WorldWideScience

Sample records for swallowing impact strategies

  1. Pharyngeal Swallowing Mechanics Secondary to Hemispheric Stroke.

    Science.gov (United States)

    May, Nelson H; Pisegna, Jessica M; Marchina, Sarah; Langmore, Susan E; Kumar, Sandeep; Pearson, William G

    2017-05-01

    Computational analysis of swallowing mechanics (CASM) is a method that utilizes multivariate shape change analysis to uncover covariant elements of pharyngeal swallowing mechanics associated with impairment using videofluoroscopic swallowing studies. The goals of this preliminary study were to (1) characterize swallowing mechanics underlying stroke-related dysphagia, (2) decipher the impact of left and right hemispheric strokes on pharyngeal swallowing mechanics, and (3) determine pharyngeal swallowing mechanics associated with penetration-aspiration status. Videofluoroscopic swallowing studies of 18 dysphagic patients with hemispheric infarcts and age- and gender-matched controls were selected from well-controlled data sets. Patient data including laterality and penetration-aspiration status were collected. Coordinates mapping muscle group action during swallowing were collected from videos. Multivariate morphometric analyses of coordinates associated with stroke, affected hemisphere, and penetration-aspiration status were performed. Pharyngeal swallowing mechanics differed significantly in the following comparisons: stroke versus controls (D = 2.19, P mechanics associated with each comparison were visualized using eigenvectors. Whereas current literature focuses on timing changes in stroke-related dysphagia, these data suggest that mechanical changes are also functionally important. Pharyngeal swallowing mechanics differed by the affected hemisphere and the penetration-aspiration status. CASM can be used to identify patient-specific swallowing impairment associated with stroke injury that could help guide rehabilitation strategies to improve swallowing outcomes. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  2. Swallowing Disorders in Parkinson's Disease: Impact of Lingual Pumping

    Science.gov (United States)

    Argolo, Natalie; Sampaio, Marília; Pinho, Patrícia; Melo, Ailton; Nóbrega, Ana Caline

    2015-01-01

    Background: Lingual pumping (LP) is a repetitive, involuntary, anteroposterior movement of the tongue on the soft palate that is executed prior to transferring the food bolus to the pharynx, but we also observed LP when multiple swallows were taken. LP may be associated with rigidity and bradykinesia in patients with Parkinson's disease (PD). This…

  3. Impact of Children’s Feeding/Swallowing Problems: Validation of a New Caregiver Instrument

    Science.gov (United States)

    Okelo, Sande O.; Wright, Jennifer M.; Collaco, Joseph M.; McGrath-Morrow, Sharon A.; Eakin, Michelle N.

    2015-01-01

    The impact of caring for children with deglutition disorders is poorly understood and tools to measure the unique concerns of these caregivers are lacking. The aims of this investigation were to develop and validate The Feeding/Swallowing Impact Survey (FS-IS) as an instrument designed to measure and improve understanding of caregiver issues. Demographic, economic, and dysphagic data were provided by the primary caregivers of 164 children (median age: 14 months, male: 78, female: 86) presenting for initial outpatient feeding/swallowing evaluations. Caregivers completed the PEDS-QL™ Family Impact Module (PEDS-QL™ FIM) and the FS-IS. A principal component analysis was conducted on the FS-IS to identify appropriate subscales. Concurrent validity was assessed by examining correlations between the FS-IS and PEDS-QL™ FIM. Caring for children with feeding/swallowing problems adversely impacted the Health-Related Quality of Life (HRQoL) of their caregivers. The FS-IS had a strong 3-factor solution to indicate 3 subscales: Daily Activities, Worry, and Feeding Difficulties. All three sub-scales and total score of the FS-IS correlated with PEDS-QL™ FIM. The FS-IS was validated as an instrument that may help clinicians detect specific factors that influence caregiver HRQoL, identify caregivers who might benefit from additional support, and ultimately improve the care of their children with feeding/swallowing disorders. PMID:25159316

  4. SWALLOWING DISORDERS IN CLINICAL PRACTICE: FUNCTIONAL ANATOMY, ASSESSMENT AND REHABILITATION STRATEGIES

    Directory of Open Access Journals (Sweden)

    STANESCU Ioana

    2014-09-01

    Full Text Available Swallowing is a complex process consisting in transporting food from mouth to the stomach; it involves voluntary and reflex activity of more than 30 nerves and muscles, requiring complex neuromuscular coordination and brainstem and cortical centers for controle. Dysphagia is defined as a alteration in the swallowing process, which cause difficulty in transporting saliva and aliments from the mouth trough the pharynx and esophagus into the stomach . It is a frequent symptom, affecting especially old people, people with neurological diseases, cancers of head and neck or severe reflux . Dysphagia can result from a wide variety of functional or structural deficits of the oral cavity, pharynx, larynx or esophagus, which could e caused by neurological conditions. Dysphagia carries serious health risks: malnutrition, dehydration, increase risk of infections. Effective dysphagia management requires an interdisciplinary approach; the goal of rehabilitation is to identify and treat abnormalities of swallowing while maintaining safe and efficient nutrition. KEY WORDS: swallowing, dysphagia, functional anatomy, rehabilitation, neuroplasticity

  5. Swallowing difficulty

    Science.gov (United States)

    ... and other swallowing tests Chest x-ray Esophageal pH monitoring (measures acid in the esophagus) Esophageal manometry ( ... Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management . 10th ed. ...

  6. Impact of Hypena opulenta on invasive swallow-worts (Vincetoxicum spp.) under different light environments

    Science.gov (United States)

    Pale and black swallow-wort (Vincetoxicum rossicum and V. nigrum; Apocynaceae, subfamily Asclepiadoideae) are European viny milkweeds that have become invasive in many habitats in the northeastern U.S.A. and southeastern Canada. A defoliating moth from the Ukraine, Hypena opulenta (Christoph) (Lepid...

  7. Impact of Abrostola asclepiadis and plant competition on invasive swallow-worts (Vincetoxicum spp.)

    Science.gov (United States)

    Pale and black swallow-wort (Vincetoxicum rossicum and V. nigrum; Apocynaceae, subfamily Asclepiadoideae) are perennial vines from Europe that have become invasive in various terrestrial habitats in the northeastern USA and southeastern Canada. A classical weed biological control program has been in...

  8. Dysphagia and swallowing-related quality of life in Friedreich ataxia.

    Science.gov (United States)

    Vogel, Adam P; Brown, Sophie E; Folker, Joanne E; Corben, Louise A; Delatycki, Martin B

    2014-02-01

    Dysphagia in Friedreich ataxia (FRDA) and its impact on quality of life is not adequately understood. The objective of this study was to characterise dysphagia in FRDA and to determine the impact of swallowing dysfunction on activities, participation, and sense of well-being. Thirty-six individuals with a confirmed diagnosis of FRDA were assessed via a clinical bedside examination (CBE), the Royal Brisbane Hospital outcome measure for swallowing, an oral-motor examination and the Australian therapy outcome measures for speech and swallowing (AusTOMS). Data on swallowing function, diet modification and swallowing strategies were collated. Thirty-three (91.67 %) participants exhibited clinical signs of dysphagia according to the CBE, and all participants received ratings indicating swallowing difficulties on at least one other measure. Dysphagia in FRDA is characterised by oral and pharyngeal stage impairment relating to incoordination, weakness and spasticity. A significant positive correlation was found between the severity of impairment, activity, participation and distress/well-being on the AusTOMS, suggesting that swallowing function decreases with overall reductions in quality of life. A significant correlation was found between activity on the AusTOMS and disease duration (r = -0.283, p = 0.012). No significant correlations were found between dysphagia severity and GAA repeat length, age of onset or disease severity. Participants employing diet modification and swallowing strategies demonstrated higher dysphagia severity, activity limitations and participation restrictions. These data advocate a holistic approach to dysphagia management in FRDA. Early detection of swallowing impairment and consideration of the potential impact dysphagia has on quality of life should be key aspects in disease management.

  9. Therapeutic singing as an early intervention for swallowing in persons with Parkinson's disease.

    Science.gov (United States)

    Stegemöller, E L; Hibbing, P; Radig, H; Wingate, J

    2017-04-01

    For persons with Parkinson's disease (PD), secondary motor symptoms such as swallow impairment impact the quality of life and are major contributors to mortality. There is a present need for therapeutic interventions aimed at improving swallow function during the early stages of PD. The purpose of this pilot study was to examine the effects of a group therapeutic singing intervention on swallowing in persons with PD with no significant dysphagia symptoms. Cohort study. University in the United States. Twenty-four participants with PD. Eight weeks of group therapeutic singing. Electromyography (EMG) was used to assess muscle activity associated with swallow pre and post the group singing intervention. Swallow quality of life (SWAL-QOL) and the Unified Parkinson's Disease Rating Scale (UPDRS) were also obtained pre- and post-intervention. Participants reported minimal difficulty with swallowing, yet results revealed a significant increase in EMG outcome measures, as well as significant improvement in UPDRS total and UPDRS motor scores. No significant differences were revealed for SWAL-QOL. Increases in EMG timing measures may suggest that group singing results in the prolongation of laryngeal elevation, protecting the airway from foreign material for longer periods of time during swallow. Combined with the improvement in UPDRS clinical measures, therapeutic singing may be an engaging early intervention strategy to address oropharyngeal dysphagia while also benefiting additional clinical symptoms of PD. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Pediatric feeding and swallowing rehabilitation: An overview

    NARCIS (Netherlands)

    Engel-Hoek, L. van den; Harding, C.; Gerven, M.H.J.C van; Cockerill, H.

    2017-01-01

    Children with neurological disabilities frequently have problems with feeding and swallowing. Such problems have a significant impact on the health and well-being of these children and their families. The primary aims in the rehabilitation of pediatric feeding and swallowing disorders are focused on

  11. Swallowing Disorders - Multiple Languages

    Science.gov (United States)

    ... Expand Section Barium Swallow - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Swallowing Problems - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual ...

  12. Impact of the defoliating moth Hypena opulenta on invasive swallow-worts (Vincetoxicum species) under different light environments

    Science.gov (United States)

    Black and pale swallow-wort (Vincetoxicum nigrum and V. rossicum, Apocynaceae: Asclepiadoideae) are twining vines from Europe that have become invasive in the northeastern USA and southeastern Canada. Hypena opulenta (Christoph) (Lepidoptera: Erebidae), a defoliating forest moth from the Ukraine, ha...

  13. Quantitative classification of pediatric swallowing through accelerometry

    Directory of Open Access Journals (Sweden)

    Celeste Merey

    2012-06-01

    Full Text Available Abstract Background Dysphagia or swallowing disorder negatively impacts a child’s health and development. The gold standard of dysphagia detection is videofluoroscopy which exposes the child to ionizing radiation, and requires specialized clinical expertise and expensive institutionally-based equipment, precluding day-to-day and repeated assessment of fluctuating swallowing function. Swallowing accelerometry is the non-invasive measurement of cervical vibrations during swallowing and may provide a portable and cost-effective bedside alternative. In particular, dual-axis swallowing accelerometry has demonstrated screening potential in older persons with neurogenic dysphagia, but the technique has not been evaluated in the pediatric population. Methods In this study, dual-axis accelerometric signals were collected simultaneous to videofluoroscopic records from 29 pediatric participants (age 6.8 ± 4.8 years; 20 males previously diagnosed with neurogenic dysphagia. Participants swallowed 3-5 sips of barium-coated boluses of different consistencies (normally, from thick puree to thin liquid by spoon or bottle. Videofluoroscopic records were reviewed retrospectively by a clinical expert to extract swallow timings and ratings. The dual-axis acceleration signals corresponding to each identified swallow were pre-processed, segmented and trimmed prior to feature extraction from time, frequency, time-frequency and information theoretic domains. Feature space dimensionality was reduced via principal components. Results Using 8-fold cross-validation, 16-17 dimensions and a support vector machine classifier with an RBF kernel, an adjusted accuracy of 89.6% ± 0.9 was achieved for the discrimination between swallows with and with out airway entry. Conclusions Our results suggest that dual-axis accelerometry has merit in the non-invasive detection of unsafe swallows in children and deserves further consideration as a pediatric medical device.

  14. Impact of a Multidisciplinary Round Visit for the Management of Dysphagia Utilizing a Wi-Fi-Based Wireless Flexible Endoscopic Evaluation of Swallowing.

    Science.gov (United States)

    Sakakura, Koichi; Tazawa, Masayuki; Otani, Natsuko; Takagi, Masato; Morita, Mariko; Kurosaki, Minori; Chiyoda, Tomoko; Kanai, Yuri; Endo, Ayaka; Murata, Takaaki; Shino, Masato; Yokobori, Yuki; Shirakura, Kenji; Wada, Naoki; Chikamatsu, Kazuaki

    2017-01-01

    The management of dysphagia requires a multidisciplinary approach, especially in large-scale hospitals. We introduce a novel protocol using a Wi-Fi-based flexible endoscopic evaluation of swallowing (FEES) system and aim to verify its effectiveness in evaluation and rehabilitation of inpatients with dysphagia. We conducted novel Wi-Fi-based FEES at the bedside using 3 iPads as monitors and recorders. Functional outcomes of swallowing in 2 different hospitals for acute care with conventional wired or wireless FEES were compared retrospectively. Using the wireless system, we could visit more patients in a short period of time. Furthermore, a large multidisciplinary team was able to be present at the bedside, which made it easy to hold discussions and rapidly devise appropriate rehabilitation strategies. Aspiration pneumonia recurred in a few cases following our intervention with wireless FEES. Functional oral intake score was significantly increased following the intervention. Moreover, the number of deaths during hospitalization using wireless FEES evaluation was lower than those observed using the conventional system. Wi-Fi-based wireless FEES system, the first of its kind, allowed our multidisciplinary team to easily and effectively assess inpatients with dysphagia by facilitating simple examinations and intensive transprofessional discussions for patient rehabilitation. © The Author(s) 2016.

  15. Oral Health and Swallowing Problems

    OpenAIRE

    Furuta, Michiko; Yamashita, Yoshihisa

    2013-01-01

    Oral health impacts systemic health. Therefore, oral care is an important consideration in maintaining quality of life (QOL). Previously, maintenance and improvement of oral hygiene was considered essential for achieving oral health. In addition to oral hygiene, oral care in terms of oral function is now considered to maintain QOL. Ingestion of exogenous nutrients via the oral cavity is fundamental to the function of all higher animals, not only human beings. Chewing and swallowing processes ...

  16. [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.

  17. Speech and Swallowing

    Science.gov (United States)

    ... Hallucinations/Delusions Pain Skeletal & Bone Health Skin Changes Sleep Disorders Small Handwriting Speech & Swallowing Problems Urinary Incontinence Vision Changes Weight Management Diagnosis Treatment Help Us Make a Difference We need your ...

  18. Prophylactic Swallowing Exercises in Head and Neck Cancer Radiotherapy

    DEFF Research Database (Denmark)

    Mortensen, H R; Jensen, Kenneth; Aksglæde, K

    2015-01-01

    Many head and neck cancer (HNC) survivors experience reduced quality of life due to radiotherapy (RT)-related dysphagia. The aim of this prospective randomized trial was to evaluate the impact of prophylactic swallowing exercises on swallowing-related outcomes in HNC patients treated with curative...

  19. The impact of dysphagia on quality of life in ageing and Parkinson's disease as measured by the swallowing quality of life (SWAL-QOL) questionnaire.

    Science.gov (United States)

    Leow, Li Pyn; Huckabee, Maggie-Lee; Anderson, Tim; Beckert, Lutz

    2010-09-01

    This prospective, cross-sectional study evaluated the impact of dysphagia on quality of life in healthy ageing and in subjects with Parkinson's disease (PD) using the Swallowing Quality of Life (SWAL-QOL) questionnaire. Sixteen healthy young adults (8 males, mean age = 25.1 years) and 16 healthy elders (8 males, mean age = 72.8 years) were recruited. Thirty-two subjects with idiopathic PD (mean age = 68.5 years) were recruited from a movement disorders clinic. The severity of PD was staged using the Hoehn and Yahr scale. Results revealed that elders experienced symptoms of dysphagia more frequently than young adults but the overall SWAL-QOL scores were not significantly different. Subjects with PD who experienced dysphagia reported greatly reduced QOL, and significant differences were found in all but one subsection of the SWAL-QOL. Disease progression detrimentally impacts QOL, with subjects in later-stage PD experiencing further reduction in the desire to eat, difficulty with food selection, and prolonged eating duration. These features, which increase with disease severity, are likely to impact negatively upon nutritional status, which is already under threat from PD-related dysphagia.

  20. Tailored Barium Swallow Study

    Science.gov (United States)

    ... Different textures of food are often given. The barium is a contrast material that makes the food and liquid show ... MRI Intravenous Contrast Information MRI with or without Contrast Small Bowel Follow Through (SBFT) Tailored Barium Swallow Study The Upper GI Study (GI Series) ...

  1. Esophagram (Barium Swallow Study)

    Science.gov (United States)

    ... drink 1 to 2 cups of barium. The barium is a contrast material that makes liquids show up on the ... MRI Intravenous Contrast Information MRI with or without Contrast Small Bowel Follow Through (SBFT) Tailored Barium Swallow Study The Upper GI Study (GI Series) ...

  2. The impact of lesion location on dysphagia incidence, pattern and complications in acute stroke. Part 2: Oropharyngeal residue, swallow and cough response, and pneumonia.

    Science.gov (United States)

    Suntrup-Krueger, S; Kemmling, A; Warnecke, T; Hamacher, C; Oelenberg, S; Niederstadt, T; Heindel, W; Wiendl, H; Dziewas, R

    2017-06-01

    Dysphagia is a well-known complication of acute stroke. Given the complexity of cerebral swallowing control it is still difficult to predict which patients are likely to develop swallowing dysfunction based on their neuroimaging. In Part 2 of a comprehensive voxel-based imaging study, whether the location of a stroke lesion can be correlated with further dysfunctional swallowing patterns, pulmonary protective reflexes and pneumonia was evaluated. In all, 200 acute stroke cases were investigated applying flexible endoscopic evaluation of swallowing within 96 h from admission. Lesions were mapped using patients' computed tomography/magnetic resonance images and these were registered to a standard space. The percentage of lesioned volume of 137 anatomically defined brain regions was determined on a voxel basis (FSL5.0). Region-specific odds ratios (ORs) were calculated with respect to the presence of oropharyngeal residue, delayed swallow response, insufficient cough reflex and occurrence of pneumonia during hospital stay. Colour-coded lesion location maps of brain regions with significant ORs were created (P pneumonia, but substantial overlap between the last two conditions. This study gives new insights on the cortical representation of single components of swallowing and airway protection behaviours. The lesion model may help to risk-stratify patients for dysphagia and pneumonia based on their brain scan. © 2017 EAN.

  3. Climate geopolitics. Negotiations, strategies, impacts

    International Nuclear Information System (INIS)

    Gemenne, Francois

    2015-01-01

    As countries are not equal in front of the climate change issue (some contribute more than the others, some will be more heavily impacted, some are more dependent on fossil energies, some could be affected by population movements related to the degradation of their environment), and as countries are to adopt measures for a more sustainable development while facing huge geopolitical challenges which affect international negotiations, this book aims at describing and analysing these issues which illustrate serious imbalances between countries. These issues relate to the development of energy policies, to geographical and demographic constraints. The author describes how the climate has become an international political issue, and a field of complex interactions with international relationships. After having recalled the origins of greenhouse gas emissions and their main expected impacts, he analyses the various responsibilities, describes these different impacts, outlines how global warming is basically unfair: the less responsible countries will be more impacted than the responsible ones. He also discusses mechanisms of international cooperation which have been implemented to address this issue: adaptation and mitigation policies, associated negotiations. He notices that the strongest mitigation efforts are, the least necessary adaptation efforts will be. He discusses the issue of financing and necessary financial and technological transfers to help southern countries in reducing their emissions without compromising their development. He highlights the current status of negotiations, their organisation, the present actors and forces, and their main point of tension

  4. Overdrinking, swallowing inhibition, and regional brain responses prior to swallowing.

    Science.gov (United States)

    Saker, Pascal; Farrell, Michael J; Egan, Gary F; McKinley, Michael J; Denton, Derek A

    2016-10-25

    In humans, drinking replenishes fluid loss and satiates the sensation of thirst that accompanies dehydration. Typically, the volume of water drunk in response to thirst matches the deficit. Exactly how this accurate metering is achieved is unknown; recent evidence implicates swallowing inhibition as a potential factor. Using fMRI, this study investigated whether swallowing inhibition is present after more water has been drunk than is necessary to restore fluid balance within the body. This proposal was tested using ratings of swallowing effort and measuring regional brain responses as participants prepared to swallow small volumes of liquid while they were thirsty and after they had overdrunk. Effort ratings provided unequivocal support for swallowing inhibition, with a threefold increase in effort after overdrinking, whereas addition of 8% (wt/vol) sucrose to water had minimal effect on effort before or after overdrinking. Regional brain responses when participants prepared to swallow showed increases in the motor cortex, prefrontal cortices, posterior parietal cortex, striatum, and thalamus after overdrinking, relative to thirst. Ratings of swallowing effort were correlated with activity in the right prefrontal cortex and pontine regions in the brainstem; no brain regions showed correlated activity with pleasantness ratings. These findings are all consistent with the presence of swallowing inhibition after excess water has been drunk. We conclude that swallowing inhibition is an important mechanism in the overall regulation of fluid intake in humans.

  5. Effects of barium concentration on oropharyngeal swallow timing measures.

    Science.gov (United States)

    Stokely, Shauna L; Molfenter, Sonja M; Steele, Catriona M

    2014-02-01

    Videofluoroscopy is commonly used for evaluating oropharyngeal swallowing but requires radiopaque contrast (typically barium). Prior studies suggest that some aspects of swallowing, including timing measures of oral and pharyngeal bolus transit, vary depending on barium concentration. The aim of our study was to identify timing differences in healthy swallowing between "thin" (40 % w/v concentration) and "ultrathin" (22 % w/v concentration) barium solutions. Twenty healthy adults (Ten women; mean age = 31 years) each performed a series of three noncued 5-ml swallows each of ultrathin and thin liquid barium solutions in videofluoroscopy. Timing measures were compared between barium concentrations using a mixed-model ANOVA. The measures of interest were stage transition duration, pharyngeal transit time, and duration of upper esophageal sphincter opening. Significant differences were observed in the timing measures of swallowing with respect to barium concentration. In all cases, longer durations were seen with the higher barium concentration. Barium concentration influences timing parameters in healthy swallowing, even between ultrathin and thin concentrations. Clinicians need to understand and control for the impact of different barium stimuli on swallowing physiology.

  6. Effect of Bolus Viscosity on the Safety and Efficacy of Swallowing and the Kinematics of the Swallow Response in Patients with Oropharyngeal Dysphagia: White Paper by the European Society for Swallowing Disorders (ESSD).

    Science.gov (United States)

    Newman, Roger; Vilardell, Natàlia; Clavé, Pere; Speyer, Renée

    2016-04-01

    Fluid thickening is a well-established management strategy for oropharyngeal dysphagia (OD). However, the effects of thickening agents on the physiology of impaired swallow responses are not fully understood, and there is no agreement on the degree of bolus thickening. To review the literature and to produce a white paper of the European Society for Swallowing Disorders (ESSD) describing the evidence in the literature on the effect that bolus modification has upon the physiology, efficacy and safety of swallowing in adults with OD. A systematic search was performed using the electronic Pubmed and Embase databases. Articles in English available up to July 2015 were considered. The inclusion criteria swallowing studies on adults over 18 years of age; healthy people or patients with oropharyngeal dysphagia; bolus modification; effects of bolus modification on swallow safety (penetration/aspiration) and efficacy; and/or physiology and original articles written in English. The exclusion criteria consisted of oesophageal dysphagia and conference abstracts or presentations. The quality of the selected papers and the level of research evidence were assessed by standard quality assessments. At the end of the selection process, 33 articles were considered. The quality of all included studies was assessed using systematic, reproducible, and quantitative tools (Kmet and NHMRC) concluding that all the selected articles reached a valid level of evidence. The literature search gathered data from various sources, ranging from double-blind randomised control trials to systematic reviews focused on changes occurring in swallowing physiology caused by thickened fluids. Main results suggest that increasing bolus viscosity (a) results in increased safety of swallowing, (b) also results in increased amounts of oral and/or pharyngeal residue which may result in post-swallow airway invasion, (c) impacts the physiology with increased lingual pressure patterns, no major changes in impaired

  7. Evidence for adaptive cortical changes in swallowing in Parkinson's disease.

    Science.gov (United States)

    Suntrup, Sonja; Teismann, Inga; Bejer, Joke; Suttrup, Inga; Winkels, Martin; Mehler, David; Pantev, Christo; Dziewas, Rainer; Warnecke, Tobias

    2013-03-01

    Dysphagia is a relevant symptom in Parkinson's disease, whose pathophysiology is poorly understood. It is mainly attributed to degeneration of brainstem nuclei. However, alterations in the cortical contribution to deglutition control in the course of Parkinson's disease have not been investigated. Here, we sought to determine the patterns of cortical swallowing processing in patients with Parkinson's disease with and without dysphagia. Swallowing function in patients was objectively assessed with fiberoptic endoscopic evaluation. Swallow-related cortical activation was measured using whole-head magnetoencephalography in 10 dysphagic and 10 non-dysphagic patients with Parkinson's disease and a healthy control group during self-paced swallowing. Data were analysed applying synthetic aperture magnetometry, and group analyses were done using a permutation test. Compared with healthy subjects, a strong decrease of cortical swallowing activation was found in all patients. It was most prominent in participants with manifest dysphagia. Non-dysphagic patients with Parkinson's disease showed a pronounced shift of peak activation towards lateral parts of the premotor, motor and inferolateral parietal cortex with reduced activation of the supplementary motor area. This pattern was not found in dysphagic patients with Parkinson's disease. We conclude that in Parkinson's disease, not only brainstem and basal ganglia circuits, but also cortical areas modulate swallowing function in a clinically relevant way. Our results point towards adaptive cerebral changes in swallowing to compensate for deficient motor pathways. Recruitment of better preserved parallel motor loops driven by sensory afferent input seems to maintain swallowing function until progressing neurodegeneration exceeds beyond the means of this adaptive strategy, resulting in manifestation of dysphagia.

  8. Bank Swallow - Monitoring [ds6

    Data.gov (United States)

    California Natural Resource Agency — The data set represents the annual count of bank swallow burrows at nesting colonies located along the Sacramento River. The data set contains two databases which...

  9. Bank Swallow - Monitoring [ds6

    Data.gov (United States)

    California Department of Resources — The data set represents the annual count of bank swallow burrows at nesting colonies located along the Sacramento River. The data set contains two databases which...

  10. Observation the swallowing mechanism in elderly patients with pharyngeal dysphagia

    Directory of Open Access Journals (Sweden)

    Claudia Ximena Campo-Cañar

    2010-09-01

    Full Text Available Observation of the swallowing dynamics is an issue that demands close attention by the health professionals involved in the diagnosis and management of patients with dysphagia. This article is a review of the literature aimed to enhance the knowledge regarding the speech therapy assessment of pharyngeal dysphagia in elder adults. The disorder of the swallowing is called dysphagia and it is defined as difficulty swallowing. The dysphagia is often caused by affectation of mechanical or neuromuscular components of the swallowing mechanism. This type of disorder is likely to impact the the oral, pharyngeal and esophageal phases of the swallowing. The speech therapist should take into account assessing aspects such as level of consciousness, vital signs, whether or not the patient is ventilator dependent, means of feeding, if intubated what type of cannula, whether or not the patient uses a speaking valve (if a trach tube is present, nutritional status, the patient’s expressive and receptive language, the anatomical and physiological state of the oral motor structures. When assessing swallowing clinicians should also make sure to develop an adequate beside clinical, voice assessment and videofluoroscopy.

  11. Inappropriate Timing of Swallow in the Respiratory Cycle Causes Breathing–Swallowing Discoordination

    Directory of Open Access Journals (Sweden)

    Naomi Yagi

    2017-09-01

    Full Text Available Rationale: Swallowing during inspiration and swallowing immediately followed by inspiration increase the chances of aspiration and may cause disease exacerbation. However, the mechanisms by which such breathing–swallowing discoordination occurs are not well-understood.Objectives: We hypothesized that breathing–swallowing discoordination occurs when the timing of the swallow in the respiratory cycle is inappropriate. To test this hypothesis, we monitored respiration and swallowing activity in healthy subjects and in patients with dysphagia using a non-invasive swallowing monitoring system.Measurements and Main Results: The parameters measured included the timing of swallow in the respiratory cycle, swallowing latency (interval between the onset of respiratory pause and the onset of swallow, pause duration (duration of respiratory pause for swallowing, and the breathing–swallowing coordination pattern. We classified swallows that closely follow inspiration (I as I-SW, whereas those that precede I as SW-I pattern. Patients with dysphagia had prolonged swallowing latency and pause duration, and tended to have I-SW or SW-I patterns reflecting breathing–swallows discoordination.Conclusions: We conclude that swallows at inappropriate timing in the respiratory cycle cause breathing–swallowing discoordination, and the prolongation of swallowing latency leads to delayed timing of the swallow, and results in an increase in the SW-I pattern in patients with dysphagia.

  12. Identification of behaviour change components in swallowing interventions for head and neck cancer patients: protocol for a systematic review.

    Science.gov (United States)

    Govender, Roganie; Smith, Christina H; Taylor, Stuart A; Grey, Daphne; Wardle, Jane; Gardner, Benjamin

    2015-06-20

    Dysphagia (difficulty in swallowing) is a predictable consequence of head and neck cancer and its treatment. Loss of the ability to eat and drink normally has a devastating impact on quality of life for survivors of this type of cancer. Most rehabilitation programmes involve behavioural interventions that include swallowing exercises to help improve swallowing function. Such interventions are complex; consisting of multiple components that may influence outcomes. These interventions usually require patient adherence to recommended behaviour change advice. To date, reviews of this literature have explored whether variation in effectiveness can be attributed to the type of swallowing exercise, the use of devices to facilitate use of swallowing muscles, and the timing (before, during or after cancer treatment). This systematic review will use a behavioural science lens to examine the content of previous interventions in this field. It aims to identify (a) which behaviour change components are present, and (b) the frequency with which they occur in interventions deemed to be effective and non-effective. Clinical trials of behavioural interventions to improve swallowing outcomes in patients with head and neck cancers will be identified via a systematic and comprehensive search of relevant electronic health databases, trial registers, systematic review databases and Web of Science. To ascertain behaviour change intervention components, we will code the content for its theory basis, intervention functions and specific behaviour change techniques, using validated tools: the Theory Coding Scheme, Behaviour Change Wheel and Behaviour Change Technique Taxonomy v1. Study quality will be assessed for descriptive purposes only. Given the specialisation and focus of this review, a small yield of studies with heterogeneous outcome measures is anticipated. Therefore, narrative synthesis is considered more appropriate than meta-analysis. We will also compare the frequency of

  13. Acoustical modeling of swallowing mechanism.

    Science.gov (United States)

    Shirazi, Samaneh Sarraf; Moussavi, Zahra M K

    2011-01-01

    In this paper, a mathematical modeling of the swallowing sound generation is presented. To evaluate the model, its application on swallowing disorder (dysphagia) diagnosis is discussed. As a starting point, a simple linear time invariant model is assumed to represent the pharyngeal wall and tissue excited by a train of impulses. The modeling is approached by two different assumptions. In one approach, it is assumed that the impulse train, representing the neural activities to trigger swallow, is the same for both groups of control and dysphagic, and it is the pharyngeal model that accounts for the difference between the two groups. On the other hand, in the second approach, it is assumed that the pharyngeal response is the same for both groups, but the neural activities to initiate the swallow are different between the two groups. The results show that the second approach complies better with the physiological characteristics of swallowing mechanism as it provides a much better discrimination between the swallowing sounds of control and dysphagic groups of this study. Though, it should be noted that our dysphagic group subjects were cerebral palsy and stroke patients. Hence, the model accounting for initiation of neural activities is reasonable to show better results.

  14. Speech–Language Pathology Evaluation and Management of Hyperkinetic Disorders Affecting Speech and Swallowing Function

    Directory of Open Access Journals (Sweden)

    Julie M. Barkmeier-Kraemer

    2017-09-01

    Full Text Available Background: Hyperkinetic dysarthria is characterized by abnormal involuntary movements affecting respiratory, phonatory, and articulatory structures impacting speech and deglutition. Speech–language pathologists (SLPs play an important role in the evaluation and management of dysarthria and dysphagia. This review describes the standard clinical evaluation and treatment approaches by SLPs for addressing impaired speech and deglutition in specific hyperkinetic dysarthria populations.Methods: A literature review was conducted using the data sources of PubMed, Cochrane Library, and Google Scholar. Search terms included 1 hyperkinetic dysarthria, essential voice tremor, voice tremor, vocal tremor, spasmodic dysphonia, spastic dysphonia, oromandibular dystonia, Meige syndrome, orofacial, cervical dystonia, dystonia, dyskinesia, chorea, Huntington’s Disease, myoclonus; and evaluation/treatment terms: 2 Speech–Language Pathology, Speech Pathology, Evaluation, Assessment, Dysphagia, Swallowing, Treatment, Management, and diagnosis.Results: The standard SLP clinical speech and swallowing evaluation of chorea/Huntington’s disease, myoclonus, focal and segmental dystonia, and essential vocal tremor typically includes 1 case history; 2 examination of the tone, symmetry, and sensorimotor function of the speech structures during non-speech, speech and swallowing relevant activities (i.e., cranial nerve assessment; 3 evaluation of speech characteristics; and 4 patient self-report of the impact of their disorder on activities of daily living. SLP management of individuals with hyperkinetic dysarthria includes behavioral and compensatory strategies for addressing compromised speech and intelligibility. Swallowing disorders are managed based on individual symptoms and the underlying pathophysiology determined during evaluation.Discussion: SLPs play an important role in contributing to the differential diagnosis and management of impaired speech and

  15. Feeding and Swallowing Disorders in Pediatric Neuromuscular Diseases: An Overview.

    Science.gov (United States)

    van den Engel-Hoek, Lenie; de Groot, Imelda J M; de Swart, Bert J M; Erasmus, Corrie E

    2015-11-20

    Feeding and swallowing problems in infants and children have a great impact on health and wellbeing. The aim of this study was to provide an overview of recognized feeding and swallowing problems in different groups of children with neuromuscular diseases, based on relevant literature and expert opinion, and to propose recommendations for the assessment and treatment of these problems. Almost all pediatric neuromuscular diseases are accompanied by feeding and swallowing problems during the different phases of deglutition, problems that give rise to a wide variety of signs and symptoms, which emphasizes the importance of a comprehensive feeding and swallowing assessment by a speech and language therapist.

  16. The Impact of Dysphagia Therapy on Quality of Life in Patients with Parkinson's Disease as Measured by the Swallowing Quality of Life Questionnaire (SWALQOL

    Directory of Open Access Journals (Sweden)

    Ayres, Annelise

    2016-04-01

    Full Text Available Introduction Dysphagia is a common symptom in Parkinson's disease (PD and it has been associated with poor quality of life (QoL, anxiety, depression. Objective The aim of this study was to evaluate the quality of life in individuals with PD before and after SLP therapy. Methods The program consisted of four individual therapy sessions. Each session comprised guidelines regarding food and postural maneuvers (chin down. The Quality of Life in Swallowing Disorders (SWAL-QOL questionnaire was applied before and after therapy. Results The sample comprised of 10 individuals (8 men, with a mean (SD age of 62.2 (11.3 years, mean educational attainment of 7.5 (4.3 years, and mean disease duration of 10.7 (4.7 years. Thirty percent of patients were Hoehn and Yahr (H&Y stage 2, 50% were H&Y stage 3, and 20% were H&Y stage 4. Mean scores for all SWAL-QOL domains increased after the intervention period, with significant pre- to post-therapy differences in total score (p = 0.033 and domain 4 (symptom frequency (p = 0.025. There was also a bias significance for domain 5 (food selection (p = 0.095. Conclusion Patients exhibited improvement in swallowing-related quality of life after a SLP therapy program. The earlier in the course of PD, greater the improvement observed after therapy.

  17. The Impact of Dysphagia Therapy on Quality of Life in Patients with Parkinson's Disease as Measured by the Swallowing Quality of Life Questionnaire (SWALQOL).

    Science.gov (United States)

    Ayres, Annelise; Jotz, Geraldo Pereira; Rieder, Carlos Roberto de Mello; Schuh, Artur Francisco Schumacher; Olchik, Maira Rozenfeld

    2016-07-01

    Dysphagia is a common symptom in Parkinson's disease (PD) and it has been associated with poor quality of life (QoL), anxiety, depression. The aim of this study was to evaluate the quality of life in individuals with PD before and after SLP therapy. The program consisted of four individual therapy sessions. Each session comprised guidelines regarding food and postural maneuvers (chin down). The Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire was applied before and after therapy. The sample comprised of 10 individuals (8 men), with a mean (SD) age of 62.2 (11.3) years, mean educational attainment of 7.5 (4.3) years, and mean disease duration of 10.7 (4.7) years. Thirty percent of patients were Hoehn and Yahr (H&Y) stage 2, 50% were H&Y stage 3, and 20% were H&Y stage 4. Mean scores for all SWAL-QOL domains increased after the intervention period, with significant pre- to post-therapy differences in total score (p = 0.033) and domain 4 (symptom frequency) (p = 0.025). There was also a bias significance for domain 5 (food selection) (p = 0.095). Patients exhibited improvement in swallowing-related quality of life after a SLP therapy program. The earlier in the course of PD, greater the improvement observed after therapy.

  18. A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer

    NARCIS (Netherlands)

    Langendijk, Johannes A.; Doornaert, Patricia; Rietveld, Derek H. F.; Verdonck-de Leeuw, Irma M.; Leemans, C. Rene; Slotman, Ben J.

    Introduction: Recently, we found that swallowing dysfunction after curative (chemo) radiation (CH) RT has a strong negative impact on health-related quality of life (HRQoL), even more than xerostomia. The purpose of this study was to design a predictive model for swallowing dysfunction after

  19. A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer.

    NARCIS (Netherlands)

    Langendijk, J.A.; Doornaert, P.A.H.; Rietveld, D.H.F.; de Leeuw, I.M.; Leemans, C.R.; Slotman, B.J.

    2009-01-01

    Introduction: Recently, we found that swallowing dysfunction after curative (chemo) radiation (CH) RT has a strong negative impact on health-related quality of life (HRQoL), even more than xerostomia. The purpose of this study was to design a predictive model for swallowing dysfunction after

  20. Swallowing disorders after ischemic stroke

    Directory of Open Access Journals (Sweden)

    Gabriela Camargo Remesso

    2011-10-01

    Full Text Available OBJECTIVE: To investigate occurrences of swallowing disorders after ischemic stroke. METHOD: This was a retrospective study on 596 medical files. The inclusion criterion was that the patients needed to have been hospitalized with a diagnosis of ischemic stroke; the exclusion criteria were the presence of associated cardiac problems and hospital stay already more than 14 days. RESULTS: 50.5% were men and 49.5% women; mean age 65.3 years (SD=±11.7 (p<0.001. Among the risk factors, 79.4% had hypertension, 36.7% had diabetes (p<0.001 and 42.7% were smokers. 13.3% of the patients died. Swallowing disorders occurred in 19.6%, among whom 91.5% had mild difficulty and 8.5% had severe difficulty. 87.1% had spontaneous recovery after a mean of 2.4 months. A lesion in the brainstem region occurred in 6.8% (p<0.001. CONCLUSION: Swallowing disorders occurred in almost 20% of the population and most of the difficulty in swallowing found was mild. The predictors for swallowing disorders were older age, diabetes mellitus and lesions in the brainstem region.

  1. [Thermovalorization: new technologies, impacts and mitigation strategies].

    Science.gov (United States)

    Buffoli, M; Capolongo, S; Loconte, V L; Signorelli, C

    2012-01-01

    In recent decades the quantity (in weight and volume) of solid waste is grown so rapidly to become a real problem especially in densely urbanized areas. The disposal of Municipal Solid Waste by incineration with energy recovery (WtE) is recognized as the most suitable system to process non-recyclable waste. However in several countries there are still concerns from experts and local communities about the environmental impact of incinerators. Epidemiological studies, developed since the 80s, are still the subject of controversial discussion because the results of research often refer to old incinerators--built a few decades ago--and therefore more impactful. In fact inadequate levels of gas cleaning and combustion process control in these facilities tended to risk the health of plant workers and local environment. This situation furthermore contributes to increase public risk perception and the spread of the NIMBY (not in my backyard) syndrome while siting this unwanted but necessary facilities. Actually, new strategies as advances in emission control designs and very stringent new governmental regulations, have resulted in large reductions in the amount of emissions. So the first aim of this work has been to understand if these high perception of risk have a reason to exist also in modern and new municipal waste incinerators. The second aim is to discover if the law, the new technologies and the mitigation strategies can really set a limit on the negative impacts on human health and on environment and if is it possible to improve or increase these strategies. Work has been divided into two parts. The first part focuses on analysis of waste environmental impact regulations, of plant operation systems and of epidemiological studies results. The second part involves the examination of the actual use of regulatory instruments, the most advanced technologies and the strategies for mitigation in the most effective new concept incinerators plants. For this verification

  2. Computational Analysis of Pharyngeal Swallowing Mechanics in Patients with Motor Neuron Disease: A Pilot Investigation.

    Science.gov (United States)

    Garand, K L; Schwertner, Ryan; Chen, Amy; Pearson, William G

    2018-04-01

    Swallowing impairment (dysphagia) is a common sequela in patients with motor neuron disease (MND). The purpose of this retrospective, observational pilot investigation was to characterize how pharyngeal swallowing mechanics are impacted in patients with MND using a comparison with healthy, non-dysphagic control group. Computational analysis of swallowing mechanics (CASM) was used to determine covariate biomechanics of pharyngeal swallowing from videofluoroscopic assessment in 15 patients with MND and 15 age- and sex-matched healthy controls. Canonical variant analysis with post hoc discriminate function analysis (DFA) was performed on coordinate data mapping functional muscle groups underlying pharyngeal swallowing. Differences in swallowing mechanics associated with group (MND; control), motor neuron predominance (upper; lower), onset (bulbar; spinal), and swallow task (thin, pudding) were evaluated and visualized. Pharyngeal swallowing mechanics differed significantly in patients with MND compared with healthy controls (D = 2.01, p mechanics by motor neuron predominance (D = 5.03, p mechanics of patients with MND differ from and are more heterogeneous than healthy controls. These findings suggest patients with MND may compensate reductions in pharyngeal shortening and tongue base retraction by extending the head and neck and increasing hyolaryngeal excursion. This work and further CASM investigations will lead to further insights into development and evaluation of targeted clinical treatments designed to prolong safe and efficient swallowing function in patients with MND.

  3. Swallowing disorders in Parkinson's disease.

    Science.gov (United States)

    Mamolar Andrés, Sandra; Santamarina Rabanal, María Liliana; Granda Membiela, Carla María; Fernández Gutiérrez, María José; Sirgo Rodríguez, Paloma; Álvarez Marcos, César

    Parkinson's disease is a type of chronic neurodegenerative pathology with a typical movement pattern, as well as different, less studied symptoms such as dysphagia. Disease-related disorders in efficacy or safety in the process of swallowing usually lead to malnutrition, dehydration or pneumonias. The aim of this study was identifying and analyzing swallowing disorders in Parkinson's disease. The initial sample consisted of 52 subjects with Parkinson's disease to whom the specific test for dysphagia SDQ was applied. Nineteen participants (36.5%) with some degree of dysphagia in the SDQ test were selected to be evaluated by volume-viscosity clinical exploration method and fiberoptic endoscopic evaluation of swallowing. Disorders in swallowing efficiency and safety were detected in 94.7% of the selected sample. With regards to efficiency, disorders were found in food transport (89.5%), insufficient labial closing (68.4%) and oral residues (47.4%), relating to duration of ingestion. Alterations in security were also observed: pharynx residues (52.7%), coughing (47.4%), penetration (31.64%), aspiration and decrease of SaO 2 (5.3%), relating to the diagnosis of respiratory pathology in the previous year. The SDQ test detected swallowing disorders in 36.5% of the subjects with Parkinson's disease. Disorders in swallowing efficiency and safety were demonstrated in 94.7% of this subset. Disorders of efficiency were more frequent than those of safety, establishing a relationship with greater time in ingestion and the appearance of respiratory pathology and pneumonias. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  4. Respiratory-Swallowing Coordination and Swallowing Safety in Patients with Parkinson’s Disease

    Science.gov (United States)

    Huebner, Irene; Rosenbek, John C.; Okun, Michael S.; Sapienza, Christine M.

    2013-01-01

    The purpose of this study was to determine if individuals with Parkinson’s disease (PD) demonstrate abnormal respiratory events when swallowing thin liquids. In addition, this study sought to define associations between respiratory events, swallowing apnea duration, and penetration–aspiration (P–A) scale scores. Thirty-nine individuals with PD were administered ten trials of a 5-ml thin liquid bolus. P–A scale score quantified the presence of penetration and aspiration during the swallowing of a 3-oz sequential bolus. Participants were divided into two groups based on swallowing safety judged during the 3-oz sequential swallowing: Group 1 = P–A ≤ 2; Group 2 = P–A ≥ 3. Swallows were examined using videofluoroscopy coupled with a nasal cannula to record respiratory signals during the event(s). Findings indicated that expiration was the predominant respiratory event before and after swallowing apnea. The data revealed no differences in our cohort versus the percentages of post-swallowing events reported in the literature for healthy adults. In addition, individuals with decreased swallowing safety, as measured by the P–A scale, were more likely to inspire after swallows and to have shorter swallowing apnea duration. Individuals who inspired before swallow also had longer swallowing apnea duration. The occurrence of inspiratory events after a swallow and the occurrence of shorter swallowing apnea durations may serve as important indicators during clinical swallowing assessments in patients at risk for penetration or aspiration with PD. PMID:20623304

  5. Hard to Swallow: Developmental Biological Insights into Pediatric Dysphagia

    Science.gov (United States)

    LaMantia, Anthony-Samuel; Moody, Sally A.; Maynard, Thomas M.; Karpinski, Beverly A.; Zohn, Irene E.; Mendelowitz, David; Lee, Norman H.; Popratiloff, Anastas

    2015-01-01

    Pediatric dysphagia—feeding and swallowing difficulties that begin at birth, last throughout childhood, and continue into maturity—is one of the most common, least understood complications in children with developmental disorders. We argue that a major cause of pediatric dysphagia is altered hindbrain patterning during pre-natal development. Such changes can compromise craniofacial structures including oropharyngeal muscles and skeletal elements as well as motor and sensory circuits necessary for normal feeding and swallowing. Animal models of developmental disorders that include pediatric dysphagia in their phenotypic spectrum can provide mechanistic insight into pathogenesis of feeding and swallowing difficulties. A fairly common human genetic developmental disorder, DiGeorge/22q11.2 Deletion Syndrome (22q11DS) includes a substantial incidence of pediatric dysphagia in its phenotypic spectrum. Infant mice carrying a parallel deletion to 22q11DS patients have feeding and swallowing difficulties. Altered hindbrain patterning, neural crest migration, craniofacial malformations, and changes in cranial nerve growth prefigure these difficulties. Thus, in addition to craniofacial and pharyngeal anomalies that arise independently of altered neural development, pediatric dysphagia may reflect disrupted hindbrain patterning and its impact on neural circuit development critical for feeding and swallowing. The mechanisms that disrupt hindbrain patterning and circuitry may provide a foundation to develop novel therapeutic approaches for improved clinical management of pediatric dysphagia. PMID:26554723

  6. Effects of tongue pressing effortful swallow in older healthy individuals.

    Science.gov (United States)

    Park, Taeok; Kim, Youngsun

    2016-01-01

    The risk of swallowing disorders is increased for older individuals due to weak tongue and pharyngeal muscle strength. This study was appraised the value of a preventative approach by developing the tongue pressing effortful swallow (TPES) applied using a home-based and self-administered procedure. The TPES was developed by combining two swallowing exercises: tongue strengthening exercise and the effortful swallow. The purpose of this study was to examine the effects of the TPES on maximum tongue pressure and peak amplitude of submental muscle activity in older individuals. 27 older individuals (mean 73 years) performed a 4-week TPES. The exercise program was adapted to a home-based and self-administered procedure. The maximum tongue pressure was measured by the Iowa Oral Performance Instrument and peak amplitude of submental muscle activity by surface electromyography (sEMG). Statistical comparisons were made by a matched pairs t-test (ptongue pressure, but the peak amplitude of the submental sEMG did not differ between before and after exercises. The TPES had a positive impact in older individuals. The TPES, a combining exercise, was possible because two exercises had common physiological events. The TPES was a more innovative and efficient approach than the tongue strengthening exercise alone. In addition, older individuals were able to perform the swallowing exercise at home and by themselves with little assistance. Future research needs to refine the TPES and apply it to patients with dysphagia. Published by Elsevier Ireland Ltd.

