactic session on RCA, followed by process mapping of the information flow at the project clinic, after which fellows conducted an actual RCA using the Ishikawa fishbone diagram. For the RCA competency assessment, fellows performed an RCA regarding a scenario describing an adverse medication event and provided possible solutions to prevent such errors in the future. All faculty strongly agreed or agreed that they were able to accurately assess competency in RCA using the tool. Interrater reliability for the global competency rating and checklist scoring were 0.96 and 0.85, respectively. Internal consistency (Cronbach's alpha) was 0.76. Six of eight of the fellows found the difficulty level of the test to be optimal. Assessment methods must accompany education programs to ensure that graduates are competent in QI methodologies and are able to apply them effectively in the workplace. The RCA assessment tool was found to be a valid, reliable, feasible, and acceptable method for assessing competency in RCA. Further research is needed to examine its predictive validity and generalizability.

  4. Clinical and electrophysiological evaluation of dysphagia in myasthenia gravis

    OpenAIRE

    1998-01-01

    OBJECTIVE—To evaluate dysphagia at the oropharyngeal stage of swallowing and to determine the pathophysiological mechanisms of dysphagia in patients with myasthenia gravis.
METHODS—Fifteen patients with myasthenia gravis with dysphagia and 10 patients without dysphagia were investigated by a combined electrophysiological and mechanical method described previously. Laryngeal movements were detected by a piezoelectric transducer and the related submental EMG (SM-EMG) and somet...

  5. Validation of the Spanish Version of the Eating Assessment Tool-10 (EAT-10spa) in Colombia. A Blinded Prospective Cohort Study.

    Science.gov (United States)

    Giraldo-Cadavid, Luis Fernando; Gutiérrez-Achury, Alejandra María; Ruales-Suárez, Karem; Rengifo-Varona, Maria Leonor; Barros, Camilo; Posada, Andrés; Romero, Carlos; Galvis, Ana María

    2016-06-01

    Dysphagia might affect 12 % of the general population, and its complications include pneumonia, malnutrition, social isolation, and death. No validated Spanish symptom survey exists to quantify dysphagia symptoms among Latin Americans. Therefore, we performed a prospective cohort study in a tertiary care university hospital to validate the Spanish version of the 10-Item Eating-Assessment-Tool (EAT-10spa) for use in Colombia. After an interdisciplinary committee of five bilingual specialists evaluated the EAT-10spa (translated and validated in Spain) and deemed it appropriate for the Colombian culture, its feasibility, reliability, validity, sensitivity to change, and diagnostic capacity were evaluated. As a reference standard, we used the flexible endoscopic evaluation of swallowing with sensory testing and a standardized clinical evaluation. All assessments were blinded. In total, 133 subjects were included (52 % women, mean age 55 years) and completed the EAT-10spa (median completion time: 2 min [IQR 1-3 min]), 39 % of whom had an elementary-level education. Cronbach's α coefficient: 0.91; test-retest intra-class correlation coefficient: 0.94. The Spearman's correlation coefficient of the EAT-10spa with the 8-point penetration-aspiration scale was 0.54 (P EAT-10spa ≥2 (sensitivity 93.6 %, specificity 36.4 %) and EAT-10spa ≥4 (sensitivity 94.3 %, specificity 49.5 %), respectively. A reduction in the EAT-10 ≥3 was the best cut-off point for a clinically significant improvement (AUC-ROC 0.83; P EAT-10spa showed excellent psychometric properties and discriminatory capacity for use in Colombia.

  6. Teaching and Learning: Using Digital Tools for Progressive Assessment

    DEFF Research Database (Denmark)

    Kastbjerg, Rita B.; Petersson, Eva; Lewis Brooks, Anthony

    2008-01-01

      Non-biased assessment becomes a reality when Information and Communication Technology (ICT) is implemented as a pedagogical tool to augment teacher practice and student learning. This paper details a study that was undertaken at a secondary school in Lithuania involving four educators and 200......) a change from an individual to a collaborative responsibility of assessment, (2) a change from an individual to a collective knowledge shaping, and (3) a change from a possibly weighted evaluation to a defined non-biased assessment outcome. Results from the study point to the potentials from CBT applied...... in education to address future augmented teacher - students' liaisons....

  7. Dysphagia and cerebrovascular accident: relationship between severity degree and level of neurological impairment.

    Science.gov (United States)

    Itaquy, Roberta Baldino; Favero, Samara Regina; Ribeiro, Marlise de Castro; Barea, Liselotte Menke; Almeida, Sheila Tamanini de; Mancopes, Renata

    2011-12-01

    The aim of this case study was to verify the occurrence of dysphagia in acute ischemic stroke within 48 hours after the onset of the first symptoms, in order to establish a possible relationship between the level of neurologic impairment and the severity degree of dysphagia. After emergency hospital admission, three patients underwent neurological clinical evaluation (general physical examination, neurological examination, and application of the National Institute of Health Stroke Scale - NIHSS), and clinical assessment of swallowing using the Protocolo Fonoaudiológico de Avaliação do Risco para Disfagia (PARD--Speech-Language Pathology Protocol for Risk Evaluation for Dysphagia). One of the patients presented functional swallowing (NIHSS score 11), while the other two had mild and moderate oropharyngeal dysphagia (NIHSS scores 15 and 19, respectively). The service flow and the delay on the patients' search for medical care determined the small sample. The findings corroborate literature data regarding the severity of the neurological condition and the manifestation of dysphagia.

  8. Transcranial direct current stimulation in post-stroke dysphagia: a systematic review of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari

    2016-07-01

    Full Text Available Introduction: The aim of this research was to systematically review all the randomized controlled trials that have evaluated the effect of transcranial direct current stimulation (tDCS on post-stroke dysphagia. Methods: Three electronic databases were searched for relevant articles that were uploaded from their inception to March 2015: PubMed, Cochrane Library (Cochrane Central Register of Controlled Trials, and Scopus. All data was that was related to the location of the cerebrovascular accident (CVA, the parameters of tDCS, post-stroke time to commencement of tDCS, the stimulated hemisphere, stimulation dose, any outcome measurements, and follow-up duration were extracted and assessed. Finally, a number of observations were generated through a qualitative synthesis of the extracted data.Result: Three eligible randomized controlled trials were included in the systematic review. All three trials reported that, in comparison to a placebo, tDCS had a statistically significant effect on post-stroke dysphagia.Discussion: The results of our systematic review suggest that tDCS may represent a promising novel treatment for post-stroke dysphagia. However, to date, little is known about the optimal parameters of tDCS for relieving post-stroke dysphagia. Further studies are warranted to refine this promising intervention by exploring the optimal parameters of tDCS.Conclusion: Since brainstem swallowing centers have bilateral cortical innervations, measures that enhance cortical input and sensorimotor control of brainstem swallowing may facilitate recovery from dysphagia.

  9. Esophageal dysphagia and reflux symptoms before and after oral IQoro(R) training.

    Science.gov (United States)

    Hägg, Mary; Tibbling, Lita; Franzén, Thomas

    2015-06-28

    To examine whether muscle training with an oral IQoro(R) screen (IQS) improves esophageal dysphagia and reflux symptoms. A total of 43 adult patients (21 women and 22 men) were consecutively referred to a swallowing center for the treatment and investigation of long-lasting nonstenotic esophageal dysphagia. Hiatal hernia was confirmed by radiologic examination in 21 patients before enrollment in the study (group A; median age 52 years, range: 19-85 years). No hiatal hernia was detected by radiologic examination in the remaining 22 patients (group B; median age 57 years, range: 22-85 years). Before and after training with an oral IQS for 6-8 mo, the patients were evaluated using a symptom questionnaire (esophageal dysphagia and acid chest symptoms; score 0-3), visual analogue scale (ability to swallow food: score 0-100), lip force test (≥ 15 N), velopharyngeal closure test (≥ 10 s), orofacial motor tests, and an oral sensory test. Another twelve patients (median age 53 years, range: 22-68 years) with hiatal hernia were evaluated using oral IQS traction maneuvers with pressure recordings of the upper esophageal sphincter and hiatus canal as assessed by high-resolution manometry. Esophageal dysphagia was present in all 43 patients at entry, and 98% of patients showed improvement after IQS training [mean score (range): 2.5 (1-3) vs 0.9 (0-2), P dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.

  10. Assessment Tools in Brief: Assessment of Personal Goals--An Online Tool for Personal Counseling, Coaching, and Business Consulting

    Science.gov (United States)

    Henderson, Sheila J.

    2009-01-01

    The Assessment of Personal Goals (APG; M. E. Ford & C.W. Nichols, 1987, 1991) is reviewed along with case examples that demonstrate how the APG can be used in personal counseling, career coaching, and business consulting. The APG is an online tool for helping people identify the sources of their discontent and possible pathways for satisfying…

  11. Comparison of occupational exposure assessment tools and concepts for nanomaterials

    DEFF Research Database (Denmark)

    Liguori, Biase; Hansen, Steffen Foss; Baun, Anders

    for Nanomaterials”; “NanoSafer vs. 1.1 – A web-based precautionary risk assessment tool for manufactured nanomaterials using first order modeling” Based on the literature information we have analyzed these tools and discussed elements regarding: the domain of application and whether it accounts for the nanospecific...... opinions, and some concepts were purely theoretical. Therefore, immediate combination of the different models into a larger holistic framework is not possible. Further development of the frameworks, harmonization and validation is needed in future research....

  12. Occupational Exposure Assessment of Nanomaterials using Control Banding Tools

    DEFF Research Database (Denmark)

    Liguori, Biase

    Nanotechnology can be termed as the “new industrial revolution”. A broad range of potential benefits in various applications for the environment and everyday life of humans can be related to the use of nanotechnology. Nanomaterials are used in a large variety of products already in the market...... assessment to nanomaterials is still a promising route. A few years ago a new conceptual model for the assessment of inhalation exposure to nanomaterials was developed. As illustrated in this thesis, this new model includes considerations on nanoparticles behaviour and physical and chemical properties...... to pursue the development of an advanced CB tool for occupational exposure assessment to nanomaterials. Such as model could be a suitable strategic component for a first exposure assessment and may also improve the risk communication between stakeholders involved in risk assessment of nanomaterials...

  13. The Pooling-score (P-score): inter- and intra-rater reliability in endoscopic assessment of the severity of dysphagia.

    Science.gov (United States)

    Farneti, D; Fattori, B; Nacci, A; Mancini, V; Simonelli, M; Ruoppolo, G; Genovese, E

    2014-04-01

    This study evaluated the intra- and inter-rater reliability of the Pooling score (P-score) in clinical endoscopic evaluation of severity of swallowing disorder, considering excess residue in the pharynx and larynx. The score (minimum 4 - maximum 11) is obtained by the sum of the scores given to the site of the bolus, the amount and ability to control residue/bolus pooling, the latter assessed on the basis of cough, raclage, number of dry voluntary or reflex swallowing acts ( 5). Four judges evaluated 30 short films of pharyngeal transit of 10 solid (1/4 of a cracker), 11 creamy (1 tablespoon of jam) and 9 liquid (1 tablespoon of 5 cc of water coloured with methlyene blue, 1 ml in 100 ml) boluses in 23 subjects (10 M/13 F, age from 31 to 76 yrs, mean age 58.56±11.76 years) with different pathologies. The films were randomly distributed on two CDs, which differed in terms of the sequence of the films, and were given to judges (after an explanatory session) at time 0, 24 hours later (time 1) and after 7 days (time 2). The inter- and intra-rater reliability of the P-score was calculated using the intra-class correlation coefficient (ICC; 3,k). The possibility that consistency of boluses could affect the scoring of the films was considered. The ICC for site, amount, management and the P-score total was found to be, respectively, 0.999, 0.997, 1.00 and 0.999. Clinical evaluation of a criterion of severity of a swallowing disorder remains a crucial point in the management of patients with pathologies that predispose to complications. The P-score, derived from static and dynamic parameters, yielded a very high correlation among the scores attributed by the four judges during observations carried out at different times. Bolus consistencies did not affect the outcome of the test: the analysis of variance, performed to verify if the scores attributed by the four judges to the parameters selected, might be influenced by the different consistencies of the boluses, was not

  14. Patient simulation: a literary synthesis of assessment tools in anesthesiology.

    Science.gov (United States)

    Edler, Alice A; Fanning, Ruth G; Chen, Michael I; Claure, Rebecca; Almazan, Dondee; Struyk, Brain; Seiden, Samuel C

    2009-12-20

    High-fidelity patient simulation (HFPS) has been hypothesized as a modality for assessing competency of knowledge and skill in patient simulation, but uniform methods for HFPS performance assessment (PA) have not yet been completely achieved. Anesthesiology as a field founded the HFPS discipline and also leads in its PA. This project reviews the types, quality, and designated purpose of HFPS PA tools in anesthesiology. We used the systematic review method and systematically reviewed anesthesiology literature referenced in PubMed to assess the quality and reliability of available PA tools in HFPS. Of 412 articles identified, 50 met our inclusion criteria. Seventy seven percent of studies have been published since 2000; more recent studies demonstrated higher quality. Investigators reported a variety of test construction and validation methods. The most commonly reported test construction methods included "modified Delphi Techniques" for item selection, reliability measurement using inter-rater agreement, and intra-class correlations between test items or subtests. Modern test theory, in particular generalizability theory, was used in nine (18%) of studies. Test score validity has been addressed in multiple investigations and shown a significant improvement in reporting accuracy. However the assessment of predicative has been low across the majority of studies. Usability and practicality of testing occasions and tools was only anecdotally reported. To more completely comply with the gold standards for PA design, both shared experience of experts and recognition of test construction standards, including reliability and validity measurements, instrument piloting, rater training, and explicit identification of the purpose and proposed use of the assessment tool, are required.

  15. Comparison of occupational exposure assessment tools and concepts for nanomaterials

    DEFF Research Database (Denmark)

    Liguori, Biase; Hansen, Steffen Foss; Baun, Anders

    The development, production and application of engineered nanomaterials have been growing in different fields. This leads to a consequent increased potential of exposure to nanomaterials in the working environment. However to determine the potential exposure risk is a challenging task for risk...... assessors, due to limited availability of data on nanomaterial exposure level. To face this challenge a number of methods have been developed including the “Control Banding Nanotool”, the “Swiss precautionary matrix”; “Stoffenmanager Nano version 1.0; “ANSES - Development of a specific Control Banding Tool...... for Nanomaterials”; “NanoSafer vs. 1.1 – A web-based precautionary risk assessment tool for manufactured nanomaterials using first order modeling” Based on the literature information we have analyzed these tools and discussed elements regarding: the domain of application and whether it accounts for the nanospecific...

  16. Comparative analysis of deterministic and probabilistic fracture mechanical assessment tools

    Energy Technology Data Exchange (ETDEWEB)

    Heckmann, Klaus [Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS) gGmbH, Koeln (Germany); Saifi, Qais [VTT Technical Research Centre of Finland, Espoo (Finland)

    2016-11-15

    Uncertainties in material properties, manufacturing processes, loading conditions and damage mechanisms complicate the quantification of structural reliability. Probabilistic structure mechanical computing codes serve as tools for assessing leak- and break probabilities of nuclear piping components. Probabilistic fracture mechanical tools were compared in different benchmark activities, usually revealing minor, but systematic discrepancies between results of different codes. In this joint paper, probabilistic fracture mechanical codes are compared. Crack initiation, crack growth and the influence of in-service inspections are analyzed. Example cases for stress corrosion cracking and fatigue in LWR conditions are analyzed. The evolution of annual failure probabilities during simulated operation time is investigated, in order to identify the reasons for differences in the results of different codes. The comparison of the tools is used for further improvements of the codes applied by the partners.

  17. Survey of mental health nurses' attitudes towards risk assessment, risk assessment tools and positive risk.

    Science.gov (United States)

    Downes, C; Gill, A; Doyle, L; Morrissey, J; Higgins, A

    2016-04-01

    WHAT IS KNOWN ON THE SUBJECT?: Risk assessment and safety planning are a core aspect of the role of the mental health nurse. Conflicting views exist on the value of risk assessment tools. Few studies have examined mental health nurses' attitudes towards risk, including use of tools and the role of positive risk in recovery. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Mental health nurses view risk assessment as a core dimension of their role and not merely an exercise to fulfil organizational clinical safety and governance obligations. The majority of nurses hold positive attitudes towards therapeutic or positive risk, and consider creative risk taking as vital to people's recovery. The majority of nurses believe that risk assessment tools facilitate professional decision making, however, some are concerned that tools may negatively impact upon therapeutic relationships. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Ongoing education on the use of risk assessment tools is required to minimize views that their use is incompatible with therapeutic engagement, and to enable nurses to develop confidence to engage with positive risk and to allow service users make decisions and take responsibility. Introduction Risk assessment and safety planning are considered core components of the role of the mental health nurse; however, little is known about nurses' attitudes towards risk assessment, use of tools to assess risk or therapeutic risk taking. Aim This study aimed to explore mental health nurses' attitudes towards completing risk assessments, use of tools as an aid, and therapeutic or positive risk. Method An anonymous survey which included 13 attitudinal statements, rated on a five-point Likert scale, was completed by 381 mental health nurses working in adult services in Ireland. Findings Findings indicate strong support for the practice of risk assessment in mental health practice. The vast majority of nurses believe that risk assessment tools facilitate professional

  18. Identification of dysphagia using the Toronto Bedside Swallowing Screening Test (TOR-BSST©): are 10 teaspoons of water necessary?

    Science.gov (United States)

    Martino, Rosemary; Maki, Ellen; Diamant, Nicholas

    2014-06-01

    Dysphagia screening often includes administration of water. This study assessed the accuracy in identifying dysphagia with each additional teaspoon of water. The original research of the TOR-BSST(©) permitted this assessment. Trained nurses from acute and rehabilitation facilities prospectively administered the TOR-BSST(©) to 311 eligible stroke inpatients. A sensitivity analysis was conducted for the water item using 10 teaspoons plus a sip as the standard. The proportion of positive screenings was 59.2% in acute and 38.5% in rehabilitation. Of all four items that form the TOR-BSST(©), the water swallow item contributed to the identification of dysphagia in 42.7% in acute and 29.0% in rehabilitation patients. Across all patients, dysphagia accuracy was that five teaspoons resulted in a sensitivity of 79% (95% confidence interval [CI] = 70-86), eight a sensitivity of 92% (95% CI = 85-96) and 10 a sensitivity of 96% (95% CI = 90-99). Although a primary contributor, the water swallow item alone does not identify all patients with dysphagia. For a water swallow to accurately identify dysphagia, it is critical to administer 10 teaspoons. The TOR-BSST(©) water swallow item contributes largely to the total TOR-BSST(©)'s screening score and in making the test highly accurate and reliable.

  19. New graduates’ perceptions of preparedness to provide speech-language therapy services in general and dysphagia services in particular

    Directory of Open Access Journals (Sweden)

    Shajila Singh

    2015-02-01

    Full Text Available Background: Upon graduation, newly qualified speech-language therapists are expected to provide services independently. This study describes new graduates’ perceptions of their preparedness to provide services across the scope of the profession and explores associations between perceptions of dysphagia theory and clinical learning curricula with preparedness for adult and paediatric dysphagia service delivery.Methods: New graduates of six South African universities were recruited to participate in a survey by completing an electronic questionnaire exploring their perceptions of the dysphagia curricula and their preparedness to practise across the scope of the profession of speechlanguage therapy. Results: Eighty graduates participated in the study yielding a response rate of 63.49%. Participants perceived themselves to be well prepared in some areas (e.g. child language: 100%; articulation and phonology: 97.26%, but less prepared in other areas (e.g. adult dysphagia: 50.70%; paediatric dysarthria: 46.58%; paediatric dysphagia: 38.36% and most unprepared to provide services requiring sign language (23.61% and African languages (20.55%. There was a significant relationship between perceptions of adequate theory and clinical learning opportunities with assessment and management of dysphagia and perceptions of preparedness to provide dysphagia services. Conclusion: There is a need for review of existing curricula and consideration of developing a standard speech-language therapy curriculum across universities, particularly in service provision to a multilingual population, and in both the theory and clinical learning of the assessment and management of adult and paediatric dysphagia, to better equip graduates for practice.

  20. An equity tool for health impact assessments: Reflections from Mongolia

    Energy Technology Data Exchange (ETDEWEB)

    Snyder, Jeremy, E-mail: jeremycsnyder@sfu.ca [Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 (Canada); Wagler, Meghan, E-mail: meghanwagler@gmail.com [Department of Health, Enkhtaivan Street, Building 13b, Suukhbaatar District, First Khoroo, Ulaanbaatar (Mongolia); Lkhagvasuren, Oyun, E-mail: l_oyun2002@yahoo.com [Department of Health, Enkhtaivan Street, Building 13b, Suukhbaatar District, First Khoroo, Ulaanbaatar (Mongolia); Laing, Lory, E-mail: lory.laing@ualberta.ca [School of Public Health, University of Alberta, 3-50E University Terrace, Edmonton, AB, T6G 2T4 (Canada); Davison, Colleen, E-mail: cmdaviso@ucalgary.ca [Department of Community Health and Epidemiology, 2nd and 3rd Floors, Carruthers Hall, Queen& #x27; s University Kingston, ON, K7L 3N6 (Canada); Janes, Craig, E-mail: craigj@sfu.ca [Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 (Canada)

    2012-04-15

    A health impact assessment (HIA) is a tool for assessing the potential effects of a project or policy on a population's health. In this paper, we discuss a tool for successfully integrating equity concerns into HIAs. This discussion is the product of collaboration by Mongolian and Canadian experts, and it incorporates comments and suggestions of participants of a workshop on equity focused HIAs that took place in Mongolia in October, 2010. Our motivation for discussing this tool is based on the observation that existing HIAs tend either to fail to define equity or use problematic accounts of this concept. In this paper we give an overview of socio-demographic and health indicators in Mongolia and briefly discuss its mining industry. We then review three accounts of equity and argue for the importance of developing a consensus understanding of this concept when integrating considerations of equity into an HIA. Finally, we present findings from the workshop in Mongolia and outline a tool, derived from lessons from this workshop, for critically considering and integrating the concept of equity into an HIA.

  1. Multiple cervical levels: increased risk of dysphagia and dysphonia during anterior cervical discectomy.

    Science.gov (United States)

    Danto, Joseph; DiCapua, John; Nardi, Dominic; Pekmezaris, Renee; Moise, Gregory; Lesser, Martin; Dimarzio, Paola

    2012-10-01

    Anterior cervical discectomy (ACD) is widely used for symptomatic cervical spine pathologies. The most common complications associated with this type of surgery are dysphagia and dysphonia; however, the risk factors associated with them have not been adequately elucidated. The purpose of this study is to assess the incidence of self-reported dysphagia and dysphonia and the associated risk factors after ACD. This study used a retrospective chart review of 149 patients who underwent ACD at a tertiary care facility operating in the New York metropolitan area over a period of 2½ years. Charts for ACD patients were reviewed by 6 trained researchers. Incidence rates for self-reported dysphagia and dysphonia were calculated using 95% exact confidence intervals (CI). Risk factors such as age, sex, surgical hours, number of disc levels, airway class, American Society of Anesthesiologists class, fiberoptic intubation, and intubation difficulty were assessed using logistic regression. The incidence of self-reported dysphagia was 12.1% (95% exact CI, 7.3%-18.4%); for dysphonia the self-reported incidence was 5.4% (95% exact CI, 2.3%-10.3%). Patients who underwent surgery at ≥4 cervical levels had a significant 4-fold increased risk (odds ratio=4; 95% CI, 1.1-13.8) of developing dysphonia and/or dysphagia compared with patients who underwent surgery at a single surgical level. This study confirms previous findings that the risk of developing dysphagia and/or dysphonia increases with the number of surgical levels, with multiple cervical levels representing a significantly higher postoperative risk, as compared with surgery at 1 level.

  2. The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia: A randomized controlled study.

    Science.gov (United States)

    Umay, Ebru K; Yaylaci, Atilay; Saylam, Guleser; Gundogdu, Ibrahim; Gurcay, Eda; Akcapinar, Dehen; Kirac, Zeynep

    2017-01-01

    Dysphagia is a serious cause of morbidity and mortality in stroke patients. As the first study in literature, we aimed to evaluate the effects of sensory-level electrical stimulation (SES) to bilateral masseter muscles in early stroke patients with dysphagia. This study was conducted at the Physical Medicine and Rehabilitation Clinic of our hospital between 2013 and 2015. Ninety-eight patients with dysphagia within the first month after ischemic stroke were included in this study. Patients were evaluated by bedside screening tests (Bedside Dysphagia Score, Neurological Examination Dysphagia Score, Total Dysphagia Score, and Mann Assessment of Swallowing Ability test) and by flexible fibreoptic endoscopic evaluation of swallowing (FEES) methods. All patients were included in a traditional swallowing therapy. Patients were divided into two groups, namely the "stimulation group" and "sham group." SES was applied to bilateral masseter muscles. Evaluation parameters were compared between the groups before and after therapy. The Friedman test, Wilcoxon Signed Rank test, Mann-Whitney U test, and Fisher exact test were used in this study. There was a significant improvement in dysphagia severity scores evaluated by bedside screening tests and FEES in cognitive and total functionality levels except in motor functional independence level in the stimulation group. In the sham group, there were no significant changes in the evaluation parameters. SES applied to bilateral masseter muscles may provide an effective treatment for both dysphagia and cognitive function in early stroke patients.

  3. Frameworks and tools for risk assessment of manufactured nanomaterials.

    Science.gov (United States)

    Hristozov, Danail; Gottardo, Stefania; Semenzin, Elena; Oomen, Agnes; Bos, Peter; Peijnenburg, Willie; van Tongeren, Martie; Nowack, Bernd; Hunt, Neil; Brunelli, Andrea; Scott-Fordsmand, Janeck J; Tran, Lang; Marcomini, Antonio

    2016-10-01

    Commercialization of nanotechnologies entails a regulatory requirement for understanding their environmental, health and safety (EHS) risks. Today we face challenges to assess these risks, which emerge from uncertainties around the interactions of manufactured nanomaterials (MNs) with humans and the environment. In order to reduce these uncertainties, it is necessary to generate sound scientific data on hazard and exposure by means of relevant frameworks and tools. The development of such approaches to facilitate the risk assessment (RA) of MNs has become a dynamic area of research. The aim of this paper was to review and critically analyse these approaches against a set of relevant criteria. The analysis concluded that none of the reviewed frameworks were able to fulfill all evaluation criteria. Many of the existing modelling tools are designed to provide screening-level assessments rather than to support regulatory RA and risk management. Nevertheless, there is a tendency towards developing more quantitative, higher-tier models, capable of incorporating uncertainty into their analyses. There is also a trend towards developing validated experimental protocols for material identification and hazard testing, reproducible across laboratories. These tools could enable a shift from a costly case-by-case RA of MNs towards a targeted, flexible and efficient process, based on grouping and read-across strategies and compliant with the 3R (Replacement, Reduction, Refinement) principles. In order to facilitate this process, it is important to transform the current efforts on developing databases and computational models into creating an integrated data and tools infrastructure to support the risk assessment and management of MNs.

  4. Clinical assessment tools identify functional deficits in fragility fracture patients

    Directory of Open Access Journals (Sweden)

    Ames TD

    2016-05-01

    Full Text Available Tyler D Ames,1 Corinne E Wee,1 Khoi M Le,1 Tiffany L Wang,1 Julie Y Bishop,2 Laura S Phieffer,2 Carmen E Quatman2 1The Ohio State University College of Medicine, 2Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA Purpose: To identify inexpensive, noninvasive, portable, clinical assessment tools that can be used to assess functional performance measures that may put older patients at risk for falls such as balance, handgrip strength, and lumbopelvic control.Patients and methods: Twenty fragility fracture patients and 21 healthy control subjects were evaluated using clinical assessment tools (Nintendo Wii Balance Board [WBB], a handheld dynamometer, and an application for the Apple iPod Touch, the Level Belt that measure functional performance during activity of daily living tasks. The main outcome measurements were balance (WBB, handgrip strength (handheld dynamometer, and lumbopelvic control (iPod Touch Level Belt, which were compared between fragility fracture patients and healthy controls.Results: Fragility fracture patients had lower scores on the vertical component of the WBB Torso Twist task (P=0.042 and greater medial–lateral lumbopelvic sway during a 40 m walk (P=0.026 when compared to healthy controls. Unexpectedly, the fracture patients had significantly higher scores on the left leg (P=0.020 and total components (P=0.010 of the WBB Single Leg Stand task as well as less faults during the left Single Leg Stand task (P=0.003.Conclusion: The clinical assessment tools utilized in this study are relatively inexpensive and portable tools of performance measures capable of detecting differences in postural sway between fragility fracture patients and controls. Keywords: fall risk, geriatric fracture, Nintendo Wii Balance Board, Level Belt, fragility fracture

  5. Developing and implementing an oral care policy and assessment tool.

    LENUS (Irish Health Repository)

    Stout, Michelle

    2012-01-09

    Oral hygiene is an essential aspect of nursing care. Poor oral care results in patients experiencing pain and discomfort, puts individuals at risk of nutritional deficiency and infection, and has an adverse effect on quality of life. This article describes how an oral care policy and assessment tool were updated to ensure the implementation of evidence-based practice at one hospital in the Republic of Ireland.

  6. System Maturity and Architecture Assessment Methods, Processes, and Tools

    Science.gov (United States)

    2012-03-02

    1 For a detailed description of the SRL methodology see Sauser, B., J.E. Ramirez- Marquez , D. Nowicki, A...and Ramirez- Marquez 2009; Magnaye, Sauser et al. 2010). Although there are guidelines and tools to support the assessment process (Nolte, Kennedy...employ these metrics (Tan, Sauser et al. 2011). Graettinger, et al. (Graettinger, Garcia et al. 2002) reports that approaches for readiness level

  7. Ultrasound Vascular Elastography as a Tool for Assessing Atherosclerotic Plaques

    DEFF Research Database (Denmark)

    Mahmood, Badar; Ewertsen, C; Carlsen, Jørn

    2016-01-01

    to distinguish between vulnerable and stable plaques. The aim of this paper is to provide an overview of the literature on vascular elastography. A systematic search of the available literature for studies using elastography for assessing atherosclerotic plaques was conducted using the MEDLINE, Embase, Cochrane...... compared to B-mode ultrasound alone. Most studies reported higher strain values for vulnerable plaques. Ultrasound elastography has potential as a clinical tool in the assessment of atherosclerotic plaques. Elastography is able to distinguish between different plaque types, but there is considerable...