  7. Does Barium Influence Tongue Behaviors during Swallowing?

    Science.gov (United States)

    Steele, Catriona M.; van Lieshout, Pascal H. H. M.

    2005-01-01

    The validity of videofluoroscopic swallowing assessments rests on the understanding that thin, nectar-, honey-, and spoon-thick radiopaque liquids resemble nonopaque liquids, both in their consistency and in the variations in swallowing that they elicit. Tongue movements during sequential swallows of opaque and nonopaque liquids were studied in 8…

  8. Effect of posture on swallowing.

    African Journals Online (AJOL)

    Ertekin C, Keskin A, Kiylioglu N, Kirazli Y, On AY,. Tarlaci S, et al. The effect of head and neck positions on oropharyngeal swallowing: a clinical and electrophysio- logic study. Archives of physical medicine and rehabilita- tion. 2001;829:1255-60. Epub 2001/09/12. 17. Logemann JA, Pauloski BR, Rademaker AW, Kahrilas.

  9. Swallowing dysfunction in cancer patients

    NARCIS (Netherlands)

    Raber-Durlacher, Judith E.; Brennan, Mike T.; Leeuw, Irma M. Verdonck-de; Gibson, Rachel J.; Eilers, June G.; Waltimo, Tuomas; Bots, Casper P.; Michelet, Marisol; Sollecito, Thomas P.; Rouleau, Tanya S.; Sewnaik, Aniel; Bensadoun, Rene-Jean; Fliedner, Monica C.; Silverman, Sol; Spijkervet, Fred K. L.

    Purpose Dysphagia (swallowing dysfunction) is a debilitating, depressing, and potentially life-threatening complication in cancer patients that is likely underreported. The present paper is aimed to review relevant dysphagia literature between 1990 and 2010 with a focus on assessment tools,

  10. Swallowing dysfunction in cancer patients

    NARCIS (Netherlands)

    Raber-Durlacher, J.E.; Brennan, M.T.; Verdonck- de Leeuw, I.M.; Gibson, R.J.; Eilers, J.G.; Waltimo, T.; Bots, C.P.; Michelet, M.; Sollecito, T.P.; Rouleau, T.S.; Sewnaik, A.; Bensadoun, R.J.; Fliedner, M.C.; Silverman, S.; Spijkervet, F.K.L.

    2012-01-01

    Purpose Dysphagia (swallowing dysfunction) is a debilitating, depressing, and potentially life-threatening complication in cancer patients that is likely underreported. The present paper is aimed to review relevant dysphagia literature between 1990 and 2010 with a focus on assessment tools,

  11. Swallowing dysfunction in cancer patients

    NARCIS (Netherlands)

    Raber-Durlacher, J.E.; Brennan, M.T.; de Leeuw, I.M.; Gibson, R.J.; Eilers, J.G.; Waltimo, T.; Bots, C.P.; Michelet, M.; Sollecito, T.P.; Rouleau, T.S.; Sewnaik, A.; Bensadoun, R.J.; Fliedner, M.C.; Silverman, S.; Spijkervet, F.K.L.

    2012-01-01

    Purpose: Dysphagia (swallowing dysfunction) is a debilitating, depressing, and potentially life-threatening complication in cancer patients that is likely underreported. The present paper is aimed to review relevant dysphagia literature between 1990 and 2010 with a focus on assessment tools,

  12. Impact of early dysphagia intervention on swallowing function and quality of life in head and neck cancer patients treated with intensity-modulated radiation therapy or image guided radiation therapy with or without surgery/chemotherapy

    Directory of Open Access Journals (Sweden)

    Rajender Kumar

    2015-01-01

    Conclusion: Results from this study demonstrated that swallowing exercises, if administered from first week of chemo-radiation and continued till 6 months, results in significant improvement in swallowing function and quality of life. Use of FEES helps in detection of silent aspiration at an early stage and reduces aspiration related morbidities.

  13. The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia.

    Science.gov (United States)

    Sasegbon, A; Hamdy, S

    2017-11-01

    Eating and drinking are enjoyable activities that positively impact on an individual's quality of life. The ability to swallow food and fluid is integral to the process of eating. Swallowing occupies a dual role being both part of the enjoyment of eating and being a critically important utilitarian activity to enable adequate nutrition and hydration. Any impairment to the process of swallowing can negatively affect a person's perception of their quality of life. The process of swallowing is highly complex and involves muscles in the mouth, pharynx, larynx, and esophagus. The oropharynx is the anatomical region encompassing the oral cavity and the pharynx. Food must be masticated, formed into a bolus and transported to the pharynx by the tongue whereas fluids are usually held within the mouth before being transported ab-orally. The bolus must then be transported through the pharynx to the esophagus without any matter entering the larynx. The muscles needed for all these steps are coordinated by swallowing centers within the brainstem which are supplied with sensory information by afferent nerve fibers from several cranial nerves. The swallowing centers also receive modulatory input from higher centers within the brain. Hence, a swallow has both voluntary and involuntary physiologic components and the term dysphagia is given to difficult swallowing while oropharyngeal dysphagia is difficult swallowing due to pathology within the oropharynx. Problems affecting any point along the complex swallowing pathway can result in dysphagia. This review focuses on the anatomy and physiology behind normal and abnormal oropharyngeal swallowing. It also details the common diseases and pathology causing oropharyngeal dysphagia. © 2017 John Wiley & Sons Ltd.

  14. Voice- and swallow-related quality of life in idiopathic Parkinson's disease.

    Science.gov (United States)

    van Hooren, Michel R A; Baijens, Laura W J; Vos, Rein; Pilz, Walmari; Kuijpers, Laura M F; Kremer, Bernd; Michou, Emilia

    2016-02-01

    This study explores whether changes in voice- and swallow-related QoL are associated with progression of idiopathic Parkinson's disease (IPD). Furthermore, it examines the relationship between patients' perception of both voice and swallowing disorders in IPD. Prospective clinical study, quality of life (QoL). One-hundred mentally competent IPD patients with voice and swallowing complaints were asked to answer four QoL questionnaires (Voice Handicap Index, MD Anderson Dysphagia Inventory, Visual Analog Scale [VAS] voice, and Dysphagia Severity Scale [DSS]). Differences in means for the QoL questionnaires and their subscales within Hoehn and Yahr stage groups were calculated using one-way analysis of variance. The relationship between voice- and swallow-related QoL questionnaires was determined with the Spearman correlation coefficient. Scores on both voice and swallow questionnaires suggest an overall decrease in QoL with progression of IPD. A plateau in QoL for VAS voice and the DSS was seen in the early Hoehn and Yahr stages. Finally, scores on voice-related QoL questionnaires were significantly correlated with swallow-related QoL outcomes. Voice- and swallow-related QoL decreases with progression of IPD. A significant association was found between voice- and swallow-related QoL questionnaires. Healthcare professionals can benefit from voice- and swallow-related QoL questionnaires in a multidimensional voice- or swallow-assessment protocol. The patient's perception of his/her voice and swallowing disorders and its impact on QoL in IPD should not be disregarded. 2b. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  15. Swallowing Disorders in Sjögren's Syndrome: Prevalence, Risk Factors, and Effects on Quality of Life.

    Science.gov (United States)

    Pierce, Jenny L; Tanner, Kristine; Merrill, Ray M; Miller, Karla L; Kendall, Katherine A; Roy, Nelson

    2016-02-01

    This epidemiological investigation examined the prevalence, risk factors, and quality-of-life effects of swallowing disorders in Sjögren's syndrome (SS). One hundred and one individuals with primary or secondary SS (94 females, 7 males; mean age 59.4, SD = 14.1) were interviewed regarding the presence, nature, and impact of swallowing disorders and symptoms. Associations among swallowing disorders and symptoms, select medical and social history factors, SS disease severity, and the M.D. Anderson Dysphagia Inventory (MDADI) and Short Form 36 Health Survey (SF-36) were examined. The prevalence of a current self-reported swallowing disorder was 64.4 %. SS disease severity was the strongest predictor of swallowing disorders, including significant associations with the following swallow symptoms: taking smaller bites, thick mucus in the throat, difficulty placing food in the mouth, and wheezing while eating (p quality of life. Among those with swallowing disorders, 42 % sought treatment, with approximately half reporting improvement. Patient-perceived swallowing disorders are relatively common in SS and increase with disease severity. Specific swallowing symptoms uniquely and significantly reduce swallow and health-related quality of life, indicating the need for increased identification and management of dysphagia in this population.

  16. Risk impact of two accident management strategies

    International Nuclear Information System (INIS)

    Dingman, S.; Camp, A.

    1992-01-01

    This report probabilistic Risk Assessment is used to evaluate two accident management strategies: intentionally depressurizing the reactor coolant system of a pressurized water reactor to prevent containment-pressurization during high pressure melt ejection, and flooding the containment of a boiling water reactor to prevent or delay vessel breach. Sensitivity studies indicated that intentional depressurization would not provide a significant risk reduction at Surry. A preliminary evaluation of the containment flooding strategy indicated that it might prove beneficial for some plants, but that further strategy development would be needed to fully evaluate the strategy-

  17. SWALLOWING IN PATIENTS WITH LARYNGITIS.

    Science.gov (United States)

    Moda, Isabela; Ricz, Hilton Marcos Alves; Aguiar-Ricz, Lilian Neto; Dantas, Roberto Oliveira

    2018-01-01

    Dysphagia is described as a complaint in 32% of patients with laryngitis. The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

  18. Impact of E-Learning Strategy on Students' Academic Performance ...

    African Journals Online (AJOL)

    This study examined the impact of e-learning strategies on students' academic performance at Strathmore University. The purpose of the study was to investigate the methodology, ideologies, output and ecology of ICT strategies and their impact on students' performance. This was done through comparing students' mean ...

  19. Supporting Knowledge Mobilization and Research Impact Strategies in Grant Applications

    Science.gov (United States)

    Phipps, David; Jensen, Krista E.; Johnny, Michael; Poetz, Anneliese

    2016-01-01

    Each application to the National Science Foundation (NSF) must contain a Broader Impact (BI) strategy. Similarly, grant applications for most research funders in Canada and the UK require strategies to support the translation of research into impacts on society; however, the guidance provided to researchers is too general to inform the specific…

  20. Effects of swallowing training combined with low-frequency electrical stimulation on dysphagia after ischemic stroke

    Directory of Open Access Journals (Sweden)

    Zhi-zhong ZHU

    2015-04-01

    Full Text Available Objective To investigate the effects of swallowing training combined with low-frequency electrical stimulation on dysphagia after ischemic stroke.  Methods A total of 68 patients with dysphagia after ischemic stroke were divided into control group (N = 34, receiving swallowing training and feeding strategies and combined treatment group (N = 34, receiving swallowing training, feeding strategies and low-frequency electrical stimulation. Video Fluoroscopic Swallowing Study (VFSS and Standardized Swallowing Assessment (SSA were used to evaluate the swallowing function of patients in 2 groups before and after 15 d of treatment. Results According to Oxfordshire Community Stroke Project (OCSP classification, 34 patients in control group were classified into 12 cases with total anterior circulation infarct (TACI, 8 cases with partial anterior circulation infarct (PACI, 10 cases with posterior circulation infarct (POCI and 4 cases with lacunar infarct (LACI; 34 patients in combined treatment group were classified into 10 cases with TACI, 7 cases with PACI, 11 cases with POCI and 6 cases with LACI. Compared with before treatment, the VFSS score increased (P = 0.003, 0.000, while SSA score decreased (P = 0.003, 0.000 in both groups. Compared with control group, the VFSS score increased (P = 0.004, while SSA score decreased (P = 0.020 in combined treatment group.  Conclusions Swallowing training combined with low-frequency electrical stimulation can significantly improve the swallowing capacity of patients with acute ischemic stroke, and the effect is better than mere swallowing training. DOI: 10.3969/j.issn.1672-6731.2015.04.007

  1. Coordination of Mastication, Swallowing and Breathing

    OpenAIRE

    Matsuo, Koichiro; Palmer, Jeffrey B.

    2009-01-01

    The pathways for air and food cross in the pharynx. In breathing, air may flow through either the nose or the mouth; it always flows through the pharynx. During swallowing, the pharynx changes from an airway to a food channel. The pharynx is isolated from the nasal cavity and lower airway by velopharyngeal and laryngeal closure during the pharyngeal swallow. During mastication, the food bolus accumulates in the pharynx prior to swallow initiation. The structures in the oral cavity, pharynx an...

  2. Differences in Swallowing between High and Low Concentration Taste Stimuli

    Directory of Open Access Journals (Sweden)

    Ahmed Nagy

    2014-01-01

    Full Text Available Taste is a property that is thought to potentially modulate swallowing behavior. Whether such effects depend on taste, intensity remains unclear. This study explored differences in the amplitudes of tongue-palate pressures in swallowing as a function of taste stimulus concentration. Tongue-palate pressures were collected in 80 healthy women, in two age groups (under 40, over 60, stratified by genetic taste status (nontasters, supertasters. Liquids with different taste qualities (sweet, sour, salty, and bitter were presented in high and low concentrations. General labeled magnitude scale ratings captured perceived taste intensity and liking/disliking of the test liquids. Path analysis explored whether factors of taste, concentration, age group, and/or genetic taste status impacted: (1 perceived intensity; (2 palatability; and (3 swallowing pressures. Higher ratings of perceived intensity were found in supertasters and with higher concentrations, which were more liked/disliked than lower concentrations. Sweet stimuli were more palatable than sour, salty, or bitter stimuli. Higher concentrations elicited stronger tongue-palate pressures independently and in association with intensity ratings. The perceived intensity of a taste stimulus varies as a function of stimulus concentration, taste quality, participant age, and genetic taste status and influences swallowing pressure amplitudes. High-concentration salty and sour stimuli elicit the greatest tongue-palate pressures.

  3. Characterizing Dysphagia and Swallowing Intervention in the Traumatic Spinal Injury Population

    Science.gov (United States)

    Valenzano, Teresa J.; Waito, Ashley A.; Steele, Catriona M.

    2016-01-01

    Dysphagia is reported to be a common secondary complication for individuals with traumatic spinal injuries. Different etiologies of traumatic spinal injuries may lead to different profiles of swallowing impairment. We conducted a systematic review to determine the characteristics of dysphagia after traumatic spinal injury and to describe interventions currently used to improve swallowing function in this population. A comprehensive multi-engine literature search identified 137 articles of which 5 were judged to be relevant. These underwent review for study quality, rating for level of evidence, and data extraction. The literature describing dysphagia after traumatic spinal injury was comprised predominantly of low level evidence and single case reports. Aspiration, pharyngeal residue, and decreased/absent hyolaryngeal elevation were found to be common characteristics of dysphagia in this population. The most commonly used swallowing interventions included tube feeding, compensatory swallowing strategies, and steroids/antibiotics. Improvement in swallowing function following swallowing intervention was reported in all studies, however there was no control for spontaneous recovery. The results demonstrate a need for high-quality research to profile the pathophysiology of dysphagia after traumatic spinal injury and controlled studies to demonstrate the efficacy of swallowing interventions in this population. PMID:27412004

  4. Changes in Swallowing after Anterior Cervical Discectomy and Fusion with Instrumentation: A Presurgical versus Postsurgical Videofluoroscopic Comparison

    Science.gov (United States)

    Muss, Lydia; Wilmskoetter, Janina; Richter, Kerstin; Fix, Constanze; Stanschus, Soenke; Pitzen, Tobias; Drumm, Joerg; Molfenter, Sonja

    2017-01-01

    Purpose: The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies. Method: We retrospectively analyzed both functional measures (penetration-aspiration, residue) and…

  5. Spatial strategies for managing visitor impacts in National Parks

    Science.gov (United States)

    Leung, Y.-F.; Marion, J.L.

    1999-01-01

    Resource and social impacts caused by recreationists and tourists have become a management concern in national parks and equivalent protected areas. The need to contain visitor impacts within acceptable limits has prompted park and protected area managers to implement a wide variety of strategies and actions, many of which are spatial in nature. This paper classifies and illustrates the basic spatial strategies for managing visitor impacts in parks and protected areas. A typology of four spatial strategies was proposed based on the recreation and park management literature. Spatial segregation is a common strategy for shielding sensitive resources from visitor impacts or for separating potentially conflicting types of use. Two forms of spatial segregation are zoning and closure. A spatial containment strategy is intended to minimize the aggregate extent of visitor impacts by confining use to limited designated or established Iocations. In contrast, a spatial dispersal strategy seeks to spread visitor use, reducing the frequency of use to levels that avoid or minimize permanent resource impacts or visitor crowding and conflict. Finally, a spatial configuration strategy minimizes impacting visitor behavior though the judicious spatial arrangement of facilities. These four spatial strategics can be implemented separately or in combination at varying spatial scales within a single park. A survey of national park managers provides an empirical example of the diversity of implemented spatial strategies in managing visitor impacts. Spatial segregation is frequently applied in the form of camping restrictions or closures to protect sensitive natural or cultural resources and to separate incompatible visitor activities. Spatial containment is the most widely applied strategy for minimizing the areal extent of resource impacts. Spatial dispersal is commonly applied to reduce visitor crowding or conflicts in popular destination areas but is less frequently applied or

  6. Prophylactic swallowing exercises for patients receiving radiotherapy for head and neck cancer.

    Science.gov (United States)

    Roe, Justin W G; Ashforth, Kate M

    2011-06-01

    Oncological treatment outcomes in head and neck cancer suggest both acute and longer-term oropharyngeal dysphagia. Studies have been published exploring the potential to improve swallowing outcomes using more targeted treatment modalities such as intensity-modulated radiotherapy (IMRT) and through the introduction of swallowing exercises prior to treatment. In this article, we will explore the literature relating to prophylactic swallowing exercises for patients undergoing (chemo-)radiotherapy. Recent studies have attempted to evaluate the benefit of prophylactic, pretreatment swallowing exercises for patients undergoing (chemo-)radiotherapy. We identified three peer-reviewed published studies which present data on the potential benefit of exercise. Only one randomized control trial which includes multidimensional swallowing evaluation with instrumental measures has been published. Authors of all the reviewed studies agree that randomized control trials including baseline measures are required with longitudinal follow-up. More research is required to complement oncological clinical trials evaluating the impact of prophylactic exercise on swallowing outcome. Multidimensional swallowing evaluation including instrumental and patient-reported measures should be conducted pretreatment and longitudinally to develop the evidence base for intervention in patients undergoing organ-preserving treatment protocols.

  7. Impact of environment on marketing strategy

    Directory of Open Access Journals (Sweden)

    Stanišić Olivera

    2005-01-01

    Full Text Available Today companies faced with manifold shifts arose in business environment recently but particularly during the last two decades. Such issues ask for sharp response rate by companies as well as very solid level of marketing intelligence, research and customer loyalty development. Paper discuss the importance of knowing what's going on in the target market within PEST approach including unavoidable technology issues. General focus is directed to needs of an appropriate marketing strategy development.

  8. How do tablet properties influence swallowing behaviours?

    Science.gov (United States)

    Yamamoto, Shinya; Taniguchi, Hiroshige; Hayashi, Hirokazu; Hori, Kazuhiro; Tsujimura, Takanori; Nakamura, Yuki; Sato, Hideaki; Inoue, Makoto

    2014-01-01

    Behavioural performance of tablet swallowing was evaluated with different tablet conditions in terms of size, number and surface coating. Four different types of tablets were prepared: small or large, and with or without a surface coating. Fourteen normal male adults were instructed to swallow the prepared tablets with 15 ml of water. The number of tablets in one trial was changed from one to three. To evaluate swallowing and tablet transport, electromyographic activity was recorded in the left suprahyoid muscles, and videofluorographic images were examined. All tablet conditions (size, number and surface coating) affected the swallowing performance in terms of total number of swallows, electromyographic burst patterns and location of remaining tablets. Increases in the size and number of tablets increased the number of swallows and electromyographic burst area and duration. In addition, all of these parameters increased while swallowing tablets without a coating compared with tablets with a coating. Location of the remaining tablets was mainly within the mouth. This study only clarified the normal pattern of tablet swallowing under several conditions in healthy subjects, but the results may facilitate comprehensive evaluation and treatment planning in terms of administering medication to dysphagic patients. © 2013 Royal Pharmaceutical Society.

  9. Impacts of climate change and adaptation strategies in rural ...

    African Journals Online (AJOL)

    Impacts of climate change and adaptation strategies in rural communities of Kaduna State, Nigeria. ... Ethiopian Journal of Environmental Studies and Management ... of some selected rural communities of Kaduna state, and the adaptation strategies employed by the people to ameliorate the scourge of climate change.

  10. Assessing climate change impacts and adaptation strategies for ...

    African Journals Online (AJOL)

    Assessing climate change impacts and adaptation strategies for smallholder agricultural systems in Uganda. ... from encroaching on swamps, which is one of the reported adaptation strategies to climate related stresses. Improving productivity of important crops (bananas for southwest, and sweet potatoes and bananas

  11. Speech and swallowing outcomes in buccal mucosa carcinoma

    Directory of Open Access Journals (Sweden)

    Sunila John

    2011-01-01

    Full Text Available Buccal carcinoma is one of the most common malignant neoplasms among all oral cancers in India. Understanding the role of speech language pathologists (SLPs in the domains of evaluation and management strategies of this condition is limited, especially in the Indian context. This is a case report of a young adult with recurrent squamous cell carcinoma of the buccal mucosa with no deleterious habits usually associated with buccal mucosa carcinoma. Following composite resection, pectoralis major myocutaneous flap reconstruction, he developed severe oral dysphagia and demonstrated unintelligible speech. This case report focuses on the issues of swallowing and speech deficits in buccal mucosa carcinoma that need to be addressed by SLPs, and the outcomes of speech and swallowing rehabilitation and prognostic issues.

  12. [Clinical impact of social marketing strategy on breast cancer detection].

    Science.gov (United States)

    Quintana-Vidaurri, Adriana Guadalupe; Santana-Chávez, Luis Alejandro; González-Villalobos, Cynthia Guadalupe

    2013-01-01

    to prove the impact of social marketing strategies in breast cancer detection, taking as a parameter the number of mammographies performed. quasi-experimental research, before and after. Sixty-nine physicians in charge of medical consultation and fourteen nurses were studied for a period of seven months, applying social marketing strategies. The total of mammographies were analyzed using Wilcoxon rank-sum test (p marketing proved to be an adequate strategy, which has an impact on the clinical practice of both physicians and nurses.

  13. Impacts of climate change and variability, and adaptation strategies ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    13 mai 2011 ... Given this overdependence on rainfed agriculture, farmers are highly vulnerable to climate change. ... evidence of climate-related impacts on crop production, local communities' perceptions of these impacts, and current adaptation strategies in two central Tanzanian villages: Kamenyanga and Kintinku.

  14. DETERMINANTS OF NETWORK OUTCOMES: THE IMPACT OF MANAGEMENT STRATEGIES.

    Science.gov (United States)

    Ysa, Tamyko; Sierra, Vicenta; Esteve, Marc

    2014-09-01

    The literature on network management is extensive. However, it generally explores network structures, neglecting the impact of management strategies. In this article we assess the effect of management strategies on network outcomes, providing empirical evidence from 119 urban revitalization networks. We go beyond current work by testing a path model for the determinants of network outcomes and considering the interactions between the constructs: management strategies, trust, complexity, and facilitative leadership. Our results suggest that management strategies have a strong effect on network outcomes and that they enhance the level of trust. We also found that facilitative leadership has a positive impact on network management as well as on trust in the network. Our findings also show that complexity has a negative impact on trust. A key finding of our research is that managers may wield more influence on network dynamics than previously theorized.

  15. Contemporary management of voice and swallowing disorders in patients with advanced lung cancer.

    Science.gov (United States)

    Brady, Grainne C; Carding, Paul N; Bhosle, Jaishree; Roe, Justin W G

    2015-06-01

    Advanced lung cancer can cause changes to swallowing and communication function. Direct tumour invasion, dyspnoea and deconditioning can all impact on swallowing function and communication. Cancer treatment, if administered, may cause or compound symptoms. In this study, the nature of swallowing and communication difficulties in patients with advanced lung cancer will be discussed, and management options including medical management, speech and language therapy (SLT) intervention, and surgical interventions will be considered. Advanced lung cancer can result in voice and swallowing difficulties, which can increase symptom burden and significantly impact on quality of life (QOL). There is a growing evidence base to support the use of injection laryngoplasty under local anaesthetic to offer immediate improvement in voice, swallowing and overall QOL. There is limited literature on the nature and extent of voice and swallowing impairment in patients with lung cancer. Well designed studies with robust and sensitive multidimensional dysphagia and dysphonia assessments are required. Outcome studies examining interventions with clearly defined treatment goals are required. These studies should include both functional and patient-reported outcome measures to develop the evidence base and to ensure that interventions are both timely and appropriate.

  16. Successful endoscopic removal of a swallowed toothbrush: case report.

    Science.gov (United States)

    Tonkic, Ante; Bogdanovic, Zoran; Grandić, Leo

    2011-04-06

    Most ingested foreign bodies will pass uneventfully through the gastrointestinal tract. Nevertheless, long and rigid foreign bodies are associated with an increased risk of gastrointestinal impaction, perforation and bleeding. Moreover, there has been no case of spontaneous passage of a toothbrush reported. Therefore, the prompt removal of such ingested foreign objects is recommended before complications develop. This case report describes a case of an 18-year-old woman who accidentally swallowed her toothbrush. The toothbrush was successfully removed via flexible endoscopy using a polypectomy snare. A swallowed toothbrush is a special clinical challenge. Early endoscopic retrieval of the toothbrush is critical for reducing morbidity and mortality. In cases when endoscopic removal fails, a laparoscopic surgical approach may be an alternative.

  17. Successful Endoscopic Removal of a Swallowed Toothbrush: Case Report

    Directory of Open Access Journals (Sweden)

    Ante Tonkic

    2011-04-01

    Full Text Available Most ingested foreign bodies will pass uneventfully through the gastrointestinal tract. Nevertheless, long and rigid foreign bodies are associated with an increased risk of gastrointestinal impaction, perforation and bleeding. Moreover, there has been no case of spontaneous passage of a toothbrush reported. Therefore, the prompt removal of such ingested foreign objects is recommended before complications develop. This case report describes a case of an 18-year-old woman who accidentally swallowed her toothbrush. The toothbrush was successfully removed via flexible endoscopy using a polypectomy snare. A swallowed toothbrush is a special clinical challenge. Early endoscopic retrieval of the toothbrush is critical for reducing morbidity and mortality. In cases when endoscopic removal fails, a laparoscopic surgical approach may be an alternative.

  18. Feasibility of a Mobile Application to Enhance Swallowing Therapy for Patients Undergoing Radiation-Based Treatment for Head and Neck Cancer.

    Science.gov (United States)

    Starmer, Heather M; Abrams, Rina; Webster, Kimberly; Kizner, Jennifer; Beadle, Beth; Holsinger, F Christopher; Quon, Harry; Richmon, Jeremy

    2017-09-30

    Dysphagia following treatment for head and neck cancer is one of the most significant morbidities impacting quality of life. Despite the value of prophylactic exercises to mitigate the impact of radiation on long-term swallowing function, adherence to treatment is limited. The purpose of this investigation was to explore the feasibility of a mobile health application to support patient adherence to swallowing therapy during radiation-based treatment. 36 patients undergoing radiation therapy were provided with the Vibrent™ mobile application as an adjunct to standard swallowing therapy. The application included exercise videos, written instructions, reminders, exercise logging, and educational content. 80% of participants used the app during treatment and logged an average of 102 exercise sessions over the course of treatment. 25% of participants logged at least two exercise sessions per day over the 7-week treatment period, and 53% recorded at least one session per day. Exit interviews regarding the patient experience with the Vibrent™ mobile application were largely positive, but also provided actionable strategies to improve future versions of the application. The Vibrent™ mobile application appears to be a tool that can be feasibly integrated into existing patient care practices and may assist patients in adhering to treatment recommendations and facilitate communication between patients and providers between encounters.

  19. Stuttered swallowing: Electric stimulation of the right insula interferes with water swallowing. A case report

    Directory of Open Access Journals (Sweden)

    Shoemaker J

    2011-02-01

    Full Text Available Abstract Background Various functional resonance imaging, magnetoencephalographic and lesion studies suggest the involvement of the insular cortex in the control of swallowing. However, the exact location of insular activation during swallowing and its functional significance remain unclear. Case presentation Invasive electroencephalographic monitoring was performed in a 24-year-old man with medically intractable stereotyped nocturnal hypermotor seizures due to a ganglioglioma. During stimulation of the right inferior posterior insular cortex with depth electrodes the patient spontaneously reported a perception of a "stutter in swallowing". Stimulation of the inferior posterior insular cortex at highest intensity (4 mA was also associated with irregular and delayed swallows. Swallowing was not impaired during stimulation of the superior posterior insular cortex, regardless of stimulation intensity. Conclusions These results indicate that the right inferior posterior insular cortex is involved in the neural circuitry underlying the control of swallowing.

  20. Role of physical bolus properties as sensory inputs in the trigger of swallowing.

    Science.gov (United States)

    Peyron, Marie-Agnès; Gierczynski, Isabelle; Hartmann, Christoph; Loret, Chrystel; Dardevet, Dominique; Martin, Nathalie; Woda, Alain

    2011-01-01

    Swallowing is triggered when a food bolus being prepared by mastication has reached a defined state. However, although this view is consensual and well supported, the physical properties of the swallowable bolus have been under-researched. We tested the hypothesis that measuring bolus physical changes during the masticatory sequence to deglutition would reveal the bolus properties potentially involved in swallowing initiation. Twenty normo-dentate young adults were instructed to chew portions of cereal and spit out the boluses at different times in the masticatory sequence. The mechanical properties of the collected boluses were measured by a texture profile analysis test currently used in food science. The median particle size of the boluses was evaluated by sieving. In a simultaneous sensory study, twenty-five other subjects expressed their perception of bolus texture dominating at any mastication time. Several physical changes appeared in the food bolus as it was formed during mastication: (1) in rheological terms, bolus hardness rapidly decreased as the masticatory sequence progressed, (2) by contrast, adhesiveness, springiness and cohesiveness regularly increased until the time of swallowing, (3) median particle size, indicating the bolus particle size distribution, decreased mostly during the first third of the masticatory sequence, (4) except for hardness, the rheological changes still appeared in the boluses collected just before swallowing, and (5) physical changes occurred, with sensory stickiness being described by the subjects as a dominant perception of the bolus at the end of mastication. Although these physical and sensory changes progressed in the course of mastication, those observed just before swallowing seem to be involved in swallowing initiation. They can be considered as strong candidates for sensory inputs from the bolus that are probably crucially involved in the triggering of swallowing, since they appeared in boluses prepared in various

  1. Role of physical bolus properties as sensory inputs in the trigger of swallowing.

    Directory of Open Access Journals (Sweden)

    Marie-Agnès Peyron

    swallowing, since they appeared in boluses prepared in various mastication strategies by different subjects.

  2. Time and the Question of Unintended Impact on Military Strategy

    DEFF Research Database (Denmark)

    Nielsen, Thomas Galasz

    2014-01-01

    CHAPTER TEN: Unintended impact on the strategy This chapter identifies two aspects in the variable “time” to address unintended impact on a strategy: Short versus long term focus and predictability. The International Security Stabilisation Force’s focus on the tactical level successes to secure...... that the short term objectives is reached has gradually changed the objective on the grand strategy level clouding the end state. At the same time the predictability focus contributed to prioritization of short-term tactical objectives, as they were easier to benchmark rather than grand strategic objectives....... This changed the end state from eradication of the Taliban to nation-building to transition of security responsibilities. The result is a strategy that has become focused on tactical level objective. This has blurred the understanding of the end state in a pursuit of tactical successes....

  3. Identification of Swallowing Tasks from a Modified Barium Swallow Study That Optimize the Detection of Physiological Impairment

    Science.gov (United States)

    Hazelwood, R. Jordan; Armeson, Kent E.; Hill, Elizabeth G.; Bonilha, Heather Shaw; Martin-Harris, Bonnie

    2017-01-01

    Purpose: The purpose of this study was to identify which swallowing task(s) yielded the worst performance during a standardized modified barium swallow study (MBSS) in order to optimize the detection of swallowing impairment. Method: This secondary data analysis of adult MBSSs estimated the probability of each swallowing task yielding the derived…

  4. IMPACT ANALYSIS OF THE CAPABILITY ON STRATEGY VIA OTHELLO GAME

    Directory of Open Access Journals (Sweden)

    Jeremy Albert Novaryan

    2014-10-01

    Full Text Available Othello is a game that is already antiquated, but the game is still played by many people. Othello game is played by 2 people. If you want to win over the opponent, you must have a good strategy so that all the pieces on the board into the color of the chip. Each player would continue to seek a new strategy to make the pieces multiply. Under these conditions, will result in job terstimulasinya brain to strategize. This of course has an impact on the development of creativity in the organization's strategy. This study was conducted to prove that the game Othello is able to train its player in developing strategies. The results showed that in the Othello game, players are able to train level strategy if he plays continuously. Automatically, playing the game of Othello can stimulate the brain so as to improve the ability to strategize. Keyword Strategic,thinking, critical thinking, tactic

  5. Favorable Swallowing Outcomes following Vagus Nerve Sacrifice for Vagal Schwannoma Resection.

    Science.gov (United States)

    Patel, Mira A; Eytan, Danielle F; Bishop, Justin; Califano, Joseph A

    2017-02-01

    Objective To determine the impact of unilateral vagal sacrifice for vagal schwannoma on postoperative swallowing function. Study Design Case series, chart review. Setting Academic medical institution. Subjects and Methods Ten patients underwent vagus nerve sacrifice for vagal schwannoma resection. Archived pathology records dating from 1985 through 2012 at our institution were retrospectively queried for cases of vagal schwannoma with vagus nerve sacrifice. Medical records were abstracted for demographic and disease information as well as cranial nerve and swallowing function. Preoperative and postoperative cranial nerve function, subjective and objective measures of swallowing function, Functional Oral Intake Scale (FOIS) level, and need for vocal fold medialization were variables collected. Data were analyzed with summary statistics. Results The patients who underwent vagal sacrifice for vagal schwannoma at our institution had a mean age of 42.3 years (median, 44 years; range, 15-63 years) and follow-up of 35.6 months (median, 9 months; range, 1-115 months). Most presented with no preoperative cranial nerve deficit or difficulty swallowing. Immediately postoperatively, 90% had a vagus nerve deficit, but 50% had no subjective difficulty swallowing, and 70% had a FOIS level of 7 at postoperative hospital discharge. Within 1 month after surgery, 70% had normal swallowing function according to a modified barium swallow study. A full diet was tolerated by mouth within an average of 2.7 days (median, 2 days; range, 1-6 days) after surgery in this cohort. Seventy percent required vocal fold medialization postoperatively for incomplete glottic closure. Conclusion Vagal nerve sacrifice during resection of vagal schwannoma can be performed with normal postoperative swallowing function.

  6. Swallowing Disorders after Oral Cavity and Pharyngolaryngeal Surgery and Role of Imaging

    Directory of Open Access Journals (Sweden)

    Caterina Giannitto

    2017-01-01

    Full Text Available Head and neck squamous cell carcinoma is the sixth most common cancer diagnosed worldwide and the eighth most common cause of cancer death. Malignant tumors of the oral cavity, oropharynx, and larynx can be treated by surgical resection or radiotheraphy with or without chemotheraphy and have a profound impact on quality of life functions, including swallowing. When surgery is the chosen treatment modality, the patient may experience swallowing impairment in the oral and pharyngeal phases of deglutition. A videofluoroscopic study of swallow enables the morphodynamics of the pharyngeal-esophageal tract to be accurately examined in patients with prior surgery. These features allow an accurate tracking of the various phases of swallowing in real time, identifying the presence of functional disorders and of complications during the short- and long-term postoperative recovery. The role of imaging is fundamental for the therapist to plan rehabilitation. In this paper, the authors aim to describe the videofluoroscopic study of swallow protocol and related swallowing impairment findings in consideration of different types of surgery.

  7. Quality-of-life scores compared to objective measures of swallowing after oropharyngeal chemoradiation.

    Science.gov (United States)

    Kendall, Katherine A; Kosek, Steven R; Tanner, Kristine

    2014-03-01

    To compare objective measures of swallowing function with patient reports of swallowing-related quality of life 1 year after treatment of oropharyngeal cancer with chemoradiation therapy. Patients seen for follow-up at least 1 year after treatment of oropharyngeal carcinoma with chemoradiation therapy were sequentially approached and asked to participate in the study. Maximum pharyngeal constriction, hyoid elevation, upper esophageal sphincter opening size, and bolus pharyngeal transit time were measured from modified barium swallowing studies in a group of 31 patients at least 1 year after chemoradiation therapy for the treatment of oropharyngeal carcinoma. Measures were made for a liquid 1-mL, 3-mL, and 20-mL bolus. Objective measure results were compared to scores from the MD Anderson Dysphagia Inventory and The University of Washington Swallowing Quality of Life Questionnaire results from the same patients. No strong correlation was identified between any of the objective measures of swallowing physiology and quality-of-life scores. Patient perception of the impact of swallowing function on quality of life does not correlate well with actual physiologic functioning. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  8. The Andean Swallow (Orochelidon andecola) in Argentina

    OpenAIRE

    Mazar Barnett, Juan; Pugnali, Germán D.; Pearman Morrison, Mark; Bodrati, Alejandro; Moschione, Flavio; Clark, Ricardo; Roesler, Carlos Ignacio; Monteleone, Diego; Casañas, Hernán; Burgos Gallardo, Freddy; Segovia, José; Pagano, Luis; Povedano, Hernán; Areta, Juan Ignacio

    2016-01-01

    During ornithological studies in the provinces of Jujuy, Salta, and San Juan, we recorded the Andean Swallow Orochelidon andecola at 40 localities. These are the first records in Argentina, and also represent the southernmost for the species. Some of these localities are up to 1500 m lower than the previously known elevational limit (now 800 masl), and up to 1100 km southwards. This is a relatively poorly known swallow, and we present novel natural history data. We found evidence of breeding ...

  9. Instrumentation for bedside analysis of swallowing disorders.

    Science.gov (United States)

    Greco, Catiuscia S S; Nunes, Luiz G Q; Melo, Pedro L

    2010-01-01

    Disordered swallowing, or dysphagia, is a common problem seen in patients undergoing treatment for cancer, stroke and neurodegenerative illnesses. This disease is associated with aspiration-induced chest infections. The methods currently used for diagnosis, however, are qualitative or based on expensive equipment. Swallowing accelerometry is a promising low-cost, quantitative and noninvasive tool for the evaluation of swallowing. This work describes the design and application of a bedside instrument able to evaluate swallowing mechanisms and to identify patients at risk of aspiration. Three-axis swallowing accelerometry was used to measure the neck vibrations associated with deglutition, providing analog signals to a virtual instrument developed in LabVIEW environment. In vivo tests in normal subjects as well as tests with disphagic patients showed that the system was able to easily and non-invasively detect changes in the swallowing acceleration pattern associated with increasing values of water volume (p disphagia. We concluded that the developed system could be a useful tool for the objective bedside evaluation of patients at risk of aspiration.

  10. Smartphone-Based Real-time Assessment of Swallowing Ability From the Swallowing Sound.

    Science.gov (United States)

    Jayatilake, Dushyantha; Ueno, Tomoyuki; Teramoto, Yohei; Nakai, Kei; Hidaka, Kikue; Ayuzawa, Satoshi; Eguchi, Kiyoshi; Matsumura, Akira; Suzuki, Kenji

    2015-01-01

    Dysphagia can cause serious challenges to both physical and mental health. Aspiration due to dysphagia is a major health risk that could cause pneumonia and even death. The videofluoroscopic swallow study (VFSS), which is considered the gold standard for the diagnosis of dysphagia, is not widely available, expensive and causes exposure to radiation. The screening tests used for dysphagia need to be carried out by trained staff, and the evaluations are usually non-quantifiable. This paper investigates the development of the Swallowscope, a smartphone-based device and a feasible real-time swallowing sound-processing algorithm for the automatic screening, quantitative evaluation, and the visualisation of swallowing ability. The device can be used during activities of daily life with minimal intervention, making it potentially more capable of capturing aspirations and risky swallow patterns through the continuous monitoring. It also consists of a cloud-based system for the server-side analyzing and automatic sharing of the swallowing sound. The real-time algorithm we developed for the detection of dry and water swallows is based on a template matching approach. We analyzed the wavelet transformation-based spectral characteristics and the temporal characteristics of simultaneous synchronised VFSS and swallowing sound recordings of 25% barium mixed 3-ml water swallows of 70 subjects and the dry or saliva swallowing sound of 15 healthy subjects to establish the parameters of the template. With this algorithm, we achieved an overall detection accuracy of 79.3% (standard error: 4.2%) for the 92 water swallows; and a precision of 83.7% (range: 66.6%-100%) and a recall of 93.9% (range: 72.7%-100%) for the 71 episodes of dry swallows.

  11. Impact assessment of adaptation options and strategies for coping ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Impact assessment of adaptation options and strategies for coping with climate change on the livelihoods of pastoral and agro-pastoral communities in Sudan' Butana area. Ibrahim, Abdelhamed M.M.. URI: http://hdl.handle.net/10625/53410. Date: 2013-11 ...

  12. Impact of Curriculum Strategies in Ameliorating Communicative Skill in English

    Science.gov (United States)

    Singaravelu, G.

    2006-01-01

    The Study investigated the problems of the students in improving communicative skill in English at standard VII and found the impact of creative competency (new curriculum strategy) to eliminate the problem of it. Eighty eight subjects were involved in the study. Achievement test was considered as instrumentation for the study. Creative competency…

  13. Impacts of climate change, variability and adaptation strategies on ...

    African Journals Online (AJOL)

    Impacts of climate change, variability and adaptation strategies on agriculture in semi arid areas of Tanzania: The case of Manyoni District in Singida Region, Tanzania. ... The changes have affected crops and livestock in a number of ways resulting in reduced productivity. Empirical analysis of rainfall suggest decreasing ...

  14. The impact of tobacco pricing and packaging strategies in middle ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The impact of tobacco pricing and packaging strategies in middle-income countries. International evidence, primarily from high-income countries, has clearly shown that higher cigarette prices reduce tobacco use, with greater reductions among young people and those from socio-economically disadvantaged groups.

  15. Eosinophilic Esophagitis: Impact of Latest Insights Into Pathophysiology on Therapeutic Strategies.

    Science.gov (United States)

    Schoepfer, Alain; Safroneeva, Ekaterina; Straumann, Alex

    Eosinophilic esophagitis (EoE) has been defined as a 'chronic, immune/antigen-mediated, esophageal disease, characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation'. A peak value of ≥15 eosinophils/high power field has been defined as histologic diagnostic cutoff. Other conditions associated with esophageal eosinophilia, such as gastro-esophageal reflux disease, PPI-responsive esophageal eosinophilia or Crohn's disease, need to be ruled out before EoE can be diagnosed. Males are affected more frequently than females and most of the patients have concomitant allergies. Currently, the EoE prevalence is about 1 of 2,000 inhabitants in Westernized countries. The first EoE patients were described only 2 decades ago. Despite this short period, considerable progress has been made regarding the understanding of the pathophysiology, natural history, assessment of disease activity and with respect to evaluating different therapeutic options. Untreated EoE can lead to esophageal remodeling with reduced compliance and stricture formation, which represents the main risk factor for food bolus impactions. The therapeutic options can be summarized with the 3 D's, which stand for drugs, diets and dilation. Of note, as of yet, there is no EoE-specific drug that has been approved by regulatory authorities. This is, among other reasons, related to the lack of validated outcome measurement instruments until recently. Swallowed topical steroids such as budesonide or fluticasone represent the standard of care for treating symptomatic pediatric and adult EoE patients with inflammatory activity. Several trials have already evaluated different biologic therapies, such as anti-interleukin-5 or anti-IgE. Further studies are on the way. As a non-pharmacologic alternative, different dietary regimens exist. Dilation can offer long-lasting symptomatic response in case of stricturing EoE but does not have any impact on the

  16. SU-E-J-193: Application of Surface Mapping in Detecting Swallowing for Head-&-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cao, D; Xie, X; Mehta, V; Shepard, D [Swedish Cancer Institute, Seattle, WA (United States)

    2015-06-15

    Purpose: Recent evidence is emerging that long term swallowing function may be improved after radiotherapy for head-&-neck cancer if doses are limited to certain swallowing structures. Immobilization of patients with head-&-neck cancer is typically done with a mask. This mask, however, doesn’t limit patient swallowing. Patient voluntary or involuntary swallowing may introduce significant tumor motion, which can lead to suboptimal delivery. In this study, we have examined the feasibility of using surface mapping technology to detect patient swallowing during treatment and evaluated its magnitude. Methods: The C-RAD Catalyst system was used to detect the patient surface map. A volunteer lying on the couch was used to simulate the patient under treatment. A virtual marker was placed near the throat and was used to monitor the swallowing action. The target motion calculated by the Catalyst system through deformable registration was also collected. Two treatment isocenters, one placed close to the throat and the other placed posterior to the base-of-tongue, were used to check the sensitivity of surface mapping technique. Results: When the patient’s throat is not in the shadow of the patient’s chest, the Catalyst system can clearly identify the swallowing motion. In our tests, the vertical motion of the skin can reach to about 5mm. The calculated target motion can reach up to 1 cm. The magnitude of this calculated target motion is more dramatic when the plan isocenter is closer to the skin surface, which suggests that the Catalyst motion tracking technique is more sensitive to the swallowing motion with a shallower isocenter. Conclusion: Surface mapping can clearly identify patient swallowing during radiation treatment. This information can be used to evaluate the dosimetric impact of the involuntary swallowing. It may also be used to potentially gate head-&-neck radiation treatments. A prospective IRB approved study is currently enrolling patients in our

  17. Intangible and Economic Impacts of Hendra Virus Prevention Strategies.

    Science.gov (United States)

    Wilson, S-J; Ward, M P

    2016-08-01

    Hendra virus (HeV), a potentially fatal zoonotic disease spread by flying foxes, to date has always infected humans via a spillover event from equine HeV infection. In a theoretical case study, we compared the impacts of two different HeV prevention strategies - vaccination and flying fox roost removal - using a recently developed framework that considers different stakeholder group perspectives. The perspectives of the four selected stakeholder groups regarding intangibles were inferred from public discussions and coverage in the media. For all stakeholder groups, the option to vaccinate horses was found to add value to the economic results when the intangible impacts were included in the analysis, while the option for roost removal unanimously detracted from economic analysis value when the intangible impacts were included. Both the mean and median stakeholder-adjusted value ratios (2.25 and 2.12, respectively) for vaccination were inflated when intangible impacts were included, by value-adding to the results of a traditional economic analysis. In the roost removal strategy, these ratios (1.19 and 1.16, respectively) were deflated when intangible impacts were included. Results of this theoretical study suggest that the inclusion of intangible impacts promotes the value of a two-dose initial vaccination protocol using a subunit vaccination considered to offer complete protection for horses, as a strategy to control HeV, whereas roost removal becomes an even more costly strategy. Outcome of the analysis is particularly sensitive to the intangible value placed on human health. Further evaluation - via sociological methods - of values placed on intangibles by various stakeholder groups is warranted. © 2015 Blackwell Verlag GmbH.

  18. Posture of the head and pharyngeal swallowing

    International Nuclear Information System (INIS)

    Ekberg, O.

    1986-01-01

    Closure of the laryngeal vestibule during swallowing is important for protection of the airways. The present investigation included 53 patients with dysphagia examined cineradiographically with the head held in resting posture, flexion and extension. The ability to protect the airways by the downward movement of the epiglottis and by obliteration of the laryngeal vestibule was studied in different postures of the head. Of 35 patients with normal laryngeal obliteration with the head in resting position 10 showed a defective closure at swallowing in extension. In 18 patients with defective closure of the laryngeal vestibule in resting position 9 were improved on flexion and two on extension of the head. In one patient with defectie closure of the laryngeal vestibule in resting position swallowing in flexion showed an aggravated dysfunction. In our other patients the defective closure became more marked on extension. Four patients had less effective downward movement of the epiglottis with the head in extension. Of 10 patients with defective epiglottic movement with the head in resting position two were improved on tilting the head forwards. The results show that the position of the head influences the closure of the airways during swallowing. Patients with defective protection of the laryngeal vestibule should be instructed to swallow with the head tilted forwards. (orig.)

  19. Seed germination behavior of swallow wort

    Directory of Open Access Journals (Sweden)

    amir hosein pahlavani

    2009-06-01

    Full Text Available The exotic plant, Swallow- wort, a twining perennial of the Milkweed family, has become increasingly invasive in some place of Iran, especially orchards. Increased knowledge of wort germination biology would facilitate development of an optimum control program. Germination of Swallow wort seeds as affected by environmental factors was studied under controlled-environment growth chamber conditions. The following studies were conducted in plant Pests & Diseases Research Institute during the years 2003-4: 1- Effect of constant temperature on germination that including 10, 15, 18, 20, 25, 30, 35 and 40˚C; 2- Effect of light on constant germination; 3- Effect of temperature fluctuations on seed germination: 15/7, 20/12, 25/17 and 30/22˚C. All experiments were conducted with 8 replications. Swallow wort seeds showed no dormancy when detachment from mother plant. Seed germination was strongly influenced by temperature. Light did not play a crucial role on seed germination of this weed. Therefore Swallow wort seeds were not photoblastic and temperature fluctuations did not increase seed germination of Swallow wort. The above characteristics are very important in making swallowwort an invasive weed. Having precise information of these traits enables us to a better management and control of this troublesome weed.

  20. Posture of the head and pharyngeal swallowing

    Energy Technology Data Exchange (ETDEWEB)

    Ekberg, O.

    Closure of the laryngeal vestibule during swallowing is important for protection of the airways. The present investigation included 53 patients with dysphagia examined cineradiographically with the head held in resting posture, flexion and extension. The ability to protect the airways by the downward movement of the epiglottis and by obliteration of the laryngeal vestibule was studied in different postures of the head. Of 35 patients with normal laryngeal obliteration with the head in resting position 10 showed a defective closure at swallowing in extension. In 18 patients with defective closure of the laryngeal vestibule in resting position 9 were improved on flexion and two on extension of the head. In one patient with defectie closure of the laryngeal vestibule in resting position swallowing in flexion showed an aggravated dysfunction. In our other patients the defective closure became more marked on extension. Four patients had less effective downward movement of the epiglottis with the head in extension. Of 10 patients with defective epiglottic movement with the head in resting position two were improved on tilting the head forwards. The results show that the position of the head influences the closure of the airways during swallowing. Patients with defective protection of the laryngeal vestibule should be instructed to swallow with the head tilted forwards.

  1. Environmental impact assessment of the national climate strategy

    International Nuclear Information System (INIS)

    Hilden, M.; Attila, M.; Hiltunen, M.; Karvosenoja, N.; Syri, S.

    2001-01-01

    The national climate strategy aims at fulfilling the obligations to reduce emissions of greenhouse gases in accordance with the Kyoto protocol. The environmental impacts of the strategy were analysed by comparing a business as usual scenario with two scenarios based on additional measures. Both scenarios with additional measures are based on more emphasis on energy saving and use of renewable sources of energy, but they differ with respect to energy production. The environmental consequences until 2010 are similar in the scenarios with additional measures, and they are better from an environmental point of view than the business as usual scenario. Many of the measures have significant effects only in the long term, and all have indirect effects, opportunities and uncertain factors. Some measures can create societal conflicts, which further increases the uncertainty in implementing the climate strategy. In order to be able to adapt to and react on deviations from the development that the strategy aims at achieving the monitoring of the strategy should examine the implementation from many different aspects, because profound knowledge of the nature of the effects and key cause and effects relations is essential in revising and updating the strategy. (orig.)

  2. Integrated manure management to reduce environmental impact: II. Environmental impact assessment of strategies

    NARCIS (Netherlands)

    Vries, de J.W.; Groenestein, C.M.; Schroder, J.J.; Hoogmoed, W.B.; Sukkel, W.; Groot Koerkamp, P.W.G.; Boer, de I.J.M.

    2015-01-01

    Manure management contributes to adverse environmental impacts through losses of nitrogen (N), phosphorus, and carbon (C). In this study, we aimed to assess the potential of newly designed strategies for integrated manure management (IS) to reduce environmental impact. An important aspect of the

  3. Swallowing in Parkinson's disease: clinical issues and management.

    Science.gov (United States)

    Miller, Nick

    2017-06-01

    Changes to swallowing affect most people with Parkinson's disease (PD). Changes may not initially exercise a decisive impact, but can later pose significant threats to nutritional, hydration and respiratory health and psychosocial quality of life. This review, from a largely clinical viewpoint, outlines the nature of changes in PD and considers the issue of how many people are affected and in what ways. It outlines main approaches to assessment and management, with an emphasis on aspects relevant to PD. Dysphagia contributes to drooling in PD. The review therefore also touches on the nature and management of this condition that has its own set of health and psychosocial quality-of-life issues.

  4. The Impacts of Climate Change Mitigation Strategies on Animal Welfare

    OpenAIRE

    Shields, Sara; Orme-Evans, Geoffrey

    2015-01-01

    Simple Summary Climate change is probably the most important environmental issue of our time. Raising animals for food contributes to the production of greenhouse gases implicated in the global warming that is causing climate change. To combat this ecological disaster, a number of mitigation strategies involving changes to agricultural practices have been proposed. However, some of these changes will impact the welfare of farmed animals. This paper reviews selected climate change mitigation s...

  5. Promotional Strategy Impacts on Organizational Market Share and Profitability

    OpenAIRE

    Adesoga Dada Adefulu

    2015-01-01

    The paper examined promotional strategy impacts on market share and profitability in Coca-Cola and 7up companies in Lagos State, Nigeria. Survey research method was adopted. The study population was the staff in marketing positions in the selected companies. Questionnaire was administered on the samples from Coca-Cola and 7UP companies. The statistical tool employed was the univariate analysis of variance (ANOVA) to determine the statistical significance and the extent to which...

  6. EFFECT OF GUM CHEWING ON AIR SWALLOWING, SALIVA SWALLOWING AND BELCHING

    Directory of Open Access Journals (Sweden)

    Ana Cristina Viana da SILVA

    2015-09-01

    Full Text Available BackgroundEructation is a physiologic event which allows gastric venting of swallowed air and most of the time is not perceived as a symptom. This is called gastric belching. Supragastric belching occurs when swallowed air does not reach the stomach and returns by mouth a short time after swallowing. This situation may cause discomfort, life limitations and problems in daily life.ObjectiveOur objective in this investigation was to evaluate if gum chewing increases the frequency of gastric and/or supragastric belches.MethodsEsophageal transit of liquid and gas was evaluated by impedance measurement in 16 patients with complaint of troublesome belching and in 15 controls. The Rome III criteria were used in the diagnosis of troublesome belching. The esophageal transit of liquid and gas was measured at 5 cm, 10 cm, 15 cm and 20 cm from the lower esophageal sphincter. The subjects were evaluated for 1 hour which was divided into three 20-minute periods: (1 while sitting for a 20-minute base period; (2 after the ingestion of yogurt (200 mL, 190 kcal, in which the subjects were evaluated while chewing or not chewing gum; (3 final 20-minute period in which the subjects then inverted the task of chewing or not chewing gum. In gastric belch, the air flowed from the stomach through the esophagus in oral direction and in supragastric belch the air entered the esophagus rapidly from proximal and was expulsed almost immediately in oral direction. Air swallows were characterized by an increase of at least 50% of basal impedance and saliva swallow by a decrease of at least 50% of basal impedance, that progress from proximal to distal esophagus.ResultsIn base period, air swallowing was more frequent in patients than in controls and saliva swallowing was more frequent in controls than in patients. There was no difference between the medians of controls and patients in the number of gastric belches and supragastric belches. In six patients, supragastric belches

  7. Methods for excluding cliff swallows from nesting on highway structures.

    Science.gov (United States)

    2009-08-01

    Cliff swallows (Petrochelidon pyrrhonota) are colonially breeding migratory birds that frequently nest on highway : structures. Protected by the Migratory Bird Treaty Act of 1918, nesting control methods cannot harm swallows or active : nests. This c...

  8. Impact of nutritional strategies on water productivity indicators for pigs

    Directory of Open Access Journals (Sweden)

    Julio Cesar Pascale Palhares

    2013-12-01

    Full Text Available The productivity of water is a poorly considered indicator in animal agriculture. This is because water is a resource still believed by persons in the production network to be abundant and of good quality. The aim of this study was to evaluate the impact of nutritional strategies in water productivity indicators for growing and slaughtering pigs. Five strategies were evaluated: control diet (T1, with a reduction in the level of crude protein (T2, phytase (T3, organic minerals (T4 and the three nutritional strategies combined (T5. The water productivity indicator is defined as the quantity of product by water used. The following indicators were calculated: total weight (kg L-1, cold carcass (kg L-1 lean carcass (L kg-1, and nutrition (kcal L-1. T5 showed the best productivities for each liter of water used. The total weight productivity in this treatment was 3.0 kg L-1, while in T1 was 2.5 kg L-1. T3 had the lowest productivities. The nutritional water productivities were 2,512, 2,763, 2,657, 2,814, and 3,039 kcal L-1, respectively for T1, T2, T3, T4, and T5. Nutritional strategies reduce the use of drinking water and therefore improve water productivities. The best productivities were observed when combining the strategies.

  9. Promotional Strategy Impacts on Organizational Market Share and Profitability

    Directory of Open Access Journals (Sweden)

    Adesoga Dada Adefulu

    2015-12-01

    Full Text Available The paper examined promotional strategy impacts on market share and profitability in Coca-Cola and 7up companies in Lagos State, Nigeria. Survey research method was adopted. The study population was the staff in marketing positions in the selected companies. Questionnaire was administered on the samples from Coca-Cola and 7UP companies. The statistical tool employed was the univariate analysis of variance (ANOVA to determine the statistical significance and the extent to which promotional strategy brings about variation in market share and profitability in the selected companies The study revealed the need for a better understanding of the organizational factors that determine the commitment of organizational resources to drive the achievement of marketing goals. In addition, promotional strategy measured by advertising, publicity and sales promotion affected market share and profitability at different percentage rates while Personal selling did not .The study concluded that promotional strategy suitable to a business caused variations in market share and profitability. Managers concerned about maintaining competitive edge in the market may find it appropriate to begin by examining promotional strategy adoption. Suggestions are also made for further research and study limitations are denoted. Researchers are encouraged to devote efforts to identifying what variables may modify the nature of relationship?

  10. Vocalizations of the South African cliff swallow Hirundo spilodera

    African Journals Online (AJOL)

    Vocalizations of the South African cliff swallow. Hirundo spilodera. A.A. Earle. National Museum, Bloemfontein. The vocalizations of both adult and juvenile South African cliff swallows Hirundo spilodera are described. This swallow has a large vocal repertoire considering that it is a highly colonial species, and at least seven ...

  11. Cortical swallowing processing in early subacute stroke

    Directory of Open Access Journals (Sweden)

    Fischer Maren

    2011-03-01

    Full Text Available Abstract Background Dysphagia is a major complication in hemispheric as well as brainstem stroke patients causing aspiration pneumonia and increased mortality. Little is known about the recovery from dysphagia after stroke. The aim of the present study was to determine the different patterns of cortical swallowing processing in patients with hemispheric and brainstem stroke with and without dysphagia in the early subacute phase. Methods We measured brain activity by mean of whole-head MEG in 37 patients with different stroke localisation 8.2 +/- 4.8 days after stroke to study changes in cortical activation during self-paced swallowing. An age matched group of healthy subjects served as controls. Data were analyzed by means of synthetic aperture magnetometry and group analyses were performed using a permutation test. Results Our results demonstrate strong bilateral reduction of cortical swallowing activation in dysphagic patients with hemispheric stroke. In hemispheric stroke without dysphagia, bilateral activation was found. In the small group of patients with brainstem stroke we observed a reduction of cortical activation and a right hemispheric lateralization. Conclusion Bulbar central pattern generators coordinate the pharyngeal swallowing phase. The observed right hemispheric lateralization in brainstem stroke can therefore be interpreted as acute cortical compensation of subcortically caused dysphagia. The reduction of activation in brainstem stroke patients and dysphagic patients with cortical stroke could be explained in terms of diaschisis.

  12. Pricing strategies and levels and their impact on corporate profitability

    Directory of Open Access Journals (Sweden)

    Deonir De Toni

    Full Text Available Abstract Price policy definition is one of the most important decisions in management as it affects corporate profitability and market competitiveness. Despite the importance that prices take in organizations, it appears that this element has not received proper attention by many academics and marketers since it represents, according to estimates, less than 2% of the papers on leading journals in the field. Thus, the aim of this study was to propose and test a theoretical model showing the impacts of pricing policy on corporate profitability. To this end, 150 companies in the metal-mechanic sector situated in the Northeast of Rio Grande do Sul State, Brazil were studied, integrating customer value-based pricing strategies, competition-based pricing strategies and cost-based pricing strategies with price levels (high and low and performance with respect to profitability. The results indicate that the profitability of the surveyed companies is positively affected by value-based pricing strategy and high price levels while it is negatively affected by low price levels. Such findings indicate that pricing policies influence the profitability of organizations and therefore, a more strategic look at the pricing process may constitute one aspect that cannot be overlooked by managers.

  13. Variation in sperm morphometry and sperm competition among barn swallow (Hirundo rustica) populations

    Czech Academy of Sciences Publication Activity Database

    Laskemoen, T.; Albrecht, Tomáš; Bonisoli-Alquati, A.; Cepák, J.; De Lope, F.; Hermosell, I. G.; Johannessen, L. E.; Kleven, O.; Marzal, A.; Mousseau, T. A.; Moller, A. P.; Robertson, R. J.; Rudolfsen, G.; Saino, N.; Vortman, Y.; Lifjeld, J. T.

    2013-01-01

    Roč. 67, č. 2 (2013), s. 301-309 ISSN 0340-5443 R&D Projects: GA ČR(CZ) GAP506/12/2472 Institutional support: RVO:68081766 Keywords : Barn swallow * Extrapair paternity * Hirundo rustica * Sperm competition * Sperm size Subject RIV: EG - Zoology Impact factor: 3.049, year: 2013

  14. Barium versus Nonbarium Stimuli: Differences in Taste Intensity, Chemesthesis, and Swallowing Behavior in Healthy Adult Women

    Science.gov (United States)

    Nagy, Ahmed; Steele, Catriona M.; Pelletier, Cathy A.

    2014-01-01

    Purpose: The authors examined the impact of barium on the perceived taste intensity of 7 different liquid tastant stimuli and the modulatory effect that these differences in perceived taste intensity have on swallowing behaviors. Method: Participants were 80 healthy women, stratified by age group (60) and genetic taste status…

  15. VIDEOFLUOROSCOPIC EVALUATION OF SWALLOWS IN ANOREXIA NERVOSA.

    Science.gov (United States)

    Santos, Carla Manfredi; Cassiani, Rachel Aguiar; Dantas, Roberto Oliveira

    2016-01-01

    There are some studies in the literature about the feeding behavior and masticatory process in patients with feeding disorders; however, it is not very well known if there are alterations in oral-pharyngeal swallowing dynamics in subjects with anorexia nervosa. To evaluate the oral and pharyngeal bolus transit in patients with anorexia nervosa. The study was conducted with 8 individuals clinically diagnosed and in treatment for restricting-type anorexia nervosa (seven women and one man), and 14 healthy individuals with no digestive or neurological symptoms (10 women, 4 men). Swallows were evaluated by videofluoroscopy with three swallows of 5 mL liquid bolus and three swallows of 5 mL paste bolus consistency, given in a random sequence. The participants were asked after each swallow about the sensation of the bolus passage. In the analysis of oral-pharyngeal transit duration, the mean duration of pharyngeal transit with paste bolus in patients with anorexia was shorter than in healthy volunteers (P=0.02). In the duration of movement of the hyoid bone, longer movement was observed in anorexia than in healthy volunteers with liquid bolus (P=0.01). With liquid bolus, five (62.5%) patients and one (7.1%) control had sensation of the bolus passage (Panorexia nervosa, although the results suggest that pharyngeal transit has shorter duration than that seen in healthy volunteers and the hyoid movement duration is longer in patients than in healthy volunteers. Fast pharyngeal transit may be the cause of bolus transit perception in patients with anorexia nervosa.

  16. Process and impact evaluation of the Greater Christchurch Urban Development Strategy Health Impact Assessment

    Science.gov (United States)

    Mathias, Kaaren R; Harris-Roxas, Ben

    2009-01-01

    Background despite health impact assessment (HIA) being increasingly widely used internationally, fundamental questions about its impact on decision-making, implementation and practices remain. In 2005 a collaboration between public health and local government authorities performed an HIA on the Christchurch Urban Development Strategy Options paper in New Zealand. The findings of this were incorporated into the Greater Christchurch Urban Development Strategy; Methods using multiple qualitative methodologies including key informant interviews, focus groups and questionnaires, this study performs process and impact evaluations of the Christchurch HIA including evaluation of costs and resource use; Results the evaluation found that the HIA had demonstrable direct impacts on planning and implementation of the final Urban Development Strategy as well as indirect impacts on understandings and ways of working within and between organisations. It also points out future directions and ways of working in this successful collaboration between public health and local government authorities. It summarises the modest resource use and discusses the important role HIA can play in urban planning with intersectoral collaboration and enhanced relationships as both catalysts and outcomes of the HIA process; Conclusion as one of the few evaluations of HIA that have been published to date, this paper makes a substantial contribution to the literature on the impact, utility and effectiveness of HIA. PMID:19344529

  17. Swallowing Disorders in Severe Brain Injury in the Arousal Phase.

    Science.gov (United States)

    Bremare, A; Rapin, A; Veber, B; Beuret-Blanquart, F; Verin, E

    2016-08-01

    The objective of this study was to determine the clinical characteristics of swallowing disorders in severe brain injury in the arousal phase after coma. Between December 1, 2013 and June 30, 2014, eleven patients with severe acquired brain injury who were admitted to rehabilitation center (Male 81.8 %; 40.7 ± 14.6 years) were included in the study. Evaluation of swallowing included a functional examination, clinical functional swallowing test, and naso-endoscopic swallowing test. All patients had swallowing disorders at admission. The first functional swallowing test showed oral (77.8 %) and pharyngeal (66.7 %) food bolus transport disorders; and alterations in airway protection mechanisms (80 %). Swallowing test under endoscopic control showed a disorder in swallowing coordination in 55.6 % of patients tested. Seven (63.6 %) patients resumed oral feeding within an average of 6 weeks after admission to rehabilitation center and 14 weeks after acquired brain injury. Six (85.7 %) of these seven patients continued to require modified solid and liquid textures. Swallowing disorders are a major concern in severe brain injury in the arousal phase. Early bedside assessment of swallowing is essential for detection of swallowing disorders to propose appropriate medical rehabilitation care to these patients in a state of altered consciousness.

  18. Effect of body posture on involuntary swallow in healthy volunteers.

    Science.gov (United States)

    Shiino, Yoshitaka; Sakai, Shogo; Takeishi, Ryosuke; Hayashi, Hirokazu; Watanabe, Masahiro; Tsujimura, Takanori; Magara, Jin; Ito, Kayoko; Tsukada, Tetsu; Inoue, Makoto

    2016-03-01

    Clinically, reclining posture has been reported to reduce risk of aspiration. However, during involuntary swallow in reclining posture, changes in orofacial and pharyngeal movement before and during pharyngeal swallow should be considered. Further, the mechanisms underlying the effect of body posture on involuntary swallow remain unclear. The aim of the present study was to determine the effect of body posture on activity patterns of the suprahyoid muscles and on patterns of bolus transport during a natural involuntary swallow. Thirteen healthy male adults participated in a water infusion test and a chewing test. In the water infusion test, thickened water was delivered into the pharynx at a very slow rate until the first involuntary swallow was evoked. In the chewing test, subjects were asked to eat 10 g of gruel rice. In both tests, the recording was performed at four body postures between upright and supine positions. Results showed that reclining changed the location of the bolus head at the start of swallow and prolonged onset latency of the swallowing initiation. Muscle burst duration and whiteout time measured by videoendoscopy significantly increased with body reclining and prolongation of the falling time. In the chewing test, reclining changed the location of the bolus head at the start of swallow, and the frequency of bolus residue after the first swallow increased. Duration and area of EMG burst and whiteout time significantly increased with body reclining. These data suggest that body reclining may result in prolongation of pharyngeal swallow during involuntary swallow. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Impact of teaching students to use evaluation strategies

    Directory of Open Access Journals (Sweden)

    Aaron R. Warren

    2010-07-01

    Full Text Available Students often make mistakes in physics courses and are expected to identify, correct, and learn from their mistakes, usually with some assistance from an instructor, textbook, or fellow students. This aid may come in many forms, such as problem solutions that are given to a class, tutoring to an individual student, or a peer discussion among several students. However, in each case a student relies upon an external agent in order to determine whether, and how, her work is mistaken. Consequently, the student’s learning process is largely contingent upon the availability and quality of external evaluating agents. One may suspect that if a student developed the ability to evaluate her own work, her dependence on external agents could be moderated and result in an enhancement of her learning. This paper presents the results of a study investigating the impact of novel activities that aim to teach students when, why, and how to use the strategies of unit analysis and special-case analysis. The data indicate that it is possible to help students dramatically improve their understanding of each strategy, and that this has a significant impact on problem-solving performance.

  20. Strategy for an assessment of cumulative ecological impacts

    International Nuclear Information System (INIS)

    Boucher, P.; Collins, J.; Nelsen, J.

    1995-01-01

    The US Department of Energy (DOE) has developed a strategy to conduct an assessment of the cumulative ecological impact of operations at the 300-square-mile Savannah River Site. This facility has over 400 identified waste units and contains several large watersheds. In addition to individual waste units, residual contamination must be evaluated in terms of its contribution to ecological risks at zonal and site-wide levels. DOE must be able to generate sufficient information to facilitate cleanup in the immediate future within the context of a site-wide ecological risk assessment that may not be completed for many years. The strategy superimposes a more global perspective on ecological assessments of individual waste units and provides strategic underpinnings for conducting individual screening-level and baseline risk assessments at the operable unit and zonal or watershed levels. It identifies ecological endpoints and risk assessment tools appropriate for each level of the risk assessment. In addition, it provides a clear mechanism for identifying clean sites through screening-level risk assessments and for elevating sites with residual contamination to the next level of assessment. Whereas screening-level and operable unit-level risk assessments relate directly to cleanup, zonal and site-wide assessments verity or confirm the overall effectiveness of remediation. The latter assessments must show, for example, whether multiple small areas with residual pesticide contamination that have minimal individual impact would pose a cumulative risk from bioaccumulation because they are within the habitat range of an ecological receptor

  1. The Impact of Brand Awareness on Companies` Marketing Strategies

    Directory of Open Access Journals (Sweden)

    Alexandra Zaif

    2016-07-01

    Full Text Available Within this paper,we will try to emphasize the importance of brand awareness and its significant role in brand-building,discussing how companies implementing brand-awareness marketing strategies will have a substantial role in creating brand image,strenghten brand equity and increase profitability . Firstly,we will conduct an empirical research based on previous published literature concerning brand awareness and will discuss the effectiveness of marketing strategies that incorporate in their objectives brand awareness increase,acknowledging its impact on significant factors such as brand image ,sales increase,influencing customer behaviour and other important equity-related aspects.We will try to corroborate our statements by referring to a marketing strategy designed to enhance brand awareness and stimulate other brand-equity dimensions (brand association,brand loyalty,etc.,as well as generate higher sales revenues , namely sponsorship and we will discuss a particular category,respectively sponsorship in the sports industry.The study case wil be concluded with an example of a succesfull partnership involving a sponsorship agreement between a reputable multinational food and beverage corporation,PepsiCo(known for famous products such as Pepsi soft drinks and foods such as Lay`s Chips and one of the most important events expected by football enthusiasts around the world,the UEFA Champions` League annual tournament.

  2. Adapting human videofluoroscopic swallow study methods to detect and characterize dysphagia in murine disease models.

    Science.gov (United States)

    Lever, Teresa E; Braun, Sabrina M; Brooks, Ryan T; Harris, Rebecca A; Littrell, Loren L; Neff, Ryan M; Hinkel, Cameron J; Allen, Mitchell J; Ulsas, Mollie A

    2015-03-01

    This study adapted human videofluoroscopic swallowing study (VFSS) methods for use with murine disease models for the purpose of facilitating translational dysphagia research. Successful outcomes are dependent upon three critical components: test chambers that permit self-feeding while standing unrestrained in a confined space, recipes that mask the aversive taste/odor of commercially-available oral contrast agents, and a step-by-step test protocol that permits quantification of swallow physiology. Elimination of one or more of these components will have a detrimental impact on the study results. Moreover, the energy level capability of the fluoroscopy system will determine which swallow parameters can be investigated. Most research centers have high energy fluoroscopes designed for use with people and larger animals, which results in exceptionally poor image quality when testing mice and other small rodents. Despite this limitation, we have identified seven VFSS parameters that are consistently quantifiable in mice when using a high energy fluoroscope in combination with the new murine VFSS protocol. We recently obtained a low energy fluoroscopy system with exceptionally high imaging resolution and magnification capabilities that was designed for use with mice and other small rodents. Preliminary work using this new system, in combination with the new murine VFSS protocol, has identified 13 swallow parameters that are consistently quantifiable in mice, which is nearly double the number obtained using conventional (i.e., high energy) fluoroscopes. Identification of additional swallow parameters is expected as we optimize the capabilities of this new system. Results thus far demonstrate the utility of using a low energy fluoroscopy system to detect and quantify subtle changes in swallow physiology that may otherwise be overlooked when using high energy fluoroscopes to investigate murine disease models.

  3. A Mathematical Model for Swallowing of Concentrated Fluids in Oesophagus

    Directory of Open Access Journals (Sweden)

    S. K. Pandey

    2011-01-01

    Full Text Available This model investigates particularly the impact of an integral and a non-integral number of waves on the swallowing of food stuff such as jelly, tomato puree, soup, concentrated fruits juices and honey transported peristaltically through the oesophagus. The fluid is considered as a Casson fluid. Emphasis is on the study of the dependence of local pressure distribution on space and time. Mechanical efficiency, reflux limit and trapping are also discussed. The effect of Casson fluid vis-à-vis Newtonian fluid is investigated analytically and numerically too. The result is physically interpreted as that the oesophagus makes more efforts to swallow fluids with higher concentration. It is observed that the pressure is uniformly distributed when an integral number of waves is there in the oesophagus; but it is non-uniform when a non-integral number of waves is present therein. It is further observed that as the plug flow region widens, the pressure difference increases, which indicates that the averaged flow rate will reduce for a Casson fluid. It is also concluded that Casson fluids are more prone to reflux.

  4. The regions and global warming: Impacts and response strategies

    International Nuclear Information System (INIS)

    1991-01-01

    To date, much of the attention given to global warming in scientific research as well as in policy development has focused on the global picture. International negotiations and agreements to stabilize, and eventually reduce, greenhouse gas emissions are very important. By themselves, however, they are not sufficient to address global warming. Regional strategies are also needed. They can help reduce greenhouse gas emissions, and they will be the most effective way to mitigate the consequences of global warming. Adaptive strategies must respond to local and regional conditions. In many countries, subnational jurisdictions such as states and provinces or community organizations can already take effective actions without direction from their national government or waiting for international agreements. An important factor in defining regional approaches is the disparate consequences of climate change for developed and developing areas. Different strategies will also be needed for industrial and agricultural regions. Wealthy industrial regions may be better able to develop capital-intensive, adaptive infrastructure than regions with fewer discretionary resources where people are more vulnerable to the vagaries of weather patterns. On the other hand, regions that rely on indigenous knowledge and local resources may be better equipped to make incremental adaptations and more willing to modify life-styles. Ultimately, all climate change effects are experienced in specific places and effective response depends upon local action. We recognize that individual localities cannot solve a problem of global proportions by acting alone. However, a regional strategy can supplement international and national action and be the focal point for addressing risks in the unique social and economic context of a particular area. These meetings discussions dealt with the impacts and implications of climate change on such things as agriculture, forestry, and policy

  5. Speech, language and swallowing in Huntington’ Disease

    Directory of Open Access Journals (Sweden)

    Maryluz Camargo-Mendoza

    2017-04-01

    Full Text Available Huntington’s disease (HD has been described as a genetic condition caused by a mutation in the CAG (cytosine-adenine-guanine nucleotide sequence. Depending on the stage of the disease, people may have difficulties in speech, language and swallowing. The purpose of this paper is to describe these difficulties in detail, as well as to provide an account on speech and language therapy approach to this condition. Regarding speech, it is worth noticing that characteristics typical of hyperkinetic dysarthria can be found due to underlying choreic movements. The speech of people with HD tends to show shorter sentences, with much simpler syntactic structures, and difficulties in tasks that require complex cognitive processing. Moreover, swallowing may present dysphagia that progresses as the disease develops. A timely, comprehensive and effective speech-language intervention is essential to improve the quality of life of people and contribute to their communicative welfare.

  6. Management of accidental swallowing in implant dentistry.

    Science.gov (United States)

    Souza, Francisley Ávila; Statkievicz, Cristian; Guilhem Rosa, Ana Laura; da Silveira Bossi, Fabrício

    2015-08-01

    This report describes a protocol for managing the accidental swallowing of dental instruments in implant dentistry, illustrated by a patient who accidentally swallowed a hexagonal wrench. The first step was to refer the patient to the medical emergency hospital service for radiographic and clinical evaluation. The hexagonal wrench was located in the stomach and was immediately removed with an endoscopic procedure. The gastric mucosa was sampled via biopsy and the sample submitted to the urease test, which was positive for Helicobacter pylori. Triple treatment was instituted for gastritis caused by H pylori to avoid exposing the patient to unnecessary risk. Removal of a foreign body by means of an endoscopic procedure constitutes a safe and effective treatment. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  7. Quality of life in swallowing of the elderly patients affected by stroke.

    Science.gov (United States)

    Pontes, Émerson Soares; Amaral, Ana Karênina de Freitas Jordão do; Rêgo, Flávia Luiza Costa do; Azevedo, Elma Heitmann Mares; Silva, Priscila Oliveira Costa

    2017-01-01

    - The elderly population faces many difficulties as a result of the aging process. Conceptualize and evaluate their life quality is a challenge, being hard to characterize the impact on daily activities and on functional capacity. The stroke is one of the most disabling neurological diseases, becoming a public health problem. As an aggravating result, there is dysphagia, a disorder that compromises the progression of the food from the mouth to the stomach, causing clinical complications to the individual. - Characterize the life quality of the elderly swallowing affected by stroke. - Cross-sectional study conducted at the University Hospital, attended by 35 elderly with stroke, being 19 women and 16 men, with age between 60 and 90 years old, that self-reported satisfactory overall clinical picture. It was applied the Quality of Life Swallowing protocol. The data were statistically analyzed, by means of ANOVA tests, Spearman correlation, t test, with significance level of 5%. - The mean age was 69.5 years; as for the scores obtained by the 35 participants in the 11 domains of the protocol, it was observed a change in score indicating severe to moderate impact in quality of life related to self-reported swallowing (31.8% to 59.5%); the domain that most interfered was the feeding time (31.8%). - Elderly affected by stroke that present dysphagia has low scores in quality of life related to swallowing.

  8. Aspirating and Nonaspirating Swallow Sounds in Children: A Pilot Study.

    Science.gov (United States)

    Frakking, Thuy; Chang, Anne; O'Grady, Kerry; David, Michael; Weir, Kelly

    2016-12-01

    Cervical auscultation (CA) may be used to complement feeding/swallowing evaluations when assessing for aspiration. There are no published pediatric studies that compare the properties of sounds between aspirating and nonaspirating swallows. To establish acoustic and perceptual profiles of aspirating and nonaspirating swallow sounds and determine if a difference exists between these 2 swallowing types. Aspiration sound clips were obtained from recordings using CA simultaneously undertaken with videofluoroscopic swallow study. Aspiration was determined using the Penetration-Aspiration Scale. The presence of perceptual swallow/breath parameters was rated by 2 speech pathologists who were blinded to the type of swallow. Acoustic data between groups were compared using Mann Whitney U-tests, while perceptual differences were determined by a test of 2 proportions. Combinations of perceptual parameters of 50 swallows (27 aspiration, 23 no aspiration) from 47 children (57% male) were statistically analyzed using area under a receiver operating characteristic (aROC), sensitivity, specificity, and positive and negative predictive values to determine predictors of aspirating swallows. The combination of post-swallow presence of wet breathing and wheeze and absence of GRS and normal breathing was the best predictor of aspiration (aROC = 0.82, 95% CI, 0.70-0.94). There were no significant differences between these 2 swallow types for peak frequency, duration, and peak amplitude. Our pilot study has shown that certain characteristics of swallow obtained using CA may be useful in the prediction of aspiration. However, further research comparing the acoustic swallowing sound profiles of normal children to children with dysphagia (who are aspirating) on a larger scale is required. © The Author(s) 2016.

  9. Technology of swallowable capsule for medical applications

    OpenAIRE

    Intzes, I; Meng, H; Cosmas, J

    2014-01-01

    Medical technology has undergone major breakthroughs in recent years, especially in the area of the examination tools for diagnostic purposes. This paper reviews the swallowable capsule technology in the examination of the gastrointestinal system for various diseases. The wireless camera pill has created a more advanced method than many traditional examination methods for the diagnosis of gastrointestinal diseases such as gastroscopy by the use of an endoscope. After years of great innovation...

  10. Prevalence of atypical swallowing: a kinesiographic study.

    Science.gov (United States)

    Monaco, A; Cattaneo, R; Spadaro, A; Marchetti, E; Barone, A

    2006-12-01

    The aim of this study was to investigate the prevalence of kinesiographic coincidence between the most cranial position during deglutition of mandible and habitual occlusal position and to evaluate the distribution of clinical diagnosis according to the kinesiographic pattern of deglutition. 201 random patients in waiting list for dental treatment and classified as orthodontic patients, prosthetic patients, TMD patients and control patients, were evaluated. Kinesiographic records were acquired using K7I and positioning a magnetic sensor frame integral with the head and with the sensory field balanced on an artificial magnet adhering to the mucosa covering the roots of the lower mandibular incisors. The kinesiographic occlusal position was compared to the kinesiographic most cranial position of the mandible during swallowing. 99 patients displayed a discrepancy between the most cranial position during swallowing and the occlusal position. 102 patients did not show any discrepancy. In this group the kinesiographic most cranial position during swallowing coincided with the occlusal position. The finding suggests that computerised kinesiography could be useful to study deglutition, detecting in a reliable way the movement pattern. Atypical deglutition seems to be less atypical than previously though in dental patient population and, despite these data confirm its correlation with malocclusion, we noted an inverse correlation with necessity of prosthetic treatment and no higher prevalence in TMD patients.

  11. Spatiotemporal characteristics of swallowing in Parkinson's disease.

    Science.gov (United States)

    Kim, Yeo H; Oh, Byung-Mo; Jung, Ii-Young; Lee, Jung C; Lee, Goo J; Han, Tai R

    2015-02-01

    The aim of this study was to quantitatively investigate spatiotemporal movement abnormalities during the pharyngeal phase of swallowing in individuals with Parkinson's disease (PD) and to investigate relationships between disease and dysphagia severities. Retrospective study. We performed two-dimensional motion analysis of the hyoid bone, epiglottis, and vocal folds using videofluoroscopic images from 33 PD patients and 33 age-matched, healthy controls. The outcome measures were spatial and temporal movement variables during swallowing. Additionally, three subgroups of patients were compared based on the Hoehn and Yahr scale to identify the relationship between disease and dysphagia severities. Individuals with PD showed a reduced anterior hyoid bone displacement after normalization for each individual. The maximal angle of the epiglottic rotation was smaller in PD patients. The time to maximal displacement of the hyoid bone, epiglottis, and vocal folds were significantly delayed in PD patients (P = 0.001, 0.002, and disease severity was related to level of diet and supervision but not with dysphagia severity. This study shows that oropharyngeal bradykinesia, incoordination, reduced anterior hyoid bone movement, and decreased epiglottic rotation angle during swallowing are the most noticeable findings in individuals with PD. N/A. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Impacts from restoration strategies. Assessment through valuation workshops

    Energy Technology Data Exchange (ETDEWEB)

    Alvarez-Farizo, Begona [IPP-CSIC, Albasanz, 26-28, 28037 Madrid (Spain); Gil, Jose M. [CREDA-UPC-IRTA, Parc Mediterrani de la Tecnologia, 08860-Castelldefels, Barcelona (Spain); Howard, B.J. [Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster LA1 4AP (United Kingdom)

    2009-01-15

    Recent decades have seen a wide range of pollutant spills affecting natural, industrial, urban and rural areas (Exxon Valdez, Amoco Cadiz, Erika, Prestige, the Chernobyl nuclear power plant, and the Aznalcollar mines in Spain, to name a few). The extent of damage covers both time and space. Therefore, in order to mitigate the effects of pollution, it is necessary to adopt integrated management of both productive and natural areas. However, to be effective it is necessary to consider not only the health or biophysical effects of the countermeasures, but also the response of individuals to these changes. The purpose of this study is to assess the potential social and environmental impacts derived from the implementation of restoration strategies resulting from spills. Our approach is based on a choice experiment applied within the context of a citizens' valuation workshop or market stall in Cumbria (UK) and Zaragoza (Spain). The results highlight the advantages of this participatory technique versus traditional surveys. (author)

  13. Impact of Laboratory Test Use Strategies in a Turkish Hospital.

    Directory of Open Access Journals (Sweden)

    Fatma Meriç Yılmaz

    Full Text Available Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH and calculate potential savings in costs.A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months.Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6-85.0% was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars.Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory tests.

  14. Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults.

    Science.gov (United States)

    Guedes, Renata; Azola, Alba; Macrae, Phoebe; Sunday, Kirstyn; Mejia, Veerley; Vose, Alicia; Humbert, Ianessa A

    2017-05-15

    Swallowing maneuvers are routinely trained in dysphagia rehabilitation with the assumption that practiced behaviors transfer to functional swallowing, however transfer is rarely examined in the deglutition literature. The goal of this study was to train the volitional laryngeal vestibule closure (vLVC) maneuver, which is a swallowing maneuver that targets prolonged laryngeal vestibule closure (LVC). In two different training experiments, 69 healthy adults underwent Long-hold (hold vLVC as long as possible) or Short-hold vLVC training (hold vLVC for 2s). Before and after vLVC training, natural swallows (swallowing without a therapeutic technique) were completed. The outcome variables included laryngeal vestibule closure reaction time and the duration of laryngeal vestibule closure. Results indicate that during both Long-hold and Short-hold vLVC trainings, vLVC swallows had faster laryngeal vestibule closure reaction times and longer durations of laryngeal vestibule closure than in pre-training 5ml liquid swallows. However, only faster laryngeal vestibule closure reaction times transferred to post-training 5ml liquid swallows (20-24% faster), but not prolonged durations of laryngeal vestibule closure. Our findings suggest that swallowing maneuver training has the potential to induce transfer of what was practiced to functional swallowing behavior, although not all practiced behaviors may generalize. These findings are significant for bolstering the effectiveness of dysphagia management in medical settings and should be tested in individuals with dysphagia. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. [Cine-MRI contribution to assess swallowing mechanism and oro-pharyngeal dysphagia].

    Science.gov (United States)

    Fauvet, F; Charpiot, A; Schultz, P; Riehm, S; Vetter, D; Veillon, F; Hémar, P; Debry, C

    2008-01-01

    This study aimed at evaluating the performance of Cine-MRI to assess swallowing in patients previously treated for head and neck cancer. 10 healthy control subjects and a cohort of 10 patients with 8 partial glossectomies, 1 total laryngectomy and 1 glossolaryngectomy underwent imaging from October 2005 to February 2007. The MRI examinations were performed on a 1.5 Tesla system (Siemens Avanto), with True-Fisp sequences (TR = 170 ms, TE = 1 ms, slice thickness = 10 mm) at a rate of 8 pictures per second, during dry swallowing. Results are relevant for real-time spatial resolution from lips to larynx and dynamic motions analyses of tongue, velum, posterior pharyngeal wall and larynx during dry swallowing. Oro-pharyngo-laryngeal occlusion deficiency induces aspiration in case of partial glossectomy. Total laryngectomy modifies tongue, velum and pharynx landmarks. Cine-MRI i) provides functional insight from the oral cavity to the larynx, ii) gives accurate informations about impairments due to the pathology and its treatment, iii) completes others investigations like fiberoptic endoscopy or transit time, iiii) allows a precise analysis of the muscular movements involved in the deficient swallowing mechanism, in order to optimize rehabilitative strategies and results.

  16. The Impact of Relationship Marketing Strategy in Indonesia Retail Industries

    Directory of Open Access Journals (Sweden)

    Freddy Pandapotan Simbolon

    2016-09-01

    Full Text Available This research aimed to examine the impact of relationship marketing strategy on customer loyalty in Indonesia’s retail industries. A questionnaire derived from previous studies and the relevant literature was completed by 182 retail customers in Jakarta. Multiple regression analysis assessed the impact on customer loyalty of four key constructs of relationship marketing (trust, commitment, communication, and conflict handling. The two variables (trust and commitment had a significant effect and predicted a good proportion of the variance in customer loyalty. Moreover, they were significantly related to one another. The relationships investigated in this study deserved further research. Since the data analyzed were collected from one sector of the service industry in one region, more studies were required before general conclusions can be drawn. It is reasonable to conclude, on this evidence, that customer loyalty can be created, reinforced, and retained by marketing plans aimed at building trust, demonstrating a commitment to service, communicating with customers in a timely, reliable and proactive fashion, and handling conflict efficiently, reinforces and refines the body of knowledge relating to customer loyalty in service industries.

  17. Effects of Barium Concentration on Oropharyngeal Swallow Timing Measures

    OpenAIRE

    Stokely, Shauna L.; Molfenter, Sonja M.; Steele, Catriona M.

    2013-01-01

    Videofluoroscopy is commonly used for evaluating oropharyngeal swallowing but requires radiopaque contrast (typically barium). Prior studies suggest that some aspects of swallowing, including timing measures of oral and pharyngeal bolus transit, vary depending on barium concentration. The aim of our study was to identify timing differences in healthy swallowing between “thin” (40 % w/v concentration) and “ultrathin” (22 % w/v concentration) barium solutions. Twenty healthy adults (Ten women; ...

  18. Event Sequence Variability in Healthy Swallowing: Building on Previous Findings

    OpenAIRE

    Molfenter, Sonja M.; Leigh, Chelsea; Steele, Catriona M.

    2014-01-01

    This study builds on previous work by Kendall, Leonard and McKenzie, which investigated event sequence variability for 12 paired-events during swallowing by healthy volunteers. They identified four event pairs, which always occurred in a stereotyped order as well as a most-common occurring overall order of events during swallowing. In the current study, we investigate overall event sequencing and the same four paired-events in a sample of swallows by healthy, young (under 45 years old) volunt...

  19. Gas swallow during meals in patients with excessive belching.

    Science.gov (United States)

    Caballero, N; Serra, J

    2017-09-01

    Swallowed gas is an important source of abdominal gas, and aerophagia is often believed as a putative cause of gas-related abdominal symptoms. However, altered gas-swallow during meals has not been demonstrated. Our aim was to characterize the number of gas swallows during meals in patients complaining of excessive belching and gaseousness and a control group without abdominal symptoms during a 24-h period. A 24-h pH-impedance monitoring was performed in 10 patients with excessive belching, and 11 patients without digestive symptoms or reflux in the pH-impedance study. During the study, patients followed their daily routine and customary meals, without any specific limitation. In each patient the number and content of swallows and belches were analyzed. Total meal periods were similar in controls (75±26 min) and patients (79±21 min; P=.339), but the number of gaseous swallows was greater in patients (114±13 swallows) than controls (71±8 swallows; P=.007), due to a greater frequency of gaseous swallows during meals (15±2 swallows/10 min vs 10±1 swallows/10 min, respectively; P=.008). During the 24-h study period, 66±13 belches were recorded in patients, but only 13±3 belches in controls (PGas is frequently swallowed during meals. Patients complaining of excessive belching have a different swallow pattern during meals, with an increased ingestion of gas that correlates with increased gastric belching events. © 2017 John Wiley & Sons Ltd.

  20. 7 CFR 1948.81 - State Investment Strategy for Energy Impacted Areas.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 13 2010-01-01 2009-01-01 true State Investment Strategy for Energy Impacted Areas... HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY... Impacted Area Development Assistance Program § 1948.81 State Investment Strategy for Energy Impacted Areas...