  8. Reliability of tactile tools for pain assessment in blind athletes.

    Science.gov (United States)

    Leite, Ana Claudia de Souza; Pagliuca, Lorita M Freitag; Almeida, Paulo Cesar P; Dallaire, Clemence C

    2008-06-01

    Health professionals have numerous visual and reporting scales at their disposal to assess pain. In recent years new tactile tools have been created (Pain Texture Scale and Tactile Pain Scale). This study validates these scales compared with the Numerical Rating Scale in 36 blind athletes who were assessed before and after competitions in the World Paralympics Games organized by the International Blind Sports Federation (IBSA) in Quebec, Canada. The reliability of these scales was analyzed through the intraclass correlation coefficient. Results showed good reliability for the Tactile Pain Scale and satisfactory reliability for the Pain Texture Scale.

  9. Assessment tool for pharmacy drug-drug interaction software.

    Science.gov (United States)

    Warholak, Terri L; Hines, Lisa E; Saverno, Kim R; Grizzle, Amy J; Malone, Daniel C

    2011-01-01

    To assess the performance of pharmacy clinical decision support (CDS) systems for drug-drug interaction (DDI) detection and to identify approaches for improving the ability to recognize important DDIs. Pharmacists rely on CDS systems to assist in the identification of DDIs, and research suggests that these systems perform suboptimally. The software evaluation tool described here may be used in all pharmacy settings that use electronic decision support to detect potential DDIs, including large and small community chain pharmacies, community independent pharmacies, hospital pharmacies, and governmental facility pharmacies. A tool is provided to determine the ability of pharmacy CDS systems to identify established DDIs. It can be adapted to evaluate potential DDIs that reflect local practice patterns and patient safety priorities. Beyond assessing software performance, going through the evaluation processes creates the opportunity to evaluate inadequacies in policies, procedures, workflow, and training of all pharmacy staff relating to pharmacy information systems and DDIs. The DDI evaluation tool can be used to assess pharmacy information systems' ability to recognize relevant DDIs. Suggestions for improvement include determining whether the software allows for customization, creating standard policies for handling specific interactions, and ensuring that drug knowledge database updates occur frequently.

  10. Development and Validation of the Tibetan Primary Care Assessment Tool

    Directory of Open Access Journals (Sweden)

    Wenhua Wang

    2014-01-01

    Full Text Available Objective. To develop a primary care assessment tool in Tibetan area and assess the primary care quality among different healthcare settings. Methods. Primary care assessment tool-Tibetan version (PCAT-T was developed to measure seven primary care domains. Data from a cross-sectional survey of 1386 patients was used to conduct validity and reliability analysis of PCAT-T. Analysis of variance was used to conduct comparison of primary care quality among different healthcare settings. Results. A 28-item PCAT-T was constructed which included seven multi-item scales and two single-item scales. All of multi-item scales achieved good internal consistency and item-total correlations. Scaling assumptions tests were well satisfied. The full range of possible scores was observed for all scales, except first contact and continuity. Compared with prefecture hospital (77.42 and county hospital (82.01, township health center achieved highest primary care quality total score (86.64. Conclusions. PCAT-T is a valid and reliable tool to measure patients' experience of primary care in the Tibet Autonomous Region. Township health center has the best primary care performance compared with other healthcare settings, and township health center should play a key role in providing primary care in Tibet.

  11. Assessment of in-hand manipulation: Tool development

    Directory of Open Access Journals (Sweden)

    Kavitha Raja

    2016-01-01

    Full Text Available Objective: The aim of this study is to develop an assessment tool for in-hand manipulation skills (IHMS and establish its psychometric properties. Design: Items are pooled based on literature and expert opinion. Content validation was performed by ten rehabilitation professionals. The test was administered to 123 typically developing, and 15 children with hand dysfunction-cerebral palsy (3, developmental coordination disorder (5, and Down syndrome (7. The latter group was given intervention, specific to upper extremity for 15 days, and test was readministered. Rasch analysis for rating scale structure, fit statistics, and dimension analysis was done. Results: Content validation was analyzed qualitatively. Suggestions were incorporated which consisted of instructions for scoring and test administration. The four-level ordinal rating scale was appropriate according to Rasch analysis. Of fifty items, three misfit items from translation subscale were removed based on fit statistics and clinical decision. The final test has 47 items. The tool had excellent inter-tester reliability and test stability and was responsive to change. Conclusion: Assessment of in-hand manipulation is a robust tool for clinical use in assessment IHMS.

  12. Dangerous chemical substances – Tools supporting occupational risk assessment

    Directory of Open Access Journals (Sweden)

    Elżbieta Dobrzyńska

    2014-10-01

    Full Text Available The assessment of risk associated with exposure to chemicals in the work environment is a task that still poses a lot of difficulties for the employers. At the same time the probability of adverse health effects faced by an employee as a result of such risks, and the related employer’s material losses should motivate employers to seek effective solutions aimed at assessing the risks and controling them to an acceptable level by the application of appropriate preventive measures. The paper presents examples of tools to assist the employer in the risk assessment associated with the presence of chemical agents in the workplace. Examples of guides, manuals, checklists and various interactive tools, developed in Poland and other European Union (EU countries, as well as in countries outside the EU and international organizations are described. These tools have been developed to meet the current requirements of the law and allow a rough estimation of chemical risk and based on these estimates take further steps to improve working conditions and safety. Med Pr 2014;65(5:683–692

  13. Clinical reasoning in nursing: teaching strategies and assessment tools.

    Science.gov (United States)

    Carvalho, Emília Campos de; Oliveira-Kumakura, Ana Railka de Souza; Morais, Sheila Coelho Ramalho Vasconcelos

    2017-01-01

    To present the concept and development of teaching strategies and the assessment tools regarding clinical reasoning for accurate practice. This is a theoretical reflection based on scientific studies. Comprehension of the essential concepts of the thought process and its articulation with the different teaching strategies and the assessment tools which has allowed presenting ways to improve the process of diagnostic or therapeutic clinical reasoning. The use of new strategies and assessment tools should be encouraged in order to contribute to the development of skills that lead to safe and effective decision making. Apresentar o conceito de raciocínio clínico, seu desenvolvimento, as estratégias para seu ensino e os instrumentos de avaliação para uma prática acurada. Trata-se de uma reflexão teórica fundamentada em estudos científicos. A compreensão dos conceitos essenciais do processo de pensamento e sua articulação com as diferentes estratégias de ensino e com os instrumentos de avaliação permitiram exemplificar meios de aprimorar o processo de raciocínio clínico diagnóstico ou terapêutico. A utilização de novas estratégias e instrumentos de avaliação deve ser estimulado para contribuir com o desenvolvimento das habilidades que culminam na tomada de decisão segura e eficaz.

  14. Ultrasound in dysphagia rehabilitation: a novel approach following partial glossectomy.

    Science.gov (United States)

    Blyth, Katrina M; McCabe, Patricia; Madill, Catherine; Ballard, Kirrie J

    2017-10-01

    While the presence of dysphagia following partial glossectomy has been widely reported, there is insufficient quality evidence to guide clinical decision making about the treatment of this disorder. This study investigated a novel dysphagia rehabilitation approach using ultrasound tongue imaging for patient training. Initially, a pilot study was conducted to investigate the feasibility of ultrasound visual feedback during swallow tasks. The protocol was then replicated using a single-case experimental designed study to investigate therapeutic effect. Swallow, speech, and oromotor functions were measured across multiple baselines using an A-B-A intervention study design. During intervention, both participants were able to interpret ultrasound tongue images during swallow tasks. Following intervention, positive therapeutic effect was achieved with reduced frequency of aspiration and self-initiated swallow strategies. Generalization of intervention was evidenced by reduced bolus transit duration on videofluoroscopy and improved functional oral intake scores. Speech and oromotor functions remained stable throughout the study demonstrating experimental control. This study establishes that ultrasound visual feedback is feasible in dysphagia rehabilitation following partial glossectomy. In addition, the predicted therapeutic effect specifically to swallow but not speech or oromotor functions were demonstrated. Implications for Rehabilitation Partial glossectomy results in altered tongue shape, movement, and function which negatively impact on speech and swallowing There is limited research evidence to support previously used speech pathology interventions (in particular, tongue range of movement exercises) to rehabilitate dysphagia following tongue cancer surgery The tongue, and hence oral phase of swallowing, can be viewed by placing an ultrasound probe under the chin Ultrasound scanning of the tongue is not invasive, can be repeated without dosage side effect. It's also

  15. Wiki as a tool for microbiology teaching, learning and assessment.

    Science.gov (United States)

    Sampaio-Maia, B; Maia, J S; Leitão, S; Amaral, M; Vieira-Marques, P

    2014-05-01

    Evidence suggests that cooperative learning and peer-assessment fosters students' ability to work with others and may lead to better cognitive outcomes and higher achievement. This work aimed to assess the use of an online collaborative tool for the teaching/learning and assessment of Microbiology. A total of 144 students were grouped and assigned to create wiki entries as well as to peer review wikis created by colleagues (peer-assessment process) using the Wiki module from Moodle Virtual Learning Environment (MVLE). MVLE actions log was used for tracking students' activity. The number of student's actions within wiki did not present a strong correlation with wiki scores, so it should not be used as a heavy evaluation parameter. The amount of work developed between members of the same group differed significantly, suggesting that final scores should be attributed individually. When peer-assessment process was implemented, the number of editing actions increased, suggesting that the peer-assessment strategy encourages the development of a better work. The vast majority of students execute the work in the last 10% of the period assigned for task development, which can be counter-productive for a truly collaborative work. Wiki revealed to be a useful tool for Microbiology teaching/learning and assessment, promoting collaborative work, promoting virtual mobility and facilitating the real-time monitoring of the students' work. This pedagogical project promoted also the involvement of students in their assessment process, encouraging their critical sense and quest for Excellency. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Palliation of Dysphagia from Esophageal Cancer

    NARCIS (Netherlands)

    M.Y.V. Homs (Marjolein)

    2004-01-01

    textabstractThe prognosis of esophageal cancer is poor with a 5-year survival of 10-15%. In addition, over 50% of patients with esophageal cancer already have an inoperable disease at presentation. The majority of these patients require palliative treatment to relieve progressive dysphagia. Metal

  17. The Neurobiology of Swallowing and Dysphagia

    Science.gov (United States)

    Miller, Arthur J.

    2008-01-01

    The neurobiological study of swallowing and its dysfunction, defined as dysphagia, has evolved over two centuries beginning with electrical stimulation applied directly to the central nervous system, and then followed by systematic investigations that have used lesioning, transmagnetic stimulation, magnetoencephalography, and functional magnetic…

  18. The Neurobiology of Swallowing and Dysphagia

    Science.gov (United States)

    Miller, Arthur J.

    2008-01-01

    The neurobiological study of swallowing and its dysfunction, defined as dysphagia, has evolved over two centuries beginning with electrical stimulation applied directly to the central nervous system, and then followed by systematic investigations that have used lesioning, transmagnetic stimulation, magnetoencephalography, and functional magnetic…

  19. The Utility of Pitch Elevation in the Evaluation of Oropharyngeal Dysphagia: Preliminary Findings

    Science.gov (United States)

    Malandraki, Georgia A.; Hind, Jacqueline A.; Gangnon, Ronald; Logemann, Jeri A.; Robbins, JoAnne

    2011-01-01

    Purpose: To evaluate the utility of a pitch elevation task in the assessment of oropharyngeal dysphagia. Method: This study was a pilot prospective cohort study including 40 consecutive patients (16 male and 24 female) who were referred by their physician for a swallowing evaluation. Patients were evaluated with a noninstrumental clinical…

  20. Software Tools to Support the Assessment of System Health

    Science.gov (United States)

    Melcher, Kevin J.

    2013-01-01

    This presentation provides an overview of three software tools that were developed by the NASA Glenn Research Center to support the assessment of system health: the Propulsion Diagnostic Method Evaluation Strategy (ProDIMES), the Systematic Sensor Selection Strategy (S4), and the Extended Testability Analysis (ETA) tool. Originally developed to support specific NASA projects in aeronautics and space, these software tools are currently available to U.S. citizens through the NASA Glenn Software Catalog. The ProDiMES software tool was developed to support a uniform comparison of propulsion gas path diagnostic methods. Methods published in the open literature are typically applied to dissimilar platforms with different levels of complexity. They often address different diagnostic problems and use inconsistent metrics for evaluating performance. As a result, it is difficult to perform a one ]to ]one comparison of the various diagnostic methods. ProDIMES solves this problem by serving as a theme problem to aid in propulsion gas path diagnostic technology development and evaluation. The overall goal is to provide a tool that will serve as an industry standard, and will truly facilitate the development and evaluation of significant Engine Health Management (EHM) capabilities. ProDiMES has been developed under a collaborative project of The Technical Cooperation Program (TTCP) based on feedback provided by individuals within the aircraft engine health management community. The S4 software tool provides a framework that supports the optimal selection of sensors for health management assessments. S4 is structured to accommodate user ]defined applications, diagnostic systems, search techniques, and system requirements/constraints. One or more sensor suites that maximize this performance while meeting other user ]defined system requirements that are presumed to exist. S4 provides a systematic approach for evaluating combinations of sensors to determine the set or sets of

  1. Reduction of inequalities in health: assessing evidence-based tools

    Directory of Open Access Journals (Sweden)

    Shea Beverley

    2006-09-01

    Full Text Available Abstract Background The reduction of health inequalities is a focus of many national and international health organisations. The need for pragmatic evidence-based approaches has led to the development of a number of evidence-based equity initiatives. This paper describes a new program that focuses upon evidence- based tools, which are useful for policy initiatives that reduce inequities. Methods This paper is based on a presentation that was given at the "Regional Consultation on Policy Tools: Equity in Population Health Reports," held in Toronto, Canada in June 2002. Results Five assessment tools were presented. 1. A database of systematic reviews on the effects of educational, legal, social, and health interventions to reduce unfair inequalities is being established through the Cochrane and Campbell Collaborations. 2 Decision aids and shared decision making can be facilitated in disadvantaged groups by 'health coaches' to help people become better decision makers, negotiators, and navigators of the health system; a pilot study in Chile has provided proof of this concept. 3. The CIET Cycle: Combining adapted cluster survey techniques with qualitative methods, CIET's population based applications support evidence-based decision making at local and national levels. The CIET map generates maps directly from survey or routine institutional data, to be used as evidence-based decisions aids. Complex data can be displayed attractively, providing an important tool for studying and comparing health indicators among and between different populations. 4. The Ottawa Equity Gauge is applying the Global Equity Gauge Alliance framework to an industrialised country setting. 5 The Needs-Based Health Assessment Toolkit, established to assemble information on which clinical and health policy decisions can be based, is being expanded to ensure a focus on distribution and average health indicators. Conclusion Evidence-based planning tools have much to offer the

  2. Hospital preparedness and response in CBRN emergencies: TIER assessment tool.

    Science.gov (United States)

    Olivieri, Carlo; Ingrassia, Pier L; Della Corte, Francesco; Carenzo, Luca; Sapori, Jean-Marc; Gabilly, Laurent; Segond, Fredrique; Grieger, Fiene; Arnod-Prin, Philippe; Larrucea, Xabier; Violi, Chrisitan; Lopez, Cédric; Djalali, Ahmadreza

    2017-10-01

    Chemical, biological, radiological, and nuclear (CBRN) emergencies need particular hospital preparedness and resources availability. Also, specific skills and capabilities are required for efficient response to these types of events. The aim of this study was to develop an assessment tool to evaluate hospital preparedness and response performance with respect to CBRN emergencies. An evaluation tool was developed using the Delphi technique. A panel of experts from 10 countries, both European and non-European, with more than 5 years of experience in research or practice in CBRN emergency management was involved in this study. The study was run online, and the experts were asked to evaluate a list of items on hospital preparedness and response in CBRN emergencies. A threshold of 85% agreement level was defined as the consensus of experts in this study. The first-round questionnaire was answered by 13 experts. Consensus on the preparedness section was reached for all 29 items during the first round and one item was also added by the experts. Consensus on the response performance indicators were reached in 51 out of the 59 items, during the first round, and eight items were modified and then approved in the second round by the experts. Hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. The assessment tool, developed through experts' consensus in this study, provides a standardized method for the evaluation of hospital preparedness and response performance with respect to CBRN emergencies. The feasibility and reliability of this assessment tool could be evaluated before and during simulated exercises in a standardized manner.

  3. Assessing Comprehension During Reading with the Reading Strategy Assessment Tool (RSAT)

    OpenAIRE

    Magliano, Joseph P.; Millis, Keith K.; Levinstein, Irwin

    2011-01-01

    Comprehension emerges as the results of inference and strategic processes that support the construction of a coherent mental model for a text. However, the vast majority of comprehension skills tests adopt a format that does not afford an assessment of these processes as they operate during reading. This study assessed the viability of the Reading Strategy Assessment Tool (RSAT), which is an automated computer-based reading assessment designed to measure readers’ comprehension and spontaneous...

  4. Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly.

    Science.gov (United States)

    Maeda, Keisuke; Akagi, Junji

    2015-02-01

    The aim of this study was to clarify the association between tongue pressure and factors related to sarcopenia such as aging, activities of daily living, nutritional state, and dysphagia. One-hundred-and-four patients without a history of treatment of stroke and without a diagnosis of neurodegenerative disease (36 men and 68 women), with a mean age of 84.1 ± 5.6 years, hospitalized from May 2013 to June 2013 were included in this study. Maximum voluntary tongue pressure against the palate (MTP) was measured by a device consisting of a disposable oral balloon probe. Nutritional and anthropometric parameters such as serum albumin concentration, Mini-Nutritional Assessment short form (MNA-SF), body mass index, arm muscle area (AMA), and others and presence of sarcopenia and dysphagia were analyzed to evaluate their relationships. Correlation analysis and univariate or multivariate analysis were performed. Simple correlation analysis showed that MTP correlated with Barthel index (BI), MNA-SF, serum albumin concentration, body mass index, and AMA. Univariate and multivariate analysis showed that sarcopenia, BI, MNA-SF, and age were the independent explanatory factors for decreased MTP, and the propensity score for dysphagia, including causes of primary or secondary sarcopenia, and the presence of sarcopenia were significantly associated with the presence of dysphagia. Decreased MTP and dysphagia were related to sarcopenia or the causes of sarcopenia in the studied population. Furthermore, the clinical condition of sarcopenic dysphagia may be partially interpreted as the presence of sarcopenia and causal factors for sarcopenia.

  5. Effects of Bilateral Repetitive Transcranial Magnetic Stimulation on Post-Stroke Dysphagia.

    Science.gov (United States)

    Park, Eunhee; Kim, Min Su; Chang, Won Hyuk; Oh, Su Mi; Kim, Yun Kwan; Lee, Ahee; Kim, Yun-Hee

    Optimal protocol of repetitive transcranial magnetic stimulation (rTMS) on post-stroke dysphagia remains uncertain with regard to its clinical efficacy. The aim of the present study is to investigate the effects of high-frequency rTMS at the bilateral motor cortices over the cortical representation of the mylohyoid muscles in the patients with post-stroke dysphagia. This study was a single-blind, randomized controlled study with a blinded observer. Thirty-five stroke patients were randomly divided into three intervention groups: the bilateral stimulation group, the unilateral stimulation group, and the sham stimulation group. For the bilateral stimulation group, 500 pulses of 10 Hz rTMS over the ipsilesional and 500 pulses of 10 Hz rTMS over the contralesional motor cortices over the cortical areas that project to the mylohyoid muscles were administered daily for 2 consecutive weeks. For the unilateral stimulation group, 500 pulses of 10 Hz rTMS over the ipsilesional motor cortex over the cortical representation of the mylohyoid muscle and the same amount of sham rTMS over the contralesional hemisphere were applied. For the sham stimulation group, sham rTMS was applied at the bilateral motor cortices. Clinical swallowing function and videofluoroscopic swallowing studies were assessed before the intervention (T0), immediately after the intervention (T1) and 3 weeks after the intervention (T2) using Clinical Dysphagia Scale (CDS), Dysphagia Outcome and Severity Scale (DOSS), Penetration Aspiration Scale (PAS), and Videofluoroscopic Dysphagia Scale (VDS). There were significant time and intervention interaction effects in the CDS, DOSS, PAS, and VDS scores (p dysphagia therapies. Copyright © 2016. Published by Elsevier Inc.

  6. Developing a tool for assessing public health law in countries.

    Science.gov (United States)

    Kim, So Yoon; Lee, Yuri; Sohn, Myongsei; Hahm, Ki-Hyun

    2012-09-01

    At present, the World Health Organization (WHO) is in the process of developing a tool designed to assess the status of public health legislation in a given country. An Expert Consultation on Public Health Law was convened in Manila, Philippines, in May 2011. The participants agreed that the tool could serve as a guide for a regional approach to assist Member States in assessing the scope, completeness, and adequacy of their public health law. Given the broad definition of "public health" and the laws that affect health, directly or indirectly, the participants further agreed to narrow the field to 4 areas based on significant WHO works/policies, each organized into an independent module: (1) International Digest on Health Law, (2) Primary Health Care, (3) International Health Regulations 2005, and (4) Framework Convention on Tobacco Control. The tool would be drafted in a questionnaire format that asks the respondent to determine whether primary and/or subsidiary legislation exists in the country on a specific topic and, if so, to cite the relevant law, describe the pertinent points, and attach and/or link to the full text where available. The participants agreed that the respondents should include government officials and/or academics with legal competency. Version 1 of the tool was piloted in the Philippines, the Republic of Korea, Samoa, and Vanuatu. At a 2nd Expert Consultation on Public Health Law, convened in Incheon, Republic of Korea, in October 2011, in conjunction with the 43rd Conference of the Asia-Pacific Academic Consortium on Public Health, the participants determined that the tool was generally usable, certain concerns notwithstanding, such as the risk of standardizing compliance with WHO policies. The agreed next step is to finalize the analysis tool by August 2012, marking the end of stage I in the development process. Stage II will consist of team building and networking of responsible officers and/or professionals in the countries. The tool

  7. Validation of a quantitative phosphorus loss assessment tool.

    Science.gov (United States)

    White, Michael J; Storm, Daniel E; Smolen, Michael D; Busteed, Philip R; Zhang, Hailin; Fox, Garey A

    2014-01-01

    Pasture Phosphorus Management Plus (PPM Plus) is a tool that allows nutrient management and conservation planners to evaluate phosphorus (P) loss from agricultural fields. This tool uses a modified version of the widely used Soil and Water Assessment Tool model with a vastly simplified interface. The development of PPM Plus has been fully described in previous publications; in this article we evaluate the accuracy of PPM Plus using 286 field-years of runoff, sediment, and P validation data from runoff studies at various locations in Oklahoma, Texas, Arkansas, and Georgia. Land uses include pasture, small grains, and row crops with rainfall ranging from 630 to 1390 mm yr, with and without animal manure application. PPM Plus explained 68% of the variability in total P loss, 56% of runoff, and 73% of the variability of sediment yield. An empirical model developed from these data using soil test P, total applied P, slope, and precipitation only accounted for 15% of the variability in total P loss, which implies that a process-based model is required to account for the diversity present in these data. PPM Plus is an easy-to-use conservation planning tool for P loss prediction, which, with modification, could be applicable at the regional and national scales. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  8. ANSYS Creep-Fatigue Assessment tool for EUROFER97 components

    Directory of Open Access Journals (Sweden)

    M. Mahler

    2016-12-01

    Full Text Available The damage caused by creep-fatigue is an important factor for materials at high temperatures. For in-vessel components of fusion reactors the material EUROFER97 is a candidate for structural application where it is subjected to irradiation and cyclic thermo-mechanical loads. To be able to evaluate fusion reactor components reliably, creep-fatigue damage has to be taken into account. In the frame of Engineering Data and Design Integration (EDDI in EUROfusion Technology Work Programme rapid and easy design evaluation is very important to predict the critical regions under typical fusion reactor loading conditions. The presented Creep-Fatigue Assessment (CFA tool is based on the creep-fatigue rules in ASME Boiler Pressure Vessel Code (BPVC Section 3 Division 1 Subsection NH which was adapted to the material EUROFER97 and developed for ANSYS. The CFA tool uses the local stress, maximum elastic strain range and temperature from the elastic analysis of the component performed with ANSYS. For the assessment design fatigue and stress to rupture curves of EUROFER97 as well as isochronous stress vs. strain curves determined by a constitutive model considering irradiation influence are used to deal with creep-fatigue damage. As a result allowable number of cycles based on creep-fatigue damage interaction under given hold times and irradiation rates is obtained. This tool can be coupled with ANSYS MAPDL and ANSYS Workbench utilizing MAPDL script files.

  9. Systematic Sustainability Assessment (SSA) Tool for Hydroelectric Project in Malaysia

    Science.gov (United States)

    Turan, Faiz Mohd; Johan, Kartina

    2017-08-01

    Sustainably developed and managed hydropower has enormous potential to contribute to global sustainability goals. It is known that hydroelectricity contributing small amounts to greenhouse gas emissions and other atmospheric pollutants. However, developing the remaining hydroelectric potential offers many challenges, and public pressure and expectations on the environmental and social performance of hydroelectric tend to increase over time. This paper aims to develop Systematic Sustainability Assessment (SSA) Tool that promotes and guides more sustainable hydroelectric projects in the context of Malaysia. The proposed SSA tool which not only provide a quality and quantitative report of sustainability performance but also act as Self-Assessment Report (SAR) to provide roadmap to achieve greater level of sustainability in project management for continuous improvement. It is expected to provide a common language that allow government, civil society, financial institutions and the hydroelectric sector to talk about and evaluate sustainability issues. The advantage of SSA tool is it can be used at any stage of hydroelectric development, from the earliest planning stages right through to operation.

  10. Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza

    Energy Technology Data Exchange (ETDEWEB)

    ORAU' s Oak Ridge Institute for Science Education (HCTT-CHE)

    2011-04-14

    The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster - readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that - help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. This tool has been reviewed by a variety of key subject matter experts from federal, state, and local agencies and organizations. It also has been piloted with various communities that consist of different population sizes, to include large urban to small rural communities.

  11. Surface electromyography as a screening method for evaluation of dysphagia and odynophagia.

    Science.gov (United States)

    Vaiman, Michael; Eviatar, Ephraim

    2009-02-20

    Patients suspected of having swallowing disorders, could highly benefit from simple diagnostic screening before being referred to specialist evaluations. The article analyzes various instrumental methods of dysphagia assessment, introduces surface electromyography (sEMG) to carry out rapid assessment of such patients, and debates proposed suggestions for sEMG screening protocol in order to identify abnormal deglutition. Subject related books and articles from 1813 to 2007 were obtained through library search, MEDLINE (1949-2007) and EMBASE (1975-2007). Specifics steps for establishing the protocol for applying the technique for screening purposes (e.g., evaluation of specific muscles), the requirements for diagnostic sEMG equipment, the sEMG technique itself, and defining the tests suitable for assessing deglutition (e.g., saliva, normal, and excessive swallows and uninterrupted drinking of water) are presented in detail. SEMG is compared with other techniques in terms of cost, timing, involvement of radiation, etc. According to the published data, SEMG of swallowing is a simple and reliable method for screening and preliminary differentiation among dysphagia and odynophagia of various origins. This noninvasive radiation-free examination has a low level of discomfort, and is simple, time-saving and inexpensive to perform. The major weakness of the method seems to be inability for precise diagnostic of neurologically induced dysphagia. With standardization of the technique and an established normative database, sEMG might serve as a reliable screening method for optimal patient management but cannot serve for proper investigation of neurogenic dysphagia.

  12. Development and testing of the codependency assessment tool.

    Science.gov (United States)

    Hughes-Hammer, C; Martsolf, D S; Zeller, R A

    1998-10-01

    Codependency constitutes a significant health risk, particularly for women, because codependent women are often involved in abusive and potentially harmful relationships. Individuals who are identified as codependent can engage in therapy and gain knowledge and freedom from such relationships. However, there is no reliable and valid measure of codependency that is consistently used to identify these individuals. This article describes the development and testing of the Codependency Assessment Tool, a multivariate tool that conceptualizes codependency as a construct comprising five factors: (1) Other Focus/Self-Neglect, (2) Low Self-Worth, (3) Hiding Self, (4) Medical Problems, and (5) Family of Origin Issues. The instrument has excellent reliability and validity. Its test-retest reliabilities = .78 to .94; Cronbach's alpha = .78 to .91. Criterion validity was determined to be established by using known groups; construct validity was established by comparing the codependency dimensions with depression.

  13. Computer Aided Safety Assessment(CASA) Tool for ISS Payloads

    Science.gov (United States)

    Hochstein, Jason; Festa, Fabrizio

    2010-09-01

    In an effort to streamline the processes established by the partners of the International Space Station(ISS) to certify the safety of hardware and experiments destined for the Station, the European Space Agency’s(ESA) ISS System Safety Team is developing the Computer Aided Safety Assessment(CASA) tool suite. These software tools guide payload developers through the creation process of two types of standard payload hazard reports via a series of questions following a predetermined logic. The responses provided by the user are used by the CASA system to complete the majority of each hazard report requisite for payload flight safety reviews, employing consistent, approved descriptions of most hazards, hazard causes, controls and verification methods. Though some manual inputs will still be required to complete these reports, working with CASA will considerably reduce the amount of time necessary to review the documentation by agency safety authorities.

  14. Benefits Assessment for Tactical Runway Configuration Management Tool

    Science.gov (United States)

    Oseguera-Lohr, Rosa; Phojanamongkolkij, Nipa; Lohr, Gary; Fenbert, James W.

    2013-01-01

    The Tactical Runway Configuration Management (TRCM) software tool was developed to provide air traffic flow managers and supervisors with recommendations for airport configuration changes and runway usage. The objective for this study is to conduct a benefits assessment at Memphis (MEM), Dallas Fort-Worth (DFW) and New York's John F. Kennedy (JFK) airports using the TRCM tool. Results from simulations using the TRCM-generated runway configuration schedule are compared with results using historical schedules. For the 12 days of data used in this analysis, the transit time (arrival fix to spot on airport movement area for arrivals, or spot to departure fix for departures) for MEM departures is greater (7%) than for arrivals (3%); for JFK, there is a benefit for arrivals (9%) but not for departures (-2%); for DFW, arrivals show a slight benefit (1%), but this is offset by departures (-2%). Departure queue length benefits show fewer aircraft in queue for JFK (29%) and MEM (11%), but not for DFW (-13%). Fuel savings for surface operations at MEM are seen for both arrivals and departures. At JFK there are fuel savings for arrivals, but these are offset by increased fuel use for departures. In this study, no surface fuel benefits resulted for DFW. Results suggest that the TRCM algorithm requires modifications for complex surface traffic operations that can cause taxi delays. For all three airports, the average number of changes in flow direction (runway configuration) recommended by TRCM was many times greater than the historical data; TRCM would need to be adapted to a particular airport's needs, to limit the number of changes to acceptable levels. The results from this analysis indicate the TRCM tool can provide benefits at some high-capacity airports. The magnitude of these benefits depends on many airport-specific factors and would require adaptation of the TRCM tool; a detailed assessment is needed prior to determining suitability for a particular airport.

  15. NDT tools for life assessment of high temperature pressure components

    Energy Technology Data Exchange (ETDEWEB)

    Delle Site, C.; De Petris, C.; Mennuti, C. [ISPESL, Rome (Italy)

    2006-07-01

    Creep damage of pressure equipment involves a great variety of high temperature components ranging from superheaters, reheaters, furnaces, reactors, etc. Consequence of failures of these components are of high economic and safety concern. Moreover, the probability of failure of high temperature components is now increasing due to frequent cyclic of power plants imposed by a deregulated market and the search for increasing temperatures in ultrasupercritical plants. In this scenario, a complete NDT campaign is necessary both during the design stage and during the in-service stage. The choice of the specific NDT technique for each component type is of great importance. In this work an overview of the existing NDT techniques for creep designed and operated components are presented. Together with metallographic replica, which is still considered the fundamental tool for creep damage assessment in the majority of materials, other NDT techniques which are able to detect creep cavity or cracks are presented and compared: ultrasonic techniques (tofd and phased-arrays), acoustic emission, holographic interferometry. In the second part of this paper the ability of some NDT tools to support residual life assessments are discussed. Among the most interesting tools are oxide scale ultrasonic measurement, micro-hardness testing, small-punch testing and on-stream deformation measurement. This tools are not strictly devoted to detecting creep defects (such as microcavities or microcracks) rather they give useful information related to creep damage, such as component deformation, material degradation and maximum service temperature. Moreover, a global procedure developed by ISPESL for inspection planning and interpretation of results of NDT examination according to a risk-based approach is presented. Eventually the new features of EN 13445-5 ''Creep Amendments'' concerning inspection and testing on creep designed components are briefly illustrated. (orig.)

  16. Development of the Barriers to Error Disclosure Assessment Tool.

    Science.gov (United States)

    Welsh, Darlene; Zephyr, Dominique; Pfeifle, Andrea L; Carr, Douglas E; Fink, Joseph L; Jones, Mandy

    2017-06-30

    An interprofessional group of health colleges' faculty created and piloted the Barriers to Error Disclosure Assessment tool as an instrument to measure barriers to medical error disclosure among health care providers. A review of the literature guided the creation of items describing influences on the decision to disclose a medical error. Local and national experts in error disclosure used a modified Delphi process to gain consensus on the items included in the pilot. After receiving university institutional review board approval, researchers distributed the tool to a convenience sample of physicians (n = 19), pharmacists (n = 20), and nurses (n = 20) from an academic medical center. Means and SDs were used to describe the sample. Intraclass correlation coefficients were used to examine test-retest correspondence between the continuous items on the scale. Factor analysis with varimax rotation was used to determine factor loadings and examine internal consistency reliability. Cronbach α coefficients were calculated during initial and subsequent administrations to assess test-retest reliability. After omitting 2 items with intraclass correlation coefficient of less than 0.40, intraclass correlation coefficients ranged from 0.43 to 0.70, indicating fair to good test-retest correspondence between the continuous items on the final draft. Factor analysis revealed the following factors during the initial administration: confidence and knowledge barriers, institutional barriers, psychological barriers, and financial concern barriers to medical error disclosure. α Coefficients of 0.85 to 0.93 at time 1 and 0.82 to 0.95 at time 2 supported test-retest reliability. The final version of the 31-item tool can be used to measure perceptions about abilities for disclosing, impressions regarding institutional policies and climate, and specific barriers that inhibit disclosure by health care providers. Preliminary evidence supports the tool's validity and reliability for measuring

  17. Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza

    Energy Technology Data Exchange (ETDEWEB)

    HCTT-CHE

    2011-04-14

    The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster—readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that—help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners' (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. While the purpose of the CAT is to further prepare the community for an influenza pandemic, its framework is an extension of the traditional all-hazards approach to planning and preparedness. As such, the information gathered by the tool is useful in preparation for most widespread public health emergencies. This tool is primarily intended for use by those involved in healthcare emergency preparedness (e.g., community planners, community disaster preparedness coordinators, 9-1-1 directors, hospital emergency preparedness coordinators). It is divided into sections based on the core agency partners, which may be involved in the community's influenza pandemic influenza response.

  18. SIAT, a sustainable impact assessment tool for understanding the drivers in integrated impact assessment

    NARCIS (Netherlands)

    Verweij, P.J.F.M.; Sieber, B.; Wien, J.J.F.; Müller, K.

    2006-01-01

    SENSOR is an Integrated Project within the 6th Framework program of the EU. The major outcome is the modeling approach Sustainable Impact Assessment Tool (SIAT). The knowledge-based model SIAT enables end users to assess the impacts of land-use relevant EU-policy strategies. The results are presente

  19. TENCompetence Assessment Model and Related Tools for Non Traditional Methods of Assessment

    NARCIS (Netherlands)

    Petrov, Milen; Aleksieva-Petrova, Adelina; Stefanov, Krassen; Schoonenboom, Judith; Miao, Yongwu

    2008-01-01

    Petrov, M., Aleksieva-Petrova, A., Stefanov, K., Schoonenboom, J., & Miao, Y. (2008). TENCompetence Assessment Model and Related Tools for Non Traditional Methods of Assessment. In H. W. Sligte & R. Koper (Eds). Proceedings of the 4th TENCompetence Open Workshop. Empowering Learners for Lifelong Com

  20. MOVEMENT SKILL ASSESSMENT OF TYPICALLY DEVELOPING PRESCHOOL CHILDREN: A REVIEW OF SEVEN MOVEMENT SKILL ASSESSMENT TOOLS

    Directory of Open Access Journals (Sweden)

    Wouter Cools

    2009-06-01

    Full Text Available The importance of movement is often overlooked because it is such a natural part of human life. It is, however, crucial for a child's physical, cognitive and social development. In addition, experiences support learning and development of fundamental movement skills. The foundations of those skills are laid in early childhood and essential to encourage a physically active lifestyle. Fundamental movement skill performance can be examined with several assessment tools. The choice of a test will depend on the context in which the assessment is planned. This article compares seven assessment tools which are often referred to in European or international context. It discusses the tools' usefulness for the assessment of movement skill development in general population samples. After a brief description of each assessment tool the article focuses on contents, reliability, validity and normative data. A conclusion outline of strengths and weaknesses of all reviewed assessment tools focusing on their use in educational research settings is provided and stresses the importance of regular data collection of fundamental movement skill development among preschool children.

  1. A generic rabies risk assessment tool to support surveillance.

    Science.gov (United States)

    Ward, Michael P; Hernández-Jover, Marta

    2015-06-01

    The continued spread of rabies in Indonesia poses a risk to human and animal populations in the remaining free islands, as well as the neighbouring rabies-free countries of Timor Leste, Papua New Guinea and Australia. Here we describe the development of a generic risk assessment tool which can be used to rapidly determine the vulnerability of rabies-free islands, so that scarce resources can be targeted to surveillance activities and the sensitivity of surveillance systems increased. The tool was developed by integrating information on the historical spread of rabies, anthropological studies, and the opinions of local animal health experts. The resulting tool is based on eight critical parameters that can be estimated from the literature, expert opinion, observational studies and information generated from routine surveillance. In the case study presented, results generated by this tool were most sensitive to the probability that dogs are present on private and fishing boats and it was predicted that rabies-infection (one infected case) might occur in a rabies-free island (upper 95% prediction interval) with a volume of 1000 boats movements. With 25,000 boat movements, the median of the probability distribution would be equal to one infected case, with an upper 95% prediction interval of six infected cases. This tool could also be used at the national-level to guide control and eradication plans. An initial recommendation from this study is to develop a surveillance programme to determine the likelihood that boats transport dogs, for example by port surveillance or regularly conducted surveys of fisherman and passenger ferries. However, the illegal nature of dog transportation from rabies-infected to rabies-free islands is a challenge for developing such surveillance.

  2. Sustainable Building Assessment Tool: Indian Leading Architects' Perceptions and Preferences

    Science.gov (United States)

    Bhatt, R.; Macwan, J. E. M.; Bhatt, D.

    2012-12-01

    As `sustainable development' has become a global focus, "Green Building" or "Sustainable Building (SB)" is the need of the day. These buildings not only reduce negative environmental impact but also improve human comfort and safety. Sustainable Buildings need to be assessed by `Assessment tool' for checking its overall contribution towards achievement of `sustainability'. In this paper an attempt is made to know Indian Architects `perceptions' and `preferences' regarding the framework of "Sustainable Building Assessment Tool (SBAT)" for India. Feedbacks were collected from the Architects of major metro cities of India. Total 81 responses were analyzed with SPSS 12 statistical analysis software. Indian Architects' gave an opinion that `SBAT' for India should be prepared firstly for commercial buildings. It should target `Architects' first and must be applied at the building level. `SBAT' should be a comprehensive one with flexible and easy to calculate scoring system. `SBAT' must cover non-controllable factors along with negative scoring system. Results can be utilized in the coming years to prepare a comprehensive `SBAT' for developing country like India.

  3. Testing a health impact assessment tool by assessing community opinion about a public park.

    Science.gov (United States)

    Hengpraprom, Sarunya; Bualert, Surat; Sithisarankul, Pornchai

    2012-01-01

    The purpose of this study was to assess a health impact assessment (HIA) tool to determine the perceived health impact by the public of a public park. The authors conducted a cross-sectional study from March to April, 2011, using this HIA questionnaire to collect data and through focus group discussions. We also assessed community concerns about the park and obtained recommendations of how to mitigate possible negative aspects of the parks. Four aspects were listed as possible benefits of the park: physical, mental, social, and spiritual health. The negative aspects mentioned by participants were that a park could be a potential place of assembly for teenagers, a place for theft and crime and accidents among children. The HIA tool used for this research seemed appropriate. The next challenge is to use this tool to assess a more controversial project.

  4. A novel tool for assessing and summarizing the built environment

    Directory of Open Access Journals (Sweden)

    Kroeger Gretchen L

    2012-10-01

    Full Text Available Abstract Background A growing corpus of research focuses on assessing the quality of the local built environment and also examining the relationship between the built environment and health outcomes and indicators in communities. However, there is a lack of research presenting a highly resolved, systematic, and comprehensive spatial approach to assessing the built environment over a large geographic extent. In this paper, we contribute to the built environment literature by describing a tool used to assess the residential built environment at the tax parcel-level, as well as a methodology for summarizing the data into meaningful indices for linkages with health data. Methods A database containing residential built environment variables was constructed using the existing body of literature, as well as input from local community partners. During the summer of 2008, a team of trained assessors conducted an on-foot, curb-side assessment of approximately 17,000 tax parcels in Durham, North Carolina, evaluating the built environment on over 80 variables using handheld Global Positioning System (GPS devices. The exercise was repeated again in the summer of 2011 over a larger geographic area that included roughly 30,700 tax parcels; summary data presented here are from the 2008 assessment. Results Built environment data were combined with Durham crime data and tax assessor data in order to construct seven built environment indices. These indices were aggregated to US Census blocks, as well as to primary adjacency communities (PACs and secondary adjacency communities (SACs which better described the larger neighborhood context experienced by local residents. Results were disseminated to community members, public health professionals, and government officials. Conclusions The assessment tool described is both easily-replicable and comprehensive in design. Furthermore, our construction of PACs and SACs introduces a novel concept to approximate varying

  5. A novel tool for assessing and summarizing the built environment

    Science.gov (United States)

    2012-01-01

    Background A growing corpus of research focuses on assessing the quality of the local built environment and also examining the relationship between the built environment and health outcomes and indicators in communities. However, there is a lack of research presenting a highly resolved, systematic, and comprehensive spatial approach to assessing the built environment over a large geographic extent. In this paper, we contribute to the built environment literature by describing a tool used to assess the residential built environment at the tax parcel-level, as well as a methodology for summarizing the data into meaningful indices for linkages with health data. Methods A database containing residential built environment variables was constructed using the existing body of literature, as well as input from local community partners. During the summer of 2008, a team of trained assessors conducted an on-foot, curb-side assessment of approximately 17,000 tax parcels in Durham, North Carolina, evaluating the built environment on over 80 variables using handheld Global Positioning System (GPS) devices. The exercise was repeated again in the summer of 2011 over a larger geographic area that included roughly 30,700 tax parcels; summary data presented here are from the 2008 assessment. Results Built environment data were combined with Durham crime data and tax assessor data in order to construct seven built environment indices. These indices were aggregated to US Census blocks, as well as to primary adjacency communities (PACs) and secondary adjacency communities (SACs) which better described the larger neighborhood context experienced by local residents. Results were disseminated to community members, public health professionals, and government officials. Conclusions The assessment tool described is both easily-replicable and comprehensive in design. Furthermore, our construction of PACs and SACs introduces a novel concept to approximate varying scales of community and

  6. Development of a clinically applicable tool for bone density assessment

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Y. [Katholieke Universiteit Leuven, Oral Imaging Center, Faculty of Medicine, Leuven (Belgium); St John' s Hospital, Department of Oral and Maxillofacial Surgery, Genk (Belgium); Dobbelaer, B. de; Suetens, P. [Katholieke Universiteit Leuven, Medical Image Computing (PSI), Faculty of Engineering, Leuven (Belgium); Nackaerts, O.; Yan, B.; Jacobs, R. [Katholieke Universiteit Leuven, Oral Imaging Center, Faculty of Medicine, Leuven (Belgium); Loubele, M. [Katholieke Universiteit Leuven, Oral Imaging Center, Faculty of Medicine, Leuven (Belgium); Katholieke Universiteit Leuven, Medical Image Computing (PSI), Faculty of Engineering, Leuven (Belgium); Politis, C.; Vrielinck, L. [St John' s Hospital, Department of Oral and Maxillofacial Surgery, Genk (Belgium); Schepers, S. [St John' s Hospital, Department of Oral and Maxillofacial Surgery, Genk (Belgium); University of Gent, Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Gent (Belgium); Lambrichts, I. [University of Hasselt, Department of Morphology, Diepenbeek (Belgium); Horner, K.; Devlin, H. [University of Manchester, School of Dentistry, Manchester (United Kingdom)

    2009-03-15

    To assess the accuracy and reliability of new software for radiodensitometric evaluations. A densitometric tool developed by MevisLab {sup registered} was used in conjunction with intraoral radiographs of the premolar region in both in vivo and laboratory settings. An aluminum step wedge was utilized for comparison of grey values. After computer-aided segmentation, the interproximal bone between the premolars was assessed in order to determine the mean grey value intensity of this region and convert it to a thickness in aluminum. Evaluation of the tool was determined using bone mineral density (BMD) values derived from decalcified human bone specimens as a reference standard. In vivo BMD data was collected from 35 patients as determined with dual X-ray absorptiometry (DXA). The intra and interobserver reliability of this method was assessed by Bland and Altman Plots to determine the precision of this tool. In the laboratory study, the threshold value for detection of bone loss was 6.5%. The densitometric data (mm Al eq.) was highly correlated with the jaw bone BMD, as determined using dual X-ray absorptiometry (r=0.96). For the in vivo study, the correlations between the mm Al equivalent of the average upper and lower jaw with the lumbar spine BMD, total hip BMD and femoral neck BMD were 0.489, 0.537 and 0.467, respectively (P<0.05). For the intraobserver reliability, a Bland and Altman plot showed that the mean difference {+-}1.96 SD were within {+-}0.15 mm Al eq. with the mean difference value small than 0.003 mm Al eq. For the interobserver reliability, the mean difference {+-}1.96 SD were within {+-}0.11 mm Al eq. with the mean difference of 0.008 mm Al eq. A densitometric software tool has been developed, that is reliable for bone density assessment. It now requires further investigation to evaluate its accuracy and clinical applicability in large scale studies. (orig.)

  7. Teaching and Learning: Using Digital Tools for Progressive Assessment

    DEFF Research Database (Denmark)

    Kastbjerg, Rita B.; Petersson, Eva; Lewis Brooks, Anthony

    2008-01-01

    pupils between 14 and 18 years of age. Both teachers and pupils reported the positive benefits from use of a computer-based test (CBT) strategy. Multiple practices of learning and a shift from individual to collaborative learning combined to indicate three notable changes resulting from the strategy: (1......  Non-biased assessment becomes a reality when Information and Communication Technology (ICT) is implemented as a pedagogical tool to augment teacher practice and student learning. This paper details a study that was undertaken at a secondary school in Lithuania involving four educators and 200...

  8. A Concise Review on Validated Risk Assessment Tools For Sexually Abusive Youth

    Directory of Open Access Journals (Sweden)

    L. C. Miccio-Fonseca

    2014-11-01

    Full Text Available Reviewed are validated and cross-validated risk assessment tools for assessing sexual improprieties in youth: J-SOAP-II, ERASOR,2.0, and MEGA♪. Assessments are significantly more accurate when tools focused on specific populations of youth are employed. The review affirms a New Paradigm of ecologically based, developmentally and gender sensitive risk assessment tools.

  9. Investigation of compensatory postures with videofluoromanometry in dysphagia patients

    Institute of Scientific and Technical Information of China (English)

    Antonio Solazzo; Luigi Monaco; Lucia Del Vecchio; Stefania Tamburrini; Francesca Iacobellis; Daniela Berritto; Nunzia Luisa Pizza

    2012-01-01

    AIM:To investigate the effectiveness of head compensatory postures to ensure safe oropharyngeal transit.METHODS:A total of 321 dysphagia patients were enrolled and assessed with videofluoromanometry (VFM).The dysphagia patients were classified as follows:safe transit; penetration without aspiration; aspiration before,during or after swallowing; multiple aspirations and no transit.The patients with aspiration or no transit were tested with VFM to determine whether compensatory postures could correct their swallowing disorder.RESULTS:VFM revealed penetration without aspiration in 71 patients (22.1%); aspiration before swallowing in 17 patients (5.3%); aspiration during swallowing in 32 patients (10%); aspiration after swallowing in 21 patients (6.5%); multiple aspirations in six patients (1.9%); no transit in five patients (1.6%); and safe transit in 169 patients (52.6%).Compensatory postures guaranteed a safe transit in 66/75 (88%) patients with aspiration or no transit.A chin-down posture achieved a safe swallow in 42/75 (56%) patients,a head-turned posture in 19/75 (25.3%) and a hyperextended head posture in 5/75 (6.7%).The compensatory postures were not effective in 9/75 (12%) cases.CONCLUSION:VFM allows the speech-language therapist to choose the most effective compensatory posture without a trial-and-error process and check the effectiveness of the posture.

  10. Dysarthria and dysphagia following treatment for a fourth ventricle choroid plexus papilloma.

    Science.gov (United States)

    Cornwell, P L; Murdoch, B E; Ward, E C; Morgan, A

    2003-07-01

    The present case report describes the presence of a persistent dysarthria and dysphagia as a consequence of surgical intervention for a choroid plexus papilloma (CPP). WM was a nine year ten month old male who at the time of the present study was seven years post-surgery. A comprehensive perceptual and instrumental test battery was used to document the nature of the dysarthria incorporating all components of speech production including respiration, phonation, resonance, articulation, and prosody. The nature of the dysphagia was evaluated through the use of videofluoroscopic evaluation of swallowing (VFS). Assessments confirmed the presence of a LMN dysarthria, marked by deficits in phonation, respiration, and prosody. Dysphagia assessment revealed deficits in oral preparatory, oral and pharyngeal stages of the swallow. The presence of persistent dysarthria and dysphagia in this case has a number of important implications for the management of children undergoing surgery for fourth ventricle CPPs, in particular the need for appropriate treatment, as well as counselling prior to surgery of the possible negative outcomes related to speech and swallowing.

  11. Field Assessment of Energy Audit Tools for Retrofit Programs

    Energy Technology Data Exchange (ETDEWEB)

    Edwards, J.; Bohac, D.; Nelson, C.; Smith, I.

    2013-07-01

    This project focused on the use of home energy ratings as a tool to promote energy retrofits in existing homes. A home energy rating provides a quantitative appraisal of a home's asset performance, usually compared to a benchmark such as the average energy use of similar homes in the same region. Home rating systems can help motivate homeowners in several ways. Ratings can clearly communicate a home's achievable energy efficiency potential, provide a quantitative assessment of energy savings after retrofits are completed, and show homeowners how they rate compared to their neighbors, thus creating an incentive to conform to a social standard. An important consideration is how rating tools for the retrofit market will integrate with existing home energy service programs. For residential programs that target energy savings only, home visits should be focused on key efficiency measures for that home. In order to gain wide adoption, a rating tool must be easily integrated into the field process, demonstrate consistency and reasonable accuracy to earn the trust of home energy technicians, and have a low monetary cost and time hurdle for homeowners. Along with the Home Energy Score, this project also evaluated the energy modeling performance of SIMPLE and REM/Rate.

  12. Geospatial tools for landscape character assessment in Cyprus

    Science.gov (United States)

    Symons, N. P.; Vogiatzakis, I. N.; Griffiths, G. H.; Warnock, S.; Vassou, V.; Zomeni, M.; Trigkas, V.

    2013-08-01

    The development of Landscape Typologies in Europe relies upon advances in geospatial tools and increasing availability of digital datasets. Landscape Character Assessment (LCA) is a technique used to classify, describe and understand the combined physical, ecological and cultural characteristics of a landscape. LCA uses a range of data sources to identify and describe areas of common character and can operate at a range of scales i.e.national and regional and local. The paper describes the steps taken to develop an island wide landscape typology for Cyprus, based on the use of GIS and remote sensing tools. The methodology involved integrating physiographical, ecological and cultural information about the Cypriot landscape. Datasets on the cultural attributes (e.g. settlement and field patterns) were not available, so they were created de novo based on information from topographical maps (for settlement dispersion and density) and medium resolution satellite imagery from Google Earth, from which a number of distinctive field patterns could be distinguished. The mapping work is carried out on two levels using a hierarchical approach. The first level at a 1:100, 000 scale has been completed resulting in a map with 17 distinct landscape types. The second level is under way with the view of producing a more detailed landscape typology at 1:50, 000 scale which will incorporate the cultural aspects of the island. This is the first time that such a typology has been produced for Cyprus and it is expected to provide an invaluable tool for landscape planning and management.

  13. Creating a Social Media Assessment Tool for Family Nursing.

    Science.gov (United States)

    Risling, Tracie; Risling, Derek; Holtslander, Lorraine

    2017-02-01

    The use of social media (SM) is contributing to an unprecedented state of global connectivity and occupying an increasingly prominent position in the lives of individuals and families. The more integrated these media become into society the more likely they are to play a role in overall health and family functioning, be it positively or negatively. Family systems theory provides an ideal lens through which to examine the effects of SM in today's family life. This article introduces a new SM assessment tool aligned with the principles of this foundational theory. Family nurses can use the proposed Social Media Assessment Package (SMAP) to gain an initial picture of usage patterns within a family as well as identify and support positive future SM choices. Practitioners may also use the SMAP in a personal evaluation of their practice as a means to maximize SM use in ongoing professional development.

  14. Field Assessment of Energy Audit Tools for Retrofit Programs

    Energy Technology Data Exchange (ETDEWEB)

    Edwards, J. [Univ. of Minnesota, St. Paul, MN (United States); Bohac, D. [Univ. of Minnesota, St. Paul, MN (United States); Nelson, C. [Univ. of Minnesota, St. Paul, MN (United States); Smith, I. [Univ. of Minnesota, St. Paul, MN (United States)

    2013-07-01

    This project focused on the use of home energy ratings as a tool to promote energy retrofits in existing homes. A home energy rating provides a quantitative appraisal of a home’s energy performance, usually compared to a benchmark such as the average energy use of similar homes in the same region. Rating systems based on energy performance models, the focus of this report, can establish a home’s achievable energy efficiency potential and provide a quantitative assessment of energy savings after retrofits are completed, although their accuracy needs to be verified by actual measurement or billing data. Ratings can also show homeowners where they stand compared to their neighbors, thus creating social pressure to conform to or surpass others. This project field-tested three different building performance models of varying complexity, in order to assess their value as rating systems in the context of a residential retrofit program: Home Energy Score, SIMPLE, and REM/Rate.

  15. A new aquifer assessment tool using reactive tracers

    Science.gov (United States)

    McKnight, D.; Smalley, A. L.; Banwart, S. A.; Lerner, D. N.; Thomson, N. R.; Thornton, S. F.; Wilson, R. D.

    2003-04-01

    A major obstacle to making informed decisions about trigger levels for restoration and choosing remediation options is that current Site Investigation (SI) practice fails to make optimal use of available SI techniques resulting in poor value for money in conceptual site models. Often it is simply too expensive to obtain the type of site data required to build the case for natural attenuation, even though this restoration option may be relatively cheaper than a pump-and-treat system. In particular, aquifer property measurement techniques for groundwater transport and reactions are too costly and this results in over-reliance on literature values or model assumptions. This results in overly uncertain predictions of in situ performance and therefore unnecessarily cautious risk assessment and costly remediation strategies. Therefore, cost-effective SI tools that have the capability of producing high quality characterisation data are required. The dipole flow test which circulates groundwater between isolated injection (source) and extraction (sink) chambers within a single borehole has been used successfully by others to delineate heterogeneous hydraulic properties in both highly permeable and fractured rock aquifers. We propose to extend this approach by adding a suite of reactive tracers into a dipole flow field to assess the geochemical properties and biodegradation potential of aquifers. If successful this will provide a method to ascertain site-specific parameters for use in appropriate reactive transport models. The initial phase of this project involves the construction of a laboratory-scale physical model of a dipole probe to investigate the utility of the dipole flow and reactive tracer test (DFRTT) as an aquifer assessment tool. This phase will also serve as the developmental stage between mathematical theory and a host of planned field trials. The development of the laboratory-scale DFRTT including initial scoping calculations, numerical simulation results

  16. Translating and validating a Training Needs Assessment tool into Greek

    Directory of Open Access Journals (Sweden)

    Hicks Carolyn M

    2007-05-01

    Full Text Available Abstract Background The translation and cultural adaptation of widely accepted, psychometrically tested tools is regarded as an essential component of effective human resource management in the primary care arena. The Training Needs Assessment (TNA is a widely used, valid instrument, designed to measure professional development needs of health care professionals, especially in primary health care. This study aims to describe the translation, adaptation and validation of the TNA questionnaire into Greek language and discuss possibilities of its use in primary care settings. Methods A modified version of the English self-administered questionnaire consisting of 30 items was used. Internationally recommended methodology, mandating forward translation, backward translation, reconciliation and pretesting steps, was followed. Tool validation included assessing item internal consistency, using the alpha coefficient of Cronbach. Reproducibility (test – retest reliability was measured by the kappa correlation coefficient. Criterion validity was calculated for selected parts of the questionnaire by correlating respondents' research experience with relevant research item scores. An exploratory factor analysis highlighted how the items group together, using a Varimax (oblique rotation and subsequent Cronbach's alpha assessment. Results The psychometric properties of the Greek version of the TNA questionnaire for nursing staff employed in primary care were good. Internal consistency of the instrument was very good, Cronbach's alpha was found to be 0.985 (p 1.0, KMO (Kaiser-Meyer-Olkin measure of sampling adequacy = 0.680 and Bartlett's test of sphericity, p Conclusion The translated and adapted Greek version is comparable with the original English instrument in terms of validity and reliability and it is suitable to assess professional development needs of nursing staff in Greek primary care settings.

  17. 77 FR 33227 - Assessment Questionnaire-IP Sector Specific Agency Risk Self Assessment Tool (IP-SSARSAT)

    Science.gov (United States)

    2012-06-05

    ... SECURITY Assessment Questionnaire--IP Sector Specific Agency Risk Self Assessment Tool (IP-SSARSAT) AGENCY...--Assessment Questionnaire--IP Sector Specific Agency Risk Self Assessment Tool (IP-SSARSAT). DHS previously...-operators and/or security managers often volunteer to conduct an automated self risk assessment....

  18. 76 FR 81955 - Assessment Questionnaire-IP Sector Specific Agency Risk Self Assessment Tool (IP-SSARSAT)

    Science.gov (United States)

    2011-12-29

    ... SECURITY Assessment Questionnaire--IP Sector Specific Agency Risk Self Assessment Tool (IP-SSARSAT) AGENCY... managers often volunteer to conduct an automated self risk assessment. The requested questionnaire...: Assessment Questionnaire--IP Sector Specific Agency Risk Self Assessment Tool (IP-SSARSAT). OMB Number:...

  19. Development of the Central Dogma Concept Inventory (CDCI) Assessment Tool.

    Science.gov (United States)

    Newman, Dina L; Snyder, Christopher W; Fisk, J Nick; Wright, L Kate

    2016-01-01

    Scientific teaching requires scientifically constructed, field-tested instruments to accurately evaluate student thinking and gauge teacher effectiveness. We have developed a 23-question, multiple select-format assessment of student understanding of the essential concepts of the central dogma of molecular biology that is appropriate for all levels of undergraduate biology. Questions for the Central Dogma Concept Inventory (CDCI) tool were developed and iteratively revised based on student language and review by experts. The ability of the CDCI to discriminate between levels of understanding of the central dogma is supported by field testing (N= 54), and large-scale beta testing (N= 1733). Performance on the assessment increased with experience in biology; scores covered a broad range and showed no ceiling effect, even with senior biology majors, and pre/posttesting of a single class focused on the central dogma showed significant improvement. The multiple-select format reduces the chances of correct answers by random guessing, allows students at different levels to exhibit the extent of their knowledge, and provides deeper insight into the complexity of student thinking on each theme. To date, the CDCI is the first tool dedicated to measuring student thinking about the central dogma of molecular biology, and version 5 is ready to use.

  20. Developing and validating a tool to assess nurse stress.

    Science.gov (United States)

    Zaghloul, Ashraf A

    2008-01-01

    Nursing is generally perceived as a demanding profession. There is a rising necessity for healthcare administrators to tackle the aspects leading to nurse stress and work burnout as a means towards maintaining a stable and continuous workforce at healthcare institutions.The study aimed at the development of a reliable and valid tool for measuring nursing staff stress and burnout at the University Hospital of King Faisal University, Saudi Arabia. A cross-sectional descriptive study was designed. All registered high nurses working at the hospital were included in the study. The total number accounted for 260 nurses. The study revealed a valid and reliable scale. Such results were indicated through face validity, content validity, and principal component analysis using the varimax rotation for the fifteen statements included in the questionnaire. The PCA explained 56.4% of the variance and concluded 3 main components under which the statements would be categorized. Dimensions were given suitable headings as follows; work aspects, working conditions, and workload. Reliability was assessed and revealed an internal consistency (Cronbach alpha=0.8) and a split-half Spearman-Brown coefficient for unequal length r= 0.79. In conclusion, the study demonstrated a short valid and reliable scale to assess the stressful areas for nurses. The scale is convenient for use by healthcare managers at different medical situations. Further studies are recommended for the use of the tool on representative samples of Saudi nurses.