  1. Journey of a Swallowed Toothbrush to the Colon

    Science.gov (United States)

    Kim, In Hee; Kim, Hyun Chul; Koh, Kang Hun; Kim, Seong Hun; Kim, Sang Wook; Lee, Seung Ok

    2007-01-01

    Toothbrush swallowing is a rare event. Because no cases of spontaneous passage have been reported, prompt removal is recommended to prevent the development of complications. Most swallowed toothbrushes have been found in the esophagus or the stomach of affected patients, and there has been no previously reported case of a toothbrush in the colon. Here, we report a case of a swallowed toothbrush found in the ascending colon that caused a fistula between the right colon and the liver, with a complicating small hepatic abscess. This patient was successfully managed using exploratory laparotomy. To our knowledge, this is the first documented case of a swallowed toothbrush found in the colon. PMID:17616026

  2. Mastication and swallowing in patients with postirradiation xerostomia

    International Nuclear Information System (INIS)

    Hamlet, Sandra; Faull, Jennifer; Klein, Barbara; Aref, Amr; Fontanesi, James; Stachler, Robert; Shamsa, Falah; Jones, Lewis; Simpson, Mark

    1997-01-01

    Purpose: Very little objective data has been reported on mastication and swallowing in xerostomic patients, which would substantiate presumed causal relationships between xerostomia and patient complaints. The purpose was to elucidate which components of mastication and swallowing were abnormal, and most directly related to xerostomia, and which appeared unaffected. Methods and Materials: A retrospective analysis of timing events in mastication and swallowing was done using videofluoroscopic data for 15 cancer patients with xerostomia, and 20 normal controls. Scintigraphy was also used to determine oropharyngeal residue after a water swallow. Cancer treatment modalities included radiation therapy or chemoradiation therapy. Results: For barium liquid and paste substances, timing measures were equivalent for controls and patients. Xerostomic patients took 46% longer to masticate a shortbread cookie, and timing for the initiation of swallowing was shorter, but duration of swallowing appeared unaffected. Oral and pharyngeal residues following the swallow were greater in the patient group. Conclusions: Xerostomia primarily affected mastication and oral manipulation of a dry, absorbent food material. Increased oral and pharyngeal residues after a water swallow are ambiguously related to xerostomia. The initiation and duration of the pharyngeal swallow was not abnormal

  3. Event sequence variability in healthy swallowing: building on previous findings.

    Science.gov (United States)

    Molfenter, Sonja M; Leigh, Chelsea; Steele, Catriona M

    2014-04-01

    This study builds on previous work by Kendall, Leonard, and McKenzie, which investigated event sequence variability for 12 paired events during swallowing by healthy volunteers. They identified four event pairs that always occurred in a stereotyped order and a most common occurring overall order of events during swallowing. In the current study, we investigated overall event sequencing and the same four paired events in a sample of swallows by healthy young (under 45 years old) volunteers. Data were collected during a 16-swallow lateral videofluoroscopy protocol, which included manipulations of bolus volume, barium density, bolus viscosity, and swallow cueing. Our results agreed with previous findings that variable event sequencing is found in healthy swallowing, and, in regard to obligatory sequencing of two paired events, movement of the arytenoids toward the base of the epiglottis begins prior to upper esophageal sphincter (UES) opening and maximum hyolaryngeal approximation occurs after UES opening. However, our data failed to replicate the previous findings that there is obligatory sequencing of maximum pharyngeal constriction after maximal UES distension and the UES opens before bolus arrival at the UES. The most common observed overall event sequence reported by Kendall et al. was observed in only 4/293 swallows in our dataset. Manipulations of bolus volume, bolus viscosity, barium concentration, swallow cueing, and swallow repetitions could not completely account for the differences observed between the two studies.

  4. Leadership Strategies of Performance Measures Impacts in Public Sector Management: A National Content Analysis.

    Science.gov (United States)

    Kubala, James Joseph

    A quantitative and qualitative study examined three leadership strategies found in performance-based management (human resource, scientific management and political strategies used in public sector management); a framework by which performance measurement (PM) supports leadership strategies; and how the strategies impact PM. It examined leadership…

  5. The Impact of Teaching Communication Strategies on English Speaking of Engineering Undergraduates

    Science.gov (United States)

    Kongsom, Tiwaporn

    2016-01-01

    This study investigates the impact of teaching communication strategies on Thai engineering undergraduate students' communication strategy use and strategic competence. Fifty-seven engineering undergraduate students were taught ten communication strategies for ten weeks and responded to a self-report communication strategy questionnaire before and…

  6. The effects of a xanthan gum-based thickener on the swallowing function of patients with dysphagia.

    Science.gov (United States)

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

    2014-05-01

    Increasing bolus viscosity of thin liquids is a basic therapeutic strategy to protect patients with oropharyngeal dysphagia (OD) from aspiration. However, conventional starch thickeners increase post-deglutitive residue. To assess the therapeutic effect of a new xanthan gum-based thickener, Resource ThickenUp Clear (Nestlé Health Science, Vevey, Switzerland) on patients with oropharyngeal dysphagia. We studied the effect of Resource ThickenUp Clear using a clinical method and videofluoroscopy on 120 patients with oropharyngeal dysphagia (66 with stroke, 41 older and 13 with neurodegenerative diseases) and 14 healthy volunteers while swallowing thin-liquid, nectar-like and spoon-thick boluses. We assessed the prevalence of signs of impaired safety and efficacy of swallow and the physiology of the swallow response. Increasing bolus viscosity with Resource ThickenUp Clear: (i) improved safety of swallow demonstrated by a reduction in the prevalence of cough and voice changes in the clinical study and penetrations and aspirations during video fluoroscopy. Prevalence of aspirations was 12.7% with thin liquid, 7.7% with nectar-like (P < 0.01) and 3.4% with spoon-thick (P < 0.01) viscosities. Penetration-Aspiration Scale was reduced from 3.24 ± 0.18 at thin liquid to 2.20 ± 0.18 at nectar-like (P < 0.001) and to 1.53 ± 0.13 at spoon-thick (P < 0.001) viscosities; (ii) did not enhance pharyngeal residue; (iii) nectar-like viscosity did not affect bolus velocity nor timing of swallow response and (iv) spoon-thick viscosity reduced bolus velocity. Resource ThickenUp Clear improves the safety of swallow without increasing residue providing a viscosity-dependent therapeutic effect for patients with oropharyngeal dysphagia. At nectar viscosity, the effect is due to intrinsic texture properties, spoon-thick viscosity adding changes in swallow physiology. NCT01158313. © 2014 John Wiley & Sons Ltd.

  7. Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia.

    Science.gov (United States)

    Kim, H D; Choi, J B; Yoo, S J; Chang, M Y; Lee, S W; Park, J S

    2017-01-01

    Tongue function can affect both the oral and pharyngeal stages of the swallowing process, and proper tongue strength is vital for safe oropharyngeal swallowing. This trial investigated the effect of tongue-to-palate resistance training (TPRT) on tongue strength and oropharyngeal swallowing function in stroke with dysphagia patients. This trial was performed using a 4-week, two-group, pre-post-design. Participants were allocated to the experimental group (n = 18) or the control group (n = 17). The experimental group performed TPRT for 4 weeks (5 days per week) and traditional dysphagia therapy, whereas the control group performed traditional dysphagia therapy on the same schedule. Tongue strength was measured using the Iowa Oral Performance Instrument. Swallowing function was measured using the videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) based on a videofluoroscopic swallowing study. Experimental group showed more improved in the tongue strength (both anterior and posterior regions, P = 0·009, 0·015). In addition, the experimental group showed more improved scores on the oral and pharyngeal phase of VDS (P = 0·029, 0·007), but not on the PAS (P = 0·471), compared with the control group. This study demonstrated the effectiveness of TPRT in increasing tongue muscle strength and improving swallowing function in patients with post-stroke dysphagia. Therefore, we recommend TPRT as an easy and simple rehabilitation strategy for improving swallowing in patients with dysphagia. © 2016 John Wiley & Sons Ltd.

  8. Swallowing difficulties in Duchenne muscular dystrophy: indications for feeding assessment and outcome of videofluroscopic swallow studies

    DEFF Research Database (Denmark)

    Aloysius, A.; Born, P.; Kinali, M.

    2008-01-01

    Feeding difficulties are known to occur with advancing age in Duchenne muscular dystrophy (DMD). We evaluated the role of videofluoroscopy swallow study (VFSS) in a group of 30 DMD patients with feeding difficulties. Indications for feeding assessment were: respiratory infections potentially...

  9. Swallowing dysfunction as a factor that should be remembered in recurrent pneumonia: videofluoroscopic swallow study.

    Science.gov (United States)

    Kaymaz, Nazan; Özçelik, Uğur; Demir, Numan; Cinel, Güzin; Yalçin, Ebru; Ersöz, Deniz D; Kiper, Nural

    2017-10-01

    The swallow function is one of the strong defense mechanism against aspiration. Aspiration and pneumonia are unavoidable in patients with defective mechanism of swallowing. The aim of this study was to evaluate patients with recurrent pneumonia in terms of videofluoroscopic examination results. The study comprised fifty pediatric cases (22 boys, 28 girls) with an average age of 2.9 years (2 months-7.5 years) who were referred to our clinic due to suffering from recurrent pneumonia. The videofluoroscopic swallow study (VFSS) was performed on all patients. The presence of a correlation with pneumonia was investigated. In 45 of the children, VFSS results were not normal. Of the children, 41 had mental-motor retardation. The results of the videofluoroscopic study show that silent aspiration was the most common pathology in participants with the percentage of 40 (27.5% mild, 17.5% severe). Patients in the study had pneumonia with an incidence of 2.6 illnesses per year. Having one than more results on VFSS was found to be associated with more number of annual pneumonia episodes. Children with neurological impairments are at risk of recurrent acute pneumonia due to aspiration. Disturbances of swallowing phases should be remembered as a cause of pneumonia in these patients.

  10. Star marketer’s impact on the market strategy choice

    Directory of Open Access Journals (Sweden)

    Vlašić Goran

    2017-01-01

    Full Text Available We focus on understanding the role of star marketers in pursuing a market-driven vs. a market-driving strategy. Results indicate that market-driving and market-driven strategies are two approaches that can be pursued by market-oriented firms. A star marketer has a robust positive influence on market-driving strategy. In contrast, a star marketer has no meaningful influence on market-driven strategy. In short, while star marketers are very important for market-driving strategy and long term success, they represent an unnecessary cost and provide no added value to companies focusing on market-driven strategies and short term results.

  11. IMPACT OF MARKETING STRATEGIES ON SACHET PRODUCTS IN BANGLADESH

    Directory of Open Access Journals (Sweden)

    Hossain Shahid SHOHROWARDHY

    2015-06-01

    Full Text Available A product is anything that can be accessible to the market for satisfaction. The basic objective of marketing is maximum satisfaction since satisfaction of consumer and business performance is positively related to each other. For satisfaction, product is diversified in different categories i.e. generic product, product type product, substitute product and product line etc. Sachet product is one of the expansions of product line. The term ‘Sachet’ is originated from the French word which means “mini”. In Bangladesh, sachet product has a strong market share. Thus, this study attempts to determine the exiting share of sachet product and measure the impact of marketing strategies on sachet product in Bangladesh. This study uses the selective 22 dimensions to favor the sachet product on the basis of 4Ps (Product, Price, Place and Promotion. To accomplish the study, 125 samples have been taken from selective markets in Cosmopolitan city, Chittagong. The study found that sachet product has strong market position comparative with other categories of products, where promotional effect is the dominant factor who played the vital role to sustain the sachet product in Bangladesh. The results of this study will be constructive for executives and policy-makers of business organization who works with fast moving consumer good (FMCG items effectively in Bangladesh.

  12. Suicidality in sleep disorders: prevalence, impact, and management strategies

    Directory of Open Access Journals (Sweden)

    Drapeau CW

    2017-09-01

    Full Text Available Christopher W Drapeau, Michael R Nadorff Department of Psychology, Mississippi State University, Mississippi State, MS, USA Abstract: Sleep disturbances are associated with suicide-related thoughts and behaviors, and the incidence of sleep concerns and suicide has increased recently in the US. Most published research exploring the sleep–suicidality relation is focused on select sleep disorders, with few reviews offering a comprehensive overview of the sleep–suicidality literature. This narrative review broadly investigates the growing research literature on sleep disorders and suicidality, noting the prevalence of suicide ideation and nonfatal and fatal suicide attempts, the impact of several sleep disorders on suicide risk, and potential sleep-disorder management strategies for mitigating suicide risk. Aside from insomnia symptoms and nightmares, there exist opportunities to learn more about suicide risk across many sleep conditions, including whether sleep disorders are associated with suicide risk independently of other psychiatric conditions or symptoms. Generally, there is a lack of randomized controlled trials examining the modification of suicide risk via evidence-based sleep interventions for individuals with sleep disorders. Keywords: sleep, suicide, suicidality, insomnia, nightmares, treatment

  13. Derangement of swallowing in children with myelomeningocele

    International Nuclear Information System (INIS)

    Fernbach, S.K.; McLone, D.G.

    1985-01-01

    Barium esophagrams performed in 13 children with myelomeningocele demonstrated a variety of swallowing disorders: difficulty in bolus formation, nasopharyngeal reflux, tracheobronchial aspiration. Cricopharyngeal spasm was not identified in this group. Antegrade peristalsis in the distal two-thirds of the esophagus was normal. Gastroesophageal reflux was demonstrated in 8 of the children. Vocal cord paralysis (8/13) and death in early child-hood (6/13) occurred with greater frequency than in the general myelomeningocele population. Correct management of these children may require tracheostomy, gastrostomy, and fundoplication. (orig.)

  14. Cliff swallows Petrochelidon pyrrhonota as bioindicators of environmental mercury, Cache Creek Watershed, California

    Science.gov (United States)

    Hothem, Roger L.; Trejo, Bonnie S.; Bauer, Marissa L.; Crayon, John J.

    2008-01-01

    To evaluate mercury (Hg) and other element exposure in cliff swallows (Petrochelidon pyrrhonota), eggs were collected from 16 sites within the mining-impacted Cache Creek watershed, Colusa, Lake, and Yolo counties, California, USA, in 1997-1998. Nestlings were collected from seven sites in 1998. Geometric mean total Hg (THg) concentrations ranged from 0.013 to 0.208 ??g/g wet weight (ww) in cliff swallow eggs and from 0.047 to 0.347 ??g/g ww in nestlings. Mercury detected in eggs generally followed the spatial distribution of Hg in the watershed based on proximity to both anthropogenic and natural sources. Mean Hg concentrations in samples of eggs and nestlings collected from sites near Hg sources were up to five and seven times higher, respectively, than in samples from reference sites within the watershed. Concentrations of other detected elements, including aluminum, beryllium, boron, calcium, manganese, strontium, and vanadium, were more frequently elevated at sites near Hg sources. Overall, Hg concentrations in eggs from Cache Creek were lower than those reported in eggs of tree swallows (Tachycineta bicolor) from highly contaminated locations in North America. Total Hg concentrations were lower in all Cache Creek egg samples than adverse effects levels established for other species. Total Hg concentrations in bullfrogs (Rana catesbeiana) and foothill yellow-legged frogs (Rana boylii) collected from 10 of the study sites were both positively correlated with THg concentrations in cliff swallow eggs. Our data suggest that cliff swallows are reliable bioindicators of environmental Hg. ?? Springer Science+Business Media, LLC 2007.

  15. Star marketer’s impact on the market strategy choice

    OpenAIRE

    Goran, Vlašić; Hair, Joe F.; Krupka, Zoran

    2017-01-01

    We focus on understanding the role of star marketers in pursuing a market-driven vs. a market-driving strategy. Results indicate that market-driving and market-driven strategies are two approaches that can be pursued by market-oriented firms. A star marketer has a robust positive influence on market-driving strategy. In contrast, a star marketer has no meaningful influence on market-driven strategy. In short, while star marketers are very important for market-driving strategy and long term su...

  16. A case of colohepatic penetration by a swallowed toothbrush

    Science.gov (United States)

    Lee, Min Ro; Hwang, Yong; Kim, Jong Hun

    2006-01-01

    Although foreign body ingestion is relatively common, toothbrush swallowing is rare. We report a case of a swallowed toothbrush which passed through the ileocecal valve and perforated the proximal transverse colon, then the liver. To our knowledge, this is the first case to be reported. PMID:16688846

  17. The surgical management and speech and swallowing rehabilitation ...

    African Journals Online (AJOL)

    Advanced tongue cancer may have a devastating effect on a person's ability to speak and to swallow. Very little is known about the surgical management and speech and swallowing rehabilitation of persons with advanced tongue cancer in South Africa. The aim of this study was to obtain information regarding clinical ...

  18. IMPLICATIONS OF MOUTH BREATHING AND ATYPICAL SWALLOWING IN BODY POSTURE

    Directory of Open Access Journals (Sweden)

    Veronique Sousa

    2017-07-01

    Conclusion: Statistically significant associations were established between the breathing pattern and the horizontal alignment of acromions, as well as the horizontal and vertical alignment of the head; between the pattern of breathing and swallowing with occlusal relationship anteroposterior and occlusal relationship vertical and also between breathing pattern and swallowing with digital sucking habits and pacifier use.

  19. Swallow-wort (Vincetoxicum spp.) biological control update

    Science.gov (United States)

    Pale swallow-wort (Vincetoxicum rossicum = Cynanchum rossicum) and black swallow-wort (V. nigrum = C. louiseae) are herbaceous, perennial, viney milkweeds introduced from Europe (Apocynaceae-subfamily Asclepiadoideae). Both species are becoming increasingly invasive in a variety of natural and manag...

  20. Current distribution and population size of the Blue Swallow Hirundo ...

    African Journals Online (AJOL)

    Two surveys of Blue Swallows were conducted in the southern Tanzanian highland grasslands in order to determine the habitat preferences and estimate the size of this subpopulation. During the 2008/09 and 2012 surveys, a total distance of 3 635 km was travelled in search of Blue Swallows (at an altitude of above 1 400 ...

  1. Relationship between swallow-specific quality of life and fiber-optic endoscopic evaluation of swallowing findings in patients with head and neck cancer.

    Science.gov (United States)

    Florie, Michelle; Baijens, Laura; Kremer, Bernd; Kross, Kenneth; Lacko, Martin; Verhees, Femke; Winkens, Bjorn

    2016-04-01

    The purpose of this study was to determine the relationship between swallow-specific quality of life (QOL) using the MD Anderson Dysphagia Inventory (MDADI) and the swallowing function using a standardized fiber-optic endoscopic evaluation of swallowing (FEES) protocol in patients with dysphagia with head and neck cancer. Sixty-three patients with dysphagia and head and neck cancer were enrolled in the study. Patients completed the MDADI questionnaire and underwent a standardized FEES examination. Ordinal FEES variables were measured. Descriptive statistics and 1-way analysis of variance tests were carried out. For all FEES variables, the observer agreement level was sufficient (kappa ≥0.7).These preliminary results show statistically significant mean differences of MDADI subscales between the ordinal scale levels for several FEES variables. The MDADI questionnaire can be used to assess the impact of dysphagia on the patients' health-related QOL. Despite clear trends, it remains unclear if the MDADI questionnaire can be used as an indicator for the severity of oropharyngeal dysphagia. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1848-E1856, 2016. © 2015 Wiley Periodicals, Inc.

  2. Swallowing in moderate and severe phases of Alzheimer's disease

    Directory of Open Access Journals (Sweden)

    Sheilla de Medeiros Correia

    2010-12-01

    Full Text Available OBJECTIVE: To characterize the problems of feeding and swallowing in individuals with moderate and severe Alzheimer´s disease (AD and to correlate these with functional aspects. METHOD: Fifty patients with AD and their caregivers participated in this study. The instruments used were: Clinical Dementia Rating (CDR, Mini-Mental State Examination, Index of Activities of Daily Living, Assessment of Feeding and Swallowing Difficulties in Dementia, Functional Outcome Questionnaire for Aphasia, and Swallowing Rating Scale. RESULTS: Problems with passivity, distraction and refusal to eat were encountered in the CDR2 group. Distraction, passivity and inappropriate feeding velocity were predominant in the CDR3 group. The problems were correlated with communication, swallowing severity of AD individuals and caregiver schooling. CONCLUSION: Given the inexorable functional alterations during the course of the disease, it is vital to observe these in patients with a compromised feeding and swallowing mechanism. The present study supplies the instruments to orient caregivers and professionals.

  3. Hemodynamic signal changes accompanying execution and imagery of swallowing in patients with dysphagia: A multiple single-case near-infrared spectroscopy study

    Directory of Open Access Journals (Sweden)

    Silvia Erika Kober

    2015-07-01

    Full Text Available In the present multiple case study we examined hemodynamic changes in the brain in response to motor execution (ME and motor imagery (MI of swallowing in dysphagia patients compared to healthy matched controls using near-infrared spectroscopy (NIRS. Two stroke patients with cerebral lesions in the right hemisphere, two stroke patients with lesions in the brainstem and two neurologically healthy control subjects actively swallowed saliva (ME and mentally imagined to swallow saliva (MI in a randomized order while changes in concentration of oxygenated hemoglobin (oxy-Hb and deoxygenated hemoglobin (deoxy-Hb were assessed. In line with recent findings in healthy young adults, MI and ME of swallowing led to the strongest NIRS signal change in the inferior frontal gyrus in stroke patients as well as in healthy elderly. We found differences in the topographical distribution and time course of the hemodynamic response in dependence on lesion location. Dysphagia patients with lesions in the brainstem showed bilateral hemodynamic signal changes in the inferior frontal gyrus during active swallowing comparable to healthy controls. In contrast, dysphagia patients with cerebral lesions in the right hemisphere showed more unilateral activation patterns during swallowing. Furthermore, patients with cerebral lesions showed a prolonged time course of the hemodynamic response during MI and ME of swallowing compared to healthy controls and patients with brainstem lesions. Brain activation patterns associated with ME and MI of swallowing were largely comparable, especially for changes in deoxy-Hb. Hence, the present results provide new evidence regarding timing and topographical distribution of the hemodynamic response during ME and MI of swallowing in dysphagia patients and may have practical impact on future dysphagia treatment.

  4. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises.

    Science.gov (United States)

    Kraaijenga, Sophie A C; van der Molen, Lisette; Jacobi, Irene; Hamming-Vrieze, Olga; Hilgers, Frans J M; van den Brekel, Michiel W M

    2015-11-01

    Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in HNC survivors, long-term (i.e., beyond 5 years) prospectively collected data on objective and subjective treatment-induced functional outcomes (and their impact on QoL) still are scarce. The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients. The study was conducted as a randomized controlled trial on preventive swallowing rehabilitation (2006-2008) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants. Multidimensional assessment of functional sequels was performed with videofluoroscopy, mouth opening measurements, Functional Oral Intake Scale, acoustic voice parameters, and (study specific, SWAL-QoL, and VHI) questionnaires. Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment. At a mean follow-up of 6.1 years most initial tumor-, and treatment-related problems remained similarly low to those observed after 2 years follow-up, except increased xerostomia (68%) and increased (mild) pain (32%). Acoustic voice analysis showed less voicedness, increased fundamental frequency, and more vocal effort for the tumors located below the hyoid bone (n = 12), without recovery to baseline values. Patients' subjective vocal function (VHI score) was good. Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort, originating from preventive and continued post-treatment rehabilitation programs.

  5. Sex-related effects of an immune challenge on growth and begging behavior of barn swallow nestlings.

    Directory of Open Access Journals (Sweden)

    Andrea Romano

    Full Text Available Parent-offspring conflicts lead the offspring to evolve reliable signals of individual quality, including parasite burden, which may allow parents to adaptively modulate investment in the progeny. Sex-related variation in offspring reproductive value, however, may entail differential investment in sons and daughters. Here, we experimentally manipulated offspring condition in the barn swallow (Hirundo rustica by subjecting nestlings to an immune challenge (injection with bacterial lipopolysaccharide, LPS that simulates a bacterial infection, and assessed the effects on growth, feather quality, expression of morphological (gape coloration and behavioral (posture begging displays involved in parent-offspring communication, as well as on food allocation by parents. Compared to sham-injected controls, LPS-treated chicks suffered a depression of body mass and a reduction of palate color saturation. In addition, LPS treatment resulted in lower feather quality, with an increase in the occurrence of fault bars on wing feathers. The color of beak flanges, feather growth and the intensity of postural begging were affected by LPS treatment only in females, suggesting that chicks of either sex are differently susceptible to the immune challenge. However, irrespective of the effects of LPS, parents equally allocated food among control and challenged offspring both under normal food provisioning and after a short period of food deprivation of the chicks. These results indicate that bacterial infection and the associated immune response entail different costs to offspring of either sex, but a decrease in nestling conditions does not affect parental care allocation, possibly because the barn swallow adopts a brood-survival strategy. Finally, we showed that physiological stress induced by pathogens impairs plumage quality, a previously neglected major negative impact of bacterial infection which could severely affect fitness, particularly among long

  6. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST

    Science.gov (United States)

    Troche, M.S.; Okun, M.S.; Rosenbek, J.C.; Musson, N.; Fernandez, H.H.; Rodriguez, R.; Romrell, J.; Pitts, T.; Wheeler-Hegland, K.M.; Sapienza, C.M.

    2010-01-01

    Objective: Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement. Methods: This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration–aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images. Results: No pretreatment group differences existed. The active treatment (EMST) group demonstrated improved swallow safety compared to the sham group as evidenced by improved PA scores. The EMST group demonstrated improvement of hyolaryngeal function during swallowing, findings not evident for the sham group. Conclusions: EMST may be a restorative treatment for dysphagia in those with PD. The mechanism may be explained by improved hyolaryngeal complex movement. Classification of evidence: This intervention study provides Class I evidence that swallow safety as defined by PA score improved post EMST. GLOSSARY CI = confidence interval; EMST = expiratory muscle strength training; MEP = maximum expiratory pressure; PA = penetration–aspiration; PD = Parkinson disease; SWAL-QOL = Swallowing Quality of Life Questionnaire; UES = upper esophageal

  7. Quality of Life in Swallowing Disorders after Nonsurgical Treatment for Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Silveira, Marta Halina

    2014-12-01

    Full Text Available Introduction Radiotherapy or chemoradiotherapy can result in severe swallowing disorders with potential risk for aspiration and can negatively impact the patient's quality of life (QOL. Objective To assess swallowing-related QOL in patients who underwent radiotherapy/chemoradiotherapy for head and neck cancer. Methods We interviewed 110 patients (85 men and 25 women who had undergone exclusive radiotherapy (25.5% or concomitant chemoradiotherapy (74.5% from 6 to 12 months before the study. The Quality of Life in Swallowing Disorders (SWAL-QOL questionnaire was employed to evaluate dysphagia-related QOL. Results The QOL was reduced in all domains for all patients. The scores were worse among men. There was a relationship between oral cavity as the primary cancer site and the fatigue domain and also between advanced cancer stage and the impact of food selection, communication, and social function domains. Chemoradiotherapy association, the presence of nasogastric tube and tracheotomy, and the persistence of alcoholism and smoking had also a negative effect on the QOL. Conclusions According to the SWAL-QOL questionnaire, the dysphagia-related impact on QOL was observed 6 to 12 months after the treatment ended.

  8. The Impact of Age on Using Language Learning Strategies

    Directory of Open Access Journals (Sweden)

    Mansoreh Sepasdar

    2014-07-01

    Full Text Available Since age plays an important role in learning a second or foreign language, the present study investigated how different students in different age groups used language learning strategies. The participants of this study were 94 Iranian EFL students from four educational levels and different age groups as, primary (10-12, guidance (13-15, high school (16-18, and university students (19-23. The Strategy Inventory for Language Learning was used as an instrument in the study. The results revealed that different age groups used different language learning strategies. Running a one-way ANOVA indicated a significant difference between age groups and using language learning strategies. Moreover, the outcomes of this study showed that in comparison with other learning strategies, compensation strategies used more frequently by guidance, high school, and university students. Among different learning strategies, social and affective strategies were used more frequently by university students. Therefore, teachers should consider age group preferences for using language learning strategies and adjust their teaching in a way to meet the students’ needs in learning a second or foreign language.

  9. Impacts, trends and strategies in urban transportation sector

    International Nuclear Information System (INIS)

    Valenti, G.

    1998-01-01

    This paper presents the urban mobility evolution from 1985 to 1995 and the possible future assets for transportation demand. For some scenarios are quantized the environmental impacts and energetic impacts [it

  10. Impact of Malaria on Productivity and Coping Strategies among Small

    African Journals Online (AJOL)

    This study examined health (malaria) as a determinant of productivity and the coping strategies employed during malaria incidence among gari processors in Odeda Local Government Area of Ogun State, Nigeria and suggest control strategy to ameliorate its effect. A total of 100 respondents were interviewed in ten ...

  11. Impact of Malaria on Productivity and Coping Strategies among Small

    African Journals Online (AJOL)

    unique firstlady

    This study examined health (malaria) as a determinant of productivity and the coping strategies employed during malaria incidence among gari processors in Odeda Local Government. Area of Ogun State, Nigeria and suggest control strategy to ameliorate its effect. A total of 100 respondents were interviewed in ten ...

  12. The Mutual Impact of Global Strategy and Organizational Learning

    DEFF Research Database (Denmark)

    Hotho, Jasper J.; Lyles, Marjorie A.; Easterby-Smith, Mark

    2015-01-01

    Despite the interest in issues of knowing and learning in the global strategy field, there has been limited mutual engagement and interaction between the fields of global strategy and organizational learning. The purpose of our article is to reflect on and articulate how the mutual exchange...... of ideas between these fields can be encouraged. To this end, we first conduct a review of the intersection of the fields of global strategy and organizational learning. We then present two recommendations regarding how the interaction between the two fields can be enhanced. Our first recommendation...... is for global strategy research to adopt a broader notion of organizational learning. Our second recommendation is for global strategy research to capitalize on its attention to context in order to inform and enhance organizational learning theory. We discuss the use of context in a number of common research...

  13. Defining Swallowing-Related Quality of Life Profiles in Individuals with Amyotrophic Lateral Sclerosis.

    Science.gov (United States)

    Tabor, Lauren; Gaziano, Joy; Watts, Stephanie; Robison, Raele; Plowman, Emily K

    2016-06-01

    Although it is known that dysphagia contributes to significant malnutrition, pneumonia, and mortality in amyotrophic lateral sclerosis (ALS), it remains unclear how swallowing impairment impacts quality of life in this vulnerable patient population. The aim of the current study was to (1) delineate swallow-related quality of life (SR-QOL) profiles in individuals with ALS and (2) evaluate relationships between SR-QOL, degree of swallowing impairment, and ALS global disease progression. Eighty-one ALS patients underwent a standardized videofluoroscopic swallow study and completed the swallowing quality of life (SWAL-QOL) instrument and ALS functional rating scale-revised (ALSFRS-R). Penetration Aspiration Scale (PAS) scores were derived by a blinded rater. Correlation analyses and a between groups ANOVA (safe vs. penetrators vs. aspirators) were performed. Mean SWAL-QOL score for this cohort was 75.94 indicating a moderate degree of SR-QOL impairment with fatigue, eating duration, and communication representing the most affected domains. Correlations were revealed between the SWAL-QOL and (1) PAS (r = -0.39, p < 0.001) and (2) ALSFRS-R (r = 0.23, p < 0.05). Mean (SD) SWAL-QOL scores for safe versus penetrator versus aspirator groups were 81.2 (2.3) versus 77 (3.4) versus 58.7 (5.9), respectively, with a main effect observed [F(2,78) = 9.71, p < 0.001]. Post hoc testing revealed lower SWAL-QOL scores for aspirators versus safe swallowers (p < 0.001) and aspirators versus penetrators (p < 0.001). Overall, SR-QOL was moderately reduced in this cohort of ALS patients and profoundly impacted in ALS aspirators and individuals with advanced disease. These findings highlight the importance of early multidisciplinary intervention to not only avoid malnutrition, weight loss, and pulmonary sequelae but also the associated reduced QOL seen in these individuals.

  14. Swallowing difficulties in Duchenne muscular dystrophy: indications for feeding assessment and outcome of videofluroscopic swallow studies

    DEFF Research Database (Denmark)

    Aloysius, A.; Born, P.; Kinali, M.

    2008-01-01

    Feeding difficulties are known to occur with advancing age in Duchenne muscular dystrophy (DMD). We evaluated the role of videofluoroscopy swallow study (VFSS) in a group of 30 DMD patients with feeding difficulties. Indications for feeding assessment were: respiratory infections potentially...... on VFSS. It is the oral phase of swallowing that is most significantly affected in DMD. The pharyngeal phase is well triggered but is weak with incomplete pharyngeal clearance leaving pharyngeal residue. Insufficient or effortful chewing coupled with weak clearance may predispose them to choking episodes...... either as a one off event or with increasing frequency with age. This study suggests that VFSS may not be of additional benefit to careful feeding history and observation in DMD with feeding difficulties Udgivelsesdato: 2008/5...

  15. E-waste: impacts, issues and management strategies.

    Science.gov (United States)

    Hussain, Mumtaz; Mumtaz, Saniea

    2014-01-01

    The present electronic era has seen massive proliferation of electrical and electronic equipment especially during the last two decades. These gadgets have become indispensable components of human life. The gravity of this sensitive 21st century problem is being felt by relevant stakeholders from the community to global level. Consequently, the annual global generation of e-waste is estimated to be 20-50 million tons. According to the Basel Action Network, 500 million computers contain 287 billion kilograms (kg) plastics; 716.7 million kg lead; and 286,700 kg mercury. These gadgets contain over 50 elements from the periodic table. The lethal components include heavy metals (like cadmium, mercury, copper, nickel, lead, barium, hexavalent chromium and beryllium); phosphor; plastics; and brominated flame retardants. These are persistent, mobile, and bioaccumulative toxins that remain in the environment but their forms are changed and are carcinogens, mutagens and teratogens. The ensuing hazardous waste has created deleterious impacts on physical, biological and socioeconomic environments. The lithosphere, hydrosphere, biosphere, and atmosphere of Earth are being gravely polluted. Human beings and other biodiversity face fatal diseases, such as cancer, reproductive disorders, neural damages, endocrine disruptions, asthmatic bronchitis, and brain retardation. Marginal populations of developing countries living in squatter/slums are most vulnerable. Numerous issues are associated with uncontrolled generation, unscientific and environmentally inappropriate recycling processes for the extraction of heavy and precious metals (e.g., gold, platinum, and silver), illegal transboundary shipments from advanced to developing countries and weak conventions/legislations at global and national levels. Although the Basel Convention has been ratified by most countries, illicit trading/trafficking of hazardous substances remains unchecked, sometimes "disguised" as donations. The fact

  16. The Impact of a Strategies-Based Instruction on Iranian EAP Students’ Reading Strategy Use: Developing Strategic EAP Readers

    Directory of Open Access Journals (Sweden)

    Seyyed Hossein Kashef

    2014-01-01

    Full Text Available Underperformance of students in EAP reading comprehension has been an issue of concern for teachers, syllabus designers, and curriculum developers in general and for EAP practitioners in particular. In spite of the fact that considerable efforts have been made to improve reading comprehension of students through strategies instruction over past decades, EAP students however have not benefited much from learning strategies. Thus, this study intended to investigate the impact of a Strategies-Based Instruction (SBI on undergraduate students’ reading strategy use in an EAP context. Taking an instructional model from strategies taxonomy of Oxford (1990; 2001, it was assumed that in contrast to conventional EAP reading methods, SBI would be more effective in encouraging reading strategy use and as a result developing reading comprehension of EAP students through encouraging the use of effective strategies and skills. To do so, 80 freshman undergraduate students were chosen as the participants of this study who were in two intact classes. After administration of a pre-test, treatment (22 sessions, 2 sessions per week, and a post-test, the collected data was analyzed using t-test to examine the effect of the proposed method of instruction. The results of the analysis showed that the teaching intervention had a significant effect on students’ reading strategy use. The findings have implications for teachers encouraging effective reading comprehension instruction through the use of strategies in EAP teaching contexts.

  17. Risk factors for swallowing dysfunction in stroke patients

    Directory of Open Access Journals (Sweden)

    Anna Flávia Ferraz Barros Baroni

    2012-06-01

    Full Text Available CONTEXT: Stroke is a frequent cause of dysphagia. OBJECTIVE: To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. METHODS: Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. RESULTS: It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. CONCLUSIONS: Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death.

  18. Fabrication of Artificial Food Bolus for Evaluation of Swallowing.

    Directory of Open Access Journals (Sweden)

    Miyu Hosotsubo

    Full Text Available Simple and easy methods to evaluate swallowing are required because of the recently increased need of rehabilitation for dysphagia. "Artificial food bolus", but not "artificial food", would be a valuable tool for swallowing evaluation without considering the mastication effect which is altered according to the individual's oral condition. Thus, this study was carried out to fabricate artificial bolus resembling natural food bolus. The mechanical property and the volume change of food bolus in normal people were firstly investigated. Thirty healthy adults without dysphagia were selected and asked to chew four sample foods (rice cake, peanut, burdock, and gummy candy. The results indicated that Young's modulus of bolus before swallowing was below 150 kPa. The bolus volume before swallowing was below 400 mm3. In addition, the saliva component ratio of each bolus was approximately 30wt%, and the average saliva viscosity of research participants was approximately 10 mPa•s. Based on the obtained data, artificial food bolus was designed and fabricated by using alginate hydrogel as a visco-elastic material and gelatin solution as a viscotic material with a ratio of 7:3 based on weight. Consequently, the swallowing time of fabricated artificial food bolus was measured among the same participants. The results indicated the participants swallowed fabricated food bolus with similar manner reflecting their mechanical property and volume. Thus, this artificial food bolus would be a promising tool for evaluation of swallowing.

  19. Differential use of learning strategies in first-year higher education: the impact of personality, academic motivation, and teaching strategies.

    Science.gov (United States)

    Donche, Vincent; De Maeyer, Sven; Coertjens, Liesje; Van Daal, Tine; Van Petegem, Peter

    2013-06-01

    Although the evidence in support of the variability of students' learning strategies has expanded in recent years, less is known about the explanatory base of these individual differences in terms of the joint influences of personal and contextual characteristics. Previous studies have often investigated how student learning is associated with either personal or contextual factors. This study takes an integrative research perspective into account and examines the joint effects of personality, academic motivation, and teaching strategies on students' learning strategies in a same educational context in first-year higher education. In this study, 1,126 undergraduate students and 90 lecturers from eight professional bachelor programmes in a university college participated. Self-report measures were used to measure students' personality, academic motivation, and learning strategies. Students' processing and regulation strategies are mapped using the Inventory of Learning Styles. Key characteristics of more content-focused versus learning-focused teaching strategies were measured. Multivariate multi-level analysis was used to take the nested data structure and interrelatedness of learning strategies into account. Different personality traits (openness, conscientiousness, and neuroticism) and academic motivation (amotivation, autonomous, and controlled motivation) were found to be independently associated with student learning strategies. Besides these student characteristics, also teaching strategies were found to be directly associated with learning strategies. The study makes clear that the impact of teaching strategies on learning strategies in first-year higher education cannot be overlooked nor overinterpreted, due to the importance of students' personality and academic motivation which also partly explain why students learn the way they do. © 2013 The British Psychological Society.

  20. The Impacts of Climate Change Mitigation Strategies on Animal Welfare.

    Science.gov (United States)

    Shields, Sara; Orme-Evans, Geoffrey

    2015-05-21

    The objective of this review is to point out that the global dialog on reducing greenhouse gas emissions in animal agriculture has, thus far, not adequately considered animal welfare in proposed climate change mitigation strategies. Many suggested approaches for reducing emissions, most of which could generally be described as calls for the intensification of production, can have substantial effects on the animals. Given the growing world-wide awareness and concern for animal welfare, many of these approaches are not socially sustainable. This review identifies the main emission abatement strategies in the climate change literature that would negatively affect animal welfare and details the associated problems. Alternative strategies are also identified as possible solutions for animal welfare and climate change, and it is suggested that more attention be focused on these types of options when allocating resources, researching mitigation strategies, and making policy decisions on reducing emissions from animal agriculture.

  1. Falls among Older Adults: Public Health Impact and Prevention Strategies.

    Science.gov (United States)

    Stevens, Judy A.

    2003-01-01

    Provides an overview of the epidemiology of falls among older adults, describes current prevention strategies, and highlights key areas that need to be addressed, including risk assessments, exercise, and environmental changes. (Contains 50 references.) (JOW)

  2. The Impacts of Climate Change Mitigation Strategies on Animal Welfare

    Directory of Open Access Journals (Sweden)

    Sara Shields

    2015-05-01

    Full Text Available The objective of this review is to point out that the global dialog on reducing greenhouse gas emissions in animal agriculture has, thus far, not adequately considered animal welfare in proposed climate change mitigation strategies. Many suggested approaches for reducing emissions, most of which could generally be described as calls for the intensification of production, can have substantial effects on the animals. Given the growing world-wide awareness and concern for animal welfare, many of these approaches are not socially sustainable. This review identifies the main emission abatement strategies in the climate change literature that would negatively affect animal welfare and details the associated problems. Alternative strategies are also identified as possible solutions for animal welfare and climate change, and it is suggested that more attention be focused on these types of options when allocating resources, researching mitigation strategies, and making policy decisions on reducing emissions from animal agriculture.

  3. Skill training for swallowing rehabilitation in patients with Parkinson's disease.

    Science.gov (United States)

    Athukorala, Ruvini P; Jones, Richard D; Sella, Oshrat; Huckabee, Maggie-Lee

    2014-07-01

    To examine the effects of skill training on swallowing in individuals with dysphagia secondary to Parkinson's disease (PD) and to explore skill retention after treatment termination. Within-subject pilot study with follow-up after 2 weeks of treatment and after a 2-week nontreatment period. Clinic in a research institute. Patients (N=10; mean age, 67.4y) included 3 women (mean Hoehn and Yahr score, 2.6) and 7 men (mean Hoehn and Yahr score, 2.4). Patients underwent 10 daily sessions of skill training therapy focused on increasing precision in muscle contraction during swallowing using visual feedback. Data from the timed water swallow test, Test of Mastication and Swallowing Solids, surface electromyography (sEMG) of submental muscles, and swallowing-related quality of life questionnaire were collected at 2 baseline sessions (conducted 2wk apart) at the end of treatment and after 2 nontreatment weeks to assess skill retention. Immediately after posttreatment, the swallowing rate for liquids (P=.034), sEMG durational parameters of premotor time (P=.003), and preswallow time (P<.001) improved. A functional carryover effect was seen from dry to water swallows (P=.009). Additionally, swallowing-related quality of life improved (P=.018). Reassessment at 2 weeks after treatment termination revealed short-term retention of treatment effects. A skill-based training approach produced functional, biomechanical, and swallowing-related quality of life improvements in this cohort indicating compelling evidence for the effectiveness of this novel approach for dysphagia rehabilitation in PD. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. IMPACT OF HEURISTIC STRATEGIES ON PUPILS’ ATTITUDES TO PROBLEM SOLVING

    Directory of Open Access Journals (Sweden)

    NOVOTNÁ, Jarmila

    2015-03-01

    Full Text Available The paper is a sequel to the article (Novotná et al., 2014, where the authors present the results of a 4-month experiment whose main aim was to change pupils’ culture of problem solving by using heuristic strategies suitable for problem solving in mathematics education. (Novotná et al., 2014 focused on strategies Analogy, Guess – check – revise, Systematic experimentation, Problem reformulation, Solution drawing, Working backwards and Use of graphs of functions. This paper focuses on two other heuristic strategies convenient for improvement of pupils’ culture of problem solving: Introduction of an auxiliary element and Omitting a condition. In the first part, the strategies Guess – Check – Revise, Working backwards, Introduction of an auxiliary element and Omitting a condition are characterized in detail and illustrated by examples of their use in order to capture their characteristics. In the second part we focus on the newly introduced strategies and analyse work with them in lessons using the tools from (Novotná et al., 2014. The analysis of results of the experiment indicates that, unlike in case of the strategy Introduction of an auxiliary element, successful use of the strategy Omitting a condition requires longer teacher’s work with the pupils. The following analysis works with the strategy Systematic experimentation, which seemed to be the easiest to master in (Novotná et al., 2014; we focus on the dangers it bears when it is used by pupils. The conclusion from (Novotná et al., 2014, which showed that if pupils are introduced to an environment that supports their creativity, their attitude towards problem solving changes in a positive way already after the period of four months, is confirmed.

  5. Decoding human swallowing via electroencephalography: a state-of-the-art review

    Science.gov (United States)

    Jestrović, Iva; Coyle, James L.; Sejdić, Ervin

    2015-10-01

    Swallowing and swallowing disorders have garnered continuing interest over the past several decades. Electroencephalography (EEG) is an inexpensive and non-invasive procedure with very high temporal resolution which enables analysis of short and fast swallowing events, as well as an analysis of the organizational and behavioral aspects of cortical motor preparation, swallowing execution and swallowing regulation. EEG is a powerful technique which can be used alone or in combination with other techniques for monitoring swallowing, detection of swallowing motor imagery for diagnostic or biofeedback purposes, or to modulate and measure the effects of swallowing rehabilitation. This paper provides a review of the existing literature which has deployed EEG in the investigation of oropharyngeal swallowing, smell, taste and texture related to swallowing, cortical pre-motor activation in swallowing, and swallowing motor imagery detection. Furthermore, this paper provides a brief review of the different modalities of brain imaging techniques used to study swallowing brain activities, as well as the EEG components of interest for studies on swallowing and on swallowing motor imagery. Lastly, this paper provides directions for future swallowing investigations using EEG.

  6. Dysarthria and dysphagia in Amyotrophic Lateral Sclerosis with spinal onset: a study of quality of life related to swallowing.

    Science.gov (United States)

    da Costa Franceschini, Andressa; Mourão, Lucia Figueiredo

    2015-01-01

    Dysarthria and dysphagia are the most common clinical problems encountered in Amyotrophic Lateral Sclerosis and may reduce the quality of life. Evaluate the association of dysarthria and dysphagia and to evaluate the impact of dysphagia on swallowing quality of life in patients with ALS with spinal onset. Seventeen patients underwent to speech and swallowing evaluation and filled out self-report assessment of the Swallowing Quality of Life (SWAL-QOL). The dysarthria severity was graded using the Speech Subscale of ALS Severity Scale. The dysphagia severity was graded using a scale proposed by Dziweas et al., and the Functional Oral Intake Scale. Over 70% of the ALS patients with spinal onset had dysarthria and dysphagia. The correlation of dysarthria and dysphagia scales was statistically significant (p dysphagia severity and SWAL-QOL outcomes was significant for the same domains: "symptom frequency", "communication" and "fear of eating". The SWAL-QOL domains presented a mild to moderate impact on quality of life. Disease duration did not impact on SWAL-QOL. Dysarthria and dysphagia were common symptoms in patients with spinal onset of ALS and the swallowing quality of life decrease was directly related to with severity of dysarthria and dysphagia.

  7. Neural and cortical analysis of swallowing and detection of motor imagery of swallow for dysphagia rehabilitation-A review.