  1. Dysphagia in patients with cerebrovascular disease. Update.

    Directory of Open Access Journals (Sweden)

    Amarilis Barbié Rubiera

    2009-03-01

    Full Text Available An important number of patients with cerebrovascular disease also present dysphagia as a result of damage in cerebral hemispheres or brainstem, which contributes to negative morbility and functional rehabilitation prognosis due to the complications liked with this condition. It is a significant cause of nutritional dysfunctions, including increased in-hospital undernourishment, increased per patient expenditure and longer in-hospital stay. One of the objectives of the Nutritional Support Team of the Neuroscience and Neurology Institute is to reduce undernourishment causes in patients with neurological diseases. A wide review of the subject was performed including experts´ opinions, from the above mentioned institutions, in order to gather an updated report related with the significance of early diagnosis of dysphagia in patients with ictus and the opportune and correct use of therapeutic measures to reduce complication risk.

  2. Mesothelioma - A rare cause of dysphagia

    Directory of Open Access Journals (Sweden)

    Vishwanathan Swati

    2016-08-01

    Full Text Available A 81-year-old elderly Caucasian male presented with progressive dysphagia and unintentional weight loss over four months. His history was significant for asbestos exposure; however there was no history of asbestos related lung disease. Barium swallow showed achalasia and a subsequent CT chest showed a posterior mediastinal mass 11.8×9.1×5.8cm, compressing the distal oesophagus. Laparoscopic biopsy of the mass showed an epitheloid mesothelioma. Mass was deemed unresectable and patient was started on chemotherapy with Cisplatin/Pemetrexed. Localised mesothelioma is extremely rare, and dysphagia can be uncommon presenting feature. 7.4 per cent of cases of Pseudoachalasia are attributed to mesothelioma

  3. [Dysphagia with lateral medullary infarction (Wallenberg's syndrome)].

    Science.gov (United States)

    Oshima, Fumiko

    2011-11-01

    Dysphagia after lateral medullary infarction (LMI) is common. The dysphagia of LMI is dynamically characterized by a failure in triggering of the pharyngeal-phase swallowing movements, reduced output, and lack of coordination (swallowing pattern abnormality). Based on accurate evaluation, we can select suitable rehabilitative approaches for individual patients, including respiratory therapy, food modification, postural changes, and oral care. We focused on the absence of upper esophageal sphincter (UES) opening of the unaffected side of the medullae. The movement pattern was defined as failure of bolus passage through the intact side of the UES, occurring at least once during the videofluorographic evaluation of each individual. Three abnormal patterns of UES opening were classified. The passage pattern abnormality shows the failure of the stereotyped motor sequence. For severe cases, it is necessary to consider long-term treatment, including botulinum toxin injection or surgery to prevent aspiration and adequate nutritional management.

  4. Pemphigus vulgaris: a rare cause of dysphagia.

    Science.gov (United States)

    Al-Janabi, Ali; Greenfield, Simon

    2015-10-22

    Pemphigus vulgaris is a rare autoimmune blistering disease of the skin and mucous membranes. The case reported presented unusually with dyspepsia that was not responsive to protein pump inhibitor (PPI) therapy. This progressed to severe dysphagia and odynophagia. An esophagogastroduodenoscopy showed extensive ulceration of the esophagus, and direct immunofluorescence of an esophageal biopsy showed bright intercellular staining with C3 and IgG, confirming the diagnosis of pemphigus vulgaris. Immunological remission was achieved after a number of courses of pulsed intravenous methylprednisolone and cyclophosphamide. The patient has remained in remission for 5 years, but has required regular dilation of esophageal strictures for symptom relief. During this period, a chronic lymphocytosis was incidentally noted on routine blood tests, and chronic lymphocytic leukaemia was diagnosed. It is essential to investigate PPI-resistant symptoms, dysphagia and odynophagia, as they may indicate a serious underlying cause.

  5. Aspiration in children and adolescents with neurogenic dysphagia: comparison of clinical judgment and fiberoptic endoscopic evaluation of swallowing.

    Science.gov (United States)

    Beer, Sabrina; Hartlieb, Till; Müller, Arnd; Granel, Michael; Staudt, Martin

    2014-12-01

    A total of 30 children and adolescents with dysphagia due to various chronic neurological disorders were assessed for their risk of aspiration. This assessment was performed clinically by experienced speech and swallowing therapists, and verified thereafter by fiberoptic endoscopy. We found the clinical judgment to be correct in only 70% (for aspiration of saliva), 55% (of puree), and 67% (of thin liquids). We conclude that, because of this unacceptably high error rate of clinical assessment, a fiberoptic evaluation of swallowing is a necessary diagnostic step both for the planning of therapy and for the development of feeding strategies in children and adolescents with neurogenic dysphagia. Georg Thieme Verlag KG Stuttgart · New York.

  6. Analytical tool for risk assessment of landscape and urban planning: Spatial development impact assessment

    Science.gov (United States)

    Rehak, David; Senovsky, Michail; Balog, Karol; Dvorak, Jiri

    2011-06-01

    This article covers the issue of preventive protection of population, technical infrastructure, and the environment against adverse impacts of careless spatial development. In the first section, we describe the relationship between sustainable development and spatial development. This discussion is followed by a review of the current state of spatial development security, primarily at a national level in the Czech Republic. The remainder of the paper features our original contribution which is a tool for risk assessment in landscape and urban planning, the Spatial Development Impact Assessment (SDIA) tool. We briefly review the most significant semi-quantitative methods of risk analysis that were used as a starting point in implementing the tool, and we discuss several of SDIA's salient features, namely, the assessment process algorithm, the catalogue of hazard and asset groups, and the spatial development impact matrix.

  7. Thyrotoxic Dysphagia in an 82-Year-Old Male

    Directory of Open Access Journals (Sweden)

    Konstantinos Parperis

    2011-01-01

    Full Text Available Dysphagia is a common problem in elderly patients and a rare manifestation of Graves' disease. We report a case of an 82-year-old male who presented with a 4-week history of dysphagia and weight loss. Workup for his dysphagia with upper endoscopy, MRI brain, electromyography, acetyl-cholinesterase receptor antibodies, and voltage-gated calcium channel antibodies were negative. Modified Barium swallow test showed oropharyngeal dysphagia. Thyroid function tests that revealed hyperthyroidism and antibodies to TSH-receptor were positive. Based on the above findings, we considered Graves' disease as the most likely diagnosis. Patient was treated with methimazole and beta-blockers and subsequently his dysphagia resolved. This paper highlights the importance to clinicians of considering thyrotoxicosis as possible diagnosis in an elderly patient presenting with unexplained dysphagia.

  8. Dysphagia associated with cervical spine and postural disorders.

    Science.gov (United States)

    Papadopoulou, Soultana; Exarchakos, Georgios; Beris, Alexander; Ploumis, Avraam

    2013-12-01

    Difficulties with swallowing may be both persistent and life threatening for the majority of those who experience it irrespective of age, gender, and race. The purpose of this review is to define oropharyngeal dysphagia and describe its relationship to cervical spine disorders and postural disturbances due to either congenital or acquired disorders. The etiology and diagnosis of dysphagia are analyzed, focusing on cervical spine pathology associated with dysphagia as severe cervical spine disorders and postural disturbances largely have been held accountable for deglutition disorders. Scoliosis, kyphosis–lordosis, and osteophytes are the primary focus of this review in an attempt to elucidate the link between cervical spine disorders and dysphagia. It is important for physicians to be knowledgeable about what triggers oropharyngeal dysphagia in cases of cervical spine and postural disorders. Moreover, the optimum treatment for dysphagia, including the use of therapeutic maneuvers during deglutition, neck exercises, and surgical treatment, is discussed.

  9. GUIDOS: tools for the assessment of pattern, connectivity, and fragmentation

    Science.gov (United States)

    Vogt, Peter

    2013-04-01

    Pattern, connectivity, and fragmentation can be considered as pillars for a quantitative analysis of digital landscape images. The free software toolbox GUIDOS (http://forest.jrc.ec.europa.eu/download/software/guidos) includes a variety of dedicated methodologies for the quantitative assessment of these features. Amongst others, Morphological Spatial Pattern Analysis (MSPA) is used for an intuitive description of image pattern structures and the automatic detection of connectivity pathways. GUIDOS includes tools for the detection and quantitative assessment of key nodes and links as well as to define connectedness in raster images and to setup appropriate input files for an enhanced network analysis using Conefor Sensinode. Finally, fragmentation is usually defined from a species point of view but a generic and quantifiable indicator is needed to measure fragmentation and its changes. Some preliminary results for different conceptual approaches will be shown for a sample dataset. Complemented by pre- and post-processing routines and a complete GIS environment the portable GUIDOS Toolbox may facilitate a holistic assessment in risk assessment studies, landscape planning, and conservation/restoration policies. Alternatively, individual analysis components may contribute to or enhance studies conducted with other software packages in landscape ecology.

  10. Oropharyngeal dysphagia, an underestimated disorder in pediatrics

    OpenAIRE

    Esther Vaquero-Sosa; Laura Francisco-González; Andrés Bodas-Pinedo; Cristina Urbasos-Garzón; Antonio Ruiz-de-León-San-Juan

    2015-01-01

    Oropharyngeal dysphagia is a rather frequent clinical entity in patients with neurological problems that can lead to serious complications such as aspiration pneumonia and other disorders like dehydration or malnutrition due to feeding difficulties. It should be suspected in children with splitting of food intake or prolonged feeding, coughing or choking during feeding, continuous drooling or repeated respiratory symptoms. For the diagnosis, apart from the examination of swallowing, additiona...

  11. Foramen Magnum Meningioma: Dysphagia of Atypical Etiology

    Science.gov (United States)

    Tsang, Matthew W.; Mobley, Bret C.; Cheng, Walter W.

    2007-01-01

    INTRODUCTION We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. A 58-year-old woman presented with an 18-month history of progressive dysphagia, chronic cough and 30-pound weight loss. Prior gastroenterologic and laryngologic workup was unrevealing. Results Her neurologic examination revealed an absent gag reflex, decreased sensation to light touch on bilateral distal extremities, hyperreflexia, and tandem gait instability. Repeat esophagogastroduodenoscopy was normal, whereas laryngoscopy and video fluoroscopy revealed marked hypopharyngeal dysfunction. Brain magnetic resonance imaging demonstrated a 3.1 × 2.7 × 2.9 cm foramen magnum mass consistent with meningioma. The patient underwent neurosurgical resection of her mass with near complete resolution of her neurologic symptoms. Pathology confirmed diagnosis of a WHO grade I meningothelial meningioma. Conclusion CNS pathology is an uncommon but impressive cause of dysphagia. Our case demonstrates the importance of a thorough neurologic survey when evaluating such a patient. PMID:18080720

  12. Developing an integration tool for soil contamination assessment

    Science.gov (United States)

    Anaya-Romero, Maria; Zingg, Felix; Pérez-Álvarez, José Miguel; Madejón, Paula; Kotb Abd-Elmabod, Sameh

    2015-04-01

    In the last decades, huge soil areas have been negatively influenced or altered in multiples forms. Soils and, consequently, underground water, have been contaminated by accumulation of contaminants from agricultural activities (fertilizers and pesticides) industrial activities (harmful material dumping, sludge, flying ashes) and urban activities (hydrocarbon, metals from vehicle traffic, urban waste dumping). In the framework of the RECARE project, local partners across Europe are focusing on a wide range of soil threats, as soil contamination, and aiming to develop effective prevention, remediation and restoration measures by designing and applying targeted land management strategies (van Lynden et al., 2013). In this context, the Guadiamar Green Corridor (Southern Spain) was used as a case study, aiming to obtain soil data and new information in order to assess soil contamination. The main threat in the Guadiamar valley is soil contamination after a mine spill occurred on April 1998. About four hm3 of acid waters and two hm3 of mud, rich in heavy metals, were released into the Agrio and Guadiamar rivers affecting more than 4,600 ha of agricultural and pasture land. Main trace elements contaminating soil and water were As, Cd, Cu, Pb, Tl and Zn. The objective of the present research is to develop informatics tools that integrate soil database, models and interactive platforms for soil contamination assessment. Preliminary results were obtained related to the compilation of harmonized databases including geographical, hydro-meteorological, soil and socio-economic variables based on spatial analysis and stakeholder's consultation. Further research will be modellization and upscaling at the European level, in order to obtain a scientifically-technical predictive tool for the assessment of soil contamination.

  13. Aqueduct: an interactive tool to empower global water risk assessment

    Science.gov (United States)

    Reig, Paul; Gassert, Francis

    2013-04-01

    The Aqueduct Water Risk Atlas (Aqueduct) is a publicly available, global database and interactive tool that maps indicators of water related risks for decision makers worldwide. Aqueduct makes use of the latest geo-statistical modeling techniques to compute a composite index and translate the most recently available hydrological data into practical information on water related risks for companies, investors, and governments alike. Twelve global indicators are grouped into a Water Risk Framework designed in response to the growing concerns from private sector actors around water scarcity, water quality, climate change, and increasing demand for freshwater. The Aqueduct framework includes indicators of water stress, variability in supply, storage, flood, drought, groundwater, water quality and social conflict, addressing both spatial and temporal variation in water hazards. It organizes indicators into three categories of risk that bring together multiple dimensions of water related risk into comprehensive aggregated scores, which allow for dynamic weighting to capture users' unique exposure to water hazards. All information is compiled into an online, open access platform, from which decision-makers can view indicators, scores, and maps, conduct global risk assessments, and export data and shape files for further analysis. Companies can use this tool to evaluate their exposure to water risks across operations and supply chains, investors to assess water-related risks in their portfolio, and public-sector actors to better understand water security. Additionally, the open nature of the data and maps allow other organizations to build off of this effort with new research, for example in the areas of water-energy or water-food relationships. This presentation will showcase the Aqueduct Water Risk Atlas online tool and the features and functionalities it offers, as well as explain how it can be used for both private and public sector applications. The session will

  14. [Oropharyngeal dysphagia associated with Chiari I malformation and syringomyelia J].

    Science.gov (United States)

    Cortés-Medina, Julio César; Cárdenas-Lara, Armando; Guerrero-Rascón, Carlos Alberto; Rodríguez-Bautista, Heber

    2014-01-01

    Dysphagia associated with neurological disease is an important clinical manifestation in the diagnosis of injury that justifies the compression of the brainstem and lower cranial nerves. To emphasize the study of dysphagia in a patient with Chiari I malformation associated with syringomyelia in the absence of primary gastroenterological symptoms. We describe the case of a 62 year-old woman with oropharyngeal dysphagia of six years of evolution, cervicobrachialgia, ptosis and facial diplexia. Magnetic resonance imaging is an essential element for establishing the etiologic diagnosis of neurogenic dysphagia.

  15. Dysphagia in the elderly: management and nutritional considerations

    Science.gov (United States)

    Sura, Livia; Madhavan, Aarthi; Carnaby, Giselle; Crary, Michael A

    2012-01-01

    Dysphagia is a prevalent difficulty among aging adults. Though increasing age facilitates subtle physiologic changes in swallow function, age-related diseases are significant factors in the presence and severity of dysphagia. Among elderly diseases and health complications, stroke and dementia reflect high rates of dysphagia. In both conditions, dysphagia is associated with nutritional deficits and increased risk of pneumonia. Recent efforts have suggested that elderly community dwellers are also at risk for dysphagia and associated deficits in nutritional status and increased pneumonia risk. Swallowing rehabilitation is an effective approach to increase safe oral intake in these populations and recent research has demonstrated extended benefits related to improved nutritional status and reduced pneumonia rates. In this manuscript, we review data describing age related changes in swallowing and discuss the relationship of dysphagia in patients following stroke, those with dementia, and in community dwelling elderly. Subsequently, we review basic approaches to dysphagia intervention including both compensatory and rehabilitative approaches. We conclude with a discussion on the positive impact of swallowing rehabilitation on malnutrition and pneumonia in elderly who either present with dysphagia or are at risk for dysphagia. PMID:22956864

  16. Dysphagia in the elderly: management and nutritional considerations.

    Science.gov (United States)

    Sura, Livia; Madhavan, Aarthi; Carnaby, Giselle; Crary, Michael A

    2012-01-01

    Dysphagia is a prevalent difficulty among aging adults. Though increasing age facilitates subtle physiologic changes in swallow function, age-related diseases are significant factors in the presence and severity of dysphagia. Among elderly diseases and health complications, stroke and dementia reflect high rates of dysphagia. In both conditions, dysphagia is associated with nutritional deficits and increased risk of pneumonia. Recent efforts have suggested that elderly community dwellers are also at risk for dysphagia and associated deficits in nutritional status and increased pneumonia risk. Swallowing rehabilitation is an effective approach to increase safe oral intake in these populations and recent research has demonstrated extended benefits related to improved nutritional status and reduced pneumonia rates. In this manuscript, we review data describing age related changes in swallowing and discuss the relationship of dysphagia in patients following stroke, those with dementia, and in community dwelling elderly. Subsequently, we review basic approaches to dysphagia intervention including both compensatory and rehabilitative approaches. We conclude with a discussion on the positive impact of swallowing rehabilitation on malnutrition and pneumonia in elderly who either present with dysphagia or are at risk for dysphagia.

  17. Oropharyngeal dysphagia in older persons – from pathophysiology to adequate intervention: a review and summary of an international expert meeting

    Science.gov (United States)

    Wirth, Rainer; Dziewas, Rainer; Beck, Anne Marie; Clavé, Pere; Hamdy, Shaheen; Heppner, Hans Juergen; Langmore, Susan; Leischker, Andreas Herbert; Martino, Rosemary; Pluschinski, Petra; Rösler, Alexander; Shaker, Reza; Warnecke, Tobias; Sieber, Cornel Christian; Volkert, Dorothee

    2016-01-01

    Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies. PMID:26966356

  18. Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting.

    Science.gov (United States)

    Wirth, Rainer; Dziewas, Rainer; Beck, Anne Marie; Clavé, Pere; Hamdy, Shaheen; Heppner, Hans Juergen; Langmore, Susan; Leischker, Andreas Herbert; Martino, Rosemary; Pluschinski, Petra; Rösler, Alexander; Shaker, Reza; Warnecke, Tobias; Sieber, Cornel Christian; Volkert, Dorothee

    2016-01-01

    Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies.

  19. Therapeutic effects of acupuncture for neurogenic dysphagia--a randomized controlled trial.

    Science.gov (United States)

    Chan, Sze-Ling; Or, Ka-Hang; Sun, Wai-Zhu; Ng, Kwan-Yee; Lo, See-Kit; Lee, Yuet-Sheung

    2012-03-01

    To evaluate the therapeutic effects and long-term efficacy of acupuncture for neurogenic dysphagia. Subjects with neurogenic dysphagia undergoing routine swallowing management were randomized to receive either 20 sessions of true acupuncture (experimental group) or sham acupuncture (control group 1) for approximately one and a half months. A third group (control group 2) comprised of non-randomized subjects with neurogenic dysphagia who received routine care were recruited from separate wards. The outcomes were assessed by the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), as well as by the consistencies of ingested food and fluid. A total of 87 subjects (experimental group, n = 20; control group 1, n = 19; control group 2, n = 48) were recruited into the trial. The average RBHOMS score showed a greater improvement in the experimental group and in control group 1 than in control group 2. The average levels of food and fluid consistencies displayed greater improvement in the experimental group than in the two control groups. This study demonstrates that acupuncture may have therapeutic effects and long-term efficacy for neurogenic dysphagia. However, due to an insufficient sample size and the lack of follow-up for control group 2, multi-centre trials employing a larger sample size may be required to draw concrete conclusions.

  20. Developing clinical skills in paediatric dysphagia management using human patient simulation (HPS).

    Science.gov (United States)

    Ward, Elizabeth C; Hill, Anne E; Nund, Rebecca L; Rumbach, Anna F; Walker-Smith, Katie; Wright, Sarah E; Kelly, Kris; Dodrill, Pamela

    2015-06-01

    The use of simulated learning environments to develop clinical skills is gaining momentum in speech-language pathology training programs. The aim of the current study was to examine the benefits of adding Human Patient Simulation (HPS) into the university curriculum in the area of paediatric dysphagia. University students enrolled in a mandatory dysphagia course (n = 29) completed two, 2-hour HPS scenarios: (a) performing a clinical feeding assessment with a medically complex infant; and (b) conducting a clinical swallow examination (CSE) with a child with a tracheostomy. Scenarios covered technical and non-technical skills in paediatric dysphagia management. Surveys relating to students' perceived knowledge, skills, confidence and levels of anxiety were conducted: (a) pre-lectures; (b) post-lectures, but pre-HPS; and (c) post-HPS. A fourth survey was completed following clinical placements with real clients. Results demonstrate significant additive value in knowledge, skills and confidence obtained through HPS. Anxiety about working clinically reduced following HPS. Students rated simulation as very useful in preparing for clinical practice. Post-clinic, students indicated that HPS was an important component in their preparation to work as a clinician. This trial supports the benefits of incorporating HPS as part of clinical preparation for paediatric dysphagia management.

  1. Dysarthria and dysphagia as long-term sequelae in a child treated for posterior fossa tumour.

    Science.gov (United States)

    Cornwell, Petrea L; Murdoch, Bruce E; Ward, Elizabeth C; Morgan, Angela

    2003-01-01

    The current case report provides a comprehensive description of the persistent dysarthria and dysphagia evident in a 7.5 year old child treated for recurrent posterior fossa tumour (PFT). AC was assessed on a comprehensive perceptual and instrumental test battery incorporating all components of the speech production system (respiration, phonation, resonance, articulation and prosody) 2 years and 4 months following completion of her treatment. The nature of her swallowing impairment was investigated through the use of videofluoroscopic evaluation of swallowing (VFS). A mild dysarthria with ataxic and LMN components was identified, although overall speech intelligibility was not affected. A moderate dysphagia was also identified with impairment in all three phases of the swallowing process; oral preparatory, oral and pharyngeal. Dysarthria and dysphagia as persistent sequelae in children treated for PFT have implications for the long-term management of these children. The need for appropriate treatment regimes, as well as pre-surgical counselling regarding dysarthria and dysphagia as possible outcomes following surgery are highlighted.

  2. Dysphagia research in the 21st century and beyond: proceedings from Dysphagia Experts Meeting, August 21, 2001.

    Science.gov (United States)

    Robbins, JoAnne; Langmore, Susan; Hind, Jacqueline A; Erlichman, Martin

    2002-01-01

    Swallowing problems (dysphagia) can occur at any age but are most prevalent in elderly individuals and are a growing healthcare concern as the geriatric population expands. Without effective diagnosis and treatment, dysphagia may lead to serious medical conditions such as pneumonia, dehydration, and malnutrition. Experts in the field of dysphagia met on August 21, 2001, in Rockville, Maryland, to respond to this heightened healthcare need and to determine the course of dysphagia research. Presentations at the meeting included epidemiological data, geriatric-specific issues, diagnostic techniques, risk factors for pneumonia, and recent relevant trials. The experts identified outstanding issues in dysphagia research, such as study design, population selection, and the standardization of diagnostic and treatment protocols. They designed a clinical trial that represents what they deem is one of the greatest needs in dysphagia research, providing a critical springboard for research endeavors with far-reaching implications.

  3. Acute coronary syndrome: emerging tools for diagnosis and risk assessment

    National Research Council Canada - National Science Library

    Scirica, Benjamin M

    2010-01-01

    .... Although there are many established tools for diagnosis, prognosis, and clinical decision making, understanding the advantages and limitations of each tool according the clinical scenario is essential...

  4. Testing the Visual Soil Assessment tool on Estonian farm fields

    Science.gov (United States)

    Reintam, Endla; Are, Mihkel; Selge, Are

    2017-04-01

    Soil quality estimation plays important role in decision making on farm as well on policy level. Sustaining the production ability and good health of the soil the chemical, physical and biological indicators should be taken into account. The system to use soil chemical parameters is usually quite well established in most European counties, including Estonia. However, measuring soil physical properties, such bulk density, porosity, penetration resistance, structural stability ect is time consuming, needs special tools and is highly weather dependent. In that reason these parameters are excluded from controllable quality parameters in policy in Estonia. Within the project "Interactive Soil Quality Assessment in Europe and China for Agricultural Productivity and Environmental Resilience" (iSQAPER) the visual soil assessment (VSA) tool was developed for easy detection of soil quality as well the different soil friendly agricultural management practices (AMP) were detected. The aim of current study was to test the VSA tool on Estonian farm fields under different management practices and compare the results with laboratory measurements. The main focus was set on soil physical parameters. Next to the VSA, the undisturbed soil samples were collected from the depth of 5-10 cm and 25-30 cm. The study revealed that results of a visually assessed soil physical parameters, such a soil structure, soil structural stability, soil porosity, presence of tillage pan, were confirmed by laboratory measurements in most cases. Soil water stable structure measurement on field (on 1 cm2 net in one 1 l box with 4-6 cm air dry clods for 5-10 min) underestimated very well structured soil on grassland and overestimated the structure aggregates stability of compacted soil. The slightly better soil quality was detected under no-tillage compared to ploughed soils. However, the ploughed soil got higher quality points compared with minimum tillage. The slurry application (organic manuring) had

  5. Application of the International Classification of Functioning, Disability and Health (ICF) to people with dysphagia following non-surgical head and neck cancer management.

    Science.gov (United States)

    Nund, Rebecca L; Scarinci, Nerina A; Cartmill, Bena; Ward, Elizabeth C; Kuipers, Pim; Porceddu, Sandro V

    2014-12-01

    The International Classification of Functioning, Disability, and Health (ICF) is an internationally recognized framework which allows its user to describe the consequences of a health condition on an individual in the context of their environment. With growing recognition that dysphagia can have broad ranging physical and psychosocial impacts, the aim of this paper was to identify the ICF domains and categories that describe the full functional impact of dysphagia following non-surgical head and neck cancer (HNC) management, from the perspective of the person with dysphagia. A secondary analysis was conducted on previously published qualitative study data which explored the lived experiences of dysphagia of 24 individuals with self-reported swallowing difficulties following HNC management. Categories and sub-categories identified by the qualitative analysis were subsequently mapped to the ICF using the established linking rules to develop a set of ICF codes relevant to the impact of dysphagia following HNC management. The 69 categories and sub-categories that had emerged from the qualitative analysis were successfully linked to 52 ICF codes. The distribution of these codes across the ICF framework revealed that the components of Body Functions, Activities and Participation, and Environmental Factors were almost equally represented. The findings confirm that the ICF is a valuable framework for representing the complexity and multifaceted impact of dysphagia following HNC. This list of ICF codes, which reflect the diverse impact of dysphagia associated with HNC on the individual, can be used to guide more holistic assessment and management for this population.

  6. Biomechanics, diagnosis, and treatment outcome in inflammatory myopathy presenting as oropharyngeal dysphagia

    Science.gov (United States)

    Williams, R B; Grehan, M J; Hersch, M; Andre, J; Cook, I J

    2003-01-01

    Aims: In patients with inflammatory myopathy and dysphagia, our aims were to determine: (1) the diagnostic utility of clinical and laboratory indicators; (2) the biomechanical properties of the pharyngo-oesophageal segment; (3) the usefulness of pharyngeal videomanometry in distinguishing neuropathic from myopathic dysphagia; and (4) clinical outcome. Methods: Clinical, laboratory, and videomanometric assessment was performed in 13 patients with myositis and dysphagia, in 17 disease controls with dysphagia (due to proven CNS disease), and in 22 healthy age matched controls. The diagnostic accuracy of creatine kinase (CPK), erythrocyte sedimentation rate, antinuclear antibody, and electromyography (EMG) were compared with the gold standard muscle biopsy. The biomechanical properties of the pharyngo-oesophageal segment were assessed by videomanometry. Results: Mean time from dysphagia onset to the diagnosis of myositis was 55 months (range 1–180). One third had no extrapharyngeal muscle weakness; 25% had normal CPK, and EMG was unhelpful in 28%. Compared with neurogenic controls, myositis patients had more prevalent cricopharyngeal restrictive disorders (69% v 14%; p=0.0003), reduced upper oesophageal sphincter (UOS) opening (p=0.01), and elevated hypopharyngeal intrabolus pressures (p=0.001). Videomanometric features favouring a myopathic over a neuropathic aetiology were: preserved pharyngeal swallow response, complete UOS relaxation, and normal swallow coordination. The 12 month mortality was 31%. Conclusions: The notable lack of supportive clinical signs and significant false negative rates for laboratory tests contribute to the marked delay in diagnosis. The myopathic process is strongly associated with restricted sphincter opening suggesting that cricopharyngeal disruption is a useful adjunct to immunosuppressive therapy. The condition has a poor prognosis. PMID:12631653

  7. From Clinical-Developmental Theory to Assessment: The Holistic Student Assessment Tool

    Directory of Open Access Journals (Sweden)

    Gil Noam

    2012-12-01

    Full Text Available A description and test of the Holistic Student Assessment Tool (HSA, an assessment tool to measure children’s and adolescents’ resiliencies in relation to externalizing and internalizing problem behaviors. The HSA is based on the authors’ research-based clinical-developmental Clover Leaf Model of resilience and psychopathology, and is one of the first attempts at closing the gap between risk and resilience approaches in developmental assessment. The HSA was tested in a cross-sectional sample of 423 children and adolescents.The results lend support to the HSA as a valid measure of children’s and adolescents’ resiliencies. Furthermore, the resilience scales mostly exhibited the theoretically expected convergent and divergent relationships with the psychopathology scales. In addition, we show how the resilience scales predict adolescents’ externalizing and internalizing symptoms. We contend that evidence-based intervention to address youth aggression needs to be based on sounddevelopmental assessment.

  8. Ultrasound as a Tool to Assess Body Fat

    Directory of Open Access Journals (Sweden)

    Dale R. Wagner

    2013-01-01

    Full Text Available Ultrasound has been used effectively to assess body fat for nearly 5 decades, yet this method is not known as well as many other body composition techniques. The purpose of this review is to explain the technical principles of the ultrasound method, explain the procedures for taking a measurement and interpreting the results, evaluate the reliability and validity of this method for measuring subcutaneous and visceral adipose tissue, highlight the advantages and limitations of ultrasound relative to other body composition methods, consider its utility to clinical populations, and introduce new body composition-specific ultrasound technology. The focus of this review is adipose, although various tissue thicknesses (e.g., muscle and bone can be measured with ultrasound. Being a portable imaging device that is capable of making fast regional estimates of body composition, ultrasound is an attractive assessment tool in instances when other methods are limited. Furthermore, much of the research suggests that it is reliable, reproducible, and accurate. The biggest limitations appear to be a lack of standardization for the measurement technique and results that are highly dependent on operator proficiency. New ultrasound devices and accompanying software designed specifically for the purpose of body composition assessment might help to minimize these limitations.

  9. Embedded performance validity testing in neuropsychological assessment: Potential clinical tools.

    Science.gov (United States)

    Rickards, Tyler A; Cranston, Christopher C; Touradji, Pegah; Bechtold, Kathleen T

    2017-01-31

    The article aims to suggest clinically-useful tools in neuropsychological assessment for efficient use of embedded measures of performance validity. To accomplish this, we integrated available validity-related and statistical research from the literature, consensus statements, and survey-based data from practicing neuropsychologists. We provide recommendations for use of 1) Cutoffs for embedded performance validity tests including Reliable Digit Span, California Verbal Learning Test (Second Edition) Forced Choice Recognition, Rey-Osterrieth Complex Figure Test Combination Score, Wisconsin Card Sorting Test Failure to Maintain Set, and the Finger Tapping Test; 2) Selecting number of performance validity measures to administer in an assessment; and 3) Hypothetical clinical decision-making models for use of performance validity testing in a neuropsychological assessment collectively considering behavior, patient reporting, and data indicating invalid or noncredible performance. Performance validity testing helps inform the clinician about an individual's general approach to tasks: response to failure, task engagement and persistence, compliance with task demands. Data-driven clinical suggestions provide a resource to clinicians and to instigate conversation within the field to make more uniform, testable decisions to further the discussion, and guide future research in this area.

  10. Evaluation of the literature: evidence assessment tools for clinicians.

    Science.gov (United States)

    Prato, Giovanpaolo Pini; Pagliaro, Umberto; Buti, Jacopo; Rotundo, Roberto; Newman, Michael G

    2013-12-01

    The progressive improvement in the quality of scientific articles has led to an increase in difficulty in reading and interpreting them so that now clinical knowledge and experience must be complemented by methodological, statistical and computer skills. The aim of this article is to offer practitioners the tools, the simplest keys, that will allow them to understand and critically judge the results of scientific studies. The "peer-review" process of a clinical article submitted to a journal is described and the Science Citation Index and the Impact Factor are presented to the reader as essential instruments to evaluate a specific article's impact and the impact of a given journal on the scientific world, respectively. An article should be evaluated on the basis of some key issues which include, at least, an assessment of methodological aspects, a critical analysis of the statistical component and a proper understanding of the clinical impact of the study outcomes. The standard approach for evaluating the quality of individual studies is based on a hierarchical grading system of research design which represents an essential tool to identify the strength of the evidence of an article. Many different biases may affect the reliability of study results. Randomized Control Trials (RCTs) and Systematic Reviews (SRs) are able to minimize the number of biases and thus are at the highest level of the scale of evidence representing the final steps of a treatment's "career." Finally, moving from research to clinical practice, attention on the clinical impact of study's outcomes is of paramount importance as the literature contains studies (including RCTs) that present statistically significant results but which, from the clinical standpoint, are only relatively or not at all significant. Clinical Practice Guidelines represent a useful tool for practitioners assisting the decision-making process when choosing the most appropriate treatment for their patients.

  11. Users' manual for the Hydroecological Integrity Assessment Process software (including the New Jersey Assessment Tools)

    Science.gov (United States)

    Henriksen, James A.; Heasley, John; Kennen, Jonathan G.; Nieswand, Steven

    2006-01-01

    This manual is a user’s guide to four computer software tools that have been developed for the Hydroecological Integrity Assessment Process. The Hydroecological Integrity Assessment Process recognizes that streamflow is strongly related to many critical physiochemical components of rivers, such as dissolved oxygen, channel geomorphology, and water temperature, and can be considered a “master variable” that limits the disturbance, abundance, and diversity of many aquatic plant and animal species.

  12. Using urban forest assessment tools to model bird habitat potential

    Science.gov (United States)

    Lerman, Susannah B.; Nislow, Keith H.; Nowak, David J.; Destefano, Stephen; King, David I.; Jones-Farrand, D. Todd

    2014-01-01

    The alteration of forest cover and the replacement of native vegetation with buildings, roads, exotic vegetation, and other urban features pose one of the greatest threats to global biodiversity. As more land becomes slated for urban development, identifying effective urban forest wildlife management tools becomes paramount to ensure the urban forest provides habitat to sustain bird and other wildlife populations. The primary goal of this study was to integrate wildlife suitability indices to an existing national urban forest assessment tool, i-Tree. We quantified available habitat characteristics of urban forests for ten northeastern U.S. cities, and summarized bird habitat relationships from the literature in terms of variables that were represented in the i-Tree datasets. With these data, we generated habitat suitability equations for nine bird species representing a range of life history traits and conservation status that predicts the habitat suitability based on i-Tree data. We applied these equations to the urban forest datasets to calculate the overall habitat suitability for each city and the habitat suitability for different types of land-use (e.g., residential, commercial, parkland) for each bird species. The proposed habitat models will help guide wildlife managers, urban planners, and landscape designers who require specific information such as desirable habitat conditions within an urban management project to help improve the suitability of urban forests for birds.

  13. Psychometric properties of the Turkish form of Codependency Assessment Tool.

    Science.gov (United States)

    Ançel, Gülsüm; Kabakçi, Elif

    2009-12-01

    This study evaluated the psychometric properties of the Codependency Assessment Tool (CODAT) developed by C. Hughes Hammer, D. S. Martsolf, and R. A. Zeller (1998a, 1998b) for Turkish students and investigated the relationship of codependency with attachment styles and family problems. After the translation of the CODAT, Beck Depression Inventory, Experiences in Close Relationships-Revised, and Family Problems of Young Adulthood Evaluation Scale, each was administrated to Turkish female nurse students (n = 400). Factor analysis and Cronbach's alpha values were then computed. Five-factor solution revealed a similar factor structure for the Turkish version of CODAT compared with that of the original tool. Five factors explained 48.38% of the variance. All of the items (with one exception) loaded on their original factors. Cronbach's alpha values for factors ranged between .62 and .78. For the total score, Cronbach's alpha was found to be .75. After statistically controlling for the effects of depressive symptoms, analysis of covariance (ANCOVA) was conducted to investigate if the attachment styles and family problems would change depending on codependency levels. For ANCOVAs, CODAT scores were treated at three levels. Students with higher CODAT scores had more attachment-related anxiety and reported more family problems after controlling for the effects of depressive symptoms. Our research results support the internal consistency and validity of the Turkish version of CODAT.

  14. Tools for peer assessment in an e-learning environment

    Directory of Open Access Journals (Sweden)

    Hugo Nordseth

    2010-11-01

    Full Text Available Our exploration of peer assessment in the formative feedback of themes within ITL111 Digital Competence for teachers (15 ECTS and GEO102 Physical Geography (15 ECTS is based on support from tools within the LMS, sets of learning based outcomes, rubrics and Six Thinking Hats. The overall effect is improved quality of the student assignments and deeper learning. The best results were registered with the use of rubrics where the students were presented with clearly defined criteria for expected performance on a sample of different themes within the course. In order to perform the peer review, the students had to acquire the basic knowledge of the various themes. In addition, seeing how others solved the assignment provided the student with reflections on the themes that would improve the student's own final portfolio.

  15. LIFE CYCLE ASSESSMENT (LCA AS A TOOL FOR BUSINESS STRATEGY

    Directory of Open Access Journals (Sweden)

    Rodrigo Salvador

    2014-09-01

    Full Text Available The growing concern about the development of sustainable production systems leads organizations to seek the support of management tools for decision-making. Considering the whole life cycle of the product, the Life Cycle Assessment (LCA has an important role in this scenario. The objective of this paper is to present, through the theoretical discussion, the role of LCA in strategic planning of the organization. It showed the enormous potential for decision making on the environmental aspect, but also the critical factor in the development shares in the competitive context. The use of LCA can reduce the environmental impacts of the system under study (primary purpose and guide the range of advantages in the fields of marketing, legislation and environmental labeling, competitive strategies, efficiency use of resources and others.

  16. Friedman 家庭评估模式在脑卒中吞咽障碍病人康复护理中的应用效果%Appl ication of Friedman family assessment model in rehabil itation nursing of stroke patients with dysphagia

    Institute of Scientific and Technical Information of China (English)

    史琴芬

    2014-01-01

    Objective:To observe the effect of Friedman family assessment model of rehabilitation nursing for stroke patients with dysphagia.Meth-ods:A total of 89 stroke patients with dysphagia were randomly divided into control group (44 cases)and observation group (45 cases).Patients in control group received conventional rehabilitation nursing,patients in observation group received rehabilitation nursing of Friedman family e-valuation model,and the intervention effect was compared between two groups after 3 months of intervention.Results:After the intervention,the total effective rate of observation group and control group were respective 86.67% and 47.73%,and the difference was statistically significant (P <0.05 ).Conclusion:Friedman family assessment model can improve the swallowing function of stroke patients with dysphagia,ensure the nutri-tion intake and promote the rehabilitation of the patients.%[目的]观察 Friedman 家庭评估模式应用于脑卒中吞咽障碍病人康复护理中的效果。[方法]随机将脑卒中吞咽障碍病人89例分为对照组(44例)和观察组(45例),对照组病人接受常规康复护理,观察组在对照组的基础上接受 Friedman 家庭评估模式康复护理,干预3个月后比较两组病人的干预效果。[结果]干预后观察组、对照组总有效率分别为86.67%和47.73%,差异有统计学意义(P <0.05)。[结论] Friedman 家庭评估模式可改善脑卒中吞咽功能障碍病人的吞咽功能,保证营养的摄入,促进病人康复。

  17. Oropharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: observational prospective study.

    Science.gov (United States)

    Cabré, Mateu; Serra-Prat, Mateu; Force, Ll; Almirall, Jordi; Palomera, Elisabet; Clavé, Pere

    2014-03-01

    To determine whether oropharyngeal dysphagia is a risk factor for readmission for pneumonia in elderly persons discharged from an acute geriatric unit. Observational prospective cohort study with data collection based on clinical databases and electronic clinical notes. All elderly individuals discharged from an acute geriatric unit from June 2002 to December 2009 were recruited and followed until death or December 31, 2010. All individuals were initially classified according to the presence of oropharyngeal dysphagia assessed by bedside clinical examination. Main outcome measure was readmission for pneumonia. Clinical notes were reviewed by an expert clinician to verify diagnosis and classify pneumonia as aspiration or nonaspiration pneumonia. A total of 2,359 patients (61.9% women, mean age 84.9 y) were recruited and followed for a mean of 24 months. Dysphagia was diagnosed in 47.5% of cases. Overall, 7.9% of individuals were readmitted for pneumonia during follow-up, 24.2% of these had aspiration pneumonia. The incidence rate of hospital readmission for pneumonia was 3.67 readmissions per 100 person-years (95% CI 3.0-4.4) in individuals without dysphagia and 6.7 (5.5-7.8) in those with dysphagia, with an attributable risk of 3.02 readmissions per 100 person-years (1.66-4.38) and a rate ratio of 1.82 (1.41-2.36). Multivariate Cox regression showed an independent effect of oropharyngeal dysphagia, with a hazard ratio of 1.6 (1.15-2.2) for hospitalization for pneumonia, 4.48 (2.01-10.0) for aspiration pneumonia, and 1.44 (1.02-2.03) for nonaspiration pneumonia. Oropharyngeal dysphagia is a very prevalent and relevant risk factor associated with hospital readmission for both aspiration and nonaspiration pneumonia in the very elderly persons.

  18. Acute and long-term dysphagia in critically ill patients with severe sepsis: results of a prospective controlled observational study.

    Science.gov (United States)

    Zielske, Joerg; Bohne, Silvia; Brunkhorst, Frank M; Axer, Hubertus; Guntinas-Lichius, Orlando

    2014-11-01

    Dysphagia is a major risk factor for morbidity and mortality in critically ill patients treated in intensive care units (ICUs). Structured otorhinolaryngological data on dysphagia in ICU survivors with severe sepsis are missing. In a prospective study, 30 ICU patients with severe sepsis and thirty without sepsis as control group were examined using bedside fiberoptic endoscopic evaluation of swallowing after 14 days in the ICU (T1) and 4 months after onset of critical illness (T2). Swallowing dysfunction was assessed using the Penetration-Aspiration Scale (PAS). The Functional Oral Intake Scale was applied to evaluate the diet needed. Primary endpoint was the burden of dysphagia defined as PAS score >5. At T1, 19 of 30 severe sepsis patients showed aspiration with a PAS score >5, compared to 7 of 30 in critically ill patients without severe sepsis (p = 0.002). Severe sepsis and tracheostomy were independent risk factors for severe dysphagia with aspiration (PAS > 5) at T1 (p = 0.042 and 0.006, respectively). 4-month mortality (T2) was 57 % in severe sepsis patients compared to 20 % in patients without severe sepsis (p = 0.006). At T2, more severe sepsis survivors were tracheostomy-dependent and needed more often tube or parenteral feeding (p = 0.014 and p = 0.040, respectively). Multivariate analysis revealed tracheostomy at T1 as independent risk factor for severe dysphagia at T2 (p = 0.030). Severe sepsis appears to be a relevant risk factor for long-term dysphagia. An otorhinolaryngological evaluation of dysphagia at ICU discharge is mandatory for survivors of severe critical illness to plan specific swallowing rehabilitation programs.

  19. Thinking Tools in Computer-Based Assessment: Technology Enhancements in Assessments for Learning

    Science.gov (United States)

    Rosen, Yigal

    2014-01-01

    One of the greatest concerns in schools today is how teachers can bring together assessment and learning in a way that is meaningful for students' thinking skills, while focusing on content standards. Better understanding of how different types of technology based thinking tools can be used for improving classroom teaching and learning,…

  20. An ensemble model of QSAR tools for regulatory risk assessment.

    Science.gov (United States)

    Pradeep, Prachi; Povinelli, Richard J; White, Shannon; Merrill, Stephen J

    2016-01-01

    Quantitative structure activity relationships (QSARs) are theoretical models that relate a quantitative measure of chemical structure to a physical property or a biological effect. QSAR predictions can be used for chemical risk assessment for protection of human and environmental health, which makes them interesting to regulators, especially in the absence of experimental data. For compatibility with regulatory use, QSAR models should be transparent, reproducible and optimized to minimize the number of false negatives. In silico QSAR tools are gaining wide acceptance as a faster alternative to otherwise time-consuming clinical and animal testing methods. However, different QSAR tools often make conflicting predictions for a given chemical and may also vary in their predictive performance across different chemical datasets. In a regulatory context, conflicting predictions raise interpretation, validation and adequacy concerns. To address these concerns, ensemble learning techniques in the machine learning paradigm can be used to integrate predictions from multiple tools. By leveraging various underlying QSAR algorithms and training datasets, the resulting consensus prediction should yield better overall predictive ability. We present a novel ensemble QSAR model using Bayesian classification. The model allows for varying a cut-off parameter that allows for a selection in the desirable trade-off between model sensitivity and specificity. The predictive performance of the ensemble model is compared with four in silico tools (Toxtree, Lazar, OECD Toolbox, and Danish QSAR) to predict carcinogenicity for a dataset of air toxins (332 chemicals) and a subset of the gold carcinogenic potency database (480 chemicals). Leave-one-out cross validation results show that the ensemble model achieves the best trade-off between sensitivity and specificity (accuracy: 83.8 % and 80.4 %, and balanced accuracy: 80.6 % and 80.8 %) and highest inter-rater agreement [kappa (κ): 0

  1. The development of a practical tool for risk assessment of manual work – the HAT-tool

    NARCIS (Netherlands)

    Kraker, H. de; Douwes, M.

    2008-01-01

    For the Dutch Ministry of Social Affairs and Employment we developed a tool to assess the risks of developing complaints of the arm, neck or shoulders during manual work. The tool was developed for every type of organization and is easy to use, does not require measurements other than time and can b

  2. The development of a practical tool for risk assessment of manual work – the HAT-tool

    NARCIS (Netherlands)

    Kraker, H. de; Douwes, M.

    2008-01-01

    For the Dutch Ministry of Social Affairs and Employment we developed a tool to assess the risks of developing complaints of the arm, neck or shoulders during manual work. The tool was developed for every type of organization and is easy to use, does not require measurements other than time and can b

  3. In Vitro Exposure Systems and Dosimetry Assessment Tools ...

    Science.gov (United States)

    In 2009, the passing of The Family Smoking Prevention and Tobacco Control Act facilitated the establishment of the FDA Center for Tobacco Products (CTP) and gave it regulatory authority over the marketing, manufacture and distribution of tobacco products, including those termed “modified risk”. On 4-6 April 2016, the Institute for In Vitro Sciences, Inc. (IIVS) convened a workshop conference titled “In Vitro Exposure Systems and Dosimetry Assessment Tools for Inhaled Tobacco Products” to bring together stakeholders representing regulatory agencies, academia, and industry to address the research priorities articulated by the FDA CTP. Specific topics were covered to assess the status of current in vitro smoke and aerosol/vapor exposure systems, as well as the various approaches and challenges to quantifying the complex exposures, in in vitro pulmonary models developed for evaluating adverse pulmonary events resulting from tobacco product exposures. The four core topics covered were, 1) Tobacco Smoke And E-Cigarette Aerosols, 2) Air-Liquid Interface-In Vitro Exposure Systems, 3) Dosimetry Approaches For Particles And Vapors; In Vitro Dosimetry Determinations and 4) Exposure Microenvironment/Physiology Of Cells. The two and a half day workshop included presentations from 20 expert speakers, poster sessions, networking discussions, and breakout sessions which identified key findings and provided recommendations to advance these technologies. Here, we will re

  4. Biomonitoring tools and risk assessment in the Arctic

    Energy Technology Data Exchange (ETDEWEB)

    Camus, L. [Akvaplan-niva, Polar Environmental Centre, Tromso (Norway); Univercity Centre at Svalbard, (Norway); Nahrgang, J.; Olsen, G.H. [Akvaplan-niva, Polar Environmental Centre, Tromso (Norway)

    2009-07-01

    With the expansion of oil and gas exploration and production activities in the Arctic, there is a need for reliable risk assessment and environmental monitoring tools adapted for the Arctic environment. Probabilistic approaches for risk assessment are used by offshore operators in the Norwegian sector of the North Sea. However, these methods are based on toxicity data on temperate species because there is insufficient data to run these models on Arctic species. Therefore, this study was conducted to perform toxicity tests with Arctic species and calculate their sensitivity distribution curve. The study was based on the Norwegian Water Column Monitoring programme. It involved a 3 year project to characterize the biological response of polar cold to oil exposure. Waterborne and dietary exposure to crude oil in polar cod collected in Svalbard was monitored. Many biological indexes ranging from molecular to biochemical, cellular and physiological levels were measured at various time points for biomonitoring the impact of oil in pack ice ecosystems. 29 refs., 3 tabs.

  5. A Participatory Approach to Develop the Power Mobility Screening Tool and the Power Mobility Clinical Driving Assessment Tool

    Directory of Open Access Journals (Sweden)

    Deepan C. Kamaraj

    2014-01-01

    Full Text Available The electric powered wheelchair (EPW is an indispensable assistive device that increases participation among individuals with disabilities. However, due to lack of standardized assessment tools, developing evidence based training protocols for EPW users to improve driving skills has been a challenge. In this study, we adopt the principles of participatory research and employ qualitative methods to develop the Power Mobility Screening Tool (PMST and Power Mobility Clinical Driving Assessment (PMCDA. Qualitative data from professional experts and expert EPW users who participated in a focus group and a discussion forum were used to establish content validity of the PMCDA and the PMST. These tools collectively could assess a user’s current level of bodily function and their current EPW driving capacity. Further multicenter studies are necessary to evaluate the psychometric properties of these tests and develop EPW driving training protocols based on these assessment tools.

  6. Clinical signs of dysphagia in infants with acute viral bronchiolitis☆

    Science.gov (United States)

    Barbosa, Lisiane De Rosa; Gomes, Erissandra; Fischer, Gilberto Bueno

    2014-01-01

    Objective: To determine the occurrence of clinical signs of dysphagia in infants with acute viral bronchiolitis, to compare the respiratory parameters during deglutition, and to ensure the intra- and inter- examiners agreement, as well as to accomplish intra and interexaminators concordance of the clinical evaluation of the deglutition. Methods: This was a cross-sectional study of 42 infants aged 0-12 months. The clinical evaluation was accompanied by measurements of respiratory rate and pulse oximetry. A score of swallowing disorders was designed to establish associations with other studied variables and to ensure the intra- and interrater agreement of clinical feeding assessments. Caregivers also completed a questionnaire about feeding difficulties. Significance was set at pdysphagia. PMID:25479843

  7. [Clinical signs of dysphagia in infants with acute viral bronchiolitis].

    Science.gov (United States)

    Barbosa, Lisiane De Rosa; Gomes, Erissandra; Fischer, Gilberto Bueno

    2014-09-01

    To determine the occurrence of clinical signs of dysphagia in infants with acute viral bronchiolitis, to compare the respiratory parameters during deglutition, and to ensure the intra- and inter- examiners agreement, as well as to accomplish intra and interexaminators concordance of the clinical evaluation of the deglutition. This was a cross-sectional study of 42 infants aged 0-12 months. The clinical evaluation was accompanied by measurements of respiratory rate and pulse oximetry. A score of swallowing disorders was designed to establish associations with other studied variables and to ensure the intra- and interrater agreement of clinical feeding assessments. Caregivers also completed a questionnaire about feeding difficulties. Significance was set at pdysphagia. Copyright © 2014 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. A rare cause of dysphagia: Herpes simplex esophagitis

    Institute of Scientific and Technical Information of China (English)

    Bee Lee; Grant Caddy

    2007-01-01

    Herpes simplex esophagitis (HSE) is well documented in immunosuppressed patients. However, it is rare in the immunocompetent host. We present a case of HSE in a 21 year-old healthy lady who was admitted to our unit with dysphagia, odynophagia and chest pAln. Clinical examination revealed mild epigastric tenderness and admission bloods including full blood picture, electrolytes and inflammatory markers were normal. She underwent an esophagogastroduodenoscopy (EGD) which revealed severe exudative, well-circumscribed ulcerations in her distal esophagus. Biopsies confirmed severe esophagitis with acute ulceration and subsequent polymerase chAln reaction (PCR) confirmed herpes simplex virus (HSV) type 1. Subsequent assessment fAlled to identify an immune disorder. HSE should be suspected when faced with characteristic endoscopic findings, even if the patient is immunocompetent. When the diagnosis of HSE is confirmed, an immune deficiency should be sought.

  9. Using the Program Sustainability Assessment Tool to Assess and Plan for Sustainability

    Science.gov (United States)

    Mainor, Avia; Moreland-Russell, Sarah; Maier, Ryan C.; Brossart, Laura; Luke, Douglas A.

    2014-01-01

    Implementing and growing a public health program that benefits society takes considerable time and effort. To ensure that positive outcomes are maintained over time, program managers and stakeholders should plan and implement activities to build sustainability capacity within their programs. We describe a 3-part sustainability planning process that programs can follow to build their sustainability capacity. First, program staff and stakeholders take the Program Sustainability Assessment Tool to measure their program’s sustainability across 8 domains. Next, managers and stakeholders use results from the assessment to inform and prioritize sustainability action planning. Lastly, staff members implement the plan and keep track of progress toward their sustainability goals. Through this process, staff can more holistically address the internal and external challenges and pressures associated with sustaining a program. We include a case example of a chronic disease program that completed the Program Sustainability Assessment Tool and engaged in program sustainability planning. PMID:24456644

  10. Using the Program Sustainability Assessment Tool to assess and plan for sustainability.

    Science.gov (United States)

    Calhoun, Annaliese; Mainor, Avia; Moreland-Russell, Sarah; Maier, Ryan C; Brossart, Laura; Luke, Douglas A

    2014-01-23

    Implementing and growing a public health program that benefits society takes considerable time and effort. To ensure that positive outcomes are maintained over time, program managers and stakeholders should plan and implement activities to build sustainability capacity within their programs. We describe a 3-part sustainability planning process that programs can follow to build their sustainability capacity. First, program staff and stakeholders take the Program Sustainability Assessment Tool to measure their program's sustainability across 8 domains. Next, managers and stakeholders use results from the assessment to inform and prioritize sustainability action planning. Lastly, staff members implement the plan and keep track of progress toward their sustainability goals. Through this process, staff can more holistically address the internal and external challenges and pressures associated with sustaining a program. We include a case example of a chronic disease program that completed the Program Sustainability Assessment Tool and engaged in program sustainability planning.

  11. Dysphagia in inflammatory myopathy: clinical characteristics, treatment strategies, and outcome in 62 patients.

    Science.gov (United States)

    Oh, Terry H; Brumfield, Kathlyn A; Hoskin, Tanya L; Stolp, Kathryn A; Murray, Joseph A; Bassford, Jeffrey R

    2007-04-01

    To assess the clinical characteristics, treatment, and outcome of patients with inflammatory myopathy-associated dysphagia. We retrospectively reviewed the medical records of all patients with inflammatory myopathy-associated dysphagia seen at the Mayo Clinic in Rochester, Minn, between January 1, 1997, and December 31, 2001. A total of 783 patients were diagnosed as having inflammatory myopathy during the 5-year study period. Of these, 62 patients (41 women and 21 men; mean age, 68.6 years) had inflammatory myopathy-associated dysphagia: 26 with inclusion body myositis (IBM), 18 with dermatomyositis, 9 with polymyositis, and 9 with overlap syndrome. Dysphagia was a presenting symptom in 13 patients (21%), with the highest incidence in the IBM group. Videofluoroscopic examinations revealed pharyngeal pooling and impaired oropharyngeal and cricopharyngeal function. The benefits of swallowing compensation techniques and exercises were difficult to establish. Interventional procedures were performed in 24 patients (39%) and most frequently (62%) in patients with IBM, with cricopharyngeal myotomy being most beneficial. Patients with IBM had the least symptomatic improvement. Overall, 11 patients died during the median follow-up of 38 months, with respiratory failure due to aspiration pneumonia as the most common cause. Mortality was high in patients who required percutaneous endoscopic gastrostomy (7/11, 64%), and 1- year mortality was highest (31%) in those with dermatomyositis. Dysphagia is a serious and at times presenting problem in patients with inflammatory myopathy. It occurs most frequently and appears to be most refractory in patients with IBM. The mortality rate was high in patients who required percutaneous endoscopic gastrostomy, and the 1-year mortality rate was the highest in patients with dermatomyositis.

  12. Acoustic characteristics of voluntary expiratory sounds after swallow for detecting dysphagia.

    Science.gov (United States)

    Yamashita, M; Yokoyama, K; Takei, Y; Furuya, N; Nakamichi, Y; Ihara, Y; Takahashi, K; Groher, M E

    2014-09-01

    This research was designed to investigate the acoustic characteristics of voluntary expiratory sounds after swallow for detecting dysphagia. Forty-nine patients with complaints of swallow difficulty received a videofluorographic (VF) examination. They were divided into three groups: nine who did not have any apparent disease (Group N), 22 patients with head and neck cancer (Group H&N) and 18 patients with other diseases including cerebrovascular disease (Group OD). After liquid barium swallows, they exhaled voluntarily without voicing. Videofluorographic findings were classified into four groups: normal (Normal), acceptable swallow (Acceptable), swallow with residue (Resid) and swallows with penetration or aspiration (Pen/Asp). The duration of expiratory sounds was measured on the time waveform. Frequency characteristics of expiratory sounds were obtained using one-third octave band analysis ranging from 62·5 to 2000·0 Hz of central frequency. The averaged level of the 1000·0-Hz band was chosen as the reference band level (RB level). The revised averaged level of each band was obtained by subtracting the RB level from the averaged level of each band. Zero decibel of the revised magnitude of the 125·0-Hz band was set as the critical value to differentiate dysphagia (Resid or Pen/Asp) from no dysphagia (Normal or Acceptable). Comparison of this assessment with VF findings showed a significant percentage agreement (85·4%). These results suggest that frequency characteristics of post-swallow expiratory sounds can differentiate dysphagia from no dysphagia among multiple dysphagic patient groups. © 2014 John Wiley & Sons Ltd.

  13. Development and assessment of the Alberta Context Tool

    Directory of Open Access Journals (Sweden)

    Birdsell Judy M

    2009-12-01

    Full Text Available Abstract Background The context of healthcare organizations such as hospitals is increasingly accepted as having the potential to influence the use of new knowledge. However, the mechanisms by which the organizational context influences evidence-based practices are not well understood. Current measures of organizational context lack a theory-informed approach, lack construct clarity and generally have modest psychometric properties. This paper presents the development and initial psychometric validation of the Alberta Context Tool (ACT, an eight dimension measure of organizational context for healthcare settings. Methods Three principles guided the development of the ACT: substantive theory, brevity, and modifiability. The Promoting Action on Research Implementation in Health Services (PARiHS framework and related literature were used to guide selection of items in the ACT. The ACT was required to be brief enough to be tolerated in busy and resource stretched work settings and to assess concepts of organizational context that were potentially modifiable. The English version of the ACT was completed by 764 nurses (752 valid responses working in seven Canadian pediatric care hospitals as part of its initial validation. Cronbach's alpha, exploratory factor analysis, analysis of variance, and tests of association were used to assess instrument reliability and validity. Results Factor analysis indicated a 13-factor solution (accounting for 59.26% of the variance in 'organizational context'. The composition of the factors was similar to those originally conceptualized. Cronbach's alpha for the 13 factors ranged from .54 to .91 with 4 factors performing below the commonly accepted alpha cut off of .70. Bivariate associations between instrumental research utilization levels (which the ACT was developed to predict and the ACT's 13 factors were statistically significant at the 5% level for 12 of the 13 factors. Each factor also showed a trend of

  14. The Sport Concussion Assessment Tool: a systematic review.

    Science.gov (United States)

    Yengo-Kahn, Aaron M; Hale, Andrew T; Zalneraitis, Brian H; Zuckerman, Scott L; Sills, Allen K; Solomon, Gary S

    2016-04-01

    OBJECTIVE Over the last 2 decades, sport-related concussion (SRC) has garnered significant attention. Even with increased awareness and athlete education, sideline recognition and real-time diagnosis remain crucial. The need for an objective and standardized assessment of concussion led to the eventual development of the Sport Concussion Assessment Tool (SCAT) during the Second International Conference on Concussion in Sport in 2004, which is now in its third iteration (SCAT3). In an effort to update our understanding of the most well-known sideline concussion assessment, the authors conducted a systematic review of the SCAT and the evidence supporting its use to date. METHODS English-language titles and abstracts published between 1995 and October 2015 were searched systematically across 4 electronic databases and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines adapted for the review of a heterogeneous collection of study designs. Peer-reviewed journal articles were included if they reported quantitative data on any iteration of the SCAT, Standardized Assessment of Concussion (SAC), or modified Balance Error Scoring System (mBESS) data at baseline or following concussion in an exclusively athlete population with any portion older than 13 years of age. Studies that included nonathletes, only children less than 13 years old, exclusively BESS data, exclusively symptom scale data, or a non-SCAT-related assessment were excluded. RESULTS The database search process yielded 549 abstracts, and 105 full-text articles were reviewed with 36 meeting criteria for inclusion. Nineteen studies were associated with the SAC, 1 was associated with the mBESS exclusively, and 16 studies were associated with a full iteration of the SCAT. The majority of these studies (56%) were prospective cohort studies. Male football players were the most common athletes studied. An analysis of the studies focused on

  15. [Factors associated with post-stroke oropharingeal dysphagia].