    Science.gov (United States)

    Yang, H; Ang, K K; Wang, C; Phua, K S; Guan, C

    2016-01-01

    Swallowing is an essential function in our daily life; nevertheless, stroke or other neurodegenerative diseases can cause the malfunction of swallowing function, ie, dysphagia. The objectives of this review are to understand the neural and cortical basis of swallowing and tongue, and review the latest techniques on the detection of motor imagery of swallow (MI-SW) and motor imagery of tongue movements (MI-TM), so that a practical system can be developed for the rehabilitation of poststroke dysphagia patients. Specifically, we firstly describe the swallowing process and how the swallowing function is assessed clinically. Secondly, we review the techniques that performed the neural and cortical analysis of swallowing and tongue based on different modalities such as functional magnetic resonance imaging, positron emission tomography, near-infrared spectroscopy (NIRS), and magnetoencephalography. Thirdly, we review the techniques that performed detection and analysis of MI-SW and MI-TM for dysphagia stroke rehabilitation based on electroencephalography (EEG) and NIRS. Finally, discussions on the advantages and limitations of the studies are presented; an example system and future research directions for the rehabilitation of stroke dysphagia patients are suggested. © 2016 Elsevier B.V. All rights reserved.

  8. Designing for Safety: Implications of a Fifteen Year Review of Swallowed and Aspirated Dentures.

    Science.gov (United States)

    Kent, Samuel J W; Mackie, James; Macfarlane, Tatiana V

    2016-01-01

    Dentures are worn by around 20% of the population, yet if they become displaced they may enter the gastrointestinal or respiratory system, sometimes with grave consequences. The aim of this study was to review recent published literature in order to identify the epidemiology of patients and characteristics of swallowed and aspirated dental prostheses, and propose strategies to minimise these risks. A fifteen year retrospective of published case series and case reports was carried out. Photographs, radiographs and descriptions of the dental prostheses were gathered, as well as the patient's presenting complaint, the anatomical site where the denture was caught and the procedure required to remove the denture. Ninety one separate events of swallowed or aspirated dentures were identified from 83 case reports and series from 28 countries. Average age was 55 years, and these were 74% male. Photographs were retrieved for 49 of these dentures. Clasps were present in 25 of the dentures. There was no significant difference between clasped and unclasped dentures for perforation rates, need for open surgery and spontaneously passed dentures. We discuss the implications of this study regarding denture designs, specifically the importance of using a radiopaque acrylic, using clasps when required even if there is a risk of aspiration, advising patients to return if a denture is loose or damaged, and finally that all patients who wear a denture are at risk of aspiration and swallowing events, and associated morbidity and mortality.

  9. Relationship between skeletal muscle mass and swallowing function in patients with Alzheimer's disease.

    Science.gov (United States)

    Takagi, Daisuke; Hirano, Hirohiko; Watanabe, Yutaka; Edahiro, Ayako; Ohara, Yuki; Yoshida, Hideyo; Kim, Hunkyung; Murakami, Kohji; Hironaka, Shouji

    2017-03-01

    The present study verified the hypothesis that decreased skeletal muscle in older adults with Alzheimer's disease is related to Alzheimer's disease progression and decreased oral or swallowing function. We investigated 232 patients with Alzheimer's disease (31 men, 201 women, average age 85.4 ± 5.9 years) in two regions in Japan. The patients provided basic information (sex and age), and were assessed for skeletal muscle index, dementia severity (clinical dementia rating), activities of daily living, nutritional status, oral status and swallowing function. Stratification by clinical dementia rating was as follows: clinical dementia rating 0.5:21 patients (9.0%), clinical dementia rating 1:85 patients (36.6%), clinical dementia rating 2:88 patients (37.9%) and clinical dementia rating 3:38 patients (16.3%). Alzheimer's disease severity was significantly related to skeletal muscle index. Logistic regression analysis showed that clinical dementia rating 3 (odds ratio 11.68, 95% confidence interval 4.52-30.20), body mass index Alzheimer's disease requires strategies to manage swallowing dysfunction. Geriatr Gerontol Int 2016; 17: 402-409. © 2016 Japan Geriatrics Society.

  10. Designing for Safety: Implications of a Fifteen Year Review of Swallowed and Aspirated Dentures

    Directory of Open Access Journals (Sweden)

    Samuel J. W. Kent

    2016-06-01

    Full Text Available Objectives: Dentures are worn by around 20% of the population, yet if they become displaced they may enter the gastrointestinal or respiratory system, sometimes with grave consequences. The aim of this study was to review recent published literature in order to identify the epidemiology of patients and characteristics of swallowed and aspirated dental prostheses, and propose strategies to minimise these risks. Material and Methods: A fifteen year retrospective of published case series and case reports was carried out. Photographs, radiographs and descriptions of the dental prostheses were gathered, as well as the patient’s presenting complaint, the anatomical site where the denture was caught and the procedure required to remove the denture. Results: Ninety one separate events of swallowed or aspirated dentures were identified from 83 case reports and series from 28 countries. Average age was 55 years, and these were 74% male. Photographs were retrieved for 49 of these dentures. Clasps were present in 25 of the dentures. There was no significant difference between clasped and unclasped dentures for perforation rates, need for open surgery and spontaneously passed dentures. Conclusions: We discuss the implications of this study regarding denture designs, specifically the importance of using a radiopaque acrylic, using clasps when required even if there is a risk of aspiration, advising patients to return if a denture is loose or damaged, and finally that all patients who wear a denture are at risk of aspiration and swallowing events, and associated morbidity and mortality.

  11. A new hybrid optimization method inspired from swarm intelligence: Fuzzy adaptive swallow swarm optimization algorithm (FASSO

    Directory of Open Access Journals (Sweden)

    Mehdi Neshat

    2015-11-01

    Full Text Available In this article, the objective was to present effective and optimal strategies aimed at improving the Swallow Swarm Optimization (SSO method. The SSO is one of the best optimization methods based on swarm intelligence which is inspired by the intelligent behaviors of swallows. It has been able to offer a relatively strong method for solving optimization problems. However, despite its many advantages, the SSO suffers from two shortcomings. Firstly, particles movement speed is not controlled satisfactorily during the search due to the lack of an inertia weight. Secondly, the variables of the acceleration coefficient are not able to strike a balance between the local and the global searches because they are not sufficiently flexible in complex environments. Therefore, the SSO algorithm does not provide adequate results when it searches in functions such as the Step or Quadric function. Hence, the fuzzy adaptive Swallow Swarm Optimization (FASSO method was introduced to deal with these problems. Meanwhile, results enjoy high accuracy which are obtained by using an adaptive inertia weight and through combining two fuzzy logic systems to accurately calculate the acceleration coefficients. High speed of convergence, avoidance from falling into local extremum, and high level of error tolerance are the advantages of proposed method. The FASSO was compared with eleven of the best PSO methods and SSO in 18 benchmark functions. Finally, significant results were obtained.

  12. The impact of maintenance strategy on steam generator reliability

    International Nuclear Information System (INIS)

    Cizelj, L.; Mavko, B.

    1992-01-01

    When employing a new or alternate maintenance strategy in a nuclear power plant, the question of safety and reliability is raised. Therefore, a comparative investigation of maintenance strategies is performed in this paper. A distribution of defects has been assumed to estimate the probability of having at least one tube in the steam generator failed at hypothetical accidental conditions. As a criterion of success, the tube failure probability has been employed. The methodology is illustrated by a numerical example. A typical steam generator has been analyzed during a hypothetical accident. The analysis was carried out by the means of Monte Carlo simulation and probabilistic fracture mechanics. (author) [sl

  13. First Steps Towards Development of an Instrument for the Reproducible Quantification of Oropharyngeal Swallow Physiology in Bottle-Fed Children.

    Science.gov (United States)

    Lefton-Greif, Maureen A; McGrattan, Katlyn Elizabeth; Carson, Kathryn A; Pinto, Jeanne M; Wright, Jennifer M; Martin-Harris, Bonnie

    2018-02-01

    The incidence of feeding/swallowing impairments (deglutition disorders) in young children is rising and poses serious acute and long-term health consequences. Accurate detection and prompt intervention can lessen the impact of dysphagia-induced sequelae. Videofluoroscopic Swallow Studies (VFSSs) are used to make critical decisions for medically fragile children despite procedural variability and the lack of agreed upon measures for interpreting and reporting results. This investigation represents the first steps in the development of a novel tool for the quantification of oropharyngeal swallow physiology from full-length VFSS examinations in bottle-fed children. The Modified Barium Swallow Impairment Profile MBSImP™© served as the conceptual assessment model for development of components and operational score variants to characterize distinguishable VFSS observations. Twenty-four components of swallowing physiology were validated via expert consensus. Training materials included a library of 94 digitized video images comprised of distinct score variants for each component. Materials were disseminated to seven speech-language pathologists (SLPs) who participated in didactic and self-training sessions, and rated components. All SLPs achieved ≥80% reliability criterion after completing two or three training sessions. Agreement for 17 (71%) components was achieved after two sessions. Nutritive sucking/oral and airway-related components were most difficult to distinguish. Three sessions were required for 2 (33%) of the sucking/oral components and 4 (57%) of the airway-related components. These findings support the feasibility to standardize training and reliably score swallowing physiology using precise definitions and unambiguous visual images, and represent preliminary steps towards content validity and reliability of a standardized VFSS tool for bottle-fed children.

  14. Enterprise Mobility Implementation Strategies and Their Impacts on Organizational Performance

    Directory of Open Access Journals (Sweden)

    Ming-Hsin Lu

    2017-06-01

    Full Text Available Mobile devices and applications have been studied within a large number of different business contexts; however, many enterprises in practice do not have sufficient and effective plans of going mobile. This study uses the modified model for mobile business value creation (MBVC to explore the initiatives, strategies and performances of 12 local companies during their transformation process of mobilization. The methodology of multi-case study with focus group interviewing is adopted. The results support that change is a critical drive to motivate mobile enterprise strategies. The proposed model of mobile business strategies and value creation concludes the findings of this study. Based on the interviews of the managers of mobile implement, an iterative design approach accompanied with needs assessment at the earlier phase of mobile device use is recommended and associated with higher performance. This study contributes to the field of research and practices by providing empirical evidences of mobile enterprises, and feasible solutions for local company to develop mobile strategies. [Article content in Chinese

  15. Socio-cultural strategies in mitigating drought impacts and water ...

    African Journals Online (AJOL)

    A critical shortage of fresh water, particularly in developing nations, is likely to become one of the most pressing issues in decades to come as droughts and rapid growing human populations join forces to deplete available fresh water resources. This article highlights some of the most important mitigation strategies within ...

  16. The Impact of Age on Using Language Learning Strategies

    Science.gov (United States)

    Sepasdar, Mansoreh; Soori, Afshin

    2014-01-01

    Since age plays an important role in learning a second or foreign language, the present study investigated how different students in different age groups used language learning strategies. The participants of this study were 94 Iranian EFL students from four educational levels and different age groups as, primary (10-12), guidance (13-15), high…

  17. Time and the Question of Unintended Impact on Military Strategy

    DEFF Research Database (Denmark)

    Nielsen, Thomas Galasz

    2014-01-01

    . This changed the end state from eradication of the Taliban to nation-building to transition of security responsibilities. The result is a strategy that has become focused on tactical level objective. This has blurred the understanding of the end state in a pursuit of tactical successes....

  18. Role of Basal Ganglia in Swallowing Process: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Hamideh Ghaemi

    2016-12-01

    Discussion: Swallowing is a multifaceted performance that needs contribution of the tongue, larynx, pharynx, and esophagus as well as the neurological structures such as neocortex and subcortical regions - BG and brainstem.

  19. Swallowing threshold parameters of subjects with shortened dental arches.

    NARCIS (Netherlands)

    Kreulen, C.M.; Witter, D.J.; Tekamp, F.A.; Slagter, A.P.; Creugers, N.H.J.

    2012-01-01

    OBJECTIVES: To quantify swallowing threshold parameters of subjects with a moderate shortened dental arch dentition (SDA: missing molar teeth, but premolar teeth in occluding position and uninterrupted anterior regions) compared to subjects with a complete dental arch dentition (CDA). METHODS:

  20. Swallowing rehabilitation before and during concurrent chemoradiotherapy for oropharyngeal cancer

    International Nuclear Information System (INIS)

    Tsuneyuki, Miki; Yonezawa, Kouichiro; Morimoto, Koichi; Tanimoto, Hitoshi; Saito, Miki; Otsuki, Naoki; Nibu, Ken-ichi

    2011-01-01

    Recently, oropharyngeal cancer is more frequently being managed with concurrent chemoradiotherapy (CCRT). As more patients receive CCRT, there is increasing attention on dysphagia. Since 2009, speech therapists in our hospital have performed swallowing rehabilitation for dysphagia associated with CCRT. We evaluated dysphagia after CCRT and examined the relationship between swallowing rehabilitation and swallowing disability. A total of 26 patients (22 males and 4 females) with a mean age of 63 years (range, 41 to 79), underwent CCRT between March 2008 and March 2010. Dysphagia after treatment was graded at the end of CCRT and discharge according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 and Fujishima dysphagia grade. Ten of the 26 patients underwent swallowing rehabilitation, exercise and education on muscle strengthening programs before and during CCRT. They tended not to have severe dysphagia, but there were no significant differences. (author)

  1. Qualitative and quantitative analysis of oropharyngeal swallowing in Down syndrome.

    Science.gov (United States)

    Sales, André Vinicius Marcondes Natel; Giacheti, Célia Maria; Cola, Paula Cristina; Silva, Roberta Gonçalves da

    2017-10-23

    To describe the qualitative and quantitative temporal analysis of oropharyngeal swallowing in children diagnosed with Down syndrome (DS) through a case series study of six individuals aged 4 to 17 months (mean age = 11.16 months; median = 12 months). Qualitative and quantitative temporal analysis of swallowing using videofluoroscopy and specific software. The following parameters were assessed: presence or absence of oral incoordination, labial sphincter sealing incompetence, oral residue, posterior oral spillage, laryngotracheal penetration and aspiration, pharyngeal and total oral transit time (TOTT). Qualitative analysis identified individuals with disorders in at least four of the swallowing parameters investigated. Only one individual presented total oral transit time (TOTT) different from the others. No difference was observed between the cases regarding pharyngeal transit time. Qualitative swallowing disorders are observed in children with DS, with difference in TOTT only in the case report of the youngest infant.

  2. The mechanics and behavior of cliff swallows during tandem flights.

    Science.gov (United States)

    Shelton, Ryan M; Jackson, Brandon E; Hedrick, Tyson L

    2014-08-01

    Cliff swallows (Petrochelidon pyrrhonota) are highly maneuverable social birds that often forage and fly in large open spaces. Here we used multi-camera videography to measure the three-dimensional kinematics of their natural flight maneuvers in the field. Specifically, we collected data on tandem flights, defined as two birds maneuvering together. These data permit us to evaluate several hypotheses on the high-speed maneuvering flight performance of birds. We found that high-speed turns are roll-based, but that the magnitude of the centripetal force created in typical maneuvers varied only slightly with flight speed, typically reaching a peak of ~2 body weights. Turning maneuvers typically involved active flapping rather than gliding. In tandem flights the following bird copied the flight path and wingbeat frequency (~12.3 Hz) of the lead bird while maintaining position slightly above the leader. The lead bird turned in a direction away from the lateral position of the following bird 65% of the time on average. Tandem flights vary widely in instantaneous speed (1.0 to 15.6 m s(-1)) and duration (0.72 to 4.71 s), and no single tracking strategy appeared to explain the course taken by the following bird. © 2014. Published by The Company of Biologists Ltd.

  3. Swallow syncope caused by third-degree atrioventricular block

    DEFF Research Database (Denmark)

    Roust Aaberg, Anne Marie; Eriksson, Anna Elin; Madsen, Per Lav

    2015-01-01

    We report a case of a patient with more than 30 years of repeated syncopes, always following food intake. The patient was diagnosed with a swallow-related third-degree atrioventricular block and successfully treated with an artificial pacemaker.......We report a case of a patient with more than 30 years of repeated syncopes, always following food intake. The patient was diagnosed with a swallow-related third-degree atrioventricular block and successfully treated with an artificial pacemaker....

  4. Quality assurance strategies in hospitals: Development, implementation and impact of quality assurance methods in Iranian hospitals

    NARCIS (Netherlands)

    Aghaei Hashjin, A.

    2015-01-01

    This thesis concentrates on the subject of quality assurance strategies in hospitals; exploring the development, implementation and impact of quality assurance (QA) methods in Iranian hospitals. A series of descriptive and analytical studies using qualitative and quantitative data were performed.

  5. Normal erect swallowing. Normal function and incidence of variations.

    Science.gov (United States)

    Curtis, D J; Cruess, D F; Dachman, A H

    1985-10-01

    Of 871 candidates presenting for upper gastrointestinal examinations, 16 met the rigorous criteria established for selecting asymptomatic normal volunteers. Frame-by-frame evaluation of their videorecorded pharyngeal swallow confirmed many observations made previously utilizing cine recording at much higher radiation dosages. In addition, new observations were made: the nasopharynx may not occlude until the bolus is entirely within the pharynx; air mixes with the bolus if the swallow is an "open" type; the epiglottis always inverts in normal individuals regardless of the type of swallow ("open," air filled oro-and hypopharynx into which the swallowed bolus is dropped; "closed," airless oropharynx into which the swallowed bolus is pushed by a continuous peristaltic drive of the tongue and palate, thus reconstituting the pharyngeal space); laryngeal descent may aid in stripping the bolus from the pharynx; the vestibule may not completely close during the swallow and the larynx can still be impervious to the bolus; the peristaltic wave does not begin until the bolus has breeched the cricopharyngeus; the cricopharyngeus may be seen frequently in normal individuals, but does not delay the passage of the bolus; asymmetric flow of the bolus around the larynx is common and may not be the result of epiglottic tilt or head positioning.

  6. Swallowing Quality of Life After Zona Incerta Deep Brain Stimulation.

    Science.gov (United States)

    Sundstedt, Stina; Nordh, Erik; Linder, Jan; Hedström, Johanna; Finizia, Caterina; Olofsson, Katarina

    2017-02-01

    The management of Parkinson's disease (PD) has been improved, but management of signs like swallowing problems is still challenging. Deep brain stimulation (DBS) alleviates the cardinal motor symptoms and improves quality of life, but its effect on swallowing is not fully explored. The purpose of this study was to examine self-reported swallowing-specific quality of life before and after caudal zona incerta DBS (cZI DBS) in comparison with a control group. Nine PD patients (2 women and 7 men) completed the self-report Swallowing Quality of Life questionnaire (SWAL-QOL) before and 12 months after cZI DBS surgery. The postoperative data were compared to 9 controls. Median ages were 53 years (range, 40-70 years) for patients and 54 years (range, 42-72 years) for controls. No significant differences were found between the pre- or postoperative scores. The SWAL-QOL total scores did not differ significantly between PD patients and controls. The PD patients reported significantly lower scores in the burden subscale and the symptom scale. Patients with PD selected for cZI DBS showed good self-reported swallowing-specific quality of life, in many aspects equal to controls. The cZI DBS did not negatively affect swallowing-specific quality of life in this study.

  7. Acoustic analysis of oropharyngeal swallowing using Sonar Doppler.

    Science.gov (United States)

    Soria, Franciele Savaris; Silva, Roberta Gonçalves da; Furkim, Ana Maria

    2016-01-01

    During the aging process, one of the functions that changes is swallowing. These alterations in oropharyngeal swallowing may be diagnosed by methods that allow both the diagnosis and biofeedback monitoring by the patient. One of the methods recently described in the literature for the evaluation of swallowing is the Sonar Doppler. To compare the acoustic parameters of oropharyngeal swallowing between different age groups. This was a field, quantitative, study. Examination with Sonar Doppler was performed in 75 elderly and 72 non-elderly adult subjects. The following acoustic parameters were established: initial frequency, first peak frequency, second peak frequency; initial intensity, final intensity; and time for the swallowing of saliva, liquid, nectar, honey, and pudding, with 5- and 10-mL free drinks. Objective, measurable data were obtained; most acoustic parameters studied between adult and elderly groups with respect to consistency and volume were significant. When comparing elderly with non-elderly adult subjects, there is a modification of the acoustic pattern of swallowing, regarding both consistency and food bolus volume. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  8. Solid bolus swallowing in the radiologic evaluation of dysphagia

    International Nuclear Information System (INIS)

    Westen, D. van; Ekberg, O.

    1993-01-01

    Patients with dysphagia, heartburn and chest pain are regularly referred for radiologic evaluation of swallowing. The liquid barium swallow has been of great value for the biphasic evaluation of the pharynx and esophagus. Though many patients complain of dysphagia specifically for solids, solid bolus swallow is ususally not part of the evaluation. For the present study we therefore included the use of a solid bolus with a diameter of 13 mm and interviewed the patients carefully for any symptoms during this tablet swallow. Of 200 patients examined, the tablet passed through the esophagus without delay in 102. In the 98 patients with delayed passage, the solid bolus arrest occurred in the pharynx in 5 and in the esophagus in 93. Arrest in the esophagus was due to esophageal dysmotility in 48 patients. Twenty of these were symptomatic during the tablet swallow. A narrowing was the cause in 45, of whom 9 had symptoms. In 18 patients (9%) the solid bolus added key information to the radiologic evaluation. We therefore recommend that the solid bolus is included in the routine radiologic work-up of patients with dysphagia. Careful attention to symptoms during the tablet swallow is important. (orig.)

  9. Interferential electric stimulation applied to the neck increases swallowing frequency.

    Science.gov (United States)

    Furuta, Takayuki; Takemura, Masanori; Tsujita, Junzo; Oku, Yoshitaka

    2012-03-01

    Swallowing disorders are a common complaint among the elderly. Recently, surface electrical stimulation applied to the neck region has received increased attention as a new modality to treat pharyngeal dysphagia. Previous reports used pulsed current at a frequency range of 1-120 Hz. Kilohertz-frequency alternating currents (ACs) have not been tested for treating dysphagia. Therefore, we evaluated the effects of interferential currents (IFCs), the most popular modality of amplitude-modulated kilohertz-frequency ACs in clinical practice, on the swallowing reflex in healthy subjects. We found that IFC stimulation at the sensory threshold with 50-Hz modulation significantly increased the number of swallows without any discomfort, but pure AC stimulation at the carrier frequency did not have a significant effect. There was no statistically significant difference in the time course of the number of swallows among 1,000-, 2,000-, 4,000-, and 6,000-Hz carrier frequencies. The number of swallows remained increased during the 15-min IFC stimulation, suggesting that IFC stimulation facilitates the swallowing reflex without adaptation, at least during this stimulation period. We suggest that an IFC stimulation or a low-frequency, modulated kilohertz AC stimulation, which would be more comfortable than pulsed currents, is an alternative stimulation mode for treating pharyngeal dysphagia.

  10. Quality of life related to swallowing in Parkinson's disease.

    Science.gov (United States)

    Carneiro, Danielle; das Graças Wanderley de Sales Coriolano, Maria; Belo, Luciana Rodrigues; de Marcos Rabelo, Aneide Rocha; Asano, Amdore Guescel; Lins, Otávio Gomes

    2014-10-01

    Swallowing difficulties in Parkinson's disease can result in decreased quality of life. The swallowing quality of life questionnaire (SWAL-QOL) is an instrument for specifically assessing quality of life with respect to swallowing, which has been little explored in patients with Parkinson's disease (PD). The goal of this study was to evaluate the quality of life with respect to swallowing in persons with PD compared to controls and at several stages of the disease using the SWAL-QOL. The experimental group was composed of 62 persons with PD at stages 1-4. Forty-one age-matched healthy subjects constituted the control group. The SWAL-QOL scores were significantly lower for the patients with PD than for the controls in all SWAL-QOL domains. Eating duration had the largest difference in score between persons with PD and the controls and the lowest mean score, followed by communication, fatigue, fear, sleep, and food selection. The scores of most domains were lower at later stages of the disease. The scores for eating duration, symptom frequency, and sleep were significantly lower at stage 4 than stages 1 and 2. In conclusion, patients with PD have significantly lower scores in all domains of the SWAL-QOL than normal controls. This means swallowing difficulties occurring in patients with PD negatively affect their QOL. Progression of the disease worsens swallowing QOL, more specifically in the domains of eating duration, symptom frequency, and sleep. This occurs mostly at later stages of the disease.

  11. Protected area types, strategies and impacts in Brazil's Amazon: public protected area strategies do not yield a consistent ranking of protected area types by impact.

    Science.gov (United States)

    Pfaff, Alexander; Robalino, Juan; Sandoval, Catalina; Herrera, Diego

    2015-11-05

    The leading policy to conserve forest is protected areas (PAs). Yet, PAs are not a single tool: land users and uses vary by PA type; and public PA strategies vary in the extent of each type and in the determinants of impact for each type, i.e. siting and internal deforestation. Further, across regions and time, strategies respond to pressures (deforestation and political). We estimate deforestation impacts of PA types for a critical frontier, the Brazilian Amazon. We separate regions and time periods that differ in their deforestation and political pressures and document considerable variation in PA strategies across regions, time periods and types. The siting of PAs varies across regions. For example, all else being equal, PAs in the arc of deforestation are relatively far from non-forest, while in other states they are relatively near. Internal deforestation varies across time periods, e.g. it is more similar across the PA types for PAs after 2000. By contrast, after 2000, PA extent is less similar across PA types with little non-indigenous area created inside the arc. PA strategies generate a range of impacts for PA types--always far higher within the arc--but not a consistent ranking of PA types by impact. © 2015 The Author(s).

  12. Health impact metrics for air pollution management strategies.

    Science.gov (United States)

    Martenies, Sheena E; Wilkins, Donele; Batterman, Stuart A

    2015-12-01

    Health impact assessments (HIAs) inform policy and decision making by providing information regarding future health concerns, and quantitative HIAs now are being used for local and urban-scale projects. HIA results can be expressed using a variety of metrics that differ in meaningful ways, and guidance is lacking with respect to best practices for the development and use of HIA metrics. This study reviews HIA metrics pertaining to air quality management and presents evaluative criteria for their selection and use. These are illustrated in a case study where PM2.5 concentrations are lowered from 10 to 8μg/m(3) in an urban area of 1.8 million people. Health impact functions are used to estimate the number of premature deaths, unscheduled hospitalizations and other morbidity outcomes. The most common metric in recent quantitative HIAs has been the number of cases of adverse outcomes avoided. Other metrics include time-based measures, e.g., disability-adjusted life years (DALYs), monetized impacts, functional-unit based measures, e.g., benefits per ton of emissions reduced, and other economic indicators, e.g., cost-benefit ratios. These metrics are evaluated by considering their comprehensiveness, the spatial and temporal resolution of the analysis, how equity considerations are facilitated, and the analysis and presentation of uncertainty. In the case study, the greatest number of avoided cases occurs for low severity morbidity outcomes, e.g., asthma exacerbations (n=28,000) and minor-restricted activity days (n=37,000); while DALYs and monetized impacts are driven by the severity, duration and value assigned to a relatively low number of premature deaths (n=190 to 230 per year). The selection of appropriate metrics depends on the problem context and boundaries, the severity of impacts, and community values regarding health. The number of avoided cases provides an estimate of the number of people affected, and monetized impacts facilitate additional economic analyses

  13. The Comparative Impacts of Using Lexical Glossing and Inferencing Strategies on Students' Reading Comprehension

    Science.gov (United States)

    Juliana

    2018-01-01

    The study compared the use of the lexical glossing and inferencing strategies that impact toward the students' reading comprehension. The objective of the study was to find out the effective strategy to use for enhancing the students' reading comprehension. The population of the study was 40 Informatics Systems students of Potensi Utama…

  14. The Impact of Brain-Based Strategies: One School's Perspective

    Science.gov (United States)

    Hodges, Jane Allen

    2013-01-01

    Research has shown student inattention, off-task behaviors, and lack of listening skills in the classroom can impact progress in reading, math, and language development. Lack of verbal interaction in home environments, variations in learning and teaching modalities, and larger class sizes contribute to the difficulties students have in developing…

  15. Dosimetric assessment of swallowing examinations with videofluoroscopy

    International Nuclear Information System (INIS)

    Costa, M.M.B.; Canevaro, L.V.; Azevedo, A.C.P.

    2001-01-01

    Dosimetric analysis measurements of the Dose-Area-Product (DAP) of 7 individuals were estimated for the deglutition dynamic using the videofluoroscopic method. The aim of this study is to establish in a preliminary way, typical DAP values for this kind of study. The DAP values were obtained attaching to the X ray tube exit, an ionization chamber from PTW and a Diamentor M4 meter. The typical DAP values obtained during the videofluoroscopic evaluation of the deglutition dynamic, including its three phases, was: 4101 ± 881 cGy.cm 2 and the typical DAP rate was 577 ± 94 cGy.cm 2 /min. These values refer to a standard patient (1.57 cm height, 56 kg. weight) and a protocol that can be performed in about 7 minutes. The values, defined herein as typical refer to the used protocol. To our knowledge, the mean DAP rate is a good parameter to estimate radiation exposure from videofluoroscopic study of swallowing process. (author)

  16. Strategies for baseline/environmental impact studies in Nigeria

    International Nuclear Information System (INIS)

    Odu, C.T.

    1991-01-01

    This paper reports that in order to assess the environmental impact of site activities and ecosystem change brought about by stress, basic baseline data are necessary to characterize the normal environment so that environmental quality control programs can be developed with a firm ecological base. The program and methodology adopted in our field surveys to assess the character, magnitude and extent of pollutant effects on soil, vegetation and water, as a basis for economic assessment of pollutant effects on agriculture, forestry and the aquatic system and for preparing environmental impact statements, are presented. These techniques were modified and adopted in the environmental impact study of the Isampou Manifold Oil Spill, a study which circumstances made necessary seven years after the oil spill. Reliance on the extent of pollution soon after the incidence was based on the determination of total hydrocarbons at creek bottoms as well as on the determinations of nickel/vanadium ratios. Hydrocarbon contents of creek banks and creek bottoms were within biogenic levels at the time of field sampling. Ni/V ratios were high in heavy impact areas and decreased in areas of medium and very light impact areas. Use of the Ni/V ratio as evidence of past oil pollution agreed closely with a sketch of the extent of crude oil pollution drawn by the Shell Petroleum Development Company seven years earlier. There were nor abnormal vegetation features. The presence of 10-15 years old Musanga cecropioides at the edge of the manifold slot and creeks indicated that vegetation above water level was not affected by the oil spillage. The physico-chemical properties of the waters, plankton composition and density of the species found, as well as the presence of endroproct bryozoan in the benthos showed that the aquatic system had by the time of sample collection, completely recovered from the oil spillage

  17. Impact of Strategy Implementation on Performance of Generic Strategy: Evidence from Thailand

    Directory of Open Access Journals (Sweden)

    Mayookapan Chaimankong

    2012-04-01

    Full Text Available The purpose of this paper is to examine the strategic orientation in terms of Miles and Snow typologies of the firms in emerging country and investigate their implications on performance. Unlike previous research, this paper focuses the importance of strategy implementation to the performance implications of Miles and Snow typology. Data was collected from 111 key informants from firms in Thailand’s chemical industry using probability sampling. The one-way Analysis of Variance (ANOVA results showed that prospectors performed better than the other three strategic types, whereas reactors exhibited the lowest performance scores. While the success in strategy implementation is found to be a significant predictor of firm performance, the two-way Analysis of Variance (ANOVA results revealed that the success in strategy implementation did not alter the relationship between Miles and Snow strategic type and a firm’s performance. This finding suggests that the relationship between Miles and Snow strategic type and a firm’s performance may be universal, regardless of the location where the study is conducted. However, additional studies in other contexts are required before the conclusion can be made whether the strategic type performance relationship will be contingent on strategy implementation.

  18. Social Media Impact on Human Resources Management Strategies

    Directory of Open Access Journals (Sweden)

    Angela-Eliza Micu

    2016-01-01

    Full Text Available The aim of this paper is to do a research of human resource management in Romania for the ITsector, and focus the attention to a couple of things like culture, trainings and the impact resultedon social media that this companies and their employees are producing. The use of social media has a huge impact on the quality of the work and also is contributing tostrengthen the relationships between employees. It can be a good resource in attracting new talentsand also promoting the company. This research used mined data from LinkedIn and other socialmedia and publicly available websites in order to statistically test hypotheses using the Pearsonchi-square method and successfully finding 6 strong correlations between data analyzed forRomanian software development companies.

  19. socio-cultural strategies in mitigating drought impacts and water ...

    African Journals Online (AJOL)

    South Asia. 1176.75. 101.30. 248.25. 5.19. Southeast Asia. 575.76. 10.44. 322.10. 7.82. Centrally planned Asia. 964.00. 158.24. 794.33. 13.25. Middle East. 88.82 .... The role of social factors and human impact on land degradation, has most certainly significantly exacerbated the region's vulnerability to drought and water.

  20. Land Use in Korean Tidal Wetlands: Impacts and Management Strategies

    Science.gov (United States)

    Hong, Sun-Kee; Koh, Chul-Hwan; Harris, Richard R.; Kim, Jae-Eun; Lee, Jeom-Sook; Ihm, Byung-Sun

    2010-05-01

    The coastal landscapes in southwestern Korea include a diverse array of tidal wetlands and salt marshes. These coastal zones link the ecological functions of marine tidal wetlands and freshwater ecosystems with terrestrial ecosystems. They are rich in biological diversity and play important roles in sustaining ecological health and processing environmental pollutants. Korean tidal wetlands are particularly important as nurseries for economically important fishes and habitats for migratory birds. Diking, draining, tourism, and conversion to agricultural and urban uses have adversely affected Korean tidal wetlands. Recent large development projects have contributed to further losses. Environmental impact assessments conducted for projects affecting tidal wetlands and their surrounding landscapes should be customized for application to these special settings. Adequate environmental impact assessments will include classification of hydrogeomorphic units and consideration of their responses to biological and environmental stressors. As is true worldwide, Korean laws and regulations are changing to be more favorable to the conservation and protection of tidal wetlands. More public education needs to be done at the local level to build support for tidal wetland conservation. Some key public education points include the role of tidal wetlands in maintaining healthy fish populations and reducing impacts of nonpoint source pollution. There is also a need to develop procedures for integrating economic and environmental objectives within the overall context of sustainable management and land uses.

  1. Land use in Korean tidal wetlands: impacts and management strategies.

    Science.gov (United States)

    Hong, Sun-Kee; Koh, Chul-Hwan; Harris, Richard R; Kim, Jae-Eun; Lee, Jeom-Sook; Ihm, Byung-Sun

    2010-05-01

    The coastal landscapes in southwestern Korea include a diverse array of tidal wetlands and salt marshes. These coastal zones link the ecological functions of marine tidal wetlands and freshwater ecosystems with terrestrial ecosystems. They are rich in biological diversity and play important roles in sustaining ecological health and processing environmental pollutants. Korean tidal wetlands are particularly important as nurseries for economically important fishes and habitats for migratory birds. Diking, draining, tourism, and conversion to agricultural and urban uses have adversely affected Korean tidal wetlands. Recent large development projects have contributed to further losses. Environmental impact assessments conducted for projects affecting tidal wetlands and their surrounding landscapes should be customized for application to these special settings. Adequate environmental impact assessments will include classification of hydrogeomorphic units and consideration of their responses to biological and environmental stressors. As is true worldwide, Korean laws and regulations are changing to be more favorable to the conservation and protection of tidal wetlands. More public education needs to be done at the local level to build support for tidal wetland conservation. Some key public education points include the role of tidal wetlands in maintaining healthy fish populations and reducing impacts of nonpoint source pollution. There is also a need to develop procedures for integrating economic and environmental objectives within the overall context of sustainable management and land uses.

  2. Adaptation strategies for health impacts of climate change in Western Australia: Application of a Health Impact Assessment framework

    International Nuclear Information System (INIS)

    Spickett, Jeffery T.; Brown, Helen L.; Katscherian, Dianne

    2011-01-01

    Climate change is one of the greatest challenges facing the globe and there is substantial evidence that this will result in a number of health impacts, regardless of the level of greenhouse gas mitigation. It is therefore apparent that a combined approach of mitigation and adaptation will be required to protect public health. While the importance of mitigation is recognised, this project focused on the role of adaptation strategies in addressing the potential health impacts of climate change. The nature and magnitude of these health impacts will be determined by a number of parameters that are dependent upon the location. Firstly, climate change will vary between regions. Secondly, the characteristics of each region in terms of population and the ability to adapt to changes will greatly influence the extent of the health impacts that are experienced now and into the future. Effective adaptation measures therefore need to be developed with these differences in mind. A Health Impact Assessment (HIA) framework was used to consider the implications of climate change on the health of the population of Western Australia (WA) and to develop a range of adaptive responses suited to WA. A broad range of stakeholders participated in the HIA process, providing informed input into developing an understanding of the potential health impacts and potential adaptation strategies from a diverse sector perspective. Potential health impacts were identified in relation to climate change predictions in WA in the year 2030. The risk associated with each of these impacts was assessed using a qualitative process that considered the consequences and the likelihood of the health impact occurring. Adaptations were then developed which could be used to mitigate the identified health impacts and provide responses which could be used by Government for future decision making. The periodic application of a HIA framework is seen as an ideal tool to develop appropriate adaptation strategies to

  3. Impact of Training Deep Vocabulary Learning Strategies on Vocabulary Retention of Iranian EFL Learners

    Directory of Open Access Journals (Sweden)

    Seyed Javad Es-hagi Sardroud

    2013-05-01

    Full Text Available Considering the overall tendency of foreign language learners to use mechanical strategies of rote rehearsal in vocabulary learning and their resistance towards use of 'deep' vocabulary learning strategies, namely contextual guessing, Keyword Method, metacognitive strategy, and semantic mapping, this study intended (a to explore what impact the instruction of these deep strategies, on vocabulary retention of 32 post-intermediate adult EFL Iranian learners, (b to determine how the variable of gender influences the vocabulary retention of students after receiving training in these strategies. To this end, on the basis of a strategy-based model of instruction–CALLA (Chamot & O'Malley, 1994, the experimental group received training in using 'deep' vocabulary learning strategies while the control group received only the common method of vocabulary teaching. After the treatment, following factorial design, the performance of the participants in the teacher-made vocabulary test as posttest was analyzed statistically.  The results indicated higher vocabulary retention for the experimental group, and it was revealed that female students were more receptive to strategy training. This study provides evidence for confirmation of 'depth of processing' hypothesis and the emerging theory about the impact of gender on effective strategy teaching and use, and it recommends incorporation of teaching these 'deep' strategies of vocabulary learning into EFL classrooms.

  4. The Impact of Metacognitive Strategies and Self-Regulating Processes of Solving Math Word Problems

    Science.gov (United States)

    Vula, Eda; Avdyli, Rrezarta; Berisha, Valbona; Saqipi, Blerim; Elezi, Shpetim

    2017-01-01

    This empirical study investigates the impact of metacognitive strategies and self-regulating processes in learners' achievement on solving math word problems. It specifically analyzes the impact of the linguistic factor and the number of steps and arithmetical operations that learners need to apply during the process of solving math word problems.…

  5. How Instructional Strategies Impact Students' Learning, Motivation, and Learning Strategies in Introductory Geology Courses

    Science.gov (United States)

    Perkins, D.; Budd, D. A.; Stempien, J. A.; Kraft, K.; Matheney, R. K.; McConnell, D.; Wirth, K. R.; Bykerk-Kauffman, A.

    2010-12-01

    The Geoscience Affective Research Network (GARNET) quantified the relationship between classroom teaching styles, student learning, and students’ motivations and attitudes for 14 different instructors at 2 community colleges, a private college, and 4 large public universities. Instruction was characterized with the Reformed Teaching Observation Protocol (RTOP). The 0-100 scale reflects the span between traditional instructor-centered lecture and interactive, student-centered courses. Every participating instructor was observed at least twice. Student learning was measured using a 15-question concept inventory (CI) focused on geologic time and plate tectonics. Twelve questions were from the Geologic Concept Inventory of Libarkin and Anderson (2005) and 3 questions were added on relative time. Students’ affective domain was measured using the Motivated Strategies for Learning Questionnaire (MSLQ), 81 questions that define 15 motivation and cognitive subcategories. 1152 students completed both surveys in the 2nd and 14th weeks of their class during the 2008-2010 academic years. RTOP scores ranged from 19 to 87. Learning gains ranged from 18.6% to 47.4% with students learning significantly more from instructors with higher RTOP scores. Learning gains and RTOP positively covary (R2 = 0.67). Adjusting for questions on which students scored high prior to instruction (>90% correct), results in an even stronger relationship (R2 = 0.89). Higher RTOP scores correlate to significant declines in many aspects of student motivation (extrinsic and intrinsic goals, task value, control of learning, and effort regulation). Declines occur mainly in lower and/or middle performing students as measured by grades. The highest performing students only show declines with respect to their control of learning beliefs. Students’ self-efficacy also declines with increasing use of student-student interactions. Higher RTOP scores only exhibit positive correlations to a few aspects of

  6. Impact of antimissile defence on nuclear strategies in Asia

    International Nuclear Information System (INIS)

    Delory, Stephane

    2015-01-01

    As antimissile defence has become a mean to compensate the limitations of nuclear deterrence in Asia, notably within the frame of the US-North Korea relationship, but has also influence on the relationships between countries which do not possess an actual operational antimissile defence like Pakistan and India, the author proposes an assessment of the consequences antimissile defence may have on deterrence logics in Asia. He also notices that various issues must be taken into account: arsenal sizes, the slow rate of ballistic modernisation processes, the weaknesses of C4ISR systems and advanced alarm systems. He recalls the peculiarities of antimissile defence, and then addresses the cases of North Korea, India and Pakistan, and China. For each country, he analyses and discusses the influence of a choice or of the existence of an antimissile defence on the nuclear strategy and doctrine, but also on the posture of other countries like the USA

  7. Swallowing rehabilitation with nutrition therapy improves clinical outcome in patients with dysphagia at an acute care hospital.

    Science.gov (United States)

    Iwamoto, Masako; Higashibeppu, Naoki; Arioka, Yasutaka; Nakaya, Yutaka

    2014-01-01

    Dysphagia is associated with nutritional deficits and increased risk of aspiration pneumonia. The aim of the present study was to evaluate the impact of nutrition therapy for the patients with dysphagia at an acute care hospital. We also tried to clarify the factors which improve swallowing function in these patients. Seventy patients with dysphagia were included in the present study. Multidisciplinary nutrition support team evaluated swallowing function and nutrition status. Most patients were fed by parenteral or enteral nutrition at the time of the first round. Of these 70 patients, 36 became able to eat orally. The improvement of swallowing function was associated with higher BMI in both genders and higher AMC in men. Mortality was high in the patients with lower BMI and %AMC, suggesting importance of maintaining muscle mass. Thirteen (38.2%) of 34 patients who did not show any improvement in swallowing function died, but no patients who showed improvement died (pdysphagia and poor outcome, compared to those with about>22 kcal/kg/day. These results suggest that it is important to maintain nutritional status to promote rehabilitation in patients with dysphagia even in an acute care hospital.

  8. Gamma radiation effects on nestling Tree Swallows

    International Nuclear Information System (INIS)

    Zach, R.; Mayoh, K.R.

    1984-01-01

    The sensitivity of Tree Swallows (Tachycineta bicolor) to the stress of ionizing radiation was investigated with growth analysis. Freshly hatched nestlings were temporarily removed from nests, taken to the laboratory and acutely exposed to 0.9, 2.7, or 4.5 Gy gamma radiation. Some of the unirradiated control nestlings were also taken to the laboratory whereas others were left in the nests. Growth of all the nestlings was measured daily and analyzed by fitting growth models. There was no detectable radiation-induced mortality up to fledgling, approx. = 20 d after irradiation. Radiation exposure did not affect the basic growth pattern; the logistic growth model was most suitable for body mass and foot length, and the von Bertalanffy model for primary-feather length, irrespective of treatment. Parameter values from these models indicated pronounced growth depression in the 2.7-Gy and 4.5-Gy groups, particularly for body mass. Radiation also affected the timing of development. The growth depression of the 2.7-Gy group was similar to that caused by hatching asynchrony in unirradiated nestlings. The 4.5-Cy nestlings grew as well as unexposed nestlings that died from natural causes. Chronic irradiation at approx. = 1.0 Cy/d caused more severe growth effects than acute exposure to 4.5 Gy and may have caused permanent stunting. Growth analysis is a potent tool for assessing man-made environmental stresses. Observed body-mass statistics and model parameters seem to be most sensitive to environmental stresses, but coefficients of variation are not necessarily correlated with sensitivity. 34 references, 2 figures, 4 tables

  9. Antifouling strategies: history and regulation, ecological impacts and mitigation.

    Science.gov (United States)

    Dafforn, Katherine A; Lewis, John A; Johnston, Emma L

    2011-03-01

    Biofouling increases drag on marine vessels resulting in higher fuel consumption and can also facilitate the transport of harmful non-indigenous species (NIS). Antifouling technologies incorporating biocides (e.g., copper and tributyltin) have been developed to prevent settlement of organisms on vessels, but their widespread use has introduced high levels of contamination into the environment and raised concerns about their toxic effects on marine communities. The recent global ban on tributyltin (1 January 2008) and increasing regulation of copper have prompted research and development of non-toxic paints. This review synthesises existing information regarding the ecological impact of biocides in a wide range of organisms and highlights directions for the management of antifouling paints. We focus particularly on representatives of the recent past (copper and tributyltin) and present (copper and 'booster') biocides. We identify knowledge gaps in antifouling research and provide recommendations relating to the regulation and phasing-out of copper. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Financial Strategies Moderate Weather Impacts on Food Security Outcomes

    Science.gov (United States)

    Brown, M. E.; Niles, M.

    2016-12-01

    Global food security relies on local agricultural capacity as well as the financial ability to import food from elsewhere. Climate change is likely to affect the ability to grow sufficient food to meet the needs of a growing population in low income countries where population expansion is the greatest. This paper presents an analysis of 2095 household surveys from 12 food insecure countries in West Africa, East Africa and Asia from the Climate Change, Agriculture, and Food Security (CCAFS) program conducted from 2010-2012. Using a multi-level hierarchical random effects model, we estimated the number of months a household was food insecure with information on the rainfall anomaly the year prior to the survey, agricultural input use, cash income, and community group membership. We found that when the rainfall was either one standard deviation above or below the mean, the number of months households experience food insecurity increased by 74%. When there is a significant weather anomaly, agricultural credit and cash income, but not agricultural inputs or social capital, are found to be critical factors reducing food insecurity. This highlights the ongoing and critical importance of risk reduction strategies such as crop insurance, government safety nets, and credit for maintaining food security in the face of climate change.

  11. Is accurate contouring of salivary and swallowing structures necessary to spare them in head and neck VMAT plans?

    Science.gov (United States)

    Delaney, Alexander R; Dahele, Max; Slotman, Ben J; Verbakel, Wilko F A R

    2018-03-28

    Current standards for organ-at-risk (OAR) contouring encourage anatomical accuracy which can be resource intensive. Certain OARs may be suitable for alternative delineation strategies. We investigated whether simplified salivary and swallowing structure contouring can still lead to good OAR sparing in automated head and neck cancer (HNC) plans. For 15 HNC patients, knowledge-based plans (KBPs) using RapidPlan™ were created using: (1) standard clinical contours for all OARs (benchmark-plans), (2) automated knowledge-based contours for the salivary glands, with standard contours for the remaining OARs (SS-plans) and (3) simplified contours (SC-plans) consisting of quick-to-draw tubular structures to account for the oral cavity, salivary glands and swallowing muscles. Individual clinical OAR contours in a RapidPlan™ model were combined to create composite salivary/swallowing structures. These were matched to tube-contours to create SC-plans. All plans were compared based on dose to anatomically accurate clinical OAR contours. Salivary gland delineation in SS-plans required on average 2 min, compared with 7 min for manual delineation of all tubular-contours. Automated atlas-based contours overlapped with, on average, 71% of clinical salivary gland contours while tube-contours overlapped with 95%/75%/93% of salivary gland/oral cavity/swallowing structure contours. On average, SC-plans were comparable to benchmark-plans and SS-plans, with average differences in composite salivary and swallowing structure dose ≤2 Gy and quickly and resulted in clinically acceptable HNC VMAT plans. They can be combined with automated planning to facilitate the implementation of advanced radiotherapy, even when resources are limited. Copyright © 2018 Elsevier B.V. All rights reserved.

  12. A swallowed sewing needle migrating to the liver.

    Science.gov (United States)

    Avcu, Serhat; Unal, Ozkan; Ozen, Ozkan; Bora, Aydın; Dülger, Ahmet Cumhur

    2009-09-01

    Swallowing foreign bodies is a common problem in children. Although most objects pass through the gastrointestinal tract with no untoward effect; long, sharppointed, or slender objects can perforate the gut. Migration of a swallowed object to the liver is extremely rare and very few cases have been reported in the literature up to now. The aim of this study is to draw attention to this subject once again by contributing a case report of a child with hepatic migration of a swallowed sewing needle. A 16-year-old girl presented to the emergency room of pediatrics department in our hospital with complaints of abdominal pain, nausea and vomiting. Physical examination revealed tenderness on the right upper quadrant of the abdomen. Laboratory examination revealed increased hepatic enzymes as well as increased white blood cell count. Abdominal ultrasonography and computed tomography examinations revealed foreign body in the liver accompanied by surrounding abscess formation. The foreign body (sewing needle) was removed surgically after two operations. The children may not be able to remember the swallowing of the foreign body or they may try to hide such a condition. The radiological diagnosis in such cases which can be achieved by X-rays, ultrasonography or computed tomography is of critical importance, as well as getting detailed patient history for foreign body swallowing.

  13. Tongue pressure production during swallowing in patients with mandibular prognathism.

    Science.gov (United States)

    Sakaue, K; Fukui, T; Sasakura, C; Hori, K; Ono, T; Saito, I

    2016-05-01

    Abnormalities of swallowing in patients with mandibular prognathism have not been evaluated quantitatively. The aim of this study was to compare tongue pressure production for bolus transfer between volunteers with normal occlusion and patients with mandibular prognathism. The control group had 10 female volunteers with normal occlusion, and the patient group had 10 women with mandibular prognathism. Tongue pressure was measured by a palatal sensor sheet at five sites on swallowing 4 mL of a tasteless and odourless jelly. The tongue pressure waveform differed between the control and patient groups. The incidence of a double-peak tongue pressure waveform was more frequent in the patient group. In both groups, the exertion of tongue pressure began at the anterior point of the sensor sheet, followed by the peripheral parts. Although the order of expression of tongue pressure was the same for the two groups, maximum tongue pressure at all parts of the sensor sheet was lower in the patient group than in the control group. Furthermore, swallowing time was longer in the patient group than in the control group at the peripheral parts of the palate. These results clearly show the difference in tongue pressure production during swallowing between patients with mandibular prognathism and volunteers with normal occlusion. The current findings suggest that maxillofacial morphology may affect tongue movement during swallowing. © 2016 John Wiley & Sons Ltd.

  14. Swallowing in patients with Parkinson's disease: a surface electromyography study.

    Science.gov (United States)

    Ws Coriolano, Maria das Graças; R Belo, Luciana; Carneiro, Danielle; G Asano, Amdore; Al Oliveira, Paulo José; da Silva, Douglas Monteiro; G Lins, Otávio

    2012-12-01

    Our goal was to study deglutition of Parkinson's disease (PD) patients and normal controls (NC) using surface electromyography (sEMG). The study included 15 patients with idiopathic PD and 15 age-matched normal controls. Surface electromyography was collected over the suprahyoid muscle group. Conditions were the following: swallow at once 10 and 20 ml of water and 5 and 10 ml of yogurt of firm consistency, and freely drink 100 ml of water. During swallowing, durations of sEMG were significantly longer in PD patients than in normal controls but no significant differences of amplitudes were found. Eighty percent of the PD patients and 20 % of the NC needed more than one swallow to consume 20 ml of water, while 70 % of the PD patients and none of the NC needed more than one swallow to consume 5 ml of yogurt. PD patients took significantly more time and needed significantly more swallows to drink 100 ml of water than normal controls. We conclude that sEMG might be a simple and useful tool to study and monitor deglutition in PD patients.

  15. Israel wildfires: future trends, impacts and mitigation strategies

    Science.gov (United States)

    Wittenberg, Lea

    2017-04-01

    Forest fires in the Euro-Mediterranean region burn about 450,000 ha each year. In Israel, the frequency and extent of wildfires have been steadily increasing over the past decades, culminating in several large and costly fires in 2010, 2012 and 2016. The extensive development of forest areas since the 1950's and the accumulation of fuel in the forests, has led to increased occurrences of high intensity fires. Land-use changes and human population growth are the most prevailing and common determinant of wildfire occurrence and impacts. Climate extremes, possibly already a sign of regional climate change, are another frequent determinant of increasing wildfire risk. Therefore, the combination of extreme dry spells, high fuel loads and increased anthropogenic pressure on the open spaces result in an overall amplified wildfire risk. These fires not only cause loss of life and damage to properties but also carry serious environmental repercussions. Combustion of standing vegetation and the leaf litter leave the soil bare and vulnerable to runoff and erosion, thereby increasing risks of flooding. Today, all of Israel's open spaces, forests, natural parks, major metropolitan centers, towns and villages are embedded within the wildland urban interface (WUI). Typically, wildfires near or in the WUI occur on uplands and runoff generated from the burned area poses flooding risks in urban and agricultural zones located downstream. Post-fire management aims at reducing associated hazards as collapsing trees and erosion risk. Often the time interval between a major fire and the definition of priority sites is in the order of days-to-weeks since administrative procedures, financial estimates and implementation of post-fire salvage logging operations require time. Defining the magnitude of the burn scar and estimating its potential impact on runoff and erosion must therefore be done quickly. A post-fire burn severity, runoff and erosion model is a useful tool in estimating

  16. Measles in Morocco: epidemiological profile and impact of vaccination strategy.

    Science.gov (United States)

    Cheikh, Amine; Ziani, Mouncif; Cheikh, Zakia; Barakat, Amina; El Menzhi, Omar; Braikat, Mohammed; Benomar, Ali; Cherrah, Yahya; El Hassani, Amine

    2015-02-01

    Measles continues to persist as one of the leading causes of infant mortality due to preventable diseases through vaccination. This study aims to highlight measles in Morocco, and to present the vaccination strategy implemented to control and eliminate the disease in this country. Throughout this study, and based on data from the Directorate of Epidemiology and Control of Diseases and those of the Directorate of Population, we present an overview on the epidemiological trends of measles from 1997 to 2012, while evoking the plans established by the Ministry of Health (MoH) for the control and elimination of this disease. The number of measles cases has decreased in Morocco between 1997 and 2012 (2574-720 reported cases per year) as a result of four important steps: first, increasing the routine vaccination coverage (73-94%); second, the introduction of the second dose of the combined vaccine against measles and rubella in schools (children aged 6 years) since 2003; third, the first catch-up campaign of vaccination in Morocco in 2008, for which coverage was highly satisfactory (96% and 100% for age groups 5-59 months and 5-14 years, respectively); and fourth, the organization of a mass vaccination campaign in 2013 that targeted children from aged 9 months to 19 years. The vaccination plan and the surveillance system executed in Morocco within the framework of the regional project implemented by the World Health Organization (WHO) to eliminate measles has given remarkable results regarding the reduction of measles cases and mortality due to this disease. According to the data from MoH and WHO, the number of reported and confirmed measles cases decreased drastically during 2014. However, these efforts are still unsatisfactory compared to the prospective of eliminating the disease by 2015.

  17. The Impact of the Arab Spring on Islamist Strategies

    Directory of Open Access Journals (Sweden)

    Ioana E. Matesan

    2012-01-01

    Full Text Available The revolutions in Tunisia and Egypt created a contagion effect that inspired a series of uprisings by sending two signals: first, that even entrenched authoritarian regimes are vulnerable; and second, that nonviolent tactics can be effective in bringing about dramatic political changes. Subsequent developments, especially in Libya and Syria, convoluted these messages. Nonetheless, the political openings and the electoral victory of Islamists in Egypt and Tunisia continue to send the signal to many Islamist opposition groups that nonviolent means and participation in politics can be effective ways to produce political change. The chance of gaining power through electoral means can give Islamists strong incentives to join in the demands for democratic institutions and change their stance towards political participation. The appeal of nonviolent tactics, however, is undermined when external threats surpass domestic considerations. When the primary concern of the public is about outside threats and the main enemy is external rather than a domestic despot, the impact of the Arab Spring on views regarding the efficacy of nonviolent tactics is diminished. Similarly, when an Islamic group is primarily concerned with the "far enemy," the incentives for moderation offered by political participation are undermined.

  18. The Impact of Cross-Age Peer Tutoring on Third and Sixth Graders' Reading Strategy Awareness, Reading Strategy Use, and Reading Comprehension

    Science.gov (United States)

    Van Keer, Hilde; Vanderlinde, Ruben

    2010-01-01

    The present study explores the impact of an experimental reading intervention focusing on explicit reading strategy instruction and cross-age peer tutoring on third and sixth graders' reading strategy awareness, cognitive and metacognitive reading strategy use, and reading comprehension achievement. A quasi-experimental pretest-posttest design was…

  19. Effective Dissemination - Building an 'Evidence to Impact' Strategy

    Directory of Open Access Journals (Sweden)

    Dan O'Neill

    2017-02-01

    Full Text Available When a piece of ‘evidence’ is generated in the research environment and almost nobody hears about it, then can we really still call it a piece of ‘evidence’? Does evidence only become evidence once it is used; and until then, is it just a piece of insignificant information? As we inexorably travel through the EBVM era, we must increasingly prioritise effective dissemination of evidence. This paper will use the VetCompass Programme at the Royal Veterinary College as a case study to explore a strategic dissemination plan and examine routes for effective dissemination.Although EBVM traditionally assumes an audience of academics or practicing veterinarians, the authors contend that substantial welfare gains can be additionally achieved by targeting current and future pet owners, the non-owner general public, industry, welfare bodies, scientific groups, breeders and kennel clubs. Effective dissemination should be strategic and give a priori consideration to identifying target audiences, appropriate formatting of the messages and open access routes for dissemination. Scientists who generate EBVM may not always be best placed to also disseminate these messages and therefore research teams should consider widening their combined skill-base to also incorporate marketing and media savvy.The VetCompass Programme is a new and hugely exciting project that shares de-identified primary-practice clinical data for research to support effective evidence based veterinary medicine and welfare reforms. VetCompass data collection commenced in 2009 and the current 470 collaborating primary-care practices have shared data on 4 million small animals and 45 million unique episodes of care. VetCompass has 15 peer-reviewed publications to date.In order to maximise the welfare gains from an array of evidence silos generated within VetCompass, a dissemination strategy was designed based on a Systems Thinking approach. The outcomes from a range of dissemination trials

  20. Respiratory Patterns and Strategies during Feeding in Preterm Infants

    Science.gov (United States)

    Vice, Frank L.; Gewolb, Ira H.

    2008-01-01

    Because patterns of integration of respiration into rhythmic suck-swallow efforts are highly variable, we examined the vagaries of respiratory efforts as they evolve from the first tentative attempts at integration through more complex rhythmic interactions, with a focus on several strategies in which breathing and suck-swallow are coordinated.…

  1. Identifying potential environmental impacts of waste handling strategies in textile industry.

    Science.gov (United States)

    Yacout, Dalia M M; Hassouna, M S

    2016-08-01

    Waste management is a successful instrument to minimize generated waste and improve environmental conditions. In spite of the large share of developing countries in the textile industry, limited information is available concerning the waste management strategies implemented for textiles on those countries and their environmental impacts. In the current study, two waste management approaches for hazardous solid waste treatment of acrylic fibers (landfill and incineration) were investigated. The main research questions were: What are the different impacts of each waste management strategy? Which waste management strategy is more ecofriendly? Life cycle assessment was employed in order to model the environmental impacts of each waste streaming approach separately then compare them together. Results revealed that incineration was the more ecofriendly approach. Highest impacts of both approaches were on ecotoxicity and carcinogenic potentials due to release of metals from pigment wastes. Landfill had an impact of 46.8 % on human health as compared to 28 % by incineration. Incineration impact on ecosystem quality was higher than landfill impact (68.4 and 51.3 %, respectively). As for resources category, incineration had a higher impact than landfill (3.5 and 2.0 %, respectively). Those impacts could be mitigated if state-of-the-art landfill or incinerator were used and could be reduced by applying waste to energy approaches for both management systems In conclusion, shifting waste treatment from landfill to incineration would decrease the overall environmental impacts and allow energy recovery. The potential of waste to energy approach by incineration with heat recovery could be considered in further studies. Future research is needed in order to assess the implementation of waste management systems and the preferable waste management strategies in the textile industry on developing countries.

  2. General coping strategies and their impact on quality of life in older adults with schizophrenia.

    Science.gov (United States)

    Cohen, Carl I; Hassamal, Sameer K; Begum, Nurun

    2011-04-01

    Both symptom specific and general coping strategies may affect the well-being of persons with schizophrenia. There are little data on how older adults with schizophrenia employ various coping styles. This study examines the types of general coping strategies used by older persons with schizophrenia and examines the extent to which the various coping strategies affect quality of life. The schizophrenia group consisted of 198 persons aged 55 and over living in the community who developed schizophrenia before age 45. A community comparison group (n=113) was recruited using randomly selected block-groups. Cognitive, instrumental, and avoidant coping scales were created based on a principal component analysis with equamax rotation of items from a self-report coping inventory. A modified version of Yanos and Moos' integrative model was used to assess the direct and mediating effects of each of the coping strategies scales on the Quality of Life Index. Older adults with schizophrenia and their age peers in the general community most commonly use cognitive coping strategies, and there was no significant difference in their scores on this scale. For persons with schizophrenia, the active coping strategies--cognitive and instrumental--were used more frequently than the avoidant strategies. Both active and avoidant strategies mediated the impact of psychiatric symptoms on quality of life as well as contributing independently to improving life quality; however, they had no impact on the other stressor variables. This study suggests that general coping strategies, especially more active approaches, may be useful in diminishing the adverse impact of psychiatric symptoms on quality of life as well as having direct effects on life quality. Such strategies can complement symptom specific approaches. Copyright © 2011 Elsevier B.V. All rights reserved.

  3. Recent Advances in Sensing Oropharyngeal Swallowing Function in Japan

    Directory of Open Access Journals (Sweden)

    Takahiro Ono

    2009-12-01

    Full Text Available Dysphagia (difficulty in swallowing is an important issue in the elderly because it causes aspiration pneumonia, which is the second largest cause of death in this group. It also causes decline in activities of daily living and quality of life. The oral phase of swallowing has been neglected, despite its importance in the evaluation of dysphagia, because adequate protocols and measuring devices are unavailable. However, recent advances in sensor technology have enabled straightforward, non-invasive measurement of the movement of important swallowing-related organs such as the lips and tongue, as well as the larynx. In this article, we report the present state and possibility of clinical application of such systems developed in Japan.

  4. Tracking the hyoid bone in videofluoroscopic swallowing studies

    Science.gov (United States)

    Kellen, Patrick M.; Becker, Darci; Reinhardt, Joseph M.; van Daele, Douglas

    2008-03-01

    Difficulty swallowing, or dysphagia, has become a growing problem. Swallowing complications can lead to malnutrition, dehydration, respiratory infection, and even death. The current gold standard for analyzing and diagnosing dysphagia is the videofluoroscopic barium swallow study. In these studies, a fluoroscope is used to image the patient ingesting barium solutions of different volumes and viscosities. The hyoid bone anchors many key muscles involved in swallowing and plays a key role in the process. Abnormal hyoid bone motion during a swallow can indicate swallowing dysfunction. Currently in clinical settings, hyoid bone motion is assessed qualitatively, which can be subject to intra-rater and inter-rater bias. This paper presents a semi-automatic method for tracking the hyoid bone that makes quantitative analysis feasible. The user defines a template of the hyoid on one frame, and this template is tracked across subsequent frames. The matching phase is optimized by predicting the position of the template based on kinematics. An expert speech pathologist marked the position of the hyoid on each frame of ten studies to serve as the gold standard. Results from performing Bland-Altman analysis at a 95% confidence interval showed a bias of 0.0+/-0.08 pixels in x and -0.08+/-0.09 pixels in y between the manually-defined gold standard and the proposed method. The average Pearson's correlation between the gold standard and the proposed method was 0.987 in x and 0.980 in y. This paper also presents a method for automatically establishing a patient-centric coordinate system for the interpretation of hyoid motion. This coordinate system corrects for upper body patient motion during the study and identifies superior-inferior and anterior-posterior motion components. These tools make the use of quantitative hyoid motion analysis feasible in clinical and research settings.

  5. VIDEOFLUOROSCOPIC SWALLOWING STUDY: esophageal alterations in patients with dysphagia

    Directory of Open Access Journals (Sweden)

    Betina SCHEEREN

    2014-09-01

    Full Text Available Context Videofluoroscopic swallowing study is a dynamic exam and allows the evaluation of the complete swallowing process. However, most published studies have only reported alterations in the oropharynx and pharyngoesophageal transition, leaving the analysis of the esophagus as a secondary goal. Objectives The goal of this study was to investigate the prevalence of alterations in the esophageal phase thorough videofluoroscopic swallowing study in patients with dysphagia. Methods Consecutive patients with dysphagia who underwent videofluoroscopic swallowing study including esophageal analysis between May 2010 and May 2012 had their exams retrospectively reviewed. Patients were classified into two groups: Group I - without a pre-established etiological diagnosis and Group II - with neurological disease. During the exam, the patients ingested three different consistencies of food (liquid, pasty and solid contrasted with barium sulfate and 19 items were analyzed according to a protocol. The esophageal phase was considered abnormal when one of the evaluated items was compromised. Results Three hundred and thirty-three (n = 333 consecutive patients were studied - 213 (64% in Group I and 120 (36% in Group II. Esophageal alterations were found in 104 (31% patients, with a higher prevalence in Group I (36.2%, especially on the items esophageal clearance (16.9% and tertiary contractions (16.4%. It was observed that 12% of individuals in Group I only presented alterations on the esophageal phase. Conclusion Evaluation of the esophageal phase of swallowing during videofluoroscopic swallowing study detects abnormalities in patients with cervical dysphagia, especially in the group without pre-established etiological diagnosis.

  6. The effect of dairy farm management regime on swallow (Hirundo rustica) abundance in the Netherlands

    NARCIS (Netherlands)

    Lubbe, S.K.; Snoo, de G.R.

    2007-01-01

    Aim To identify differences in Swallow abundance between organically and conventionally managed dairy farms, by examining three factors: farm buildings, food availability and farmer attitudes to Swallows. Methods Organic and conventional dairy farm holdings were compared in pairwise fashion. On

  7. Comparison of endoscopy and barium swallow with marshmallow in dysphagia.

    Science.gov (United States)

    Somers, S; Stevenson, G W; Thompson, G

    1986-06-01

    Forty-four patients with dysphagia were examined both by endoscopy and by barium swallow with a marshmallow bolus. In these patients 36 stenoses were found: 34 by radiology and 30 by endoscopy. The radiologic criteria for stenosis included arrest of the marshmallow in a manner to support a column of barium and reproduction of the patient's symptoms at the time this occurred. Radiologic false negative findings were partly due to an inability by patients to swallow an adequate marshmallow bolus; endoscopic failures were associated with small endoscopes and mild stenoses.

  8. Impact of Optimization Strategy and Adoption Rate on V2X Technology on Environmental Impact

    Science.gov (United States)

    2018-12-31

    This research evaluated the effects of automated vehicle control strategies on system level emissions, travel time and wait time through a series of traffic lights. The study was conducted using traffic simulation and a realistic vehicle mix. Two con...

  9. Strategies to reduce the environmental impact of an aluminium pressure die casting plant: a scenario analysis.

    Science.gov (United States)

    Neto, Belmira; Kroeze, Carolien; Hordijk, Leen; Costa, Carlos; Pulles, Tinus

    2009-02-01

    This study explores a model (MIKADO) to analyse scenarios for the reduction of the environmental impact of an aluminium die casting plant. Our model calculates the potential to reduce emissions, and the costs associated with implementation of reduction options. In an earlier paper [Neto, B., Kroeze, C., Hordijk, L., Costa, C., 2008. Modelling the environmental impact of an aluminium pressure die casting company and options for control. Environmental Modelling & Software 23 (2) 147-168] we included the model description and explored the model by applying it to a plant in which no reduction options are assumed to be implemented (so-called zero case, reflecting the current practice in the plant). Here, we perform a systematic analysis of reduction options. We analysed seven types of reduction strategies, assuming the simultaneous implementation of different reduction options. These strategies are analysed with respect to their potential to reduce emissions, environmental impact and costs associated with the implementation of options. These strategies were found to differ largely in their potential to reduce the environmental impact of the plant (10-87%), as well as in the costs associated with the implementation of options (-268 to +277keuro/year). We were able to define 11 strategies, reducing the overall environmental impact by more than 50%. Of these, two have net negative costs, indicating that the company may in fact earn money through their implementation.

  10. A theoretical assessment of the relations between innovation and businesses strategies with social impact

    Directory of Open Access Journals (Sweden)

    Damiana Machado de Almeida

    2016-11-01

    Full Text Available This work seeks to explain theoretically the relationship between innovation and business strategies that have social impact. This theoretical study adopts an exploratory and qualitative approach, including bibliographic research in books and articles that deal with the pertinent topics. We found that the knowledge needed for innovation is spread more easily in environments in which there is freedom, encouragement of personal development, and creativity. The adoption of a culture that favors innovation generates several kinds of impacts in the organizational environment, especially in relation to issues of business that have a social impact. Both through the initiative of entrepreneurs and by organizational action, social innovation acquires its own features and contours, which are distinct from traditional innovation strategies. As a consequence, innovation must be present in businesses with social impact, in order to reach uncommon solutions that are not present in traditional businesses.

  11. Evaluation of Heliostat Standby Aiming Strategies to Reduce Avian Flux Hazards and Impacts on Operational Performance

    Energy Technology Data Exchange (ETDEWEB)

    Wendelin, Timothy J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Ho, Clifford K. [Sandia National Laboratories; Horstman, Luke [Sandia National Laboratories

    2017-06-03

    This paper presents a study of alternative heliostat standby aiming strategies and their impact on avian flux hazards and operational performance of a concentrating solar power plant. A mathematical model was developed that predicts the bird-feather temperature as a function of solar irradiance, thermal emittance, convection, and thermal properties of the feather. The irradiance distribution in the airspace above the Ivanpah Unit 2 heliostat field was simulated using a ray-trace model for two different times of the day, four days of the year, and nine different standby aiming strategies. The impact of the alternative aiming strategies on operational performance was assessed by comparing the heliostat slew times from standby position to the receiver for the different aiming strategies. Increased slew times increased a proxy start-up time that reduced the simulated annual energy production. Results showed that spreading the radial aim points around the receiver to a distance of ~150 m or greater reduced the hazardous exposure times that the feather temperature exceeded the hazard metric of 160 degrees C. The hazardous exposure times were reduced by ~23% and 90% at a radial spread of aim points extending to 150 m and 250 m, respectively, but the simulated annual energy production decreased as a result of increased slew times. Single point-focus aiming strategies were also evaluated, but these strategies increased the exposure hazard relative to other aiming strategies.

  12. Impact of Different Ventilation Strategies on Driving Pressure, Mechanical Power, and Biological Markers During Open Abdominal Surgery in Rats

    NARCIS (Netherlands)

    Maia, Lígia de A.; Samary, Cynthia S.; Oliveira, Milena V.; Santos, Cintia L.; Huhle, Robert; Capelozzi, Vera L.; Morales, Marcelo M.; Schultz, Marcus J.; Abreu, Marcelo G.; Pelosi, Paolo; Silva, Pedro L.; Rocco, Patricia Rieken Macedo

    2017-01-01

    Intraoperative mechanical ventilation may yield lung injury. To date, there is no consensus regarding the best ventilator strategy for abdominal surgery. We aimed to investigate the impact of the mechanical ventilation strategies used in 2 recent trials (Intraoperative Protective Ventilation

  13. Tongue Movements during Water Swallowing in Healthy Young and Older Adults

    Science.gov (United States)

    Steele, Catriona M.; Van Lieshout, Pascal

    2009-01-01

    Purpose: The purpose of this study was to explore the nature and extent of variability in tongue movement during healthy swallowing as a function of aging and gender. In addition, changes were quantified in healthy tongue movements in response to specific differences in the nature of the swallowing task (discrete vs. sequential swallows). Method:…

  14. Evaluating the environmental sustainability of biomass-based energy strategy: Using an impact matrix framework

    International Nuclear Information System (INIS)

    Weldu, Yemane W.; Assefa, Getachew

    2016-01-01

    A roadmap for a more sustainable energy strategy is complex, as its development interacts critically with the economic, social, and environmental dimensions of sustainable development. This paper applied an impact matrix method to evaluate the environmental sustainability and to identify the desirable policy objectives of biomass-based energy strategy for the case of Alberta. A matrix with the sustainability domains on one axis and areas of environmental impact on the other was presented to evaluate the nexus effect of policy objectives and bioenergy production. As per to our analysis, economic diversification, technological innovation, and resource conservation came up as the desirable policy objectives of sustainable development for Alberta because they demonstrated environmental benefits in all environmental impact categories, namely climate change, human health, and ecosystem. On the other hand, human health and ecosystem impacts were identified as trade-offs when the policy objectives for sustainability were energy security, job creation, and climate change. Thus, bioenergy can mitigate climate change but may impact human health and ecosystem which then in turn can become issues of concern. Energy strategies may result in shifting of risks from one environmental impact category to another, and from one sustainable domain to another if the technical and policy-related issues are not identified.

  15. The Impact of Teaching Communication Strategies on EFL Learners' Willingness to Communicate

    Science.gov (United States)

    Mesgarshahr, Abulfazl; Abdollahzadeh, Esmaeel

    2014-01-01

    One of the pedagogical implications of the research on the Willingness to Communicate (WTC) might be to propose practical ways of making language learners more willing to communicate in the classroom. This study investigated the impact of teaching communication strategies (CSs) on Iranian EFL learners' WTC. To this end, 8 intact classes were…

  16. Impact of European Media Education Strategies on Russian Media Education Development

    Science.gov (United States)

    Mikhaleva, Galina V.

    2015-01-01

    The article attempts to examine the impact of European media education theories and approaches on Russian media education evolution basing on a comparative analysis of Russian and European media literacy promotion strategies in the historical context. This influence resulted in the appearance and development of socio-cultural models of media…

  17. Impact assessment of the carbon reduction strategy for transport, low carbon transport : a greener future

    Science.gov (United States)

    2009-07-01

    This is an impact assessment for the Carbon Reduction Strategy for Transport (DfT, 2009), Low Carbon Transport: A Greener Future, which is part of the UK Governments wider UK Low Carbon Transition Plan (DECC, 2009), Britains path to ta...

  18. Teaching Strategies and Practices That Impact English Language Learners' Vocabulary and Language Proficiency in Reading

    Science.gov (United States)

    Blackwell, Jacqueline Rushin

    2013-01-01

    The purpose of this research is to identify teaching strategies and practices that impact the vocabulary and language development for English Language Learners. Today, there are over 3.5 million non-English speaking students enrolled in public classrooms and the number has continued to climb over the past decade. Many ELL students live in poverty…

  19. The Relationship between Offshoring Strategies and Firm Performance: Impact of innovation, absorptive capacity and firm size

    NARCIS (Netherlands)

    M.W. Roza-van Vuren (Marja)

    2011-01-01

    textabstractHow do offshoring strategies impact firm performance? And how are innovation, absorptive capacity and firm size influencing this relationship? This research investigates how firms of varying size, well-established firms and growing firms may profit from relocating business activities to

  20. The Impact of Educational R & D Centers and Laboratories: An Analysis of Effective Organizational Strategies.

    Science.gov (United States)

    Baldridge, J. Victor; Johnson, Rudolph

    The purpose of this research was to study the link between effective management strategies and the impact of educational research and development. The 19 R & D Centers and Regional Laboratories of the United States Office of Education were selected as the focal organizations for analysis. Using document analysis and interviews, the researchers…

  1. Assessing climate change impacts and adaptation strategies for smallholder agricultural systems in Uganda

    NARCIS (Netherlands)

    Bagamba, F.; Bashaasha, B.; Claessens, L.F.G.; Antle, J.

    2012-01-01

    The debate on whether climate change will impact on peoples’ livelihoods and, hence, the need to act is essentially over and has instead shifted to the development of strategies needed by different regions and countries to adapt to climate change effects. However, there is still scanty information

  2. Multimedia Instructional Tools' Impact on Student Motivation and Learning Strategies in Computer Applications Courses

    Science.gov (United States)

    Chapman, Debra; Wang, Shuyan

    2015-01-01

    Multimedia instructional tools (MMIT) have been identified as a way effectively and economically present instructional material. MMITs are commonly used in introductory computer applications courses as MMITs should be effective in increasing student knowledge and positively impact motivation and learning strategies, without increasing costs. This…

  3. The Impact of Marketing Strategies on Craftsmen: A Case Study of Oaxaca, Mexico.

    Science.gov (United States)

    Dominguez Hernandez, Maria Luisa; Hernandez Giron, Jose de la Paz

    1996-01-01

    Interviews with 50 Mexican craftworkers and their families identified their marketing strategies and their impact on community welfare. Results confirmed the need for improving marketing knowledge and entrepreneurship and the necessity of changing attitudes to accept competition, which represents a cultural change. (SK)

  4. Short communications: White-throated Swallow Hirundo albigularis ...

    African Journals Online (AJOL)

    Short communications: White-throated Swallow Hirundo albigularis in Tanzania. NE Baker, EM Baker. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for ...

  5. \\'The snake will swallow you': supernatural snakes and the creation ...

    African Journals Online (AJOL)

    \\'The snake will swallow you': supernatural snakes and the creation of the Khotso legend. Felicity Wood. Abstract. No Abstract. Indilinga: African Journal of Indigenous Knowledge Systems (IAJIKS) Vol. 4(1) 2005: 347-359. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  6. Ellen Swallow Richards (1842-1911): Ecological Foremother.

    Science.gov (United States)

    Thompson, Patricia J.

    Most educated women (in the sciences and other fields) still have a hard time discarding the patriarchal socialization and pressures in their own fields which prevent them from seeing this extraordinary woman as an environmental pioneer and ecological foremother. Ellen Swallow Richards merits attention and respect as a foremother of what would…

  7. Current conservation status of the Blue Swallow Hirundo ...

    African Journals Online (AJOL)

    The overall probability of extinction of the species in the wild is 3%. Minimum viable population size analysis suggests that a goal for the long-term conservation of the Blue Swallow should be to mitigate current threats that are driving declines such that the population increases to a minimum of 3 600 individuals. This should ...

  8. Mastication and swallowing : influence of fluid addition to foods

    NARCIS (Netherlands)

    Pereira, Luciano Jose; Duarte Gaviao, Maria Beatriz; Engelen, Lina; van der Bilt, Andries

    2007-01-01

    introduction: The production of sufficient saliva is indispensable for good chewing. Recent research has demonstrated that salivary flow rate has little influence on the swallowing threshold. Objectives: The hypothesis examined in the present study was that adding fluids to foods will influence

  9. Evaluation of Manometric Measures during Tongue-Hold Swallows

    Science.gov (United States)

    Doeltgen, Sebastian H.; Witte, Ulrike; Gumbley, Freya; Huckabee, Maggie-Lee

    2009-01-01

    Purpose: Based on visual inspection, prior research documented increased movement of the posterior pharyngeal wall in healthy volunteers during tongue-hold swallows. This manometric study investigated the immediate effects of the tongue-hold maneuver on pharyngeal peak pressure generation, duration of pressure generation, and pressure slope…

  10. White-throated Swallow Hirundo albigularis in Tanzania

    African Journals Online (AJOL)

    Scopus 33: 84–85, January 2014. Received 22 August 2013. White-throated Swallow Hirundo ... Paul Oliver and John Whittle for submitting records to the Atlas database. N.E. and E.M. Baker. P.O. Box 1605, Iringa, Tanzania; Email: tzbirdatlas@yahoo.co.uk. Scopus 33: 85, January 2014. Received 21 December 2011.

  11. Effect of posture on swallowing | Alghadir | African Health Sciences

    African Journals Online (AJOL)

    Background: Swallowing is a systematic process. Any structural, physiological or neurological disturbance in this process may cause dysphagia. Although there are studies that report head/neck movements during mastication, there are fewer studies that show the effect of different head/neck postures on difficulty while ...

  12. Quantitative Measures of Swallowing Deficits in Patients With Parkinson's Disease.

    Science.gov (United States)

    Ellerston, Julia K; Heller, Amanda C; Houtz, Daniel R; Kendall, Katherine A

    2016-05-01

    Dysphagia and associated aspiration pneumonia are commonly reported sequelae of Parkinson's disease (PD). Previous studies of swallowing in patients with PD have described prolonged pharyngeal transit time, delayed onset of pharyngeal transit, cricopharyngeal (CP) achalasia, reduced pharyngeal constriction, and slowed hyolaryngeal elevation. These studies were completed using inconsistent evaluation methodology, reliance on qualitative analysis, and a lack of a large control group, resulting in concerns regarding diagnostic precision. The purpose of this study was to investigate swallowing function in patients with PD using a norm-referenced, quantitative approach. This retrospective study includes 34 patients with a diagnosis of PD referred to a multidisciplinary voice and swallowing clinic. Modified barium swallow studies were performed using quantitative measures of pharyngeal transit time, hyoid displacement, CP sphincter opening, area of the pharynx at maximal constriction, and timing of laryngeal vestibule closure relative to bolus arrival at the CP sphincter. Reduced pharyngeal constriction was found in 30.4%, and a delay in airway closure relative to arrival of the bolus at the CP sphincter was the most common abnormality, present in 62% of patients. Previously reported findings of prolonged pharyngeal transit, poor hyoid elevation, and CP achalasia were not identified as prominent features. © The Author(s) 2015.

  13. Impact of Contractors’ Bidding Strategies on Bid Success in the Nigeria Construction Industry

    Directory of Open Access Journals (Sweden)

    Tolulope Samuel Fawale

    2017-01-01

    Full Text Available Several types of researches have been carried out prior to the new millennium on the subject of bidding strategies in the construction industry. Today, organizations are faced with a very complex decision of bid/no-bid because it requires the assessment of large number of highly inter-related variables. The study aims at examining different types of Contractors’ Bidding Strategies (CBS with a view to determining their impact on bid success. In line with the aim, the study objectives include; evaluation of different types of CBS and; assessment of the success rate of contractors’ bid. The method of approach elicits information on the number of projects bided and successes recorded over a period of time. A total of one hundred and seventy-one useable responses were retrieved from questionnaire administration. Descriptive statistics, tables and percentages as well as mean item score (MIS were used for data analysis. The study showed that lowest bid, public relations and joint venture bidding strategies have great impact on contractors’ bid success especially on residential, educational and administrative projects in the Nigeria Construction Industry (NCI. Therefore, the study concluded that relationship exists between contractors’ bidding strategies and equivalent successes recorded over a period of time. It is important to also know that lowest bid strategy still remains the most effective bidding strategy for public works contracting in the NCI.

  14. The impacts of different bidding segment numbers on bidding strategies of generation companies

    International Nuclear Information System (INIS)

    Wang, L.; Yu, C.W.; Wen, F.S.

    2008-01-01

    In a competitive electricity market, generation companies design bidding strategies to maximize their individual profits subject to the constraints imposed by bidding rules. For a generation company, obviously, the optimal bidding strategy and hence the potential of exercising market power may be different if different bidding rules are employed. Hence, a well-designed bidding protocol is vital to the effective and efficient operation of an electricity market. Based on the widely used stepwise bidding rules, the impacts of different numbers of bidding segments on the bidding strategies of generation companies are investigated. This study is focused on a price-taker generation company in an electricity market. A probabilisic model is used to simulate electricity price in the competitive market environment. With a given number of bidding segments, the optimal bidding strategy for a price-taker generation company is then developed. The effects of risk preferences as well as information asymmetry on the optimal bidding strategy are also examined. With particular references to the impacts of different numbers of bidding segments on the optimal bidding strategy, a numerical example is employed to demonstrate the validity of the proposed model and methodology. (author)

  15. Radiation doses to children during modified barium swallow studies

    International Nuclear Information System (INIS)

    Weir, Kelly A.; McMahon, Sandra M.; Long, Gillian; Bunch, Judith A.; Pandeya, Nirmala; Coakley, Kerry S.; Chang, Anne B.

    2007-01-01

    There are minimal data on radiation doses to infants and children undergoing a modified barium swallow (MBS) study. To document screening times, dose area product (DAP) and effective doses to children undergoing MBS and to determine factors associated with increased screening times and effective dose. Fluoroscopic data (screening time, DAP, kVp) for 90 consecutive MBS studies using pulse fluoroscopy were prospectively recorded; effective dose was calculated and data were analyzed for effects of behavior, number of swallow presentations, swallowing dysfunction and medical problems. Mean effective dose for the entire group was 0.0826 ± 0.0544 mSv, screening time 2.48 ± 0.81 min, and DAP 28.79 ± 41.72 cGy cm 2 . Significant differences were found across three age groups (≤1.0, >1.0-3.0 and >3.0 years) for effective dose (mean 0.1188, 0.0651 and 0.0529 mSv, respectively; P < 0.001), but not for screening time or DAP. Effective dose was correlated with screening time (P 0.007), DAP (P < 0.001), number of swallow presentations (P = 0.007), lower age (P = 0.017), female gender (P = 0.004), and height (P < 0.001). Screening time was correlated with total number of swallow presentations (P < 0.001) and DAP (P < 0.001). Screening times, DAP, effective dose, and child and procedural factors associated with higher effective doses are presented for children undergoing MBS studies. (orig.)

  16. Dynamic evaluation of swallowing disorders with electron-beam tomography

    International Nuclear Information System (INIS)

    Raith, J.; Lindbichler, F.; Kern, R.; Groell, R.; Rienmueller, R.

    1996-01-01

    Three cases preselected by videofluorography were studied to evaluate whether electron beam tomography (EBT) permits more detailed dynamic imaging of swallowing disorders focusing on the mesonasopharyngeal segment, the hypopharynx and the upper esophageal sphincter (UES). Immediately after videofluorographic examination of the oropharyngeal deglutition, EBT is performed. The patient is in a supine position and while the patient swallows a 20 ml bolus of water or diluted iodine containing contrast agent, a sequence of 20 images per level is scanned. The levels, which are determined by using the scout view, are oriented parallel to the hard palate either at the level of the hard palate to image the mesonasopharyngel segment or just above the hyoid bone to focus on the hypopharynx or at the location of the USE. The scan technique is a single-slice cinemode with a slice thickness of 3 mm (exposure time 100 ms, interscan delay 16 ms, 130 kV, 620 mA). The following structural interactions that we have so far been unable to image can be clearly demonstrated with EBT: During normal swallowing, the mesonasopharyngeal segment is completely and symmetrically closed by the soft palate and Passavant's cushion; lateral hypopharyngeal pouches can be located more precisely; and disorders of the UES can be differentiated into functional or morphologically caused disorders (e.g., goiter or cervical osteophytes). Videofluorography and cinematography are still the gold standard in functional evaluation of swallowing disorders. However, EBT permits dynamic imaging of pharyngeal deglutition in a preselected transverse plane and can give useful additional information concerning functional anatomical changes in the pharynx during swallowing. Further clinical evaluation is needed. (orig.) [de

  17. Barn swallows nesting near radioactive leaching ponds in southeastern Idaho

    International Nuclear Information System (INIS)

    Millard, J.B.; Whicker, F.W.; Markham, O.D.

    1978-01-01

    Seasonally occurring populations of barn swallows nest near the Test Reactor Area (TRA) radioactive leaching ponds on the Idaho National Engineering Laboratory (INEL) Site. These birds utilize leaching pond arthropods and are therefore capable of accumulating radioactive materials and exporting them from the INEL Site during migration. The breeding biology is discussed for these swallows and a control group located 100 km away. Total nestling mortality for the controls and a 1977 TRA population was found to be statistically identical. Over 20 fission and activation products have been detected in immature and adult TRA birds. Mean concentrations of detectable radionuclides were used to calculate internal dose rates, and results showed that Na-24 contributed about 72% of the total average of 21.9 mrad/d for adult birds. Concentration factors were also calculated for predominant radionuclides in swallows relative to filtered pond water. Data from LiF dosimeters in swallow nests constructed with contaminated mud indicated average dose rates were 84 mrad/d for eggs and 220 mrad/d for nestlings. Growth curves were constructed for the immature TRA birds and controls. The first clutch of TRA swallows was found to have a significantly lower mean growth rate constant than the first clutch of controls. The statistical difference in growth rate between the control and TRA first clutch populations may have resulted from differences in climate, nesting site habitat, or available food sources, and cannot be solely attributed to radiation exposure as a causative factor. Growth rate parameters for TRA birds were within the range of values reported in the literature

  18. Functional MRI study of cerebral cortical activation during volitional swallowing

    International Nuclear Information System (INIS)

    Wakasa, Toru; Aiga, Hideki; Yanagi, Yoshinobu; Kawai, Noriko; Sugimoto, Tomosada; Kuboki, Takuo; Kishi, Kanji

    2002-01-01

    The purpose of this study was to investigate the somatotropic distribution and lateralization of motor and sensory cortical activity during swallowing in healthy adult human subjects using functional MR imaging. Nine healthy right-handed adult volunteers (6 men, 3 women; ages 22-38) were examined. Their cortical activities were evoked by having them swallow, five times, a small bolus of water (3 ml) supplied through a plastic catheter. As a positive control, the subjects performed five repetitions of right-handed grasping tasks. Blood oxygenation level-dependent images were obtained using a 1.5 Tesla MR system (Magnetom Vision, Siemens Germany; repetition time/echo time (TR/TE)=0.96/0.66, flip angle (FA)=90 deg). T1 weighted anatomical images were obtained for the same slices in each subject. Cerebral activity was observed most notably in the primary motor cortex and primary somatosensory cortex, followed by the premotor cortex, anterior cingulate cortex, frontal operculum, and insula. The hand-grasping task activated relatively superior parts of the primary motor and somatosensory cortices. The swallowing task, on the other hand, activated the inferior parts of the pre- and postcentral gyri. The hand-grasping activation of motor and sensory cortices was localized absolutely on the contralateral side, whereas swallowing activated the motor cortex either bilaterally or unilaterally. Swallowing activated the sensory cortex almost always bilaterally. This study suggested that fMRI could be used to identify the specific areas of cortical activation caused by various tasks, and to differentiate the locations of cortical activation between tasks. (author)

  19. Radiation doses to children during modified barium swallow studies

    Energy Technology Data Exchange (ETDEWEB)

    Weir, Kelly A. [University of Queensland, Discipline of Paediatrics and Child Health, School of Medicine, Herston, Queensland (Australia); McMahon, Sandra M. [SpeechNet Speech Pathology Services, Brisbane (Australia); Long, Gillian; Bunch, Judith A. [Royal Children' s Hospital, Department of Medical Imaging, Herston (Australia); Pandeya, Nirmala [Queensland Institute of Medical Research, Herston (Australia); Coakley, Kerry S. [Biomedical Technology Services, Royal Brisbane and Women' s Hospital, Herston (Australia); Chang, Anne B. [Royal Children' s Hospital, Department of Respiratory Medicine, Herston (Australia)

    2007-03-15

    There are minimal data on radiation doses to infants and children undergoing a modified barium swallow (MBS) study. To document screening times, dose area product (DAP) and effective doses to children undergoing MBS and to determine factors associated with increased screening times and effective dose. Fluoroscopic data (screening time, DAP, kVp) for 90 consecutive MBS studies using pulse fluoroscopy were prospectively recorded; effective dose was calculated and data were analyzed for effects of behavior, number of swallow presentations, swallowing dysfunction and medical problems. Mean effective dose for the entire group was 0.0826 {+-} 0.0544 mSv, screening time 2.48 {+-} 0.81 min, and DAP 28.79 {+-} 41.72 cGy cm{sup 2}. Significant differences were found across three age groups ({<=}1.0, >1.0-3.0 and >3.0 years) for effective dose (mean 0.1188, 0.0651 and 0.0529 mSv, respectively; P < 0.001), but not for screening time or DAP. Effective dose was correlated with screening time (P = 0.007), DAP (P < 0.001), number of swallow presentations (P = 0.007), lower age (P = 0.017), female gender (P = 0.004), and height (P < 0.001). Screening time was correlated with total number of swallow presentations (P < 0.001) and DAP (P < 0.001). Screening times, DAP, effective dose, and child and procedural factors associated with higher effective doses are presented for children undergoing MBS studies. (orig.)

  20. Functional MRI study of cerebral cortical activation during volitional swallowing

    Energy Technology Data Exchange (ETDEWEB)

    Wakasa, Toru; Aiga, Hideki; Yanagi, Yoshinobu; Kawai, Noriko; Sugimoto, Tomosada; Kuboki, Takuo; Kishi, Kanji [Okayama Univ. (Japan). Graduate School of Medicine and Dentistry

    2002-12-01

    The purpose of this study was to investigate the somatotropic distribution and lateralization of motor and sensory cortical activity during swallowing in healthy adult human subjects using functional MR imaging. Nine healthy right-handed adult volunteers (6 men, 3 women; ages 22-38) were examined. Their cortical activities were evoked by having them swallow, five times, a small bolus of water (3 ml) supplied through a plastic catheter. As a positive control, the subjects performed five repetitions of right-handed grasping tasks. Blood oxygenation level-dependent images were obtained using a 1.5 Tesla MR system (Magnetom Vision, Siemens Germany; repetition time/echo time (TR/TE)=0.96/0.66, flip angle (FA)=90 deg). T1 weighted anatomical images were obtained for the same slices in each subject. Cerebral activity was observed most notably in the primary motor cortex and primary somatosensory cortex, followed by the premotor cortex, anterior cingulate cortex, frontal operculum, and insula. The hand-grasping task activated relatively superior parts of the primary motor and somatosensory cortices. The swallowing task, on the other hand, activated the inferior parts of the pre- and postcentral gyri. The hand-grasping activation of motor and sensory cortices was localized absolutely on the contralateral side, whereas swallowing activated the motor cortex either bilaterally or unilaterally. Swallowing activated the sensory cortex almost always bilaterally. This study suggested that fMRI could be used to identify the specific areas of cortical activation caused by various tasks, and to differentiate the locations of cortical activation between tasks. (author)

  1. Modern treatment strategies in rheumatoid arthritis: Impact on, and predictors of, disease activity and disease course

    DEFF Research Database (Denmark)

    Hetland, Merete Lund

    trial (CIMESTRA), whereas (B) was investigated in an observational, nationwide cohort study (the DANBIO database). The main findings were: 1. Treatment strategy (A) with methotrexate (MTX) and injections of glucocorticoids into swollen joints had rapid and sustained effect and reduced disease activity......The main aim of the thesis was to evaluate the impact of modern treatment strategies on disease activity and disease course in patients with rheumatoid arthritis (RA), and to identify predictors for treatment response. Two different treatment strategies were investigated: (A) Aggressive......, remission rates and adherence to therapy. Adalimumab had the highest treatment response and remission rates, whereas etanercept had the highest adherence. In conclusion, the results from the CIMESTRA trial and the DANBIO database showed that an aggressive treatment strategy with conventional drugs and intra...