    Science.gov (United States)

    Peña-Chávez, Rodolfo; López-Espinoza, Miguel; Guzmán-Inostroza, Madelein; Jara-Parra, Mirna; Sepúlveda-Arriagada, Claudia; Sepulveda-Arriagada, Constanza; Zapata-Sepúlveda, Priscila

    2015-10-01

    Neurogenic dysphagia is a consequence of stroke that sometimes threatens the patient's life. The magnitude of the brain damage commonly generated by stroke generates the emergence of other disorders that accompany dysphagia and worsen the patient's health. To analyze possible associations between communication disorders, disease factors, demographic factors and comorbidities with post-stroke dysphagia in years 2009 to 2011. We studied 1519 medical records of patients that suffered stroke between 2009 and 2011. From medical records reviewed, 206 had dysphagia (13.6%). 80,1% from dysphagic patients had between 60 to 89 years old. 66% from them stayed hospitalized for more than 11 days. Age (odds ratio = 2.36; p dysphagia. Finally, 73,3% from dysphagic patients they had dysphagia with aphasia or dysarthria or apraxia of speech, however, 26,7% only had dysphagia. Neurogenic dysphagia seems to be associated with communication disorders, increase the time of hospitalization and associated with a hypertension. However, prospective studies consider a great time to confirm these findings are required.

  16. Challenges in oral drug delivery in patients with esophageal dysphagia

    NARCIS (Netherlands)

    Kappelle, W.F.; Siersema, P.D.; Bogte, A.; Vleggaar, F.P.

    2016-01-01

    INTRODUCTION: Esophageal dysphagia is a commonly reported symptom with various benign and malignant causes. Esophageal dysphagia can impede intake of oral medication, which often poses a major challenge for both patients and physicians. The best way to address this challenge depends of the cause of

  17. Family Involvement in School-Based Dysphagia Management

    Science.gov (United States)

    Angell, Maureen E.; Bailey, Rita L.; Nicholson, Joanna K.; Stoner, Julia B.

    2009-01-01

    This article provides a practitioner-friendly synthesis of existing literature on family involvement in the management of dysphagia for school-age. Research reviewed includes family perspectives on programs, therapists, and characteristics that comprise effective family involvement in school-based dysphagia management programs. Also included are…

  18. Risks associated with suspected dysphagia in infants admitted to a ...

    African Journals Online (AJOL)

    dysphagia and nutritional problems than typically developing, ... appears that a close relationship exists between dysphagia, the infant's ... nutrition and hydration.[13] ... participants were referred by medical doctors, nurses, audiologists,. SLTs ... Being a retrospective study, there was no direct ... HIV status of mother (N=196).

  19. Pharyngeal Electrical Stimulation for Treatment of Dysphagia in Subacute Stroke

    DEFF Research Database (Denmark)

    Bath, Philip M W; Scutt, Polly; Love, Jo

    2016-01-01

    BACKGROUND AND PURPOSE: Dysphagia is common after stroke, associated with increased death and dependency, and treatment options are limited. Pharyngeal electric stimulation (PES) is a novel treatment for poststroke dysphagia that has shown promise in 3 pilot randomized controlled trials. METHODS:...

  20. Transcultural adaptation of the Johns Hopkins Fall Risk Assessment Tool.

    Science.gov (United States)

    Martinez, Maria Carmen; Iwamoto, Viviane Ernesto; Latorre, Maria do Rosário Dias de Oliveira; Noronha, Adriana Moreira; Oliveira, Ana Paula de Sousa; Cardoso, Carlos Eduardo Alves; Marques, Ifigenia Augusta Braga; Vendramim, Patrícia; Lopes, Paula Cristina; Sant'Ana, Thais Helena Saes de

    2016-08-29

    to perform the transcultural adaptation and content validity analysis of the Johns Hopkins Fall Risk Assessment Tool to assess both fall risk and fall-related injury risk for hospitalized elderly in Brazil. the transcultural adaptation consisted of translating the scale to Portuguese (Brazil), back-translating it into its language of origin, establishing a consensus version, and having an expert committee verify its transcultural equivalence. Content assessment was conducted by a committee of judges, ending with the calculation of the items and scales' content validity index. Nurses tested the tool. the scale's translated version went through two evaluation rounds by the judges, based on which, the items with unsatisfactory performance were changed. The content validity index for the items was ≥80.0% and the global index 97.1%. The experimental application showed the scale is user-friendly. the scale presents valid content for the assessment of fall risk and risk of fall-related injuries and is easy to use, with the potential to contribute to the proper identification of risks and the establishment of care actions. realizar a adaptação transcultural para uso no Brasil e a avaliação da validade de conteúdo da Johns Hopkins Fall Risk Assessment Tool para avaliação de risco de quedas e de danos por quedas em pacientes adultos hospitalizados. adaptação transcultural consistiu na tradução da escala para a língua portuguesa (Brasil), retrotradução para a língua de origem, versão de consenso e análise da equivalência transcultural por um comitê de especialistas. A avaliação do conteúdo foi realizada por meio de um comitê de juízes, finalizando com o cálculo do índice de validade de conteúdo dos itens e da escala. Foi realizada a aplicação experimental do instrumento por enfermeiros. a versão traduzida da escala passou por duas rodadas de avaliação pelos juízes, a partir das quais os itens com desempenho insatisfatório foram modificados

  1. Dysphagia-gastroesophageal reflux complex: complications due to dysfunction of solitary tract nucleus-mediated vago-vagal reflex.

    Science.gov (United States)

    Saito, Y; Kawashima, Y; Kondo, A; Chikumaru, Y; Matsui, A; Nagata, I; Ohno, K

    2006-06-01

    We report on the complication of gastroesophageal reflux (GER) in four patients with lower brainstem dysfunction. These patients suffered from perinatal asphyxia, cerebellar hemorrhage, or congenital dysphagia of unknown origin and showed facial nerve palsy, inspiratory stridor due to vocal cord paralysis, central sleep apnea, and dysphagia, in various combinations. Naso-intestinal tube feeding was introduced in all of the patients due to recurrent vomiting and aspiration pneumonia resulting from GER. T2-weighted magnetic resonance (MR) imaging revealed symmetrical high intensity lesions in the tegmentum of the lower pons and the medulla oblongata in two of the patients, and pontomedullary atrophy in another patient. In normal subjects, lower esophageal sphincter contraction is provoked by distension of the gastric wall, through a vago-vagal reflex. Since this reflex arc involves the solitary tract nucleus, where the swallowing center is located, the association of dysphagia and GER in the present patients is thought to result from the lesions in the tegmentum of medulla oblongata. We propose the term "dysphagia-GER complex" to describe the disturbed motility of the upper digestive tract due to lower brainstem involvement. In children with brainstem lesions, neurological assessment of GER is warranted, in addition to the examination of other signs of brainstem dysfunction, including dysphagia and respiratory disturbance.

  2. Evaluation of an Innovative Digital Assessment Tool in Dental Anatomy.

    Science.gov (United States)

    Lam, Matt T; Kwon, So Ran; Qian, Fang; Denehy, Gerald E

    2015-05-01

    The E4D Compare software is an innovative tool that provides immediate feedback to students' projects and competencies. It should provide consistent scores even when different scanners are used which may have inherent subtle differences in calibration. This study aimed to evaluate potential discrepancies in evaluation using the E4D Compare software based on four different NEVO scanners in dental anatomy projects. Additionally, correlation between digital and visual scores was evaluated. Thirty-five projects of maxillary left central incisors were evaluated. Among these, thirty wax-ups were performed by four operators and five consisted of standard dentoform teeth. Five scores were obtained for each project: one from an instructor that visually graded the project and from four different NEVO scanners. A faculty involved in teaching the dental anatomy course blindly scored the 35 projects. One operator scanned all projects to four NEVO scanners (D4D Technologies, Richardson, TX, USA). The images were aligned to the gold standard, and tolerance set at 0.3 mm to generate a score. The score reflected percentage match between the project and the gold standard. One-way ANOVA with repeated measures was used to determine whether there was a significant difference in scores among the four NEVO scanners. Paired-sample t-test was used to detect any difference between visual scores and the average scores of the four NEVO scanners. Pearson's correlation test was used to assess the relationship between visual and average scores of NEVO scanners. There was no significant difference in mean scores among four different NEVO scanners [F(3, 102) = 2.27, p = 0.0852 one-way ANOVA with repeated measures]. Moreover, the data provided strong evidence that a significant difference existed between visual and digital scores (p = 0.0217; a paired - sample t-test). Mean visual scores were significantly lower than digital scores (72.4 vs 75.1). Pearson's correlation coefficient of 0.85 indicated

  3. Dysphagia in the patient after stroke: consequences and nurse intervention

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    Ana Frias

    2015-12-01

    Full Text Available Objectives: to check the consequences of poststroke dysphagia and to reflect on the nurse’s intervention in dysphagia rehabilitation. Methodology: it was performed a systematic literature review of the topic in question; research based on international databases EBSCOhost, LILACS, SciELO.We were able to identify some studies publications between 2006 and 2014. We intend to answer the guiding question: What are the consequences of dysphagia in the patient after stroke? » Results vs. Discussion: after a thorough analysis, we have selected 11 articles and found that the most frequent consequences of dysphagia are the pulmonary complications by saliva and/or food suction. The nurse specialist still has a barely visible role, but his/her interventions are critical in these patients rehabilitation. Conclusions: rehabilitation is essential to avoid the consequences of poststroke dysphagia. The rehabilitation process must go through a multidisciplinary team of which nurses are an integral and essential part.

  4. The spiritual distress assessment tool: an instrument to assess spiritual distress in hospitalised elderly persons

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    Martin Estelle

    2010-12-01

    Full Text Available Abstract Background Although spirituality is usually considered a positive resource for coping with illness, spiritual distress may have a negative influence on health outcomes. Tools are needed to identify spiritual distress in clinical practice and subsequently address identified needs. This study describes the first steps in the development of a clinically acceptable instrument to assess spiritual distress in hospitalized elderly patients. Methods A three-step process was used to develop the Spiritual Distress Assessment Tool (SDAT: 1 Conceptualisation by a multidisciplinary group of a model (Spiritual Needs Model to define the different dimensions characterizing a patient's spirituality and their corresponding needs; 2 Operationalisation of the Spiritual Needs Model within geriatric hospital care leading to a set of questions (SDAT investigating needs related to each of the defined dimensions; 3 Qualitative assessment of the instrument's acceptability and face validity in hospital chaplains. Results Four dimensions of spirituality (Meaning, Transcendence, Values, and Psychosocial Identity and their corresponding needs were defined. A formalised assessment procedure to both identify and subsequently score unmet spiritual needs and spiritual distress was developed. Face validity and acceptability in clinical practice were confirmed by chaplains involved in the focus groups. Conclusions The SDAT appears to be a clinically acceptable instrument to assess spiritual distress in elderly hospitalised persons. Studies are ongoing to investigate the psychometric properties of the instrument and to assess its potential to serve as a basis for integrating the spiritual dimension in the patient's plan of care.

  5. Integrated assessment of marine biodiversity status using a prototype indicator-based assessment tool

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    Jesper H. Andersen

    2014-10-01

    Full Text Available Integrated assessment of the status of marine biodiversity is and has been problematic compared to, for example, assessments of eutrophication and contamination status, mostly as a consequence of the fact that monitoring of marine habitats, communities and species is expensive, often collected at an incorrect spatial scale and/or poorly integrated with existing marine environmental monitoring efforts. The objective of this Method Paper is to introduce and describe a simple tool for integrated assessment of biodiversity status based on the HELCOM Biodiversity Assessment Tool (BEAT, where interim biodiversity indicators are grouped by themes: broad-scale habitats, communities, and species as well as supporting non-biodiversity indicators. Further, we report the application of an initial indicator-based assessment of biodiversity status of Danish marine waters where we have tentatively classified the biodiversity status of Danish marine waters. The biodiversity status was in no areas classified as ‘unaffected by human activities’. In all the 22 assessment areas, the status was classified as either ‘moderately affected by human activities’ or ‘significantly affected by human activities. Spatial variations in the biodiversity status were in general related to the eutrophication status as well as fishing pressure.

  6. Doloplus-2, a valid tool for behavioural pain assessment?

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    Loge Jon H

    2007-12-01

    Full Text Available Abstract Background The Doloplus-2 is used for behavioural pain assessment in cognitively impaired patients. Little data exists on the psychometric properties of the Doloplus-2. Our objectives were to test the criterion validity and inter-rater reliability of the Doloplus-2, and to explore a design for validations of behavioural pain assessment tools. Methods Fifty-one nursing home patients and 22 patients admitted to a geriatric hospital ward were included. All were cognitively impaired and unable to self-report pain. Each patient was examined by an expert in pain evaluation and treatment, who rated the pain on a numerical rating scale. The ratings were based on information from the medical record, reports from nurses and patients (if possible about pain during the past 24 hours, and a clinical examination. These ratings were used as pain criterion. The Doloplus-2 was administered by the attending nurse. Regression analyses were used to estimate the ability of the Doloplus-2 to explain the expert's ratings. The inter-rater reliability of the Doloplus-2 was evaluated in 16 patients by comparing the ratings of two nurses administrating the Doloplus-2. Results There was no association between the Doloplus-2 and the expert's pain ratings (R2 = 0.02. There was an association (R2 = 0.54 between the expert's ratings and the Doloplus-2 scores in a subgroup of 16 patients assessed by a geriatric expert nurse (the most experienced Doloplus-2 administrator. The inter-rater reliability between the Doloplus-2 administrators assessed by the intra-class coefficient was 0.77. The pain expert's ratings were compared with ratings of two independent geriatricians in a sub sample of 15, and were found satisfactory (intra-class correlation 0.74. Conclusion It was challenging to conduct such a study in patients with cognitive impairment and the study has several limitations. The results do not support the validity of the Doloplus-2 in its present version and they

  7. Developing Anticipatory Life Cycle Assessment Tools to Support Responsible Innovation

    Science.gov (United States)

    Wender, Benjamin

    Several prominent research strategy organizations recommend applying life cycle assessment (LCA) early in the development of emerging technologies. For example, the US Environmental Protection Agency, the National Research Council, the Department of Energy, and the National Nanotechnology Initiative identify the potential for LCA to inform research and development (R&D) of photovoltaics and products containing engineered nanomaterials (ENMs). In this capacity, application of LCA to emerging technologies may contribute to the growing movement for responsible research and innovation (RRI). However, existing LCA practices are largely retrospective and ill-suited to support the objectives of RRI. For example, barriers related to data availability, rapid technology change, and isolation of environmental from technical research inhibit application of LCA to developing technologies. This dissertation focuses on development of anticipatory LCA tools that incorporate elements of technology forecasting, provide robust explorations of uncertainty, and engage diverse innovation actors in overcoming retrospective approaches to environmental assessment and improvement of emerging technologies. Chapter one contextualizes current LCA practices within the growing literature articulating RRI and identifies the optimal place in the stage gate innovation model to apply LCA. Chapter one concludes with a call to develop anticipatory LCA---building on the theory of anticipatory governance---as a series of methodological improvements that seek to align LCA practices with the objectives of RRI. Chapter two provides a framework for anticipatory LCA, identifies where research from multiple disciplines informs LCA practice, and builds off the recommendations presented in the preceding chapter. Chapter two focuses on crystalline and thin film photovoltaics (PV) to illustrate the novel framework, in part because PV is an environmentally motivated technology undergoing extensive R&D efforts and

  8. Oral conditions and dysphagia in Japanese, community-dwelling middle- and older- aged adults, independent in daily living

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    Inui A

    2017-03-01

    Full Text Available Akinari Inui,1 Ippei Takahashi,2 Sizuka Kurauchi,2 Yuki Soma,2 Toshiaki Oyama,1 Yoshihiro Tamura,1 Takao Noguchi,1 Kouichi Murashita,3 Shigeyuki Nakaji,2 Wataru Kobayashi1 1Department of Oral and Maxillofacial Surgery, 2Department of Social Medicine, 3COI Research Initiatives Organization, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori Prefecture, Japan Purpose: Prevention, early detection and effective rehabilitation of dysphagia are important issues to be considered in an aging society. Previous studies have shown conflicting findings regarding the association between dysphagia and its potential risk factors, including age, malnutrition, oral conditions, lifestyle and medical history. Herein, we assessed the prevalence and association of dysphagia with potential risk factors in 50- to 79-year-old adults dwelling in a community in Japan. Patients and methods: In this study, there were 532 participants (185 males and 347 females. Participants who responded positively to the question “Do you sometimes choke on drinks/food such as tea and soup?” or those who presented with abnormal repetitive saliva swallowing test findings were diagnosed with dysphagia. The data collected from these participants included the following: number of teeth, occurrence of oral dryness, age, body mass index, serum albumin concentration, smoking, drinking and exercise habits, presence of diseases, such as diabetes mellitus and hypertension, and questions from the Mini–Mental State Examination. Results: Dysphagia was observed in 33 males (17.8% and 76 females (21.9%. To explore the effect of the potential risk factors on the prevalence of dysphagia, a model was built by multivariate logistic regression analysis. Using the forced entry method, oral dryness (odds ratio [OR] =3.683 and P=0.003 in males; OR =1.797 and P=0.032 in females and the number of teeth (OR =0.946 and P=0.038 in males were found to be significantly related to dysphagia

  9. [Sedation and analgesia assessment tools in ICU patients].

    Science.gov (United States)

    Thuong, M

    2008-01-01

    Sedative and analgesic treatment administered to critically ill patients need to be regularly assessed to ensure that predefinite goals are well achieved as the risk of complications of oversedation is minimized. In most of the cases, which are lightly sedation patients, the goal to reach is a calm, cooperative and painless patient, adapted to the ventilator. Recently, eight new bedside scoring systems to monitor sedation have been developed and mainly tested for reliability and validity. The choice of a sedation scale measuring level of consciousness, could be made between the Ramsay sedation scale, the Richmond Agitation Sedation scale (RASS) and the Adaptation to The Intensive Care Environment scale-ATICE. The Behavioral Pain Scale (BPS) is a behavioral pain scale. Two of them have been tested with strong evidence of their clinimetric properties: ATICE, RASS. The nurses'preference for a convenient tool could be defined by the level of reliability, the level of clarity, the variety of sedation and agitation states represented user friendliness and speed. In fine, the choice between a simple scale easy to use and a well-defined and complex scale has to be discussed and determined in each unit. Actually, randomized controlled studies are needed to assess the potential superiority of one scale compared with others scales, including evaluation of the reliability and the compliance to the scale. The usefulness of the BIS in ICU for patients lightly sedated is limited, mainly because of EMG artefact, when subjective scales are more appropriated in this situation. On the other hand, subjective scales are insensitive to detect oversedation in patients requiring deep sedation. The contribution of the BIS in deeply sedation patients, patients under neuromuscular blockade or barbiturates has to be proved. Pharmacoeconomics studies are lacking.

  10. Characteristics of Dysphagia in Infants with Microcephaly Caused by Congenital Zika Virus Infection, Brazil, 2015

    Science.gov (United States)

    van der Linden, Vanessa; Bezerra, Thiago P.; de Valois, Luciana; Borges, Adriana C.G.; Antunes, Margarida M.C.; Brandt, Kátia G.; Moura, Catharina X.; Rodrigues, Laura C.; Ximenes, Coeli R.

    2017-01-01

    We summarize the characteristics of dysphagia in 9 infants in Brazil with microcephaly caused by congenital Zika virus infection. The Schedule for Oral Motor Assessment, fiberoptic endoscopic evaluation of swallowing, and the videofluoroscopic swallowing study were used as noninstrumental and instrumental assessments. All infants had a degree of neurologic damage and showed abnormalities in the oral phase. Of the 9 infants, 8 lacked oral and upper respiratory tract sensitivity, leading to delays in initiation of the pharyngeal phase of swallowing. Those delays, combined with marked oral dysfunction, increased the risk for aspiration of food, particularly liquid foods. Dysphagia resulting from congenital Zika virus syndrome microcephaly can develop in infants >3 months of age and is severe. PMID:28604336

  11. Viscosity threshold that allows safe swallow in elderly with post-stroke dysphagia

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    Rodolfo Peña

    2017-08-01

    Full Text Available Objective: To determine the viscosity threshold that allows safe swallowing in older adults with post-stroke dysphagia. Method: Cross-sectional analytical study. 6 patients over 60 years old with dysphagia participated. Were given six viscosities (50mPa s, 110mPa s, 170mPa s, 230mPa s, 290mPa s and 350mPa s made from no carbonated water and a corn starch-based thickener. Swallowing safety signs (wet voice, cough and oxygen saturation were assessed in each viscosity by Fiberoptic Endoscopic Evaluation of Swallowing (FEES. Viscosities’ performances in swallowing safety signs were compared in order to know which viscosity would be the safest. Results: 100% of swallowing safety signs did not appear in any viscosity assessed. Conclusions: It is not possible to determine the viscosity threshold that allows safe swallowing in patients with post-stroke dysphagia in the viscosities assessed. We discuss about multiple factors that had had affect our results: size sample, use of FEES to assess low viscosities, and viscosities’ intervals used.

  12. Can multicriteria assessment tools help build trust into organic products?

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    Bernhard Freyer

    2014-12-01

    Full Text Available In a continuously expanding, globalizing, and industrializing organic market, organic consumers confront increasing complexity in organic product representation, labeling, and information that challenges how they build trust in organic products. We present a conceptual framework to analyze how consumers might build and practice trust in the organic agrifood chain. We asked specifically about the role of multicriteria assessment tools (MCATs for trust building. We identified three consumer trust types: uninformed trust in labels (type 1; informed trust in extensive information, control, and certification (type 2; and informed and engaged trust in forms of close farmer-consumer relationships (type 3. Three concepts of "reflexivity" - unreflective, reflective, self-reflective - are used to explain how these three consumer trust types are operating. We see MCATs as tools accepted and applied mainly by the informed and reflective type. We further examined how reflexivity about two aspects - ethics and systems thinking - in the context of the organic agrifood chain can affect how people trust. Hedonistic, materialistic-oriented consumers might not care about MCATs to deepen their trust in organic, while anthropocentric-oriented consumers were identified as those applying MCATs; eco-centric and holistic-oriented consumers perceive MCATs more as a confinement that limits their self-reflexive and holistic understanding of organic. Awareness of, and interest in, systems thinking by unreflective and uninformed consumer trust types is rather limited; any MCAT is therefore without relevance. The reflective and informed consumer trust type uses a bundle of systems thinking methodologies, and in this context, MCATs would serve as an orientation. The self-reflective, informed, and engaged consumer trust type applies systems theory to learn how to become independent and to better learn how to protect against power interventions; e.g., from industries into the

  13. Assess the flood resilience tools integration in the landuse projects

    Science.gov (United States)

    Moulin, E.; Deroubaix, J.-F.

    2012-04-01

    Despite a severe regulation concerning the building in flooding areas, 80% of these areas are already built in the Greater Paris (Paris, Val-de-Marne, Hauts-de-Seine and Seine-Saint-Denis). The land use in flooding area is presented as one of the main solutions to solve the ongoing real estate pressure. For instance some of the industrial wastelands located along the river are currently in redevelopment and residential buildings are planned. So the landuse in the flooding areas is currently a key issue in the development of the Greater Paris area. To deal with floods there are some resilience tools, whether structural (such as perimeter barriers or building aperture barriers, etc) or non structural (such as warning systems, etc.). The technical solutions are available and most of the time efficient1. Still, we notice that these tools are not much implemented. The people; stakeholders and inhabitants, literally seems to be not interested. This papers focus on the integration of resilience tools in urban projects. Indeed one of the blockages in the implementation of an efficient flood risk prevention policy is the lack of concern of the landuse stakeholders and the inhabitants for the risk2. We conducted an important number of interviews with stakeholders involved in various urban projects and we assess, in this communication, to what extent the improvement of the resilience to floods is considered as a main issue in the execution of an urban project? How this concern is maintained or could be maintained throughout the project. Is there a dilution of this concern? In order to develop this topic we rely on a case study. The "Ardoines" is a project aiming at redeveloping an industrial site (South-East Paris), into a project including residential and office buildings and other amenities. In order to elaborate the master plan, the urban planning authority brought together some flood risk experts. According to the comments of the experts, the architect in charge of the

  14. Health Impact Assessment: a useful tool for decision makers

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    Livia Turco

    2007-09-01

    Full Text Available Health Impact Assessment is defined as ‘the combination of procedures, methods and tools through which it is possible to evaluate a policy, a program or a development plan concerning possible effects on public health and their distribution in the general population’. In a constructive debate this definition points out some interesting observations: - health is not the result of health policies alone, but it is often defined by the attention given to it in other contexts; - health is however the result of policies and it therefore must deserve the attention of Decision Makers; - health must not be taken into consideration without taking into account an evaluation of its distribution and its determinants within a population. Particular attention must therefore be paid into inequalities; - following the Council of the European Union recent conclusions on Health in All Policies we have to consider that everyday environments such as day-care centers, schools,workplaces,neighborhoods and the commute between them have significant effects on health and that health, in turn, has an effect on the economy by enabling active and productive participation in working life. In the past 20 years huge progress has been achieved in the epidemiological contest to define risks. Nowadays, it is known that a low cultural level lowers the capacity to respond to prevention, that elevated pollution levels do represent a health risk, and that the scarce social relationships that elderly people have in our society have strong consequences on their health and their quality of life.

  15. Assessment of leakage from an engineered reservoir using hydrogeological tools

    Energy Technology Data Exchange (ETDEWEB)

    Smerdon, B.D.; Mendoza, C.A. [Alberta Univ., Edmonton, AB (Canada); McCann, A.; Kraushar, C. [Omni-McCann Consultants Ltd., Edmonton, AB (Canada); Nilson, A. [Alberta Infrastructure, Edmonton, AB (Canada)

    2003-07-01

    Seepage from earth-filled dams can be determined using steady-state, cross sectional, flow net analysis or transient response to fluid pressure within dam construction materials. This paper described the methods used to quantify leakage from a surface-water reservoir (Pine Coulee) located in southern Alberta. The methods included buried valley aquifer tests, three-dimensional groundwater flow simulations and stable isotope water samples. The aquifer tests were conducted when the reservoir was maintained at leaking elevation as well as when it was at non-leaking elevation. When the reservoir was leaking, the results showed a recharge boundary condition in the aquifer. When the reservoir was not leaking, a barrier boundary was present. To verify field-measured parameters and to determine the hydraulic properties and location of the leakage zone, three-dimensional groundwater flow simulations were calibrated to the datasets. Stable isotopes confirmed the seepage of reservoir water to the aquifer. Seepage rates and the required aquifer pumping rates to control aquifer water levels were predicted by the model. The results were in good agreement with field observations since relief well installation. The use of hydrogeological tools proved to be diagnostic and predictive in assessing the subsurface dynamics associated with man-made reservoirs. 15 refs., 2 tabs., 6 figs.

  16. Financial instability in the region: assessment methods and elimination tools

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    Pavel Andreevich Ivanov

    2015-01-01

    Full Text Available Financial instability is one of the most important factors in the level and sustainability of socio-economic development of territories. However, at present, from the viewpoint of methodology, this concept is developed insufficiently in relation to the elimination and forecasting of economic and financial crisis threats. This problem is especially acute at the regional level. For its solution the article proposes a methodology for assessing the risks of financial instability; it helps to determine the indicators of the current state and development of regional finances that are most liable to volatility in the context of the main institutional sectors (government, business, households; the methodology also helps to forecast the probable maximum change in the indicators in the future with the use of the VaR methodology The calculations carried out according to the proposed methodology on the example of the Republic of Bashkortostan show that regional finances are most vulnerable to fiscal risk. As a tool to eliminate budget risk the authors give several suggestions on improving the efficiency of interbudgetary transfers that make it possible to increase the degree of financial autonomy of the regions and to act as an effective incentive to their innovation development

  17. The Mental Disability Military Assessment Tool : A Reliable Tool for Determining Disability in Veterans with Post-traumatic Stress Disorder

    NARCIS (Netherlands)

    Fokkens, Andrea S.; Groothoff, Johan W.; van der Klink, Jac J. L.; Popping, Roel; Stewart, Roy E.; van de Ven, Lex; Brouwer, Sandra; Tuinstra, Jolanda

    2015-01-01

    Purpose An assessment tool was developed to assess disability in veterans who suffer from post-traumatic stress disorder (PTSD) due to a military mission. The objective of this study was to determine the reliability, intra-rater and inter-rater variation of the Mental Disability Military (MDM) asses

  18. Demonstration of vascular abnormalities compressing esophagus by MDCT: Special focus on dysphagia lusoria

    Energy Technology Data Exchange (ETDEWEB)

    Alper, Fatih [Department of Radiology, Medical Faculty, Atatuerk University, Erzurum (Turkey)]. E-mail: fatihrad@yahoo.com; Akgun, Metin [Department of Chest Diseases, Medical Faculty, Atatuerk University, Erzurum (Turkey); Kantarci, Mecit [Department of Radiology, Medical Faculty, Atatuerk University, Erzurum (Turkey); Eroglu, Atilla [Department of Thoracic Surgery, Medical Faculty, Atatuerk University, Erzurum (Turkey); Ceyhan, Elvan [Department of Mathematics, College of Arts and Sciences, Koc University, Istanbul (Turkey); Onbas, Omer [Department of Radiology, Medical Faculty, Atatuerk University, Erzurum (Turkey); Duran, Cihan [Department of Radiology, Florence Nightingale Hospital, Istanbul (Turkey); Okur, Adnan [Department of Radiology, Medical Faculty, Atatuerk University, Erzurum (Turkey)

    2006-07-15

    Purpose: Dysphagia lusoria (DL) is described in the literature as difficulty in swallowing caused by vascular abnormalities. The most common cause is an aberrant right subclavian artery (SCA) which passes behind the esophagus and is also called arteria lusoria (AL). Our aim was to demonstrate the use of multidetector computed tomography (MDCT) in the diagnosis of AL, as there is no comprehensive study investigating the role of MDCT in such cases. Material and methods: A total of 38 consecutive patients, comprising of 23 females (61%) and 15 males (39%), who had extrinsic compression were included in the study. These patients are selected from the cases who were admitted due to their gastrointestinal symptoms, such as dysphagia, epigastric pain, chronic nausea, vomiting, etc. The mean age of patients was 40 {+-} 25 years (range 15-65). Following barium esophagogram and then endoscopy performed, MDCT angiography was carried out on the same or the following few days. MDCT sections were examined to determine the following: presence of vascular abnormality; the diameter and angle of that vascular structure; and the compressed area of esophagus. Radiological findings and dysphagia scores were also compared. Results: In each of 15 cases, there was a compression due to vascular abnormality which were all located between the esophagus and the spine. There was an esophageal compression in each of 12 cases, due to right aberrant SCA, in one case due to right superior aortic arch and in two cases due to both right aortic arch and left SCA with Kommerell's diverticulum. The mean diameter and the angle of AL were 16.4 mm and 48.8{sup o}, respectively, and the mean area of pressured esophagus was 194.7 mm{sup 2}. Dysphagia scores of the cases was 1 in thirteen cases and 2 in two cases. However, dysphagia scores were not correlated with these parameters. Conclusions: MDCT angiography is a useful diagnostic tool for evaluation of patients with dysphagia, especially caused by a

  19. Concept Maps as a Research and Evaluation Tool To Assess Conceptual Change in Quantum Physics.

    Science.gov (United States)

    Sen, Ahmet Ilhan

    2002-01-01

    Informs teachers about using concept maps as a learning tool and alternative assessment tools in education. Presents research results of how students might use concept maps to communicate their cognitive structure. (Author/KHR)

  20. PALLIATIVE TREATMENT OF DYSPHAGIA: FAILURES AND COMPLICATIONS

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    E. A. Drobyazgin

    2017-01-01

    Full Text Available Background. Dysphagia is the main clinical symptom in patients with locally advanced esophageal carcinoma and proximal part of the stomach. Esophageal stenting is a highly effective and safe method to restore esophageal lumen patency. Published data indicate a high rate of stent-related complications. Material and methods. A retrospective, two-centered study included 166 patients (102 males and 64 females, who underwent endoscopically-guided esophageal stenting from 2004 to 2015. The age of the patients ranged from 36 to 92 years. Expandable metal stents were used for all patients. In most cases (81.3%, drug-eluting stents (22 mm diameter, 120 mm length were preferable. Treatment outcomes and complications were analyzed. Results. Complications during stent placement (incorrect stent disclosure were observed in 7 patients. All these complications were eliminated by relocating the stent to the desired position. Postoperative complications were noted in 29 patients (stent migration in 9 patients, stent fracture and migration in 2 patients, stent obstruction in 1 patient, destruction of stent coating and fragmentation in 5 patients, and dysphagia recurrence due to continuing tumor growth in 11 patients. All stent-related complications were corrected by re-endoscopy. Conclusions. The data obtained indicate the need for lifelong surveillance of patients after stenting.