  2. China's new strategy to block Schistosoma japonicum transmission: experiences and impact beyond schistosomiasis.

    Science.gov (United States)

    Wang, Long-De; Guo, Jia-Gang; Wu, Xiao-Hua; Chen, Hong-Gen; Wang, Tian-Ping; Zhu, Shao-Ping; Zhang, Zhi-Hai; Steinmann, Peter; Yang, Guo-Jing; Wang, Shi-Ping; Wu, Zhong-Dao; Wang, Li-Ying; Hao, Yang; Bergquist, Robert; Utzinger, Jürg; Zhou, Xiao-Nong

    2009-12-01

    Despite sustained efforts for its control made over the past 50+ years, the re-emergence of schistosomiasis in China was noted around the turn of the new millennium. Consequently, a new integrated strategy was proposed to stop the contamination of schistosome eggs to the environment, which emphasizes health education, access to clean water and adequate sanitation, mechanization of agriculture and fencing of water buffaloes, along with chemotherapy. Validation of this integrated control strategy in four pilot counties in the provinces of Anhui, Hubei, Hunan and Jiangxi revealed significant reductions in the rate of Schistosoma japonicum infection in humans and intermediate host snails. Importantly, this strategy showed an impact on diseases beyond schistosomiasis, signified by concomitant reductions in the prevalence of soil-transmitted helminth infections. In view of China's new integrated strategy for transmission control of schistosomiasis showing an ancillary benefit on other helminthic diseases, we encourage others to investigate the scope and limits of integrated control of neglected tropical diseases.

  3. Development of risk-based air quality management strategies under impacts of climate change.

    Science.gov (United States)

    Liao, Kuo-Jen; Amar, Praveen; Tagaris, Efthimios; Russell, Armistead G

    2012-05-01

    Climate change is forecast to adversely affect air quality through perturbations in meteorological conditions, photochemical reactions, and precursor emissions. To protect the environment and human health from air pollution, there is an increasing recognition of the necessity of developing effective air quality management strategies under the impacts of climate change. This paper presents a framework for developing risk-based air quality management strategies that can help policy makers improve their decision-making processes in response to current and future climate change about 30-50 years from now. Development of air quality management strategies under the impacts of climate change is fundamentally a risk assessment and risk management process involving four steps: (1) assessment of the impacts of climate change and associated uncertainties; (2) determination of air quality targets; (3) selections of potential air quality management options; and (4) identification of preferred air quality management strategies that minimize control costs, maximize benefits, or limit the adverse effects of climate change on air quality when considering the scarcity of resources. The main challenge relates to the level of uncertainties associated with climate change forecasts and advancements in future control measures, since they will significantly affect the risk assessment results and development of effective air quality management plans. The concept presented in this paper can help decision makers make appropriate responses to climate change, since it provides an integrated approach for climate risk assessment and management when developing air quality management strategies. Development of climate-responsive air quality management strategies is fundamentally a risk assessment and risk management process. The risk assessment process includes quantification of climate change impacts on air quality and associated uncertainties. Risk management for air quality under the impacts of

  4. Effectiveness of Chin-tuck Maneuver to Facilitate Swallowing in Neurologic Dysphagia

    Directory of Open Access Journals (Sweden)

    Saconato, Mariana

    2015-10-01

    Full Text Available Introduction The chin-tuck maneuver is the most frequently employed postural maneuver in the treatment of neurogenic oropharyngeal dysphagia caused by encephalic vascular strokes and degenerative diseases. Objective The purpose of this study was to investigate the effectiveness of this maneuver in patients with neurogenic dysphagia and factors that could interfere in it. Methods In this retrospective cohort, we analyzed the medical files and videofluoroscopy exams of 35 patients (19 male – 54% and 16 female – 46%; age range between 20 and 89 years old; mean = 69 years. Results The results suggest that the effectiveness of chin-tuck maneuver is related to the overall degree of dysphagia: the more severe the dysphagia, the less effective the maneuver. Conclusion Chin-tuck maneuver should benefit dysphagic patients with delay in the swallowing trigger, reduced laryngeal elevation, and difficulties to swallow liquids, but is not the best compensatory strategy for patients with severe dysphagia.

  5. Dysphagia progression and swallowing management in Parkinson's disease: an observational study

    Directory of Open Access Journals (Sweden)

    Karen Fontes Luchesi

    2015-02-01

    Full Text Available Introduction: Dysphagia is relatively common in individuals with neurological disorders. Objective: To describe the swallowing management and investigate associated factors with swallowing in a case series of patients with Parkinson's disease. Methods: It is a long-term study with 24 patients. The patients were observed in a five-year period (2006-2011. They underwent Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale and therapeutic intervention every three months. In the therapeutic intervention they received orientation about exercises to improve swallowing. The Chi-square, Kruskal-Wallis and Fisher's tests were used. The period of time for improvement or worsening of swallowing was described by Kaplan-Meier analysis. Results: During the follow-up, ten patients improved, five stayed the same and nine worsened their swallowing functionality. The median time for improvement was ten months. Prior to the worsening there was a median time of 33 months of follow-up. There was no associated factor with improvement or worsening of swallowing. The maneuvers frequently indicated in therapeutic intervention were: chin-tuck, bolus consistency, bolus effect, strengthening-tongue, multiple swallows and vocal exercises. Conclusion: The swallowing management was characterized by swallowing assessment every three months with indication of compensatory and rehabilitation maneuvers, aiming to maintain the oral feeding without risks. There was no associated factor with swallowing functionality in this case series.

  6. Dysphagia progression and swallowing management in Parkinson's disease: an observational study.

    Science.gov (United States)

    Luchesi, Karen Fontes; Kitamura, Satoshi; Mourão, Lucia Figueiredo

    2015-01-01

    Dysphagia is relatively common in individuals with neurological disorders. To describe the swallowing management and investigate associated factors with swallowing in a case series of patients with Parkinson's disease. It is a long-term study with 24 patients. The patients were observed in a five-year period (2006-2011). They underwent Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale and therapeutic intervention every three months. In the therapeutic intervention they received orientation about exercises to improve swallowing. The Chi-square, Kruskal-Wallis and Fisher's tests were used. The period of time for improvement or worsening of swallowing was described by Kaplan-Meier analysis. During the follow-up, ten patients improved, five stayed the same and nine worsened their swallowing functionality. The median time for improvement was ten months. Prior to the worsening there was a median time of 33 months of follow-up. There was no associated factor with improvement or worsening of swallowing. The maneuvers frequently indicated in therapeutic intervention were: chin-tuck, bolus consistency, bolus effect, strengthening-tongue, multiple swallows and vocal exercises. The swallowing management was characterized by swallowing assessment every three months with indication of compensatory and rehabilitation maneuvers, aiming to maintain the oral feeding without risks. There was no associated factor with swallowing functionality in this case series. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  7. The swallowing reflex and its significance as an airway defensive reflex

    Directory of Open Access Journals (Sweden)

    Takashi eNishino

    2013-01-01

    Full Text Available Swallowing function, in humans, is very complex. Swallowing plays, not only an important role in food digestion, but also a major role in preventing the entrance of food and/or other materials into the lower respiratory tract. To achieve this, precise coordination is necessary between breathing and swallowing since the pharynx serves as a common pathway for both respiration and digestion. The swallowing reflex consists of afferent pathways, central integration, and efferent pathways. Any defect or disorder along reflex arc can cause a potential delay or impairment in swallow function. The swallowing reflex can be modulated not only by pathological factors but also by physiological factors. Among these, timing of swallows in relation to the phase of respiration may be the most important factor that determines the occurrence of pulmonary aspiration, since phases of inspiration and the expiration-inspiration transition are the most vulnerable for pulmonary aspiration.

  8. The Impact of Modified Multi-Component Cognitive Strategy Instruction in the Acquisition of Metacognitive Strategy Knowledge in the Text Comprehension Process of Students with Mental Retardation

    Science.gov (United States)

    Doganay Bilgi, Arzu; Ozmen, E. Ruya

    2014-01-01

    The purpose of this study was to determine the impact of Modified Multi-component Cognitive Strategy Instruction on the metacognitive strategy knowledge used for the comprehension process of descriptive texts for students with mild mental retardation (MMR). Three students with MMR from inclusive classes participated in the study. The study was…

  9. Effect of occlusal vertical dimension on swallowing patterns and perioral electromyographic activity.

    Science.gov (United States)

    MacAvoy, S K; Jack, H C; Kieser, J; Farella, M

    2016-07-01

    Abnormal swallow patterns have been associated with specific dentofacial traits, such as an anterior open bite, but the cause-effect relationship between swallowing and malocclusion remains highly controversial. The aim of this research was to determine the effects of acute change in occlusal vertical dimension (OVD) on intraoral pressure swallow patterns and perioral electromyographic activity (EMG) during swallowing. Ten volunteers (five female, five male; 27-32 years) repeated standardised swallowing tasks as the OVD was progressively increased using mandibular trays of different heights. Standardised swallowing tasks were performed repetitively with each tray in place. Individual swallowing waveforms were quantitatively and qualitatively analysed. Peak pressure, swallow duration, time to peak pressure and lip EMG peak activity were assessed for each swallow. Data were analysed using mixed-model analysis. As OVD increased, lip peak pressure during swallowing increased almost threefold (+2·1 kPa; P ≤ 0·001), whereas swallow duration increased by 12·7 per cent (+160 ms; P = 0·01) at lip level and by 26·4 per cent (+270 ms; P < 0·001) at tongue level. Perioral muscle activity during swallows increased by 43·7 per cent (P ≤ 0·01) up to the OVD where resting lip seal was not attainable. Swallowing waveforms varied markedly between individuals, but interindividual waveforms were only minimally affected. The adaptive response and the waveform similarities associated with OVD variation supports the existence of a central control mechanism for swallowing, which may be modified by peripheral inputs. © 2016 John Wiley & Sons Ltd.

  10. Impact of the Converter Control Strategies on the Drive Train of Wind Turbine during Voltage Dips

    Directory of Open Access Journals (Sweden)

    Fenglin Miao

    2015-10-01

    Full Text Available The impact of converter control strategies on the drive train of wind turbines during voltage dips is investigated in this paper using a full electromechanical model. Aerodynamics and tower vibration are taken into consideration by means of a simulation program, named FAST. Detailed gearbox and electrical subsystems are represented in MATLAB. The dynamic response of electromagnetic torque and its impact on the mechanical variables are the concern in this paper and the response of electrical variables is less discussed. From the mechanical aspects, the effect of rising power recovery speed and unsymmetrical voltage dips are analyzed on the basis of the dynamic response of the high-speed shaft (HSS. A comparison of the impact on the drive train is made for two converter control strategies during small voltage dips. Through the analysis of torque, speed and tower vibration, the results indicate that both power recovery speed and the sudden torque sag have a significant impact on drive trains, and the effects depend on the different control strategies. Moreover, resonance might be excited on the drive train by an unbalanced voltage.

  11. Design and construction strategies for reducing embodied impacts from buildings – Case study analysis

    DEFF Research Database (Denmark)

    Malmqvist, Tove; Nehasilova, Marie; Moncaster, Alice

    2018-01-01

    emissions (EEG) from buildings. The aim of this paper is to identify and provide a collected and comprehensive overview of quantitative reduction potentials of the particular EEG reduction strategies which should be considered by the stakeholders engaged in, and with the capacity to influence the outcome of...... of national energy mixes. Stakeholders therefore have a growing interest in understanding the possibilities for reducing em- bodied impacts in buildings. In the IEA EBC project ‘Annex 57’ a broad call for case studies was launched with the aim to identify design strategies for reducing embodied energy and GHG...

  12. Study of impacts of physical contracts and financial contracts on bidding strategies of GENCOs

    International Nuclear Information System (INIS)

    Xiaoling Chen; He, Y.; Song, Y.H.

    2004-01-01

    This paper studies the impacts of physical contracts and financial contracts on the bidding strategies of GENCOs, including Physical Bilateral Contracts, Contracts for Difference (CfDs), Call Options and Put Options under discriminatory pricing mechanism. The integrated bidding decision model is applied, which has three main modules - probabilistic local marginal price simulator, market-oriented unit commitment model and multi-criteria decision system. The numerical results show that the GENCO will choose different bidding strategies if it holds different types of contract. The results also suggest that CfDs have the best performance for risk alleviation. (author)

  13. Long-term swallow function after chemoradiotherapy for oropharyngeal cancer: the influence of a prophylactic gastrostomy or reactive nasogastric tube.

    Science.gov (United States)

    Prestwich, R J D; Teo, M T W; Gilbert, A; Williams, G; Dyker, K E; Sen, M

    2014-02-01

    Two contrasting approaches of a prophylactic gastrostomy or a nasogastric tube as needed are widely used to support patients receiving chemoradiotherapy for head and neck cancer. The influence of the type and timing of enteral feeding tube support upon long-term swallowing is uncertain. This study analysed the patients' perspective on long-term swallowing, comparing two groups of patients who received chemoradiotherapy for oropharyngeal cancer managed with the two approaches. The MD Anderson Dysphagia Inventory (MDADI) was posted to 63 consecutive patients with oropharyngeal squamous cell cancer treated with concurrent chemoradiotherapy between January 2007 and June 2009, who had not required therapeutic enteral feeding before treatment and who were disease free on follow-up at least 2 years after treatment. In total, 56/63 patients completed questionnaires; 43 had been managed with a prophylactic gastrostomy and 13 with a policy of nasogastric tube as needed. There were no significant differences in all global, emotional, physical or functional domains of the MDADI according to enteral feeding strategy. Diet at 6 months after treatment was significantly correlated with better MDADI scores. In this study, the choice of a prophylactic gastrostomy or nasogastric tube as needed did not seem to influence long-term swallowing function. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  14. Health assessment of tree swallows (Tachycineta bicolor) on the oil sands using stress, immune function and growth indicators

    Energy Technology Data Exchange (ETDEWEB)

    Harms, N.J.; Smits, J.E. [Saskatchewan Univ., Saskatoon, SK (Canada)

    2009-07-01

    Oil sand mining companies in Alberta continue to explore reclamation strategies for tailings water and are evaluating the ecological effectiveness of constructed wetlands for the bioremediation of liquid and solid tailings contaminated with naphthenic acids, polycyclic aromatic hydrocarbons, and dissolved inorganic ions. The success of reclaimed sites and ecosystem health can be measured by examining health variables in wild tree swallows (Tachycineta bicolor) nesting on experimental wetlands receiving tailings or water from tailings ponds. This presentation reported on a study that measured clutch size, egg mass, and hatching and fledging success of 40 breeding pairs of tree swallows on 3 experimental wetlands on Suncor Energy Inc. and Syncrude Canada Ltd. oil sands leases. The Shallow Wetlands/Demonstration Pond (Syncrude), Consolidated Tailings and Natural Wetlands (Suncor) represent sites of different ages and different categories of wetland reclamation, notably mature, maturing, and newly reclaimed. Due to lack of nesting success on the selected reference site, the Shallow Wetlands/Demonstration Pond was selected as the reference site because it has undergone nearly complete bioremediation and had a very low level of contamination. Nestling growth and survival were measured in 199 tree swallows nestlings on the 3 experimental wetlands. Two mid-weight nestlings from 12 nest boxes on each study site were also examined for feather corticosterone levels and adaptive immune function.

  15. Aging-related changes in swallowing, and in the coordination of swallowing and respiration determined by novel non-invasive measurement techniques.

    Science.gov (United States)

    Wang, Chin-Man; Chen, Ji-Yih; Chuang, Chiung-Cheng; Tseng, Wen-Chun; Wong, Alice M K; Pei, Yu-Cheng

    2015-06-01

    Previous studies have shown that the process of swallowing changes with aging, a phenomenon known as presbyphagia. These subtle and subclinical age-related changes make older adults more vulnerable to dysphagia during disease insults. However, there are limited studies of the swallowing process in older adults, because measurements are typically invasive or require exposure to X-rays. In the present study, we used integrated non-invasive measurements to determine aging-related changes of swallowing, and in the coordination of swallowing and respiration for a population of healthy participants. The non-invasive system provided measurements of larynx movement with piezoelectric sensors, submental muscle activity with surface electromyography and respiration-swallowing coordination by measurement of nasal airflow. We recruited 112 healthy participants from the community, 35 in a young-age group (age 20-30 years), 38 in a middle-age group (age 31-50 years) and 39 in an old-age group (age 51-70 years). The oropharyngeal swallowing parameters of the old-age group had delayed onset latency and longer swallowing apnea duration relative to the other groups, and these differences were greater for larger boluses. The middle- and old-age groups had less expiratory-expiratory respiratory phase pattern than the young-age group. The probability of piecemeal deglutition was highest in the old-age group and lowest in the young-age group. These results show that the phases of oropharyngeal swallowing and the coordination of swallowing with respiration gradually change with aging. We used integrated non-invasive measurements to document age-related changes in swallowing, and in the coordination of swallowing and respiration in healthy adults. © 2014 The Authors. Geriatrics & Gerontology International published by Wiley Publishing Asia Pty Ltd on behalf of Japan Geriatrics Society.

  16. Impact Time Guidance Law Considering Autopilot Dynamics Based on Variable Coefficients Strategy for Maneuvering Target

    Directory of Open Access Journals (Sweden)

    Wei Shang

    2015-01-01

    Full Text Available This paper investigates the terminal guidance problem for the missile intercepting a maneuvering target with impact time constraint. An impact time guidance law based on finite time convergence control theory is developed regarding the target motion as an unknown disturbance. To further improve the performance of the guidance law, an autopilot dynamics which is considered as a first-order lag is taken into consideration. In the proposed method, the coefficients change with the relative distance between missile and target. This variable coefficient strategy ensures that the missile impacts the target at the desired time with little final miss distance. Then it is proved that states of the guidance system converge to sliding mode in finite time under the proposed guidance law. Numerical simulations are presented to demonstrate the effectiveness of the impact time guidance law with autopilot dynamics (ITGAD.

  17. Effects of Change in Tongue Pressure and Salivary Flow Rate on Swallow Efficiency Following Chemoradiation Treatment for Head and Neck Cancer.

    Science.gov (United States)

    Rogus-Pulia, Nicole M; Larson, Charles; Mittal, Bharat B; Pierce, Marge; Zecker, Steven; Kennelty, Korey; Kind, Amy; Connor, Nadine P

    2016-10-01

    Patients treated with chemoradiation for head and neck cancer frequently develop dysphagia. Tissue damage to the oral tongue causing weakness along with decreases in saliva production may contribute to dysphagia. Yet, effects of these variables on swallowing-related measures are unclear. The purpose of this study was (1) to determine effects of chemoradiation on tongue pressures, as a surrogate for strength, and salivary flow rates and (2) to elucidate relationships among tongue pressures, saliva production, and swallowing efficiency by bolus type. Twenty-one patients with head and neck cancer treated with chemoradiation were assessed before and after treatment and matched with 21 healthy control participants who did not receive chemoradiation. Each participant was given a questionnaire to rate dysphagia symptoms. Videofluoroscopic Evaluation of Swallowing (VFES) was used to determine swallowing efficiency; the Saxon test measured salivary flow rate; and the Iowa Oral Performance Instrument (IOPI) was used for oral tongue maximum and endurance measures. Results revealed significantly lower tongue endurance measures for patients post-treatment as compared to controls (p = .012). Salivary flow rates also were lower compared to pre-treatment (p = .000) and controls (p = .000). Simple linear regression analyses showed that change in salivary flow rate was predictive of change in swallow efficiency measures from pre- to post-treatment for 1 mL thin liquid (p = .017), 3 mL nectar-thick liquid (p = .026), and 3 mL standard barium pudding (p = .011) boluses. Based on these findings, it appears that chemoradiation treatment affects tongue endurance and salivary flow rate, and these changes may impact swallow efficiency. These factors should be considered when planning treatment for dysphagia.

  18. Testosterone, plumage colouration and extra-pair paternity in male North-American barn swallows.

    Directory of Open Access Journals (Sweden)

    Cas Eikenaar

    Full Text Available In most monogamous bird species, circulating testosterone concentration in males is elevated around the social female's fertile period. Variation in elevated testosterone concentrations among males may have a considerable impact on fitness. For example, testosterone implants enhance behaviours important for social and extra-pair mate choice. However, little is known about the relationship between natural male testosterone concentration and sexual selection. To investigate this relationship we measured testosterone concentration and sexual signals (ventral plumage colour and tail length, and determined within and extra-pair fertilization success in male North American barn swallows (Hirundo rustica erythrogaster. Dark rusty coloured males had higher testosterone concentrations than drab males. Extra-pair paternity was common (42% and 31% of young in 2009 and 2010, respectively, but neither within- nor extra-pair fertilization success was related to male testosterone concentration. Dark rusty males were less often cuckolded, but did not have higher extra-pair or total fertilization success than drab males. Tail length did not affect within- or extra-pair fertilization success. Our findings suggest that, in North American barn swallows, male testosterone concentration does not play a significant direct role in female mate choice and sexual selection. Possibly plumage colour co-varies with a male behavioural trait, such as aggressiveness, that reduces the chance of cuckoldry. This could also explain why dark males have higher testosterone concentrations than drab males.

  19. The Impact of Quantum Teaching Strategy on Student Academic Achievements and Self-Esteem in Inclusive Schools

    Science.gov (United States)

    Gunarhadi; Kassim, Mustapa; Shaari, Abdull Sukor

    2014-01-01

    Purpose: This research was aimed at showing the impact of a teaching strategy called the Quantum Teaching Strategy on students' academic achievements in two school subjects, namely in Bahasa Indonesia and Science, in comparison to that experienced through classes using a conventional teaching strategy. This research also examined the role of…

  20. The impact of globalisation on SME-subcontractors'supply chain strategies: a Danish case study

    DEFF Research Database (Denmark)

    Mathiasen, John Bang; Gammelgaard, Britta

    2007-01-01

    with higher demands on all parameters but again the price has become decisive and the traditional customer relations no longer automatically generate new orders. Subcontractors in their turn try to meet these new conditions using various strategies, moving production facilities and accepting new roles......Globalisation and competition have impacted on not only large firms but also Small and Medium sizes Enterprises (SME) and these enterprises often act as subcontractors to larger firms operating in international markets. The impact of globalisation is severe on the SME-subcontractors due to supply...

  1. Impact of production strategies and animal performance on economic values of dairy sheep traits.

    Science.gov (United States)

    Krupová, Z; Wolfová, M; Krupa, E; Oravcová, M; Daňo, J; Huba, J; Polák, P

    2012-03-01

    The objective of this study was to carry out a sensitivity analysis on the impact of various production strategies and performance levels on the relative economic values (REVs) of traits in dairy sheep. A bio-economic model implemented in the program package ECOWEIGHT was used to simulate the profit function for a semi-extensive production system with the Slovak multi-purpose breed Improved Valachian and to calculate the REV of 14 production and functional traits. The following production strategies were analysed: differing proportions of milk processed to cheese, customary weaning and early weaning of lambs with immediate sale or sale after artificial rearing, seasonal lambing in winter and aseasonal lambing in autumn. Results of the sensitivity analysis are presented in detail for the four economically most important traits: 150 days milk yield, conception rate of ewes, litter size and ewe productive lifetime. Impacts of the differences in the mean value of each of these four traits on REVs of all other traits were also examined. Simulated changes in the production circumstances had a higher impact on the REV for milk yield than on REVs of the other traits investigated. The proportion of milk processed to cheese, weaning management strategy for lambs and level of milk yield were the main factors influencing the REV of milk yield. The REVs for conception rate of ewes were highly sensitive to the current mean level of the trait. The REV of ewe productive lifetime was most sensitive to variation in ewe conception rate, and the REV of litter size was most affected by weaning strategy for lambs. On the basis of the results of sensitivity analyses, it is recommended that economic values of traits for the overall breeding objective for dairy sheep be calculated as the weighted average of the economic values obtained for the most common production strategies of Slovak dairy sheep farms and that economic values be adjusted after substantial changes in performance levels

  2. Strategies to accommodate resident work-hour restrictions: impact on surgical education.

    Science.gov (United States)

    Freiburg, Carter; James, Ted; Ashikaga, Takamura; Moalem, Jacob; Cherr, Greg

    2011-01-01

    The introduction of duty-hour restrictions has impacted surgical training. Several strategies were introduced by training programs in response to these restrictions. The purpose of this study was to assess the various strategies employed by residency programs to comply with work-hour restrictions with respect to the impact on the quality of surgical education. A national survey was developed and distributed to resident members of the Resident and Associate Society of the American College of Surgeons in all accredited residency programs across North America. Questions in the survey addressed 10 separate accommodation strategies used by training programs to adhere to resident work-hour restrictions. Resident respondents completed a 5-point Likert scale rating each strategy according to its impact on surgical education (detrimental, not very helpful, neutral, somewhat helpful, and very helpful). A total of 599 (9.7%) responses were received from 6186 members of the Resident Associate Society. The use of health information technology (IT), nurse practitioners, and physician assistants were most highly rated. Hiring clinical fellows, establishing nonteaching services, and shift-work scheduling were the three most poorly rated accommodations to work-hour restrictions with respect to resident education. Hospital IT and nonphysician care providers were rated by residents to optimize surgical education in the current work-hour limitation environment. We infer that strategies which lead to increased efficiency and redistribution of resident workload allow surgical trainees to spend more time on activities perceived to have higher educational value. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  3. The impact of teaching communication strategies on EFL learners’ Willingness to Communicate

    OpenAIRE

    Abulfazl Mesgarshahr; Esmaeel Abdollahzadeh

    2014-01-01

    One of the pedagogical implications of the research on the Willingness to Communicate (WTC) might be to propose practical ways of making language learners more willing to communicate in the classroom. This study investigated the impact of teaching communication strategies (CSs) on Iranian EFL learners’ WTC. To this end, 8 intact classes were included as the experimental and control groups. The control group underwent regular language instruction, while the experimental group received the trea...

  4. Optimizing Preventive Strategies and Malaria Diagnostics to Reduce the Impact of Malaria on US Military Forces

    Science.gov (United States)

    2012-05-01

    quinine (Q), intramuscular artemether, intravenous AS, and AS suppositories are used to treat severe malaria ; all are efficacious and should be...DOD Malaria Stakeholder Meeting May 30-31, 2012 Bethesda, MD Optimizing Preventive Strategies and Malaria Diagnostics to Reduce the Impact...of Malaria on US Military Forces The Armed Forces Health Surveillance Center, the U.S. Army Medical Research and Materiel Command and OSD/Health

  5. A STUDY ON IMPACT OF ICT ON THE MARKETING STRATEGY OF INDIAN TOURISM INDUSTRY

    OpenAIRE

    Md. Kashif Ansari; Garima Jain; Jasleen Kaur

    2017-01-01

    Deployment of ICT has been changing the way companies in every industry conduct their business. The most impacted is the marketing department. Marketers need to constantly study the market and the rapid changes in technology to continue satisfying the new-age customers. These customers have access to multiple sources of information due to increased usage of ICT. The present study analyses the evolution of Indian tourism industry, focusing on its marketing strategies over the years. The author...

  6. Market Impact of Foot-and-Mouth Disease Control Strategies: A UK Case Study.

    Science.gov (United States)

    Feng, Siyi; Patton, Myles; Davis, John

    2017-01-01

    Foot-and-mouth disease (FMD) poses a serious threat to the agricultural sector due to its highly contagious nature. Outbreaks of FMD can lead to substantial disruptions to livestock markets due to loss of production and access to international markets. In a previously FMD-free country, the use of vaccination to augment control of an FMD outbreak is increasingly being recognized as an alternative control strategy to direct slaughtering [stamping-out (SO)]. The choice of control strategy has implications on production, trade, and hence prices of the sector. Specific choice of eradication strategies depends on their costs and benefits. Economic impact assessments are often based on benefit-cost framework, which provide detailed information on the changes in profit for a farm or budget implications for a government (1). However, this framework cannot capture price effects caused by changes in production due to culling of animals; access to international markets; and consumers' reaction. These three impacts combine to affect equilibrium within commodity markets (2). This paper provides assessment of sectoral level impacts of the eradication choices of FMD outbreaks, which are typically not available from benefit-cost framework, in the context of the UK. The FAPRI-UK model, a partial equilibrium model of the agricultural sector, is utilized to investigate market outcomes of different control strategies (namely SO and vaccinate-to-die) in the case of FMD outbreaks. The outputs from the simulations of the EXODIS epidemiological model (number of animals culled/vaccinated and duration of outbreak) are used as inputs within the economic model to capture the overall price impact of the animal destruction, export ban, and consumers' response.

  7. Innate immune response development in nestling tree swallows

    Science.gov (United States)

    Stambaugh, T.; Houdek, B.J.; Lombardo, M.P.; Thorpe, P.A.; Caldwell, Hahn D.

    2011-01-01

    We tracked the development of innate immunity in nestling Tree Swallows (Tachycineta bicolor) and compared it to that of adults using blood drawn from nestlings during days 6, 12, and 18 of the ???20-day nestling period and from adults. Innate immunity was characterized using an in vitro assay of the ability of whole blood to kill Escherichia coli. The ability of whole blood to kill E. coli increased as nestlings matured. Neither this component of innate immunity nor right wing chord length on day18 were as developed as in adults indicating that development of the innate immune system and growth both continued after fledging. Narrow sense heritability analyses suggest that females with strong immune responses produced nestlings with strong immune responses. These data suggest nestling Tree Swallows allocated sufficient energy to support rapid growth to enable fledging by day 18, but that further development of innate immunity occurred post-fledging. ?? 2011 by the Wilson Ornithological Society.

  8. "Music & Memory" and improved swallowing in advanced dementia.

    Science.gov (United States)

    Cohen, Dan; Post, Stephen G; Lo, Angela; Lombardo, Robin; Pfeffer, Brandon

    2018-01-01

    Background Dysphagia and difficulty with eating affects a significant portion of individuals with advanced dementia. Such problems with oral intake can have serious health consequences including mealtime distress, dehydration and malnutrition, aspiration, reduced quality of life, and increased mortality risk. Design We present the first data indicating that "Music & Memory" interventions improve swallowing in individuals with advanced dementia, thereby making oral feeding easier and potentially diminishing reliance on PEG. Setting Columbia Health Care Center, Wyocena, WI (with Music&Memory.org, Mineola, NY and Stony Brook University). Participants Residents with advanced dementia (N = 5). Observation by eight professional caregivers. Results (1) Enhanced swallowing mechanism with Music & Memory prior to dining; (2) decreased incidents of choking during mealtime; (3) improved nutritional status; (4) reduced weight loss; (5) reduced need for speech interventions; (6) enhanced quality of life. Conclusions The preliminary results call for additional research.

  9. The potential impact of labor choices on the efficacy of marine conservation strategies.

    Directory of Open Access Journals (Sweden)

    Zachary D Hughes

    Full Text Available Conservation of marine resources is critical to the wellbeing of human communities. Coastal artisanal fishing communities are particularly reliant on marine resources for food and for their livelihoods. Management actions aimed at marine conservation may lead to unanticipated changes in human behavior that influence the ability of conservation programs to achieve their goals. We examine how marine conservation strategies may impact labor decisions that influence both the ecosystem and human livelihoods using simulation modeling. We consider two conservation strategies in the model: direct action through fisheries regulation enforcement, and indirect action through land conservation. Our results indicate that both strategies can increase the abundance of fish, and thus contribute to the maintenance of marine resources. However, our results also show that marine fisheries enforcement may negatively impact the livelihoods of human communities. Land conservation, on the other hand, potentially enhances the livelihood of the human populations. Thus, depending on management objectives, indirect or a combination of direct and indirect conservation strategies may be effective at achieving conservation and sustainability goals. These results highlight the importance of accounting for changes in human behavior resulting from management actions in conservation and management.

  10. An Evidence-Based Review of Impacts, Strategies and Tools to Mitigate Urban Heat Islands

    Directory of Open Access Journals (Sweden)

    Walter Leal Filho

    2017-12-01

    Full Text Available The impacts of climate changes on cities, which are home to over half of the world’s population, are already being felt. In many cases, the intensive speed with which urban centres have been growing means that little attention has been paid to the role played by climatic factors in maintaining quality of life. Among the negative consequences of rapid city growth is the expansion of the problems posed by urban heat islands (UHIs, defined as areas in a city that are much warmer than other sites, especially in comparison with rural areas. This paper analyses the consistency of the UHI-related literature in three stages: first it outlines its characteristics and impacts in a wide variety of cities around the world, which poses pressures to public health in many different countries. Then it introduces strategies which may be employed in order to reduce its effects, and finally it analyses available tools to systematize the initial high level assessment of the phenomenon for multidisciplinary teams involved in the urban planning process. The analysis of literature on the characteristics, impacts, strategies and digital tools to assess on the UHI, reveals the wide variety of parameters, methods, tools and strategies analysed and suggested in the different studies, which does not always allow to compare or standardize the diagnosis or solutions.

  11. An Evidence-Based Review of Impacts, Strategies and Tools to Mitigate Urban Heat Islands

    Science.gov (United States)

    Leal Filho, Walter; Echevarria Icaza, Leyre; Emanche, Victoria Omeche; Quasem Al-Amin, Abul

    2017-01-01

    The impacts of climate changes on cities, which are home to over half of the world’s population, are already being felt. In many cases, the intensive speed with which urban centres have been growing means that little attention has been paid to the role played by climatic factors in maintaining quality of life. Among the negative consequences of rapid city growth is the expansion of the problems posed by urban heat islands (UHIs), defined as areas in a city that are much warmer than other sites, especially in comparison with rural areas. This paper analyses the consistency of the UHI-related literature in three stages: first it outlines its characteristics and impacts in a wide variety of cities around the world, which poses pressures to public health in many different countries. Then it introduces strategies which may be employed in order to reduce its effects, and finally it analyses available tools to systematize the initial high level assessment of the phenomenon for multidisciplinary teams involved in the urban planning process. The analysis of literature on the characteristics, impacts, strategies and digital tools to assess on the UHI, reveals the wide variety of parameters, methods, tools and strategies analysed and suggested in the different studies, which does not always allow to compare or standardize the diagnosis or solutions. PMID:29257100

  12. Fetal swallowing as a protective mechanism against oligohydramnios and polyhydramnios in late gestation sheep.

    Science.gov (United States)

    Brace, Robert A; Anderson, Debra F; Cheung, Cecilia Y

    2013-03-01

    Our objectives were to (1) quantify the relationship between daily swallowed volume and amniotic fluid volume (AF volume) in late gestation ovine fetuses and (2) use the resulting regression equation to explore the role of swallowing in regulating AF volume. Daily swallowed volume ranged from 36 to 1963 mL/d while experimental AF volume ranged from 160 to 6150 mL (n = 115). Swallowed volume was near zero when AF volume was far below normal, a maximum of 635 ± 41 (standard error) mL/d when AF volume was 1682 ± 31 mL and did not increase further with higher AF volumes. Computer simulations predicted that fetal swallowing would (1) return AF volume to normal in 5 to 6 days following an acute volume change in the absence of changes in other amniotic inflows or outflows and (2) stabilize AF volume in 4 to 8 days following sustained alterations in amniotic inflows or outflows other than swallowing. The volume of AF swallowed each day by the fetus is a strong function of AF volume and reaches a maximum when mild polyhydramnios develops. With deviations in AF volume from normal, changes in fetal swallowing protect against oligohydramnios and polyhydramnios because the changes in swallowing over time reduce the extent of the AF volume change. However, with experimental changes in AF volume stabilizing in 1 to 2 days, it appears that swallowing is not the major regulator of AF volume.

  13. Attentional resource allocation and swallowing safety in Parkinson's disease: a dual task study.

    Science.gov (United States)

    Troche, Michelle S; Okun, Michael S; Rosenbek, John C; Altmann, Lori J; Sapienza, Christine M

    2014-04-01

    Aspiration pneumonia is a leading cause of death in persons with Parkinson's disease (PD). Despite this, the mechanisms underlying dysphagia in this population are unclear. To date, researchers have not investigated the effects of varying cognitive demand on objective measures of swallowing safety. This study assessed whether swallowing safety could be disrupted by increasing cognitive demands during the task of swallowing. Twenty participants with moderate PD and dysphagia were tested while completing a novel dual task experimental paradigm under videofluoroscopy. In the dual task condition, participants swallowed 10 cc of thin liquid barium while completing a digits forward task. Four females and 16 males completed the study. Results revealed differential effects to swallowing safety based on baseline measures of cognitive flexibility and attention. Participants with mild impairment in cognitive flexibility and attention demonstrated cognitive-motor interference with worsening of both swallowing and cognitive performance. In contrast, participants who were most impaired in the domains of cognitive flexibility and attention improved swallowing safety in the dual task condition. Additionally, decreased swallow timing durations existed in the dual task condition compared to the single task condition. The results of this study support the hypothesis that supramedullary drive can influence the swallowing plan. Additionally, this study highlights the need for cognitive taxing during swallowing evaluations. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Attentional resource allocation and swallowing safety in Parkinson’s disease: A dual task study

    Science.gov (United States)

    Troche, Michelle S.; Okun, Michael S.; Rosenbek, John C.; Altmann, Lori J.; Sapienza, Christine M.

    2015-01-01

    Background Aspiration pneumonia is a leading cause of death in persons with Parkinson’s disease (PD). Despite this, the mechanisms underlying dysphagia in this population are unclear. To date, researchers have not investigated the effects of varying cognitive demand on objective measures of swallowing safety. This study assessed whether swallowing safety could be disrupted by increasing cognitive demands during the task of swallowing. Methods Twenty participants with moderate PD and dysphagia were tested while completing a novel dual task experimental paradigm under videofluoroscopy. In the dual task condition, participants swallowed 10 cc of thin liquid barium while completing a digits forward task. Results Four females and 16 males completed the study. Results revealed differential effects to swallowing safety based on baseline measures of cognitive flexibility and attention. Participants with mild impairment in cognitive flexibility and attention demonstrated cognitive-motor interference with worsening of both swallowing and cognitive performance. In contrast, participants who were most impaired in the domains of cognitive flexibility and attention improved swallowing safety in the dual task condition. Additionally, decreased swallow timing durations existed in the dual task condition compared to the single task condition. Conclusions The results of this study support the hypothesis that supramedullary drive can influence the swallowing plan. Additionally, this study highlights the need for cognitive taxing during swallowing evaluations. PMID:24444532

  15. Automated acoustic analysis in detection of spontaneous swallows in Parkinson's disease.

    Science.gov (United States)

    Golabbakhsh, Marzieh; Rajaei, Ali; Derakhshan, Mahmoud; Sadri, Saeed; Taheri, Masoud; Adibi, Peyman

    2014-10-01

    Acoustic monitoring of swallow frequency has become important as the frequency of spontaneous swallowing can be an index for dysphagia and related complications. In addition, it can be employed as an objective quantification of ingestive behavior. Commonly, swallowing complications are manually detected using videofluoroscopy recordings, which require expensive equipment and exposure to radiation. In this study, a noninvasive automated technique is proposed that uses breath and swallowing recordings obtained via a microphone located over the laryngopharynx. Nonlinear diffusion filters were used in which a scale-space decomposition of recorded sound at different levels extract swallows from breath sounds and artifacts. This technique was compared to manual detection of swallows using acoustic signals on a sample of 34 subjects with Parkinson's disease. A speech language pathologist identified five subjects who showed aspiration during the videofluoroscopic swallowing study. The proposed automated method identified swallows with a sensitivity of 86.67 %, a specificity of 77.50 %, and an accuracy of 82.35 %. These results indicate the validity of automated acoustic recognition of swallowing as a fast and efficient approach to objectively estimate spontaneous swallow frequency.

  16. Time budget of South African cliff swallows during breeding

    African Journals Online (AJOL)

    The use of time by the South African cliff swallow was determined and use of energy calculated by using equations for predicting standard metabolic rate and the cost of flight. The highest daily energy expenditur.e was during the feeding of nestlings when 9,22 h were spent foraging. The cost of 127 kJ for building a nest is ...

  17. Immediate effect of laryngeal surface electrical stimulation on swallowing performance.

    Science.gov (United States)

    Takahashi, Keizo; Hori, Kazuhiro; Hayashi, Hirokazu; Fujiu-Kurachi, Masako; Ono, Takahiro; Tsujimura, Takanori; Magara, Jin; Inoue, Makoto

    2018-01-01

    Surface electrical stimulation of the laryngeal region is used to improve swallowing in dysphagic patients. However, little is known about how electrical stimulation affects tongue movements and related functions. We investigated the effect of electrical stimulation on tongue pressure and hyoid movement, as well as suprahyoid and infrahyoid muscle activity, in 18 healthy young participants. Electrical stimulation (0.2-ms duration, 80 Hz, 80% of each participant's maximal tolerance) of the laryngeal region was applied. Each subject swallowed 5 ml of barium sulfate liquid 36 times at 10-s intervals. During the middle 2 min, electrical stimulation was delivered. Tongue pressure, electromyographic activity of the suprahyoid and infrahyoid muscles, and videofluorographic images were simultaneously recorded. Tongue pressure during stimulation was significantly lower than before or after stimulation and was significantly greater after stimulation than at baseline. Suprahyoid activity after stimulation was larger than at baseline, while infrahyoid muscle activity did not change. During stimulation, the position of the hyoid at rest was descended, the highest hyoid position was significantly inferior, and the vertical movement was greater than before or after stimulation. After stimulation, the positions of the hyoid at rest and at the maximum elevation were more superior than before stimulation. The deviation of the highest positions of the hyoid before and after stimulation corresponded to the differences in tongue pressures at those times. These results suggest that surface electrical stimulation applied to the laryngeal region during swallowing may facilitate subsequent hyoid movement and tongue pressure generation after stimulation. NEW & NOTEWORTHY Surface electrical stimulation applied to the laryngeal region during swallowing may facilitate subsequent hyoid movement and tongue pressure generation after stimulation. Tongue muscles may contribute to overshot recovery

  18. Pain, masticatory performance and swallowing threshold in orthodontic patients

    Directory of Open Access Journals (Sweden)

    Marcos Porto Trein

    2013-12-01

    Full Text Available OBJECTIVE: The aim of this study was to assess pain, masticatory performance and swallowing threshold of patients undergoing orthodontic treatment. METHODS: Ten patients of both genders (mean age of 17.25 ± 5.21 years, with complete permanent dentition, who underwent orthodontic treatment with fixed appliances were evaluated. The masticatory performance and the swallowing threshold were assessed by patient's individual capacity of fragmenting an artificial test food (Optocal which was chewed and had the resulting particles processed by a standardized sieving method, presenting the median particle size (MPS of crushed units. The intensity of pain / discomfort during chewing was evaluated by means of a visual analog scale. All tests were performed at the following times: T0 - before activating the orthodontic appliance; T1 - 24 hours after activation, and T2 - 30 days after activation. RESULTS: The results showed a significant increase in pain at T1 (T0 - 0.60 ± 0.70 mm; T1 - 66.2 ± 34.5 mm, returning to baseline values at T2 (3.20 ± 3.82 mm. Masticatory performance was also reduced in T1 (MPS 10.15 ± 1.1 mm² in comparison to T0 (MPS 7.01 ± 2.9 mm² and T2 (MPS 6.76 ± 1.3 mm². However, particle size was not affected in the swallowing threshold test (T0 - 5.47 ± 2.37 mm²; T1 - 6.19 ± 2.05 mm²; T2 - 5.94 ± 2.36 mm². CONCLUSION: The orthodontic appliances did not interfere in the size of the particles that would be swallowed, even in the presence of pain.

  19. Difficult to swallow: patient preferences for alternative valproate pharmaceutical formulations

    Directory of Open Access Journals (Sweden)

    Monali Bhosle

    2009-06-01

    Full Text Available Monali Bhosle,1 Joshua S Benner,1 Mitch DeKoven,1 Jeff Shelton21Health Economics and Outcomes Research, IMS Health Inc, Falls Church, VA, USA; 2Answers and Insights Market Research, Inc, Indianapolis, IN, USAObjective: To determine the degree to which swallowing valproate (VP tablets is an issue, the proportion of patients who would prefer an alternative formulation, and the predictors of preference.Methods: A quantitative telephone survey of eligible adults (n = 400, ≥18 years old who currently take (n = 236 or previously took (n = 164 VP tablets within the past 6 months was conducted.Results: More than half of the patients indicated that VP tablets were ‘uncomfortable to swallow’ (68.5%, n = 274 and were ‘very interested’ (65.8%, n = 263 in medications that were easier to swallow. When choosing conceptually between taking VP tablet once/day or an equally safe and effective but significantly smaller soft gel capsule twice per day, the 82.8%, (n = 331 preferred the soft gel capsule. In the multivariate regression analysis, perceiving soft gel capsules to be easier to swallow (OR = 73.54; 95% CI = 15.01 to 360.40 and taking VP more frequently (OR = 2.02; 95% CI = 1.13 to 3.61 were significant predictors of soft gel capsule treatment preference.Conclusion: VP users would prefer a formulation that is easier to swallow, even if it is needed to be taken twice per day. When choosing between medications with similar efficacy and safety, physicians can consider patient preferences to optimize conditions for medication adherence.Keywords: patient preference, valproate formulations, tablet characteristics

  20. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer.

    Science.gov (United States)

    Eisbruch, Avraham; Lyden, Teresa; Bradford, Carol R; Dawson, Laura A; Haxer, Marc J; Miller, Amy E; Teknos, Theodoros N; Chepeha, Douglas B; Hogikyan, Norman D; Terrell, Jeffrey E; Wolf, Gregory T

    2002-05-01

    pneumonia occurred among 17 patients who had demonstrated aspiration in the post-therapy studies, compared with no cases of pneumonia among 8 patients who had not demonstrated aspiration (p = 0.1). Of the 4 patients who had not undergone any post-therapy study, 1 developed pneumonia. Mucositis scores, prolonged tube feeding, presence of tracheostomy tube, and gemcitabine doses were not found to be related to aspiration or pneumonia risk. After intensive chemoradiotherapy, significant objective swallowing dysfunction is prevalent. It promotes aspiration, which may not elicit a cough reflex and may be associated with pneumonia. Aspiration pneumonia may be an underdocumented complication of chemoradiotherapy for head-and-neck cancer. Future studies should examine whether routine post-therapy videofluoroscopy and training aspirating patients in safe swallowing strategies can reduce this risk.