  1. The value of tools to assess pulmonary arterial hypertension

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    H. Gupta

    2011-12-01

    Full Text Available Pulmonary hypertension is a common but complex clinical problem. When suspected in an appropriate clinical setting or detected incidetally, an array of investigative tools are employed with an intent to confirm the diagnosis, define aetiology, evaluate the functional and haemodynamic impairment, define treatment options, monitor the therapy, and establish long-term prognosis. However, no single tool provides comprehensive information that encompasses the aforementioned aims. Therefore, judicious use of these tools is of paramount importance, in order to maximise outcome and cost-effectiveness, while minimising risks and redundancies. Furthermore, a number of promising tools and techniques are emerging rapidly in the arena of pulmonary hypertension. These tools augment our understanding of pathophysiology and natural history of pulmonary hypertension. There is, therefore, increasing need for validating these emerging paradigms in multicentre trials. In this review, we focus on the tools commonly used to evaluate pulmonary arterial hyertension and also define some of the new approaches to pulmonary arterial hypertension.

  2. The fracture risk assessment tool (FRAX® score in subclinical hyperthyroidism

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    Polovina Snežana

    2015-01-01

    Full Text Available Background/Aim. The Fracture Risk Assessment Tool (FRAX® score is the 10-year estimated risk calculation tool for bone fracture that includes clinical data and hip bone mineral density measured by dual-energy x-ray absorptiometry (DXA. The aim of this cross-sectional study was to elucidate the ability of the FRAX® score in discriminating between bone fracture positive and negative pre- and post-menopausal women with subclinical hyperthyroidism. Methods. The bone mineral density (by DXA, thyroid stimulating hormone (TSH level, free thyroxine (fT4 level, thyroid peroxidase antibodies (TPOAb titre, osteocalcin and beta-cross-laps were measured in 27 pre- and post-menopausal women with newly discovered subclinical hyperthyroidism [age 58.85 ± 7.83 years, body mass index (BMI 27.89 ± 3.46 kg/m2, menopause onset in 46.88 ± 10.21 years] and 51 matched euthyroid controls (age 59.69 ± 5.72 years, BMI 27.68 ± 4.66 kg/m2, menopause onset in 48.53 ± 4.58 years. The etiology of subclinical hyperthyroisims was autoimmune thyroid disease or toxic goiter. FRAX® score calculation was performed in both groups. Results. In the group with subclinical hyperthyroidism the main FRAX® score was significantly higher than in the controls (6.50 ± 1.58 vs 4.35 ± 1.56 respectively; p = 0.015. The FRAX® score for hip was also higher in the evaluated group than in the controls (1.33 ± 3.92 vs 0.50 ± 0.46 respectively; p = 0.022. There was no correlations between low TSH and fracture risk (p > 0.05. The ability of the FRAX® score in discriminating between bone fracture positive and negative pre- and postmenopausal female subjects (p < 0.001 is presented by the area under the curve (AUC plotted via ROC analysis. The determined FRAX score cut-off value by this analysis was 6%, with estimated sensitivity and specificity of 95% and 75.9%, respectively. Conclusion. Pre- and postmenopausal women with subclinical hyperthyroidism have higher FRAX® scores and thus

  3. Critical Dysphagia is Common in Parkinson Disease and Occurs Even in Early Stages: A Prospective Cohort Study.

    Science.gov (United States)

    Pflug, Christina; Bihler, Moritz; Emich, Katharina; Niessen, Almut; Nienstedt, Julie Cläre; Flügel, Till; Koseki, Jana-Christiane; Plaetke, Rosemarie; Hidding, Ute; Gerloff, Christian; Buhmann, Carsten

    2017-08-21

    To assess the prevalence of dysphagia and its typical findings in unselected "real-world" Parkinson patients using an objective gold-standard method. This was a prospective, controlled, cross-sectional study conducted in 119 consecutive Parkinson patients of all stages independent of subjective dysphagia. Patients and 32 controls were clinically and endoscopically examined by flexible endoscopic evaluation of swallowing (FEES) to evaluate the deglutition with regard to three consistencies (water, biscuit, and bread). Typical findings of dysphagia like penetration and aspiration, residues, and leakage were assessed. Dysphagia was common in Parkinson patients and occurred in all, even early, disease stages. Only 5% (6/119) of patients showed a completely unremarkable deglutition. Aspiration was seen in 25% (30/119) of patients and always related to water. Residues occurred in 93% (111/119), most commonly for bread. Leakage was much less frequent and was found in only 3-18%, depending on consistency. In a significant fraction of patients, objective dysphagia was not subjectively perceived. A total of 16% of asymptomatic patients suffered from critical aspiration. Significant swallowing deficiencies already occurred in early disease. Aspiration was found in 4 of 20 (20%) patients with disease duration of less than 2 years. Seven of 57 patients (12%) with Hoehn and Yahr stage 2 suffered from severe aspiration. Given the high frequency of critical aspiration in Parkinson disease, these patients should be evaluated early for dysphagia to avoid complications and recommend an adequate therapy. FEES is a simple, cost efficient, minimally invasive method that is ideally suited for this purpose.

  4. Towards the creation of the South African Pedestrian Environment Assessment Tool

    CSIR Research Space (South Africa)

    Albers, P

    2010-09-01

    Full Text Available , Gauteng • Collated accident data obtained from the Road traffic Management Corporation • Site selection: - five sites were chosen using random sampling, specifically quota sampling, from two police stations with the highest number... of pedestrian fatalities • examined existing pedestrian environment assessment tools • Compiled a South African specific environment assessment tool • Piloted the tool at five selected sites in Pretoria. ReSultS figure 1: Summary of tools that informed...

  5. Developing Tools to Assess European Trace Gas Trends

    Science.gov (United States)

    Wilson, Rebecca; Fleming, Zoe; Henne, Stephan; Monks, Paul

    2010-05-01

    The GEOmon (Global Earth Observation and MONitoring) project has produced a harmonised data set of trace gases from thirty ground-based measurement stations belonging to a number of regional, national and European air quality networks (e.g. EMEP, GAW). A variety of tools have been developed in R to evaluate European trace gas trends as a method to assess data quality and the effectiveness of European emission legislation. Long-term O3, NO2 and CO have been characterised at all sites using lowess regression. Additionally, O3 was deseasonalised and linear trends were fitted to and quantified for monthly means, 5th and 95th percentiles (to illustrate changes in mean, background and peak concentrations respectively). Twenty-four of these sites have data between 1996-2005 (Incl). Analysis of these sites for the time period provides an easily comparable characterisation of continental-scale O3 trends. However, few sites have statistically significant trends during this limited analysis period. The RETRO monthly NOx emissions fluxes at the GEOmon harmonised data sites were plotted from 1985-2000. The introduction of catalytic converters in Europe in 1985 and subsequent EU legislation in 1993 (requiring catalytic converters in all new petrol cars sold), corresponds to a decrease in NOx emissions throughout 1990's for the majority of sites. It is noted that the rate of reduction in NOx emissions decreases from the mid-1990's to 2000 for fifteen locations. This may account for the less pronounced, and reduced statistical significance of, O3 trends during the 1996-2005 period. Although the spatial distribution of European O3 trends 1996-2005 is inconclusive for the present GEOmon harmonised dataset, the expansion to more European sites may lead to a more detailed characterisation.

  6. A bacteriophage detection tool for viability assessment of Salmonella cells.

    Science.gov (United States)

    Fernandes, E; Martins, V C; Nóbrega, C; Carvalho, C M; Cardoso, F A; Cardoso, S; Dias, J; Deng, D; Kluskens, L D; Freitas, P P; Azeredo, J

    2014-02-15

    Salmonellosis, one of the most common food and water-borne diseases, has a major global health and economic impact. Salmonella cells present high infection rates, persistence over inauspicious conditions and the potential to preserve virulence in dormant states when cells are viable but non-culturable (VBNC). These facts are challenging for current detection methods. Culture methods lack the capacity to detect VBNC cells, while biomolecular methods (e.g. DNA- or protein-based) hardly distinguish between dead innocuous cells and their viable lethal counterparts. This work presents and validates a novel bacteriophage (phage)-based microbial detection tool to detect and assess Salmonella viability. Salmonella Enteritidis cells in a VBNC physiological state were evaluated by cell culture, flow-cytometry and epifluorescence microscopy, and further assayed with a biosensor platform. Free PVP-SE1 phages in solution showed the ability to recognize VBNC cells, with no lysis induction, in contrast to the minor recognition of heat-killed cells. This ability was confirmed for immobilized phages on gold surfaces, where the phage detection signal follows the same trend of the concentration of viable plus VBNC cells in the sample. The phage probe was then tested in a magnetoresistive biosensor platform allowing the quantitative detection and discrimination of viable and VBNC cells from dead cells, with high sensitivity. Signals arising from 3 to 4 cells per sensor were recorded. In comparison to a polyclonal antibody that does not distinguish viable from dead cells, the phage selectivity in cell recognition minimizes false-negative and false-positive results often associated with most detection methods.

  7. Embedded value systems in sustainability assessment tools and their implications.

    Science.gov (United States)

    Gasparatos, Alexandros

    2010-08-01

    This paper explores the implications that arise with the selection of specific sustainability evaluation tools. Sustainability evaluation tools are conceptualized in this paper as value articulating institutions and as such their choice is a far from a trivial matter. In fact their choice can entail various ethical and practical repercussions. However, in most cases the choice of the evaluation tool is made by the analyst(s) without taking into consideration the values of the affected stakeholders. By choosing the analytical tool the analyst essentially "subscribes to" and ultimately "enforces" a particular worldview as the legitimate yardstick to evaluate the sustainability of a particular project (or policy). Instead, this paper argues that the selection of evaluation tools should be consistent with the values of the affected stakeholders. With this in mind, different sustainability evaluation tools' assumptions are critically reviewed and a number of suggestions that could facilitate the choice of the most appropriate tool according to the context of the sustainability evaluation are provided. It is expected that conscious evaluation tool selection, following the suggestions made in this paper, will reduce the risk of providing distorted sustainability evaluations.

  8. Surface electromyography as a screening method for evaluation of dysphagia and odynophagia

    Directory of Open Access Journals (Sweden)

    Eviatar Ephraim

    2009-02-01

    Full Text Available Abstract Objective Patients suspected of having swallowing disorders, could highly benefit from simple diagnostic screening before being referred to specialist evaluations. The article analyzes various instrumental methods of dysphagia assessment, introduces surface electromyography (sEMG to carry out rapid assessment of such patients, and debates proposed suggestions for sEMG screening protocol in order to identify abnormal deglutition. Data sources Subject related books and articles from 1813 to 2007 were obtained through library search, MEDLINE (1949–2007 and EMBASE (1975–2007. Methods Specifics steps for establishing the protocol for applying the technique for screening purposes (e.g., evaluation of specific muscles, the requirements for diagnostic sEMG equipment, the sEMG technique itself, and defining the tests suitable for assessing deglutition (e.g., saliva, normal, and excessive swallows and uninterrupted drinking of water are presented in detail. SEMG is compared with other techniques in terms of cost, timing, involvement of radiation, etc. Results According to the published data, SEMG of swallowing is a simple and reliable method for screening and preliminary differentiation among dysphagia and odynophagia of various origins. This noninvasive radiation-free examination has a low level of discomfort, and is simple, time-saving and inexpensive to perform. The major weakness of the method seems to be inability for precise diagnostic of neurologically induced dysphagia. Conclusion With standardization of the technique and an established normative database, sEMG might serve as a reliable screening method for optimal patient management but cannot serve for proper investigation of neurogenic dysphagia.

  9. Surface electromyography as a screening method for evaluation of dysphagia and odynophagia

    Science.gov (United States)

    Vaiman, Michael; Eviatar, Ephraim

    2009-01-01

    Objective Patients suspected of having swallowing disorders, could highly benefit from simple diagnostic screening before being referred to specialist evaluations. The article analyzes various instrumental methods of dysphagia assessment, introduces surface electromyography (sEMG) to carry out rapid assessment of such patients, and debates proposed suggestions for sEMG screening protocol in order to identify abnormal deglutition. Data sources Subject related books and articles from 1813 to 2007 were obtained through library search, MEDLINE (1949–2007) and EMBASE (1975–2007). Methods Specifics steps for establishing the protocol for applying the technique for screening purposes (e.g., evaluation of specific muscles), the requirements for diagnostic sEMG equipment, the sEMG technique itself, and defining the tests suitable for assessing deglutition (e.g., saliva, normal, and excessive swallows and uninterrupted drinking of water) are presented in detail. SEMG is compared with other techniques in terms of cost, timing, involvement of radiation, etc. Results According to the published data, SEMG of swallowing is a simple and reliable method for screening and preliminary differentiation among dysphagia and odynophagia of various origins. This noninvasive radiation-free examination has a low level of discomfort, and is simple, time-saving and inexpensive to perform. The major weakness of the method seems to be inability for precise diagnostic of neurologically induced dysphagia. Conclusion With standardization of the technique and an established normative database, sEMG might serve as a reliable screening method for optimal patient management but cannot serve for proper investigation of neurogenic dysphagia. PMID:19232090

  10. The Use of Brain Stimulation in Dysphagia Management.

    Science.gov (United States)

    Simons, Andre; Hamdy, Shaheen

    2017-04-01

    Dysphagia is common sequela of brain injury with as many as 50% of patients suffering from dysphagia following stroke. Currently, the majority of guidelines for clinical practice in the management of dysphagia focus on the prevention of complications while any natural recovery takes place. Recently, however, non-invasive brain stimulation (NIBS) techniques like transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have started to attract attention and are applied to investigate both the physiology of swallowing and influences on dysphagia. TMS allows for painless stimulation of the brain through an intact skull-an effect which would normally be impossible with electrical currents due to the high resistance of the skull. By comparison, tDCS involves passing a small electric current (usually under 2 mA) produced by a current generator over the scalp and cranium external to the brain. Initial studies used these techniques to better understand the physiological mechanisms of swallowing in healthy subjects. More recently, a number of studies have investigated the efficacy of these techniques in the management of neurogenic dysphagia with mixed results. Controversy still exists as to which site, strength and duration of stimulation yields the greatest improvement in dysphagia. And while multiple studies have suggested promising effects of NIBS, more randomised control trials with larger sample sizes are needed to investigate the short- and long-term effects of NIBS in neurogenic dysphagia.

  11. Preliminary Evaluation of the Pathomechanisms of Dysphagia After Occipitospinal Fusion: Kinematic Analysis by Videofluoroscopic Swallowing Study.

    Science.gov (United States)

    Kaneyama, Shuichi; Sumi, Masatoshi; Takabatake, Masato; Kasahara, Koichi; Kanemura, Aritetsu; Koh, Akihiro; Hirata, Hiroaki

    2016-12-01

    Kinematic analysis of swallowing function using videofluoroscopic swallowing study (VFSS). The aims of this study were to analyze swallowing process in the patients who underwent occipitospinal fusion (OSF) and elucidate the pathomechanism of dysphagia after OSF. Although several hypotheses about the pathomechanisms of dysphagia after OSF were suggested, there has been little tangible evidence to support these hypotheses since these hypotheses were based on the analysis of static radiogram or CT. Considering that swallowing is a compositive motion of oropharyngeal structures, the etiology of postoperative dysphagia should be investigated through kinematic approaches. Each four patients with or without postoperative dysphagia (group D and N, respectively) participated in this study. For VFSS, all patients were monitored to swallow 5-mL diluted barium solution by fluoroscopy, and then dynamic passing pattern of the barium solution was analyzed. Additionally, O-C2 angle (O-C2A) was measured for the assessment of craniocervical alignment. O-C2A in group D was -7.5 degrees, which was relatively smaller than 10.3 degrees in group N (P = 0.07). In group D, all cases presented smooth medium passing without any obstruction at the upper cervical level regardless of O-C2A, whereas the obstruction to the passage of medium was detected at the apex of mid-lower cervical ocurvature, where the anterior protrusion of mid-lower cervical spine compressed directly the pharyngeal space. In group N, all cases showed smooth passing of medium through the whole process of swallowing. This study presented that postoperative dysphagia did not occur at the upper cervical level even though there was smaller angle of O-C2A and demonstrated the narrowing of the oropharyngeal space towing to direct compression by the anterior protrusion of mid-lower cervical spine was the etiology of dysphagia after OSF. Therefore, surgeon should pay attention to the alignment of mid-cervical spine as well as

  12. Perspectives and Practices of Elementary Teachers Using an Internet-Based Formative Assessment Tool: The Case of "Assessing Mathematics Concepts"

    Science.gov (United States)

    Martin, Christie S.; Polly, Drew; Wang, Chuang; Lambert, Richard G.; Pugalee, David K.

    2016-01-01

    This study examined the influence of professional development on elementary school teachers' perceptions of and use of an internet-based formative assessment tool focused on students' number sense skills. Data sources include teacher-participants' pre and post survey, open ended response on post survey, use of the assessment tool and their written…

  13. Assessing Change in High School Student Information Literacy Using the Tool for Real-Time Assessment of Information Literacy Skills

    Science.gov (United States)

    Kovalik, Cindy L.; Yutzey, Susan D.; Piazza, Laura M.

    2012-01-01

    Change in high school student information literacy (IL) knowledge and skills, from freshman year to senior year in high school was the focus of this quasi-experimental research project. Researchers used a free information literacy skills assessment tool entitled TRAILS (Tool for Real-time Assessment of Information Literacy Skills) to measure…

  14. Oral muscles are progressively affected in Duchenne muscular dystrophy: implications for dysphagia treatment.

    Science.gov (United States)

    van den Engel-Hoek, Lenie; Erasmus, Corrie E; Hendriks, Jan C M; Geurts, Alexander C H; Klein, Willemijn M; Pillen, Sigrid; Sie, Lilian T; de Swart, Bert J M; de Groot, Imelda J M

    2013-05-01

    Dysphagia is reported in advanced stages of Duchenne muscular dystrophy (DMD). The population of DMD is changing due to an increasing survival. We aimed to describe the dysphagia in consecutive stages and to assess the underlying mechanisms of dysphagia in DMD, in order to develop mechanism based recommendations for safe swallowing. In this cross-sectional study, participants were divided into: early and late ambulatory stage (AS, n = 6), early non-ambulatory stage (ENAS, n = 7), and late non-ambulatory stage (LNAS, n = 11). Quantitative oral muscle ultrasound was performed to quantify echo intensity. Swallowing was assessed with a video fluoroscopic swallow study, surface electromyography (sEMG) of the submental muscle group and tongue pressure. Differences in outcome parameters among the three DMD stages were tested with analysis of variance. Oral muscles related to swallowing were progressively affected, starting in the AS with the geniohyoid muscle. Tongue (pseudo) hypertrophy was found in 70 % of patients in the ENAS and LNAS. Oral phase problems and post-swallow residue were observed, mostly in the LNAS with solid food. sEMG and tongue pressure data of swallowing solid food revealed the lowest sEMG amplitude, the longest duration and lowest tongue pressure in the LNAS. In case of swallowing problems in DMD, based on the disturbed mechanisms of swallowing, it is suggested to (1) adjust meals in terms of less solid food, and (2) drink water after meals to clear the oropharyngeal area.

  15. Development of an indicator-based Tool for assessment of marine biodiversity status

    DEFF Research Database (Denmark)

    Andersen, Jesper; Borja, Angel; Berg, Torsten

    ) and consequently, there is a pan-European need to overcome shortcomings in regard to biodiversity monitoring, indicators and tools. Here, we present a prototype tool for assessment of marine biodiversity status sensu the MSFD. The tool has a modular structure and is based on a conceptual view of the marine......With the adoption of the EU Marine Strategy Framework Directive (MSFD), Member States are committed to produce Initial Assessments including assessments of marine biodiversity status. Only few EU Member States have applied indicator-based assessment tools in the first reporting round (2012......, the tool also examines the propagation of uncertainty from indicators to overall biodiversity assessment. Based on an existing set of indicators with numerical target values from the North Sea - Baltic Sea transition area, we test the tool, discuss its strengths and weakness and compare it with earlier...

  16. Tool for Land Suitability Assessment for Rice Production in

    African Journals Online (AJOL)

    Geographic Information Systems (GIS) as a Decision Support. Tool for Land ... Systems Analysis/Agro-Ecological Zone (FAO/IIASA/AEZ) methodology was adopted and modified to suit .... to as the total available water capacity. (TAWC).

  17. An EMG screening method (dysphagia limit) for evaluation of neurogenic dysphagia in childhood above 5 years old.

    Science.gov (United States)

    Ozdemirkiran, T; Secil, Y; Tarlaci, S; Ertekin, C

    2007-03-01

    Oropharyngeal dysphagia is not rare in older children before the adult age, especially the patients with cerebral palsy. Non-invasive simple tests are needed for the evaluation of children with neurogenic dysphagia including the patients with cerebral palsy. So we aimed to evaluate non-invasive ways to screen for dysphagia in children and the usefulness of this almost new electrophysiologic method for the detection of dysphagia in children with cerebral palsy. Twenty-eight healthy children and 12 patients with cerebral palsy were investigated for the applicability of this method. The movement of the larynx was monitored using a simple piezoelectric wafer sensor and submental surface EMG activity was recorded by bipolar silver-chloride electrodes taped under the chin over the submental muscle complex. The onset and duration of pharyngeal swallowing was recorded from submental-suprahyoid muscles such as the mylohyoid-genitohyoid-anterior digastric complex. By this method, the maximal water volume capacity was measured in single swallows with progressively increasing water volumes, this was called 'dysphagia limit'. The healthy control children revealed to swallow the bolus at once maximally 11.2+/-0.4 and 2.5 ml in average. Dysphagia limit varied from 7 to above 20 ml water volume from age 5-16 years old. Patients with cerebral palsy had the dysphagia limit of 7.7+/-1.8 and 6.4 ml in average. The dysphagia limit was significantly reduced in patients with cerebral palsy (pDysphagia limit seemed to be less sensitive in demonstrating the oropharyngeal swallowing disorders in childhood period (90% in the adult dysphagic patients). But the majority of patients with cerebral palsy (58%) showed abnormality. This electrophysiologic method is completely non-invasive, devoid from any hazard and applicable to children above 5 years. It may be candidate as a screening test before selection of dysphagic children.

  18. Oropharyngeal dysphagia, an underestimated disorder in pediatrics.

    Science.gov (United States)

    Vaquero-Sosa, Esther; Francisco-González, Laura; Bodas-Pinedo, Andrés; Urbasos-Garzón, Cristina; Ruiz-de-León-San-Juan, Antonio

    2015-02-01

    Oropharyngeal dysphagia is a rather frequent clinical entity in patients with neurological problems that can lead to serious complications such as aspiration pneumonia and other disorders like dehydration or malnutrition due to feeding difficulties. It should be suspected in children with splitting of food intake or prolonged feeding, coughing or choking during feeding, continuous drooling or repeated respiratory symptoms. For the diagnosis, apart from the examination of swallowing, additional tests can be run like the water-swallowing test, the viscosity-volume test (which determines what kind of texture and how much volume the patient is able to tolerate), a fiberoptic endoscopy of swallowing or a videofluoroscopic swallow study, which is the gold standard for the study of swallowing disorders.It requires a multidisciplinary approach to guarantee an adequate intake of fluids and nutrients with minimal risk of aspiration. If these two conditions cannot be met, a gastrostomy feeding may be necessary.

  19. Oropharyngeal dysphagia, an underestimated disorder in pediatrics

    Directory of Open Access Journals (Sweden)

    Esther Vaquero-Sosa

    2015-02-01

    Full Text Available Oropharyngeal dysphagia is a rather frequent clinical entity in patients with neurological problems that can lead to serious complications such as aspiration pneumonia and other disorders like dehydration or malnutrition due to feeding difficulties. It should be suspected in children with splitting of food intake or prolonged feeding, coughing or choking during feeding, continuous drooling or repeated respiratory symptoms. For the diagnosis, apart from the examination of swallowing, additional tests can be run like the water-swallowing test, the viscosity-volume test (which determines what kind of texture and how much volume the patient is able to tolerate, a fiberoptic endoscopy of swallowing or a videofluoroscopic swallow study, which is the gold standard for the study of swallowing disorders. It requires a multidisciplinary approach to guarantee an adequate intake of fluids and nutrients with minimal risk of aspiration. If these two conditions cannot be met, a gastrostomy feeding may be necessary.

  20. Teaching Students How to Integrate and Assess Social Networking Tools in Marketing Communications

    Science.gov (United States)

    Schlee, Regina Pefanis; Harich, Katrin R.

    2013-01-01

    This research is based on two studies that focus on teaching students how to integrate and assess social networking tools in marketing communications. Study 1 examines how students in marketing classes utilize social networking tools and explores their attitudes regarding the use of such tools for marketing communications. Study 2 focuses on an…

  1. Teaching Students How to Integrate and Assess Social Networking Tools in Marketing Communications

    Science.gov (United States)

    Schlee, Regina Pefanis; Harich, Katrin R.

    2013-01-01

    This research is based on two studies that focus on teaching students how to integrate and assess social networking tools in marketing communications. Study 1 examines how students in marketing classes utilize social networking tools and explores their attitudes regarding the use of such tools for marketing communications. Study 2 focuses on an…

  2. HEFCE's People Management Self-Assessment Tool: Ticking Boxes or Adding Value? A Case Study

    Science.gov (United States)

    McDonald, Claire

    2009-01-01

    This article examines one specific organisational development tool in depth and uses a case study to investigate whether using the tool is more than a tick-box exercise and really can add value and help organisations to develop and improve. The People Management Self-Assessment Tool (SAT) is used to examine higher education institutions' (HEIs)…

  3. The ANIE a math assessment tool that reveals learning and informs teaching

    CERN Document Server

    Bird, Kevin

    2014-01-01

    A powerful classroom tool, the ANIE (Assessment for Numeracy in Education) is a user-friendly, one-page template that transforms math assessment from traditional right or wrong answers to an in-depth look at student understanding.

  4. [Aural Stimulation with Capsaicin Ointment Improved the Swallowing Function in Patients with Dysphagia: Evaluation by the SMRC Scale].

    Science.gov (United States)

    Kondo, Eiji; Jinnouchi, Osamu; Ohnishi, Hiroki; Kawata, Ikuji; Takeda, Noriaki

    2015-11-01

    Cough and swallowing reflexes are important airway-protective mechanisms against aspiration. Angiotensin-converting enzyme (ACE) inhibitors, one of the side effects of which is cough, have been reported to reduce the incidence of aspiration pneumonia in hypertensive patients with stroke. ACE inhibitors have also been reported to improve the swallowing function in post-stroke patients. On the other hand, stimulation of the Arnold nerve, the auricular branch of the vagus, triggers the cough reflex (Arnold's ear-cough reflex). Capsaicin, an agonist of Transient Receptor Potential Vanilloid 1 (TRPV1), has been shown to activate the peripheral sensory C-fibers. Stimulation of the sensory branches of the vagus in the laryngotracheal mucosa with capsaicin induces the cough reflex and has been reported to improve the swallowing function in patients with dysphagia. In our previous study, we showed that aural stimulation of the Arnold nerve with 0.025% capsaicin ointment improved the swallowing function, as evaluated by the endoscopic swallowing score, in 26 patients with dysphagia. In the present study, the video images of swallowing recorded in the previous study were re-evaluated using the SMRC scale by an independent otolaryngologist who was blinded to the information about the patients and the endoscopic swallowing score. The SMRC scale is used to evaluate four aspects of the swallowing function: 1) Sensory: the initiation of the swallowing reflex as assessed by the white-out timing; 2) Motion: the ability to hold blue-dyed water in the oral cavity and induce laryngeal elevation; 3) Reflex: glottal closure and the cough reflex induced by touching the epiglottis or arytenoid with the endoscope; 4) Clearance: pharyngeal clearance of the blue-dyed water after swallowing. Accordingly, we demonstrated that a single application of capsaicin ointment to the external auditory canal of patients with dysphagia significantly improved the R, but not the S, M or C scores, and this

  5. Development of the public information and communication technology assessment tool.

    Science.gov (United States)

    Ripat, Jacquie; Watzke, James; Birch, Gary

    2008-09-01

    Public information and communication technologies, such as information kiosks, automated banking machines and ticket dispensers, allow people to access services in a convenient and timely manner. However, the development of these technologies has occurred largely without consideration of access by people with disabilities. Inaccessible technical features make operation of a public technology difficult and barriers in the environment create navigational challenges, limiting the opportunity of people with disabilities to use these devices and access the services they provide. This paper describes the development of a tool that individuals, disability advocacy groups, business owners, healthcare providers, and urban planners can use to evaluate the accessibility of public technologies and the surrounding environment. Evaluation results can then be used to develop recommendations and advocate for technical and environmental changes to improve access. Tool development consisted of a review of the literature and key Canadian Standards Association documents, task analysis, and consultation with accessibility experts. Studies of content validity, tool usability, inter-rater and test-retest reliability were conducted in sites across Canada. Accessibility experts verified the content validity of the tool. The current version of the tool has incorporated the findings of a usability study. Initial testing indicated excellent agreement for inter-rater and test-retest reliability scores. Social exclusion can arise when public technologies are not accessible. This newly developed instrument provides detailed information that can be used to advocate for more accessible and inclusive public information and communication technologies.

  6. Electrophysiological Evaluation of Oropharyngeal Dysphagia in Parkinson’s Disease

    Science.gov (United States)

    Ertekin, Cumhur

    2014-01-01

    Parkinson’s disease (PD) is a chronic, neurodegenerative movement disorder that typically affects elderly patients. Swallowing disorders are highly prevalent in PD and can have grave consequences, including pneumonia, malnutrition, dehydration and mortality. Neurogenic dysphagia in PD can manifest with both overt clinical symptoms or silent dysphagia. Regardless, early diagnosis and objective follow-up of dysphagia in PD is crucial for timely and appropriate care for these patients. In this review, we provide a comprehensive summary of the electrophysiological methods that can be used to objectively evaluate dysphagia in PD. We discuss the electrophysiological abnormalities that can be observed in PD, their clinical correlates and the pathophysiology underlying these findings. PMID:25360228

  7. Electrophysiological Evaluation of Oropharyngeal Dysphagia in Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Cumhur Ertekin

    2014-10-01

    Full Text Available Parkinson’s disease (PD is a chronic, neurodegenerative movement disorder that typically affects elderly patients. Swallowing disorders are highly prevalent in PD and can have grave consequences, including pneumonia, malnutrition, dehydration and mortality. Neurogenic dysphagia in PD can manifest with both overt clinical symptoms or silent dysphagia. Regardless, early diagnosis and objective follow-up of dysphagia in PD is crucial for timely and appropriate care for these patients. In this review, we provide a comprehensive summary of the electrophysiological methods that can be used to objectively evaluate dysphagia in PD. We discuss the electrophysiological abnormalities that can be observed in PD, their clinical correlates and the pathophysiology underlying these findings.

  8. Dysphagia lusorium in elderly:A case report

    Institute of Scientific and Technical Information of China (English)

    Bulent Kantarceken; Ertan Bulbuloglu; Murvet Yuksel; Ali Cetinkaya

    2004-01-01

    AIM: Late unset of dysphagia due to vascular abnormalities is a rare condition. We aimed to present a case of right subclavian artery abnormalities caused dysphagia in the elderly.METHODS: A 68-year-old female was admitted with dysphagia seven months ago. Upper endoscopic procedures and routine examinations could not demonstrate any etiology. Multislice computed thorax tomography was performed for probable extra- esophagial lesions.RESULTS: Multislice computed thorax tomography showed right subclavian artery abnormality and esophagial compression with this aberrant artery.CONCLUSION: Causes of dysphagia in the elderly are commonly malignancies, strictures and/or motility disorders. If routine examinations and endoscopic procedures fail to show any etiology, rare vascular abnormalities can be considered in such patients. Multislice computed tomography is a usefull choice in such conditions.

  9. Dysphagia Secondary to Anterior Osteophytes of the Cervical Spine.

    Science.gov (United States)

    Egerter, Alexander C; Kim, Eric S; Lee, Darrin J; Liu, Jonathan J; Cadena, Gilbert; Panchal, Ripul R; Kim, Kee D

    2015-10-01

    Study Design Retrospective case series. Objective Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier disease involves hyperostosis of the spinal column. Hyperostosis involving the anterior margin of the cervical vertebrae can cause dysphonia, dyspnea, and/or dysphagia. However, the natural history pertaining to the risk factors remain unknown. We present the surgical management of two cases of dysphagia secondary to cervical hyperostosis and discuss the etiology and management of DISH based on the literature review. Methods This is a retrospective review of two patients with DISH and anterior cervical osteophytes. We reviewed the preoperative and postoperative images and clinical history. Results Two patients underwent anterior cervical osteophytectomies due to severe dysphagia. At more than a year follow-up, both patients noted improvement in swallowing as well as their associated pain. Conclusion The surgical removal of cervical osteophytes can be highly successful in treating dysphagia if refractory to prolonged conservative therapy.

  10. Validation of the videofluoroscopic dysphagia scale in various etiologies.

    Science.gov (United States)

    Kim, Juyong; Oh, Byung-Mo; Kim, Jung Yoon; Lee, Goo Joo; Lee, Seung Ah; Han, Tai Ryoon

    2014-08-01

    The videofluoroscopic dysphagia scale (VDS) was developed as an objective predictor of the prognosis of dysphagia after stroke. We evaluated the clinical validity of the VDS for various diseases. We reviewed the medical records of 1,995 dysphagic patients (1,222 men and 773 women) who underwent videofluoroscopic studies in Seoul National University Hospital from April 2002 through December 2009. Their American Speech–Language–Hearing Association’s National Outcome Measurement System (ASHA NOMS) swallowing scale, clinical dysphagia scale (CDS), and VDS scores were evaluated on the basis of the clinical and/or videofluoroscopic findings by the consensus of two physiatrists. The correlations between the VDS and the other scales were calculated. The VDS displayed significant correlations with the ASHA NOMS swallowing scale and the CDS in every disease group (p dysphagia

  11. Development of an Automated Security Risk Assessment Methodology Tool for Critical Infrastructures.

    Energy Technology Data Exchange (ETDEWEB)

    Jaeger, Calvin Dell; Roehrig, Nathaniel S.; Torres, Teresa M.

    2008-12-01

    This document presents the security automated Risk Assessment Methodology (RAM) prototype tool developed by Sandia National Laboratories (SNL). This work leverages SNL's capabilities and skills in security risk analysis and the development of vulnerability assessment/risk assessment methodologies to develop an automated prototype security RAM tool for critical infrastructures (RAM-CITM). The prototype automated RAM tool provides a user-friendly, systematic, and comprehensive risk-based tool to assist CI sector and security professionals in assessing and managing security risk from malevolent threats. The current tool is structured on the basic RAM framework developed by SNL. It is envisioned that this prototype tool will be adapted to meet the requirements of different CI sectors and thereby provide additional capabilities.

  12. Assessment Tools as Drivers for SPI: Short-term Benefits and Long-term Challenges

    DEFF Research Database (Denmark)

    Mûller, Sune Dueholm; Nørbjerg, Jacob; Cho, Hiu Ngan

    2007-01-01

    Full scale software process maturity assessments are costly, can have large organizational impact, and are carried out at long (12-24 months) intervals. Consequently, there is a need for techniques and tools to monitor and help manage an SPI project through inexpensive, ongoing progress assessments....... In this paper we present findings from two cases of using such a tool. We have found that the tool does provide useful snapshots of the status of SPI projects, but that long-term use of the tool introduces costs and challenges related to modifying and tailoring the tool to both the organizational context...... and the SPI implementation approach. Also, persistent use of an assessment tool may jeopardize assessment reliability due to wear-out and routinization....

  13. Assessment Tools as Drivers for SPI: Short-term Benefits and Long-term Challenges

    DEFF Research Database (Denmark)

    Mûller, Sune Dueholm; Nørbjerg, Jacob; Cho, Hiu Ngan

    2007-01-01

    Full scale software process maturity assessments are costly, can have large organizational impact, and are carried out at long (12-24 months) intervals. Consequently, there is a need for techniques and tools to monitor and help manage an SPI project through inexpensive, ongoing progress assessment....... In this paper we present findings from two cases of using such a tool We have found that the tool does provide useful snapshots of the status of an SPI projects, but that long-term use of the tool introduces costs and challenges related to modifying and tailoring the tool to both the organizational context...... and the SPI implementation approach. Also, persistent use of an assessment tool may jeopardize assessment reliability due to wear-out and routinization....

  14. Sustainability assessment in the 21. century. Tools, trends and applications. Symposium abstracts

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-07-01

    Focus on sustainability of products and corporations has been increasing over the last decade. New market trends develop, engendering new tools and application areas with the purpose of increasing sustainability, thus setting new demands for industry and academia. The 2012 SETAC LCA Case Study Symposium focuses on the experiences gained in industry and academia on the application of LCA and on the application of new tools for sustainability assessment. These tools may relate to environmental 'footstep' assessments, such as carbon, water or chemical footprints, as well as life cycle oriented tools for assessing other dimensions of sustainability. (LN)

  15. Development and validation of a Clinical Assessment Tool for Nursing Education (CAT-NE).

    Science.gov (United States)

    Skúladóttir, Hafdís; Svavarsdóttir, Margrét Hrönn

    2016-09-01

    The aim of this study was to develop a valid assessment tool to guide clinical education and evaluate students' performance in clinical nursing education. The development of the Clinical Assessment Tool for Nursing Education (CAT-NE) was based on the theory of nursing as professional caring and the Bologna learning outcomes. Benson and Clark's four steps of instrument development and validation guided the development and assessment of the tool. A mixed-methods approach with individual structured cognitive interviewing and quantitative assessments was used to validate the tool. Supervisory teachers, a pedagogical consultant, clinical expert teachers, clinical teachers, and nursing students at the University of Akureyri in Iceland participated in the process. This assessment tool is valid to assess the clinical performance of nursing students; it consists of rubrics that list the criteria for the students' expected performance. According to the students and their clinical teachers, the assessment tool clarified learning objectives, enhanced the focus of the assessment process, and made evaluation more objective. Training clinical teachers on how to assess students' performances in clinical studies and use the tool enhanced the quality of clinical assessment in nursing education.

  16. Development of the Assessment of Burden of COPD tool : an integrated tool to measure the burden of COPD

    NARCIS (Netherlands)

    Slok, Annerika H. M.; in 't Veen, Johannes C. C. M.; Chavannes, Niels H.; van der Molen, Thys; Rutten-van Molken, Maureen P. M. H.; Kerstjens, Huib A. B.; Salome, Philippe L.; Holverda, Sebastiaan; Dekhuijzen, P. N. Richard; Schuiten, Denise; Asijee, Guus M.; van Schayck, Onno C. P.

    2014-01-01

    In deciding on the treatment plan for patients with chronic obstructive pulmonary disease (COPD), the burden of COPD as experienced by patients should be the core focus. It is therefore important for daily practice to develop a tool that can both assess the burden of COPD and facilitate communicatio

  17. Development of the assessment of burden of COPD tool: An integrated tool to measure the burden of COPD

    NARCIS (Netherlands)

    A.H.M. Slok (Annerika); J.C.C.M. in 't Veen (Johannes); N.H. Chavannes (Nicolas); T. van der Molen (Thys); M.P.M.H. Rutten-van Mölken (Maureen); H.A.M. Kerstjens (Huib); J. Salomé; S. Holverda (Sebastiaan); P.N.R. Dekhuijzen (Richard); D. Schuiten (Denise); G.M. Asijee (Guus); O.C.P. Schayck (Onno)

    2014-01-01

    textabstractIn deciding on the treatment plan for patients with chronic obstructive pulmonary disease (COPD), the burden of COPD as experienced by patients should be the core focus. It is therefore important for daily practice to develop a tool that can both assess the burden of COPD and facilitate

  18. Development of the Assessment of Burden of COPD tool: an integrated tool to measure the burden of COPD

    NARCIS (Netherlands)

    Slok, A.H.; Veen, J.C. In 't; Chavannes, N.H.; Molen, T. van der; Molken, M.P. Rutten-van; Kerstjens, H.A.; Salome, P.L.; Holverda, S.; Dekhuijzen, P.N.R.; Schuiten, D.; Asijee, G.M.; Schayck, O.C.P. van

    2014-01-01

    In deciding on the treatment plan for patients with chronic obstructive pulmonary disease (COPD), the burden of COPD as experienced by patients should be the core focus. It is therefore important for daily practice to develop a tool that can both assess the burden of COPD and facilitate communicatio

  19. FEAT - Flash Environmental Assessment Tool to identify acute environmental risks following disasters. The tool, the explanation and a case study

    NARCIS (Netherlands)

    van Dijk S; Brand E; de Zwart D; Posthuma L; Middelaar J van; IMG

    2009-01-01

    Voor veldteams van de Verenigde Naties die bij (natuur)rampen worden ingezet is de methode Flash Environmental Assessment Tool (FEAT) ontwikkeld. Hiermee kan worden ingeschat in welk gebied effecten van vrijgekomen chemische stoffen voor mens en milieu te verwachten zijn. De methode geeft aan welk

  20. Pain Assessment Using The Adolescent Pediatric Pain Tool: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Ananda Maria Fernandes

    2014-01-01

    Full Text Available BACKGROUND: The Adolescent Pediatric Pain Tool (APPT is a multidimensional pain assessment tool designed to assess pain location (body outline diagram, intensity (word graphic rating scale and quality (list of pain descriptors in hospitalized children eight to 17 years of age.

  1. Environmental assessment tools for the evaluation and improvement of European livestock production systems

    NARCIS (Netherlands)

    Halberg, N.; Werf, H.M.G.; Basset-Mens, C.; Dalgaard, P.; Boer, de I.J.M.

    2005-01-01

    Different types of assessment tools have been developed in Europe with the purpose of determining the environmental impact of various livestock production systems at farm level. The assessment tools differ in terms of which environmental objectives are included and how indicators are constructed and

  2. 77 FR 70809 - Agency Information Collection Activities: Assessment Tools for Park-Based Youth Education and...

    Science.gov (United States)

    2012-11-27

    ... impact. II. Data OMB Number: 1024-NEW. Title: Assessment Tools for Park-Based Youth Education and... National Park Service Agency Information Collection Activities: Assessment Tools for Park-Based Youth Education and Employment Experience Programs at Santa Monica Mountains National Recreation Area AGENCY...

  3. 77 FR 70808 - Agency Information Collection Activities: Assessment Tools for Park-Based Youth Education and...

    Science.gov (United States)

    2012-11-27

    ... impact. II. Data OMB Number: 1024-NEW. Title: Assessment Tools for Park-Based Youth Education and... National Park Service Agency Information Collection Activities: Assessment Tools for Park-Based Youth Education and Employment Experience Programs at Santa Monica Mountains National Recreation Area AGENCY...

  4. Portfolio as a learning strategy and a tool for assessment - a Danish experience

    DEFF Research Database (Denmark)

    Mogensen, Arne

    2008-01-01

    A short presentation of some Danish expereriences using portfolio in maths teaching in primary and lower secondary schools as a learning strategy AND a tool for assessment.......A short presentation of some Danish expereriences using portfolio in maths teaching in primary and lower secondary schools as a learning strategy AND a tool for assessment....

  5. Developing an Intelligent Diagnosis and Assessment E-Learning Tool for Introductory Programming

    Science.gov (United States)

    Huang, Chenn-Jung; Chen, Chun-Hua; Luo, Yun-Cheng; Chen, Hong-Xin; Chuang, Yi-Ta

    2008-01-01

    Recently, a lot of open source e-learning platforms have been offered for free in the Internet. We thus incorporate the intelligent diagnosis and assessment tool into an open software e-learning platform developed for programming language courses, wherein the proposed learning diagnosis assessment tools based on text mining and machine learning…

  6. Towards sustainability in cold chains: Development of a quality, energy and environmental assessment tool (QEEAT)

    NARCIS (Netherlands)

    Gwanpua, S.G.; Verboven, P.; Brown, T.; Leducq, D.; Verlinden, B.E.; Evans, J.; Van Der Sluis, S.; Wissink, E.B.; Taoukis, P.; Gogou, E.; Stahl, V.; El Jabri, M.; Thuault, D.; Claussen, I.; Indergård, E.; M. Nicolai, B.; Alvarez, G.; Geeraerd, A.H.

    2014-01-01

    Quantification of the impact of refrigeration technologies in terms of the quality of refrigerated food, energy usage, and environmental impact is essential to assess cold chain sustainability. In this paper, we present a software tool QEEAT (Quality, Energy and Environmental Assessment Tool) for ev

  7. Towards sustainability in cold chains: Development of a quality, energy and environmental assessment tool (QEEAT)

    NARCIS (Netherlands)

    Gwanpua, S.G.; Verboven, P.; Brown, T.; Leducq, D.; Verlinden, B.E.; Evans, J.; Van Der Sluis, S.; Wissink, E.B.; Taoukis, P.; Gogou, E.; Stahl, V.; El Jabri, M.; Thuault, D.; Claussen, I.; Indergård, E.; M. Nicolai, B.; Alvarez, G.; Geeraerd, A.H.

    2014-01-01

    Quantification of the impact of refrigeration technologies in terms of the quality of refrigerated food, energy usage, and environmental impact is essential to assess cold chain sustainability. In this paper, we present a software tool QEEAT (Quality, Energy and Environmental Assessment Tool) for ev

  8. THE BALANCED SCORECARD AS AN ASSESSMENT TOOL FOR ADMINISTRATIVE MANAGEMENT

    Directory of Open Access Journals (Sweden)

    César Alveiro Montoya

    2011-01-01

    Full Text Available This paper makes a reflection against the component that gives you the tool of the (BSC Balanced Scorecard, the administrative process, in that connection that is shared at today's organizations from becoming highly competitive institutions. Similarly, the contribution is presented by Kaplan and Norton introduced for the evaluation of organizational management as a new tool for the fulfillment of the objectives in the organization.Similarly, it is a development of the four perspectives of BSC which seeks to identify the contribution that each of these contributes to the mission and competitive performance of the organization.

  9. Implementation of a risk assessment tool based on a probabilistic safety assessment developed for radiotherapy practices

    Energy Technology Data Exchange (ETDEWEB)

    Paz, A.; Godinez, V.; Lopez, R., E-mail: abpaz@cnsns.gob.m [Comision Nacional de Seguridad Nuclear y Salvaguardias, Dr. Barragan No. 779, Col. Narvarte, 03020 Mexico D. F. (Mexico)

    2010-10-15

    The present work describes the implementation process and main results of the risk assessment to the radiotherapy practices with Linear Accelerators (Linac), with cobalt 60, and with brachytherapy. These evaluations were made throughout the risk assessment tool for radiotherapy practices SEVRRA (risk evaluation system for radiotherapy), developed at the Mexican National Commission in Nuclear Safety and Safeguards derived from the outcome obtained with the Probabilistic Safety Analysis developed at the Ibero-American Regulators Forum for these radiotherapy facilities. The methodology used is supported by risk matrices method, a mathematical tool that estimates the risk to the patient, radiation workers and public from mechanical failures, mis calibration of the devices, human mistakes, and so. The initiating events are defined as those undesirable events that, together with other failures, can produce a delivery of an over-dose or an under-dose of the medical prescribed dose, to the planned target volume, or a significant dose to non prescribed human organs. Initiating events frequency and reducer of its frequency (actions intended to avoid the accident) are estimated as well as robustness of barriers to those actions, such as mechanical switches, which detect and prevent the accident from occurring. The spectrum of the consequences is parameterized, and the actions performed to reduce the consequences are identified. Based on this analysis, a software tool was developed in order to simplify the evaluations to radiotherapy installations and it has been applied as a first step forward to some Mexican installations, as part of a national implementation process, the final goal is evaluation of all Mexican facilities in the near future. The main target and benefits of the SEVRRA implementation are presented in this paper. (Author)

  10. Dysphagia produced by cervical spine osteophyte. A case report

    Directory of Open Access Journals (Sweden)

    Claudio Silveri

    2014-01-01

    Full Text Available We present a case of a 73-year-old male patient with progressive dysphagia, and hoarseness (irritability in the throat. He was studied with the appropriate imaging techniques, and esophagoscopy led to a diagnosis of extrinsic esophageal dysphagia for osteophyte obstruction of the cervical spine due to the arthrosis. A surgical resection was performed, without complications. Some considerations are given on this theme.

  11. Predictors and Outcomes of Dysphagia Screening After Acute Ischemic Stroke.

    Science.gov (United States)

    Joundi, Raed A; Martino, Rosemary; Saposnik, Gustavo; Giannakeas, Vasily; Fang, Jiming; Kapral, Moira K

    2017-04-01

    Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many and which patients are screened and how failing a swallowing screen affects patient outcomes. We sought to evaluate predictors of receiving dysphagia screening after acute ischemic stroke and outcomes after failing a screening test. We used the Ontario Stroke Registry from April 1, 2010, to March 31, 2013, to identify patients hospitalized with acute ischemic stroke and determine predictors of documented dysphagia screening and outcomes after failing the screening test, including pneumonia, disability, and death. Among 7171 patients, 6677 patients were eligible to receive dysphagia screening within 72 hours, yet 1280 (19.2%) patients did not undergo documented screening. Patients with mild strokes were significantly less likely than those with more severe strokes to have documented screening (adjusted odds ratio, 0.51; 95% confidence interval [CI], 0.41-0.64). Failing dysphagia screening was associated with poor outcomes, including pneumonia (adjusted odds ratio, 4.71; 95% CI, 3.43-6.47), severe disability (adjusted odds ratio, 5.19; 95% CI, 4.48-6.02), discharge to long-term care (adjusted odds ratio, 2.79; 95% CI, 2.11-3.79), and 1-year mortality (adjusted hazard ratio, 2.42; 95% CI, 2.09-2.80). Associations were maintained in patients with mild strokes. One in 5 patients with acute ischemic stroke did not have documented dysphagia screening, and patients with mild strokes were substantially less likely to have documented screening. Failing dysphagia screening was associated with poor outcomes, including in patients with mild strokes, highlighting the importance of dysphagia screening for all patients with acute ischemic stroke. © 2017 American Heart Association, Inc.

  12. Treatment of post-stroke dysphagia by vitalstim therapy coupled with conventional swallowing training.

    Science.gov (United States)

    Xia, Wenguang; Zheng, Chanjuan; Lei, Qingtao; Tang, Zhouping; Hua, Qiang; Zhang, Yangpu; Zhu, Suiqiang

    2011-02-01

    To investigate the effects of VitalStim therapy coupled with conventional swallowing training on recovery of post-stroke dysphagia, a total of 120 patients with post-stroke dysphagia were randomly and evenly divided into three groups: conventional swallowing therapy group, VitalStim therapy group, and VitalStim therapy plus conventional swallowing therapy group. Prior to and after the treatment, signals of surface electromyography (sEMG) of swallowing muscles were detected, swallowing function was evaluated by using the Standardized Swallowing Assessment (SSA) and Videofluoroscopic Swallowing Study (VFSS) tests, and swallowing-related quality of life (SWAL-QOL) was evaluated using the SWAL-QOL questionnaire. There were significant differences in sEMG value, SSA, VFSS, and SWAL-QOL scores in each group between prior to and after treatment. After 4-week treatment, sEMG value, SSA, VFSS and SWAL-QOL scores were significantly greater in the VitalStim therapy plus conventional swallowing training group than in the conventional swallowing training group and VitalStim therapy group, but no significant difference existed between conventional swallowing therapy group and VitalStim therapy group. It was concluded that VitalStim therapy coupled with conventional swallowing training was conducive to recovery of post-stroke dysphagia.

  13. CLIMCONG: A framework-tool for assessing CLIMate CONGruency

    Science.gov (United States)

    Buras, Allan; Kölling, Christian; Menzel, Annette

    2016-04-01

    It is widely accepted that the anticipated elevational and latitudinal shifting of climate forces living organisms (including humans) to track these changes in space over a certain time. Due to the complexity of climate change, prediction of consequent migrations is a difficult procedure afflicted with many uncertainties. To simplify climate complexity and ease respective attempts, various approaches aimed at classifying global climates. For instance, the frequently used Köppen-Geiger climate classification (Köppen, 1900) has been applied to predict the shift of climate zones throughout the 21st century (Rubel and Kottek, 2010). Another - more objective but also more complex - classification approach has recently been presented by Metzger et al. (2013). Though being comprehensive, classifications have certain drawbacks, as I) often focusing on few variables, II) having discrete borders at the margins of classes, and III) subjective selection of an arbitrary number of classes. Ecological theory suggests that when only considering temperature and precipitation (such as Köppen, 1900) particular climate features - e.g. radiation and plant water availability - may not be represented with sufficient precision. Furthermore, sharp boundaries among homogeneous classes do not reflect natural gradients. To overcome the aforementioned drawbacks, we here present CLIMCONG - a framework-tool for assessing climate congruency for quantitatively describing climate similarity through continua in space and time. CLIMCONG allows users to individually select variables for calculation of climate congruency. By this, particular foci can be specified, depending on actual research questions posed towards climate change. For instance, while ecologists focus on a multitude of parameters driving net ecosystem productivity, water managers may only be interested in variables related to drought extremes and water availability. Based on the chosen parameters CLIMCONG determines congruency of

  14. Dysphagia. Impact on quality of life after radio(chemo)therapy of head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, Julia; Hipp, Matthias; Koelbl, Oliver [Regensburg Univ. Medical Center (Germany). Dept. of Radiotherapy; Schaefer, Christof [Hospital St. Elisabeth Straubing (Germany). Dept. of Radiotherapy

    2011-11-15

    In the past, xerostomia was considered one of the most important determining factors of quality of life (QoL) after radiotherapy (RT) of the head and neck region. In addition, more recent studies have shown that RT-induced dysphagia has an essential influence on the QoL. Between September 2005 and August 2007, 35 patients with locally advanced squamous cell carcinoma of the head and neck region were included in the prospective study. Patients were treated by IMAT (intensity-modulated arc therapy) or IMRT (intensity-modulated radiotherapy) planned on 3D imaging. A total of 28 patients (80%) received concomitant chemotherapy. The evaluation of QoL (EORTC QLQ - C30, H and N C-35) and toxicities (CTC 2.0) were assessed at the beginning of, during, and after RT as well as up to 12 months after the end of therapy. At the end of therapy, 86% of the patients experienced difficulties in swallowing (62% CTC II-III ). Twelve months after the end of treatment, 15% still suffered from dysphagia CTC II-III . Concomitant chemotherapy exacerbated the incidence and gravity of dysphagia, resulting in increasing dietary problems. QoL (EORTC) was significantly affected by dysphagia. In particular, the global state of health and QoL were influenced at the end of treatment (p = 0.033) and at a later stage (p = 0.050). The findings of this study suggest that more emphasis should be placed on structured clinical diagnostics, therapy, and rehabilitation of deglutition problems. This means in particular to not only spare the parotids while planning the irradiation, but also to take into consideration the important structures for deglutition, like the retropharyngeal muscles. (orig.)

  15. On-line Tools for Assessing Petroleum Releases

    Science.gov (United States)

    The Internet tools described in this report provide methods and models for evaluation of contaminated sites. Two problems are addressed by models. The first is the placement of wells for correct delineation of contaminant plumes. Because aquifer recharge can displace plumes dow...

  16. Third Party Risk Assessment Tool (3PRAT) User Guide

    Science.gov (United States)

    2012-06-26

    2 Lethal Crash Area – LCA Tab...Program includes five modules; Casualty Expectation, Probability of Loss of Aircraft (PLoA), Potential Crash Location, Lethal Crash Area ( LCA ), and...hypothetical UAS example, the fixed wing “Robin” is provided to assist in the comprehension of the LCA portion of the tool. Specifications for the Robin are

  17. Critical Technology Assessment of Five Axis Simultaneous Control Machine Tools

    Science.gov (United States)

    2009-07-01

    some of the less traditional end-uses cited in export license applications for these particular machine tools include the manufacture of artificial ... insemination equipment for cattle and the manufacture of moulds for the soles of shoes. C. Military Applications According to DOD’s Military

  18. The development of a partnering assessment tool for projects

    NARCIS (Netherlands)

    Holkers, A.; Voordijk, J.T.; Greenwood, D.

    2008-01-01

    Many firms in the construction industry claim to be working in a ‘partnering’ or even in an ‘integrated’ way. It is, however, very difficult to verify these claims with the tools currently available. The purpose of this study was to collect and refine existing work on integrative and collaborative w

  19. Tools and Techniques for Basin-Scale Climate Change Assessment

    Science.gov (United States)

    Zagona, E.; Rajagopalan, B.; Oakley, W.; Wilson, N.; Weinstein, P.; Verdin, A.; Jerla, C.; Prairie, J. R.

    2012-12-01

    The Department of Interior's WaterSMART Program seeks to secure and stretch water supplies to benefit future generations and identify adaptive measures to address climate change. Under WaterSMART, Basin Studies are comprehensive water studies to explore options for meeting projected imbalances in water supply and demand in specific basins. Such studies could be most beneficial with application of recent scientific advances in climate projections, stochastic simulation, operational modeling and robust decision-making, as well as computational techniques to organize and analyze many alternatives. A new integrated set of tools and techniques to facilitate these studies includes the following components: Future supply scenarios are produced by the Hydrology Simulator, which uses non-parametric K-nearest neighbor resampling techniques to generate ensembles of hydrologic traces based on historical data, optionally conditioned on long paleo reconstructed data using various Markov Chain techniuqes. Resampling can also be conditioned on climate change projections from e.g., downscaled GCM projections to capture increased variability; spatial and temporal disaggregation is also provided. The simulations produced are ensembles of hydrologic inputs to the RiverWare operations/infrastucture decision modeling software. Alternative demand scenarios can be produced with the Demand Input Tool (DIT), an Excel-based tool that allows modifying future demands by groups such as states; sectors, e.g., agriculture, municipal, energy; and hydrologic basins. The demands can be scaled at future dates or changes ramped over specified time periods. Resulting data is imported directly into the decision model. Different model files can represent infrastructure alternatives and different Policy Sets represent alternative operating policies, including options for noticing when conditions point to unacceptable vulnerabilities, which trigger dynamically executing changes in operations or other

  20. A Targeted Swallow Screen for the Detection of Postoperative Dysphagia.

    Science.gov (United States)

    Gee, Erica; Lancaster, Elizabeth; Meltzer, Jospeh; Mendelsohn, Abie H; Benharash, Peyman

    2015-10-01

    Postoperative dysphagia leads to aspiration pneumonia, prolonged hospital stay, and is associated with increased mortality. A simple and sensitive screening test to identify patients requiring objective dysphagia evaluation is presently lacking. In this study, we evaluated the efficacy of a novel targeted swallow screen evaluation. This was a prospective trial involving all adult patients who underwent elective cardiac surgery with cardiopulmonary bypass at our institution over an 8-week period. Within 24 hours of extubation and before the initiation of oral intake, all postsurgical patients were evaluated using the targeted swallow screen. A fiberoptic endoscopic evaluation of swallowing was requested for failed screenings. During the study, 50 postcardiac surgery patients were screened. Fifteen (30%) failed the targeted swallow screen, and ten of the fifteen (66%) failed the subsequent fiberoptic endoscopic evaluation of swallowing exam and were confirmed to have dysphagia. The screening test had 100 per cent sensitivity for detecting dysphagia in our patient population, and a specificity of 87.5 per cent. The overall incidence of dysphagia was 20 per cent. We have shown that a targeted swallow evaluation can efficiently screen patients during the postcardiac surgery period. Furthermore, we have shown that the true incidence of dysphagia after cardiac surgery is significantly higher than previously recognized in literature.