  1. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer

    International Nuclear Information System (INIS)

    Eisbruch, Avraham; Lyden, Teresa; Bradford, Carol R.; Dawson, Laura A.; Haxer, Marc J.; Miller, Amy E.; Teknos, Theodoros N.; Chepeha, Douglas B.; Hogikyan, Norman D.; Terrell, Jeffrey E.; Wolf, Gregory T.

    2002-01-01

    death in 2 patients. Five cases of pneumonia occurred among 17 patients who had demonstrated aspiration in the post-therapy studies, compared with no cases of pneumonia among 8 patients who had not demonstrated aspiration (p=0.1). Of the 4 patients who had not undergone any post-therapy study, 1 developed pneumonia. Mucositis scores, prolonged tube feeding, presence of tracheostomy tube, and gemcitabine doses were not found to be related to aspiration or pneumonia risk. Conclusions: After intensive chemoradiotherapy, significant objective swallowing dysfunction is prevalent. It promotes aspiration, which may not elicit a cough reflex and may be associated with pneumonia. Aspiration pneumonia may be an underdocumented complication of chemoradiotherapy for head-and-neck cancer. Future studies should examine whether routine post-therapy videofluoroscopy and training aspirating patients in safe swallowing strategies can reduce this risk

  2. Study protocol for the SOFIA project: Swallowing function, Oral health, and Food Intake in old Age: a descriptive study with a cluster randomized trial.

    Science.gov (United States)

    Hägglund, Patricia; Olai, Lena; Ståhlnacke, Katri; Persenius, Mona; Hägg, Mary; Andersson, Maria; Koistinen, Susanne; Carlsson, Eva

    2017-03-23

    Extensive studies have shown that older people are negatively impacted by impaired eating and nutrition. The abilities to eat, enjoy food, and participate in social activities associated with meals are important aspects of health-related quality of life (HRQoL) and recovery after illness. This project aims to (i) describe and analyze relationships between oral health and oral HRQoL, swallowing ability, eating ability, and nutritional risk among older individuals admitted to short-term care; (ii) compare the perceptions that older individuals and staff report on care quality related to oral hygiene and eating; and (iii) study the feasibility and effects of a training program for people with impaired swallowing (i.e., dysphagia). This project consists of two parts, which will be performed in five Swedish counties. It will include approximately 400 older individuals and 200 healthcare professionals. Part 1 is a cross-sectional, descriptive study of older people admitted to short-term care. Subjects will be assessed by trained professionals regarding oral health status, oral HRQoL, eating and nutritional risk, and swallowing ability. Swallowing ability will be measured with a teaspoon test and a swallowing capacity test (SCT). Furthermore, subjects and staff will complete a questionnaire regarding their perceptions of care quality. Part 2 is a cluster randomized intervention trial with controls. Older participants with dysphagia (i.e., SCT health status, oral HRQoL, eating and nutritional risk, swallowing ability, and swallowing-related QoL. Then, the intervention group will receive 5 weeks of training with an oral screen for neuromuscular training focused on orofacial and pharyngeal muscles. After completing the intervention, and at six months post-intervention, all assessments will be repeated in both study groups. The results will make important contributions to rehabilitation knowledge, including approaches for improving swallowing function, oral health, and food

  3. Suck, swallow and breathing coordination in infants with infantile colic

    Directory of Open Access Journals (Sweden)

    Hanlie Degenaar

    2015-12-01

    Objective: The objective of the study was to explore the suck, swallow and breathing coordination in infants with infantile colic and compare it with infants without the condition. Method: An assessment protocol for suck, swallow and breathing coordination was compiled from literature. This protocol was performed on a research group of 50 infants, independently diagnosed with infantile colic, and a control group of 28 infants without the condition. All participants were from two rural towns in the North–West province, South Africa, selected with a snowball selection method and strict selection criteria. The study followed a static comparison group design. Results: A significant difference in the key components of feeding and the presence of colic in participants of four age categories were found. The correlation between postural control and the presence of infantile colic were sustained in participants from 2–19 weeks old. Conclusion: Suck, swallow and breathing were found to be significantly associated with infantile colic. The findings should be investigated further. It appears that speech-language therapists may play an expanding role in infantile colic. [pdf to follow

  4. Effect of age on proximal esophageal response to swallowing

    Directory of Open Access Journals (Sweden)

    Roberto Oliveira Dantas

    2010-12-01

    Full Text Available CONTEXT: It has been demonstrated that the ageing process affects esophageal motility. OBJECTIVES: To evaluate the effect of the age on the proximal esophageal response to wet swallows. METHOD: We measured the proximal esophageal response to swallows of a 5 mL bolus of water in 69 healthy volunteers, 20 of them aged 18-30 years (group I, 27 aged 31-50 years (group II, and 22 aged 51-74 years (group III. We used the manometric method with continuous perfusion. The proximal esophageal contractions were recorded 5 cm from a pharyngeal recording site located 1 cm above the upper esophageal sphincter. The time between the onset of the pharyngeal and of the proximal esophageal recording (pharyngeal-esophageal time and the amplitude, duration and area under the curve of the proximal esophageal contraction were measured. RESULTS: The pharyngeal-esophageal time was shorter in group I subjects than in group II and III subjects (P<0.05. The duration of proximal esophageal contractions was longer in group I than in groups II and III (P<0.001. There was no differences between groups in the amplitude or area under the curve of contractions. There were no differences between groups II and III for any of the measurements. CONCLUSION: We conclude that the age may affects the response of the proximal esophagus to wet swallows.

  5. Tongue-surface movement patterns during speech and swallowing

    Science.gov (United States)

    Green, Jordan R.; Wang, Yu-Tsai

    2003-05-01

    The tongue has been frequently characterized as being composed of several functionally independent articulators. The question of functional regionality within the tongue was examined by quantifying the strength of coupling among four different tongue locations across a large number of consonantal contexts and participants. Tongue behavior during swallowing was also described. Vertical displacements of pellets affixed to the tongue were extracted from the x-ray microbeam database. Forty-six participants recited 20 vowel-consonant-vowel (VCV) combinations and swallowed 10 ccs of water. Tongue-surface movement patterns were quantitatively described by computing the covariance between the vertical time-histories of all possible pellet pairs. Phonemic differentiation in vertical tongue motions was observed as coupling varied predictably across pellet pairs with place of articulation. Moreover, tongue displacements for speech and swallowing clustered into distinct groups based on their coupling profiles. Functional independence of anterior tongue regions was evidenced by a wide range of movement coupling relations between anterior tongue pellets. The strengths and weaknesses of the covariance-based analysis for characterizing tongue movement are considered.

  6. Cine-MRI swallowing evaluation after tongue reconstruction

    International Nuclear Information System (INIS)

    Hartl, Dana M.; Kolb, Frederic; Bretagne, Evelyne; Bidault, Francois; Sigal, Robert

    2010-01-01

    Objective: To determine the feasibility of cine-MRI for non-invasive swallowing evaluation after surgery for lingual carcinoma with reconstruction using microvascular free flaps. Methods: Ten patients with stage IV carcinoma of the mobile tongue and/or tongue base treated by surgical resection and reconstruction with a free flap were evaluated after an average of 4.3 years (range: 1.5-11 years), using cine-MRI in 'single-shot fast spin echo' (SSFSE) mode. Fiberoptic laryngoscopy of swallowing was performed before MRI to detect aspiration. The tolerance and ability to complete the exam were noted. The mobilities of the oral and pharyngeal structures visualized were evaluated as normal, reduced or increased. Results: Cine-MRI was well tolerated in all cases; 'dry' swallow was performed for the 2 patients with clinical aspiration. Tongue base-pharyngeal wall contact was observed in 5 cases. An increased anterior tongue recoil, increased mandibular recoil, increased posterior oropharyngeal wall advancement and an increased laryngeal elevation were observed in 4 cases. One case of a passive 'slide' mechanism was observed. Conclusions: Cine-MRI is a safe, non-invasive technique for the evaluation of the mobility of oral and oropharyngeal structures after free-flap reconstruction of the tongue. For selected cases, it may be complementary to clinical examination for evaluation of dysphagia after surgery and free-flap reconstruction. Further technical advances will be necessary before cine-MRI can replace videofluoroscopy, however.

  7. Evaluation of Chewing and Swallowing Sensors for Monitoring Ingestive Behavior.

    Science.gov (United States)

    Fontana, Juan M; Sazonov, Edward S

    2013-03-01

    Monitoring Ingestive Behavior (MIB) of individuals is of special importance to identify and treat eating patterns associated with obesity and eating disorders. Current methods for MIB require subjects reporting every meal consumed, which is burdensome and tend to increase the reporting bias over time. This study presents an evaluation of the burden imposed by two wearable sensors for MIB during unrestricted food intake: a strain sensor to detect chewing events and a throat microphone to detect swallowing sounds. A total of 30 healthy subjects with various levels of adiposity participated in experiments involving the consumption of four meals in four different visits. A questionnaire was handled to subjects at the end of the last visit to evaluate the sensors burden in terms of the comfort levels experienced. Results showed that sensors presented high comfort levels as subjects indicated that the way they ate their meal was not considerably affected by the presence of the sensors. A statistical analysis showed that chewing sensor presented significantly higher comfort levels than the swallowing sensor. The outcomes of this study confirmed the suitability of the chewing and swallowing sensors for MIB and highlighted important aspects of comfort that should be addressed to obtain acceptable and less burdensome wearable sensors for MIB.

  8. Evaluation of the environmental impact of apple pest control strategies using pesticide risk indicators.

    Science.gov (United States)

    Ioriatti, Claudio; Agnello, Arthur M; Martini, Fabrizio; Kovach, Joseph

    2011-10-01

    Various pesticide risk indicators have been developed for estimating pesticide impact on human health and the environment. The present work applied a pesticide risk indicator to estimate change in pesticide risk in apple production between 2001 and 2009. The "Environmental Impact Quotient" was used, which evaluates potential impacts of pesticide active ingredients on farm workers, consumers, and nontarget organisms. A modified Environmental Impact Quotient was also tested, which accounts for all ingredients in the formulation presenting a health or environmental hazard, as identified in the Security Data Sheet. Irrespective of the rating system applied, an overall average improvement in environmental impact of apple protection strategies was indicated ranging from 23 to 24%. Hazard reduction was more significant when estimated per treatment, and was higher for acaricides and insecticides than for fungicides. Improvement appeared to be a consequence of using more selective and more effective active ingredients, applying alternative pest control techniques, compulsory periodic sprayer calibration, and wider use of dwarfing orchards. The modified Environmental Impact Quotient does not overcome all limitations regarding accuracy of pesticide risk indicators, but its ease of use in relying on official, easily accessible data, and the consistency of its results, makes it a good candidate for monitoring the success of reduced risk policies. Copyright © 2011 SETAC.

  9. Swallowing sound detection using hidden markov modeling of recurrence plot features

    International Nuclear Information System (INIS)

    Aboofazeli, Mohammad; Moussavi, Zahra

    2009-01-01

    Automated detection of swallowing sounds in swallowing and breath sound recordings is of importance for monitoring purposes in which the recording durations are long. This paper presents a novel method for swallowing sound detection using hidden Markov modeling of recurrence plot features. Tracheal sound recordings of 15 healthy and nine dysphagic subjects were studied. The multidimensional state space trajectory of each signal was reconstructed using the Taken method of delays. The sequences of three recurrence plot features of the reconstructed trajectories (which have shown discriminating capability between swallowing and breath sounds) were modeled by three hidden Markov models. The Viterbi algorithm was used for swallowing sound detection. The results were validated manually by inspection of the simultaneously recorded airflow signal and spectrogram of the sounds, and also by auditory means. The experimental results suggested that the performance of the proposed method using hidden Markov modeling of recurrence plot features was superior to the previous swallowing sound detection methods.

  10. Critical Factors in the Oral Control Needed for Chewing and Swallowing.

    Science.gov (United States)

    Logemann, Jerilyn A

    2014-06-01

    Normal oropharyngeal swallowing is a complex set of neuromotor behaviors containing three phases: 1) Oral preparation to break food down to a swallowable consistency; 2) Oral phase which propels food from the mouth; 3) Pharyngeal phase creates pressure to push food into the esophagus, and includes valve functions which prevent food from entering the nose or airway and allow food into the esophagus. Systematic changes in normal oropharyngeal swallow are based on volume, viscosity, and taste of the food swallowed as well as age. Patients with oropharyngeal swallowing difficulties (dysphagia) react differently to these systematic variables in food characteristics. This review manuscript presents the results of a series of studies that examine the role of each of the stages of the nonoral orpharyngeal swallow. The importance of the definition of food viscosity in the care of dysphagic patients and the role of food production companies in this effort are emphasized.

  11. The Impact of Listening Strategy Training on the Meta-Cognitive Listening Strategies Awareness of Different Learner Types

    Science.gov (United States)

    Zarrabi, Fatemeh

    2016-01-01

    The present study investigated the effectiveness of listening strategy instruction on the metacognitive listening strategies awareness of different EFL learner types (LTs). To achieve this goal, 150 EFL students took part in the study and were taught based on a guided lesson plan regarding listening strategies and a pre-test/post-test design was…

  12. Noninvasive Mechanical Ventilation Improves Breathing-Swallowing Interaction of Ventilator Dependent Neuromuscular Patients: A Prospective Crossover Study.

    Science.gov (United States)

    Garguilo, Marine; Lejaille, Michèle; Vaugier, Isabelle; Orlikowski, David; Terzi, Nicolas; Lofaso, Frédéric; Prigent, Hélène

    2016-01-01

    Respiratory involvement in neuromuscular disorders may contribute to impaired breathing-swallowing interactions, swallowing disorders and malnutrition. We investigated whether the use of non-invasive ventilation (NIV) controlled by the patient could improve swallowing performances in a population of neuromuscular patients requiring daytime NIV. Ten neuromuscular patients with severe respiratory failure requiring extensive NIV use were studied while swallowing without and with NIV (while ventilated with a modified ventilator allowing the patient to withhold ventilation as desired). Breathing-swallowing interactions were investigated by chin electromyography, cervical piezoelectric sensor, nasal flow recording and inductive plethysmography. Two water-bolus sizes (5 and 10ml) and a textured yogurt bolus were tested in a random order. NIV use significantly improved swallowing fragmentation (defined as the number of respiratory interruption of the swallowing of a single bolus) (p = 0.003) and breathing-swallowing synchronization (with a significant increase of swallows followed by an expiration) (p <0.0001). Patient exhibited piecemeal swallowing which was not influenced by NIV use (p = 0.07). NIV use also significantly reduced dyspnea during swallowing (p = 0.04) while preserving swallowing comfort, regardless of bolus type. The use of patient controlled NIV improves swallowing parameters in patients with severe neuromuscular respiratory failure requiring daytime NIV, without impairing swallowing comfort. ClinicalTrials.gov NCT01519388.

  13. SUPPLIER SELECTION STRATEGY AND MANUFACTURING FLEXIBILITY: IMPACT OF QUALITY AND TECHNOLOGY ROADMAPS

    Directory of Open Access Journals (Sweden)

    Muhamad Jantan

    2006-01-01

    Full Text Available The study evaluates the relationship between technology, quality, cost and delivery performance-based, supplier selection strategies, and manufacturing flexibilities namely, product flexibility, launch flexibility, and volume flexibility. Moreover, the moderating impact of supplier management strategies, namely quality roadmap and technology roadmap on the above relationships were also explored. The data for the study was drawn from a sample of companies listed in the factory directory published by the Penang Development Corporation (PDC. A postal survey of 120 manufacturers provided a return of 92 usable responses. The results reveal that the selection of suppliers based on technological and quality performance positively affects all the three dimensions of manufacturing flexibility, with complementary effects of good technology and quality roadmaps. Technology and quality roadmaps act as predictors for product and volume flexibilities. However, when launch flexibility is the focus, both technology and quality roadmaps moderate the impact of supplier selection strategies. Details of the findings, theoretical and practical implications, and the research limitation are discussed.

  14. Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy.

    Science.gov (United States)

    Joosen, Margot C W; van Beurden, Karlijn M; Terluin, Berend; van Weeghel, Jaap; Brouwers, Evelien P M; van der Klink, Jac J L

    2015-04-24

    Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs' barriers were evaluated. OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs' experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training. The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p method to enhance guideline adherence. Moreover, the strategy contributed to OPs' knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.

  15. Characterizing functional connectivity patterns during saliva swallows in different head positions

    OpenAIRE

    Jestrovi?, Iva; Coyle, James L.; Sejdi?, Ervin

    2015-01-01

    Background The anatomical rationale and efficacy of the chin tuck in improving airway protection for some people with swallowing disorders have been well researched and established. However, there are still open questions regarding whether brain activity for swallowing control is altered while performing this chin-tuck maneuver. Methods In this study, we collected EEG signals from 55 healthy adults while swallowing in the neutral and chin-tuck head positions. The time-frequency based synchron...

  16. Impact of digital intraoral scan strategies on the impression accuracy using the TRIOS Pod scanner.

    Science.gov (United States)

    Müller, Philipp; Ender, Andreas; Joda, Tim; Katsoulis, Joannis

    2016-04-01

    Little information is available on the impact of different scan strategies on the accuracy of full-arch scans with intraoral scanners. The aim of this in-vitro study was to investigate the trueness and precision of full-arch maxillary digital impressions comparing three scan strategies. Three scan strategies (A, B, and C) were applied each five times on one single model (A, first buccal surfaces, return from occlusal-palatal; B, first occlusal-palatal, return buccal; C, S-type one-way). The TRIOS Pod scanner (3shape, Copenhagen, Denmark) with a color detector was used for these digital impressions. A cast of a maxillary dentate jaw was fabricated and scanned with an industrial reference scanner. This full-arch data record was digitally superimposed with the test scans (trueness) and within-group comparison was performed for each group (precision). The values within the 90/10 percentiles from the digital superimposition were used for calculation and group comparisons with nonparametric tests (ANOVA, post-hoc Bonferroni). The trueness (mean ± standard deviation) was 17.9 ± 16.4 μm for scan strategy A, 17.1 ± 13.7 μm for B, and 26.8 ± 14.7 μm for C without statistically significant difference. The precision was lowest for scan strategy A (35.0 ± 51.1 μm) and significantly different to B (7.9 ± 5.6 μm) and C (8.5 ± 6.3 μm). Scan strategy B may be recommended as it provides the highest trueness and precision in full-arch scans and therefore minimizes inaccuracies in the final reconstruction.

  17. Dietary Strategies to Reduce Environmental Impact: A Critical Review of the Evidence Base.

    Science.gov (United States)

    Ridoutt, Bradley G; Hendrie, Gilly A; Noakes, Manny

    2017-11-01

    The food system is a major source of environmental impact, and dietary change has been recommended as an important and necessary strategy to reduce this impact. However, assessing the environmental performance of diets is complex due to the many types of foods eaten and the diversity of agricultural production systems and local environmental settings. To assess the state of science and identify knowledge gaps, an integrative review of the broad topic of environment and diet was undertaken, with particular focus on the completeness of coverage of environmental concerns and the metrics used. Compared with the 14 discrete environmental areas of concern identified in the United Nations Sustainable Development Goals, the located journal literature mainly addressed greenhouse gas (GHG) emissions and, to a lesser extent, land and water use. Some relevant concerns were rarely addressed or not addressed at all. In the case of GHG emissions, changes in land use and soil carbon stocks were seldom considered. This represents a disconnect between the science informing strategic climate action in the agricultural sector and the science informing public health nutrition. In the case of land and water use, few studies used metrics that are appropriate in a life-cycle context. Some metrics produce inherently biased results, which misinform about environmental impact. The limited evidence generally points to recommended diets having lower environmental impacts than typical diets, although not in every case. This is largely explained by the overconsumption of food energy associated with average diets, which is also a major driver of obesity. A shared-knowledge framework is identified as being needed to guide future research on this topic. Until the evidence base becomes more complete, commentators on sustainable diets should not be quick to assume that a dietary strategy to reduce overall environmental impact can be readily defined or recommended. © 2017 American Society for

  18. Developing Broader Impacts Activities through Informal STEM Education Collaborations and Strategies

    Science.gov (United States)

    Bell, James

    2015-03-01

    With the National Science Foundation and other funding agencies' renewed emphasis on broader impacts merit criterion in proposals, investigators and directors of education, outreach and engagement are challenged to identify, plan and implement innovative and transformative activities that engage a variety of audiences in the broader impacts of scientific research. These activities are also often required to have an evaluation plan for assessing the effectiveness of the strategies employed to achieve learning goals or other intended impacts. One approach to developing such plans is to partner with an informal science education institution, program, project or individual to create exhibits, media or programming that will convey the scientific concepts and processes involved in research and engage students and public audiences in appreciation for, and understanding of same. A growing body of evidence -based knowledge about what works for whom and under what conditions in fostering science learning and literacy in informal settings, as well as an expanding network of informal science, technology, engineering and math (STEM) education professionals provide researchers, graduate students and staff resources to tap into as they consider their broader impacts directions. Web infrastructure like the informalscience.org website and others offer aggregated, vetted, and searchable examples of successful partnerships and strategies, as well as access to a community of colleagues working at the nexus of scientific research and informal education for further exploration. Through heightened awareness, stronger connectivity and a growing repository of knowledge, projects like the Center for Advancement of Informal Science Education (CAISE) hope to support and disseminate the results of efforts that are enhancing the quality and visibility of broader impacts activities in whatever form they take.

  19. A bi-level environmental impact assessment framework for comparing construction and demolition waste management strategies.

    Science.gov (United States)

    Yazdanbakhsh, Ardavan

    2018-04-27

    Several pioneering life cycle assessment (LCA) studies have been conducted in the past to assess the environmental impact of specific methods for managing mineral construction and demolition waste (MCDW), such as recycling the waste for use in concrete. Those studies focus on comparing the use of recycled MCDW and that of virgin components to produce materials or systems that serve specified functions. Often, the approaches adopted by the studies do not account for the potential environmental consequence of avoiding the existing or alternative waste management practices. The present work focuses on how product systems need to be defined in recycling LCA studies and what processes need to be within the system boundaries. A bi-level LCA framework is presented for modelling alternative waste management approaches in which the impacts are measured and compared at two scales of strategy and decision-making. Different functional units are defined for each level, all of which correspond to the same flow of MCDW in a cascade of product systems. For the sole purpose of demonstrating how the framework is implemented an illustrative example is presented, based on real data and a number of simplifying assumptions, which compares the impacts of a number of potential MCDW management strategies in New York City. Copyright © 2018 Elsevier Ltd. All rights reserved.

  20. A geomorphological strategy for conducting environmental impact assessments in karst areas

    Science.gov (United States)

    Veni, George

    1999-12-01

    In their efforts to protect regional groundwater supplies, governmental agencies are increasingly requiring studies of karst areas and their features. In areas where tracer tests or geophysics are not required, funded, or otherwise feasible, geomorphological methods remain as the primary tool for assessing karst. This study proposes a geomorphologically-based environmental impact assessment strategy for karst areas. While it is supported with results from a study of the karstic Edwards Aquifer recharge zone on the Camp Bullis Military Training Installation, TX, USA, it is based on the study of several karst areas and is generalized to accommodate and be fine-tuned for regional variations. Biological and other resource issues can also be assessed with this strategy. The assessment identifies environmentally sensitive features and areas, as is often required to meet regulatory directives. In karst areas with relatively small features, excavation is a key tool for accurate assessment. Although the results of this study will help to better manage karst areas, proper management must be done on a regional scale. The highly permeable nature of karst precludes adequate management solely on a feature-by-feature basis. Studies on the relationship of water quality to impervious cover show adverse environmental impacts significantly increase when impervious cover exceeds 15% of a surface watershed. The Camp Bullis study finds similar impacts in its groundwater drainage basin, supporting the argument of 15% impervious cover as a regionally effective means of also protecting karst aquifers when coupled with protection of critical areas identified by field surveys.

  1. Alternative Assessment Strategy and Its Impact on Student Comprehension in an Undergraduate Microbiology Course

    Directory of Open Access Journals (Sweden)

    Barry J. Margulies

    2009-12-01

    Full Text Available Medical Microbiology is a content-intensive course that requires a large time commitment from the students. Students are typically biology or prenursing majors, including students headed for professional schools, such as medical school and pharmacy school. This group is somewhat diverse in terms of background science coursework, so it can be difficult to teach in a way that benefits all the students. Numerous changes have been implemented in our microbiology curriculum to address the different abilities of our students by altering assessment and teaching strategies. It was hypothesized that changing the assessment strategy from the traditional scheme of two or three exams and one final to a new model of seven or eight shorter exams would have a positive impact on student comprehension and retention. The quantity of material taught or expected of the students to learn did not change, but there was definitely an impact on them. Although 30.0% of students routinely did not pass microbiology in previous semesters, the new method of assessment resulted in only 9.63% not completing the semester successfully, as determined by earning a grade of C or better. There is some evidence from conversations and interviews with students that indicates a positive impact of this methodology on student attitude. Implementation of these changes in other courses and their current effectiveness will be examined in the future, with an eye towards more broadly applicable successful teaching techniques in the sciences, especially for nonmajors.

  2. Multiple night-time light-emitting diode lighting strategies impact grassland invertebrate assemblages.

    Science.gov (United States)

    Davies, Thomas W; Bennie, Jonathan; Cruse, Dave; Blumgart, Dan; Inger, Richard; Gaston, Kevin J

    2017-07-01

    White light-emitting diodes (LEDs) are rapidly replacing conventional outdoor lighting technologies around the world. Despite rising concerns over their impact on the environment and human health, the flexibility of LEDs has been advocated as a means of mitigating the ecological impacts of globally widespread outdoor night-time lighting through spectral manipulation, dimming and switching lights off during periods of low demand. We conducted a three-year field experiment in which each of these lighting strategies was simulated in a previously artificial light naïve grassland ecosystem. White LEDs both increased the total abundance and changed the assemblage composition of adult spiders and beetles. Dimming LEDs by 50% or manipulating their spectra to reduce ecologically damaging wavelengths partially reduced the number of commoner species affected from seven to four. A combination of dimming by 50% and switching lights off between midnight and 04:00 am showed the most promise for reducing the ecological costs of LEDs, but the abundances of two otherwise common species were still affected. The environmental consequences of using alternative lighting technologies are increasingly well established. These results suggest that while management strategies using LEDs can be an effective means of reducing the number of taxa affected, averting the ecological impacts of night-time lighting may ultimately require avoiding its use altogether. © 2017 John Wiley & Sons Ltd.

  3. Impact of the Canadian Diabetes Association Guidelines Dissemination Strategy on clinician knowledge and behaviour change outcomes.

    Science.gov (United States)

    Yu, Catherine H; Lillie, Erin; Mascarenhas-Johnson, Alekhya; Gall Casey, Carolyn; Straus, Sharon E

    2018-04-04

    Implementation of clinical practice guideline(CPG) into clinical practice remains limited. Using the Knowledge-To-Action framework, a guideline dissemination and implementation strategy for the Canadian Diabetes Association's 2013 CPG was developed and launched to clinicians and people with diabetes. The RE-AIM framework guided evaluation of this strategy clinician; we report here one aspect of the effectiveness dimension using mixed methods. We measured impact of the strategy on clinican knowledge and behaviour change constructs using evaluation forms, national online survey and individual interviews. After attending a lecture, clinician confidence(n=915) increased(3.7(SD 0.7) to 4.5(SD 0.6) on a 5-point scale(pcontent, and education sessions facilitated uptake; lack of time, team-based consensus, and seamless integration into care and patient complexity were barriers. The complexity of diabetes care requires systemic adoption of organization of care interventions, including interprofessional collaboration and consensus. Augmenting our strategy to include scalable models for professional development, integration of guidelines into electronic medical records, and expansion of our target audience to include health care teams and patients, may optimize guideline uptake. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. Impacts of a national strategy to reduce population salt intake in England: serial cross sectional study.

    Science.gov (United States)

    Millett, Christopher; Laverty, Anthony A; Stylianou, Neophytos; Bibbins-Domingo, Kirsten; Pape, Utz J

    2012-01-01

    The UK introduced an ambitious national strategy to reduce population levels of salt intake in 2003. The aim of this study was to evaluate the impact of this strategy on salt intake in England, including potential effects on health inequalities. Secondary analysis of data from the Health Survey for England. Our main outcome measure was trends in estimated daily salt intake from 2003-2007, as measured by spot urine. Secondary outcome measures were knowledge of government guidance and voluntary use of salt in food preparation over this time period. There were significant reductions in salt intake between 2003 and 2007 (-0.175 grams per day per year, pprofessional; 64.9% v 71.0% AOR 0.76 95% CI 0.58-0.99). Self reported use of salt added at the table reduced significantly during the study period (56.5% to 40.2% pcooking (white 42.8%, black 74.1%, south Asian 88.3%) and those from lower social class groups (unskilled manual 46.6%, professional 35.2%) were more likely to add salt at the table. The introduction a national salt reduction strategy was associated with uniform but modest reductions in salt intake in England, although it is not clear precisely which aspects of the strategy contributed to this. Knowledge of government guidance was lower and voluntary salt use and total salt intake was higher among occupational and ethnic groups at greatest risk of cardiovascular disease.

  5. The impact of active/cooperative instruction on beginning nursing student learning strategy preference.

    Science.gov (United States)

    Sand-Jecklin, Kari

    2007-07-01

    Rapid changes in the nursing field and high demand for practicing nurses put pressure on nursing faculty to educate increasing numbers of nursing students, often without corresponding increases in resources. Although the use of active and cooperative instruction methods in the classroom has been associated with improved student learning, these practices require increased effort on the part of both faculty and students. In addition, little is known about whether these methods influence student nurses' use of these more elaborative processing strategies in their independent study. The purpose of this quasi-experimental investigation was to identify the impact of incorporating active and cooperative classroom instructional activities on student preference for teaching methods and use of learning strategies in independent study. A convenience sample of beginning baccalaureate nursing students at a large Mid-Atlantic University was randomly assigned by the registrar to two class sections. Students in one section received primarily active/cooperative instruction, while the other received primarily traditional lecture-based instruction. Results indicated that student nurses exposed to active/cooperative instructional methods had an increased preference for these methods after a semester of instruction, while those exposed to traditional instruction had a higher preference for traditional methods. In addition, students participating in active class instruction reported increased preference for more elaborative independent study strategies, although overall preference for both groups indicated a reliance on surface study strategies of memorization and recall. Implications for use of instruction and student testing methodologies are presented.

  6. Central inhibition of initiation of swallowing by systemic administration of diazepam and baclofen in anaesthetized rats.

    Science.gov (United States)

    Tsujimura, Takanori; Sakai, Shogo; Suzuki, Taku; Ujihara, Izumi; Tsuji, Kojun; Magara, Jin; Canning, Brendan J; Inoue, Makoto

    2017-05-01

    Dysphagia is caused not only by neurological and/or structural damage but also by medication. We hypothesized memantine, dextromethorphan, diazepam, and baclofen, all commonly used drugs with central sites of action, may regulate swallowing function. Swallows were evoked by upper airway (UA)/pharyngeal distension, punctate mechanical stimulation using a von Frey filament, capsaicin or distilled water (DW) applied topically to the vocal folds, and electrical stimulation of a superior laryngeal nerve (SLN) in anesthetized rats and were documented by recording electromyographic activation of the suprahyoid and thyrohyoid muscles and by visualizing laryngeal elevation. The effects of intraperitoneal or topical administration of each drug on swallowing function were studied. Systemic administration of diazepam and baclofen, but not memantine or dextromethorphan, inhibited swallowing evoked by mechanical, chemical, and electrical stimulation. Both benzodiazepines and GABA A receptor antagonists diminished the inhibitory effects of diazepam, whereas a GABA B receptor antagonist diminished the effects of baclofen. Topically applied diazepam or baclofen had no effect on swallowing. These data indicate that diazepam and baclofen act centrally to inhibit swallowing in anesthetized rats. NEW & NOTEWORTHY Systemic administration of diazepam and baclofen, but not memantine or dextromethorphan, inhibited swallowing evoked by mechanical, chemical, and electrical stimulation. Both benzodiazepines and GABA A receptor antagonists diminished the inhibitory effects of diazepam, whereas a GABA B receptor antagonist diminished the effects of baclofen. Topical applied diazepam or baclofen was without effect on swallowing. Diazepam and baclofen act centrally to inhibit swallowing in anesthetized rats. Copyright © 2017 the American Physiological Society.

  7. Characteristics of sequential swallowing of liquids in young and elderly adults: an integrative review.

    Science.gov (United States)

    Veiga, Helena Perrut; Bianchini, Esther Mandelbaum Gonçalves

    2012-01-01

    To perform an integrative review of studies on liquid sequential swallowing, by characterizing the methodology of the studies and the most important findings in young and elderly adults. Review of the literature written in English and Portuguese on PubMed, LILACS, SciELO and MEDLINE databases, within the past twenty years, available fully, using the following uniterms: sequential swallowing, swallowing, dysphagia, cup, straw, in various combinations. Research articles with a methodological approach on the characterization of liquid sequential swallowing by young and/or elderly adults, regardless of health condition, excluding studies involving only the esophageal phase. The following research indicators were applied: objectives, number and gender of participants; age group; amount of liquid offered; intake instruction; utensil used, methods and main findings. 18 studies met the established criteria. The articles were categorized according to the sample characterization and the methodology on volume intake, utensil used and types of exams. Most studies investigated only healthy individuals, with no swallowing complaints. Subjects were given different instructions as to the intake of all the volume: usual manner, continually, as rapidly as possible. The findings about the characterization of sequential swallowing were varied and described in accordance with the objectives of each study. It found great variability in the methodology employed to characterize the sequential swallowing. Some findings are not comparable, and sequential swallowing is not studied in most swallowing protocols, without consensus on the influence of the utensil.

  8. 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.

  9. 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

  10. Coordination of cough and swallow: a meta-behavioral response to aspiration.

    Science.gov (United States)

    Pitts, Teresa; Rose, Melanie J; Mortensen, Ashley N; Poliacek, Ivan; Sapienza, Christine M; Lindsey, Bruce G; Morris, Kendall F; Davenport, Paul W; Bolser, Donald C

    2013-12-01

    Airway protections is the prevention and/or removal of material by behaviors such as cough and swallow. We hypothesized these behaviors are coordinated to respond to aspiration. Anesthetized animals were challenged with simulated aspiration that induced both coughing and swallowing. Electromyograms of upper airway and respiratory muscles together with esophageal pressure were recorded to identify and evaluate cough and swallow. During simulated aspiration, both cough and swallow intensity increased and swallow duration decreased consistent with rapid pharyngeal clearance. Phase restriction between cough and swallow was observed; swallow was restricted to the E2 phase of cough. These results support three main conclusions: 1) the cough and swallow pattern generators are tightly coordinated so as to generate a protective meta-behavior; 2) the trachea provides feedback on swallow quality, informing the brainstem about aspiration incidences; and 3) the larynx and upper esophageal sphincter act as two separate valves controlling the direction of positive and negative pressures from the upper airway into the thorax. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. The relationship between limit of Dysphagia and average volume per swallow in patients with Parkinson's disease.

    Science.gov (United States)

    Belo, Luciana Rodrigues; Gomes, Nathália Angelina Costa; Coriolano, Maria das Graças Wanderley de Sales; de Souza, Elizabete Santos; Moura, Danielle Albuquerque Alves; Asano, Amdore Guescel; Lins, Otávio Gomes

    2014-08-01

    The goal of this study was to obtain the limit of dysphagia and the average volume per swallow in patients with mild to moderate Parkinson's disease (PD) but without swallowing complaints and in normal subjects, and to investigate the relationship between them. We hypothesize there is a direct relationship between these two measurements. The study included 10 patients with idiopathic PD and 10 age-matched normal controls. Surface electromyography was recorded over the suprahyoid muscle group. The limit of dysphagia was obtained by offering increasing volumes of water until piecemeal deglutition occurred. The average volume per swallow was calculated by dividing the time taken by the number of swallows used to drink 100 ml of water. The PD group showed a significantly lower dysphagia limit and lower average volume per swallow. There was a significantly moderate direct correlation and association between the two measurements. About half of the PD patients had an abnormally low dysphagia limit and average volume per swallow, although none had spontaneously related swallowing problems. Both measurements may be used as a quick objective screening test for the early identification of swallowing alterations that may lead to dysphagia in PD patients, but the determination of the average volume per swallow is much quicker and simpler.

  12. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial.

    Science.gov (United States)

    Troche, M S; Okun, M S; Rosenbek, J C; Musson, N; Fernandez, H H; Rodriguez, R; Romrell, J; Pitts, T; Wheeler-Hegland, K M; Sapienza, C M

    2010-11-23

    Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement. This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration-aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images. No pretreatment group differences existed. The active treatment (EMST) group demonstrated improved swallow safety compared to the sham group as evidenced by improved PA scores. The EMST group demonstrated improvement of hyolaryngeal function during swallowing, findings not evident for the sham group. EMST may be a restorative treatment for dysphagia in those with PD. The mechanism may be explained by improved hyolaryngeal complex movement. This intervention study provides Class I evidence that swallow safety as defined by PA score improved post EMST.

  13. Objective Measures of Swallowing Function Applied to the Dysphagia Population: A One Year Experience.

    Science.gov (United States)

    Kendall, Katherine A; Ellerston, Julia; Heller, Amanda; Houtz, Daniel R; Zhang, Chong; Presson, Angela P

    2016-08-01

    Quantitative, reliable measures of swallowing physiology can be made from an modified barium swallowing study. These quantitative measures have not been previously employed to study large dysphagic patient populations. The present retrospective study of 139 consecutive patients with dysphagia seen in a university tertiary voice and swallowing clinic sought to use objective measures of swallowing physiology to (1) quantify the most prevalent deficits seen in the patient population, (2) identify commonly associated diagnoses and describe the most prevalent swallowing deficits, and (3) determine any correlation between objective deficits and Eating Assessment Tool (EAT-10) scores and body mass index. Poor pharyngeal constriction (34.5 %) and airway protection deficits (65.5 %) were the most common swallowing abnormalities. Reflux-related dysphagia (36 %), nonspecific pharyngeal dysphagia (24 %), Parkinson disease (16 %), esophageal abnormality (13 %), and brain insult (10 %) were the most common diagnoses. Poor pharyngeal constriction was significantly associated with an esophageal motility abnormality (p dysphagia symptoms as determined by the EAT-10 did not correlate with swallowing function abnormalities. This preliminary study indicates that reflux disease is common in patients with dysphagia and that associated esophageal abnormalities are common in dysphagic populations and may be associated with specific pharyngeal swallowing abnormalities. However, symptom scores from the EAT-10 did not correspond to swallowing pathophysiology.

  14. Associations between chewing and swallowing problems and physical and psychosocial health status of long-term care residents in taiwan: a pilot study.

    Science.gov (United States)

    Wang, Tze-Fang; Chen, I-Ju; Li, I-Chuan

    2012-01-01

    Oral health is often overlooked in institutional elder care but may have an impact on general health and ability to communicate. We aimed to determine the factor associated with chewing and swallowing problems among long-term care residents in Taiwan. Staff nurses trained to evaluate oral health assessed 781 residents using relevant sections of the Minimum Data Set 2.1 for nursing homes (Chinese version), including the Cognitive Performance Scale, Index of Social Engagement, and Activities of Daily Living Scale. Individuals with chewing and swallowing problems (n = 345) tended to be women (odds ratio [OR] = 1.51, P = .019) in smaller facilities (OR = 4.18, P broken, loose, or carious teeth (OR = 1.74, P = .042); and with more frequently inflamed gums (OR = 2.72, P = .025) than residents without chewing and swallowing problems (n = 436). Residents' chewing and swallowing problems were significantly associated with parenteral/enteral intake, oral health status, nutritional status, concomitant disease and infection, cognitive function, and social engagement. Copyright © 2012 Mosby, Inc. All rights reserved.

  15. How externalities impact an evaluation of strategies to prevent antimicrobial resistance in health care organizations

    Directory of Open Access Journals (Sweden)

    Jenine R. Leal

    2017-06-01

    Full Text Available Abstract Background The rates of antimicrobial-resistant organisms (ARO continue to increase for both hospitalized and community patients. Few resources have been allocated to reduce the spread of resistance on global, national and local levels, in part because the broader economic impact of antimicrobial resistance (i.e. the externality is not fully considered when determining how much to invest to prevent AROs, including strategies to contain antimicrobial resistance, such as antimicrobial stewardship programs. To determine how best to measure and incorporate the impact of externalities associated with the antimicrobial resistance when making resource allocation decisions aimed to reduce antimicrobial resistance within healthcare facilities, we reviewed the literature to identify publications which 1 described the externalities of antimicrobial resistance, 2 described approaches to quantifying the externalities associated with antimicrobial resistance or 3 described macro-level policy options to consider the impact of externalities. Medline was reviewed to identify published studies up to September 2016. Main body An externality is a cost or a benefit associated with one person’s activity that impacts others who did not choose to incur that cost or benefit. We did not identify a well-accepted method of accurately quantifying the externality associated with antimicrobial resistance. We did identify three main methods that have gained popularity to try to take into account the externalities of antimicrobial resistance, including regulation, charges or taxes on the use of antimicrobials, and the right to trade permits or licenses for antimicrobial use. To our knowledge, regulating use of antimicrobials is the only strategy currently being used by health care systems to reduce antimicrobial use, and thereby reduce AROs. To justify expenditures on programs that reduce AROs (i.e. to formally incorporate the impact of the negative externality of

  16. Management strategies in anticipation of climatic change and the resulting impact on wetlands

    International Nuclear Information System (INIS)

    Clay, R.; Neraasen, T.; Coley, R.

    1991-01-01

    Two significant impacts of climate change could affect waterfowl. Climate changes that induce dryness and reduce surface water would have a detrimental effect on waterfowl production capabilities. Global warming could also increase sea levels and flood critical waterfowl overwintering habitat. Strategies undertaken by Ducks Unlimited, a waterfowl conservation organization, to respond to the threat posed by global warming to waterfowl are reviewed. Ducks Unlimited will continue to assist with wetland restoration and preservation throughout the Great Plains. Strategies to enhance retention include converting marginally arable land to permanent forage, forage backflooding, and encouragement of zero and minimum tillage operations. Improved efficiency of irrigation projects is important to foster water conservation. Widespread surface water drainage should be discouraged, by combinations of legislation and economic incentives. Ducks Unlimited is refocusing its activites on parts of Alberta, Saskatchewan and Manitoba that are likely to have relatively wetter conditions under climatic warming

  17. Understanding the impact of eating disorders: using the reflecting team as a learning strategy for students.

    Science.gov (United States)

    Stringfellow, Alicia; Evans, Nicola; Evans, Anne-Marie

    2018-02-08

    This article outlines how the application of a reflecting team from systemic family therapy practice was used as a learning strategy for a postgraduate programme for healthcare students. The programme was designed to increase the students' skills, knowledge and awareness of the needs of people with eating disorders, and their families. There were some benefits to this learning strategy. Students reported that the use of a reflecting team enabled them to gain a deep understanding of the emotional impact of eating disorders on individuals and their carers. However, as this method of learning was new to the students, they needed some initial instruction on the approach. During the programme of study, it became evident that the health professionals were deeply affected by the experiences of people with eating disorders. This would suggest that possibly it was the presence of the sufferers themselves as part of the reflecting team that provided the pivotal learning opportunity, rather than the reflecting team per se.

  18. The impact of teaching communication strategies on EFL learners’ Willingness to Communicate

    Directory of Open Access Journals (Sweden)

    Abulfazl Mesgarshahr

    2014-01-01

    Full Text Available One of the pedagogical implications of the research on the Willingness to Communicate (WTC might be to propose practical ways of making language learners more willing to communicate in the classroom. This study investigated the impact of teaching communication strategies (CSs on Iranian EFL learners’ WTC. To this end, 8 intact classes were included as the experimental and control groups. The control group underwent regular language instruction, while the experimental group received the treatment (i.e., communication strategy training. The self-report measurement of WTC (MacIntyre, Baker, Clément, & Conrad, 2001 was done before (pre-test and after the treatment (post-test. The results of the independent-samples t test showed that the degree of WTC of the treatment group was significantly higher compared with that of the control group. It was concluded that teaching CSs helps learners become more willing to communicate in the classroom.

  19. Dam pre-release as an important operation strategy in reducing flood impact in Malaysia

    Directory of Open Access Journals (Sweden)

    Hidayah Ishak Nurul

    2018-01-01

    Full Text Available The 2014 flood was reported to be one of the worst natural disaster has ever affected several states in the northern part of Peninsular Malaysia. Overwhelming rainfall was noted as one of the main factors causing such impact, which was claimed to be unprecedented to some extent. The state of Perak, which is blessed with four cascading dams had also experienced flood damage at a scale that was considered the worst in history. The rainfall received had caused the dam to reach danger level that necessitated additional discharge to be released. Safety of the dams was of great importance and such unavoidable additional discharge was allowed to avoid catastrophic failure of the dam structures. This paper discusses the dam pre-release as a significant dam management strategy in reducing flood impact. An important balance between required dam storage to be maintained and the risk element that can be afforded is the crucial factor in such enhanced operation strategy. While further possibility in developing a carefully engineered dam pre-release strategy can be explored for dam operation in Malaysia, this has already been introduced in some developed countries. Australia and South Africa are examples where pre-release has been practiced and proven to reduce flood risk. The concept involves controlling the dam lake level throughout the year, in reference to the rainfall data and the hydrological properties for the catchment area of the dams. Plentiful data analysis need to be done in contemplation of producing the optimal pre-release model. The amount of heavy rainfalls received is beyond human control but the distribution of the discharge from the dams can be further managed with the appropriate pre-release strategy.

  20. Dam pre-release as an important operation strategy in reducing flood impact in Malaysia

    Science.gov (United States)

    Hidayah Ishak, Nurul; Mustafa Hashim, Ahmad

    2018-03-01

    The 2014 flood was reported to be one of the worst natural disaster has ever affected several states in the northern part of Peninsular Malaysia. Overwhelming rainfall was noted as one of the main factors causing such impact, which was claimed to be unprecedented to some extent. The state of Perak, which is blessed with four cascading dams had also experienced flood damage at a scale that was considered the worst in history. The rainfall received had caused the dam to reach danger level that necessitated additional discharge to be released. Safety of the dams was of great importance and such unavoidable additional discharge was allowed to avoid catastrophic failure of the dam structures. This paper discusses the dam pre-release as a significant dam management strategy in reducing flood impact. An important balance between required dam storage to be maintained and the risk element that can be afforded is the crucial factor in such enhanced operation strategy. While further possibility in developing a carefully engineered dam pre-release strategy can be explored for dam operation in Malaysia, this has already been introduced in some developed countries. Australia and South Africa are examples where pre-release has been practiced and proven to reduce flood risk. The concept involves controlling the dam lake level throughout the year, in reference to the rainfall data and the hydrological properties for the catchment area of the dams. Plentiful data analysis need to be done in contemplation of producing the optimal pre-release model. The amount of heavy rainfalls received is beyond human control but the distribution of the discharge from the dams can be further managed with the appropriate pre-release strategy.

  1. A comparative analysis of DBSCAN, K-means, and quadratic variation algorithms for automatic identification of swallows from swallowing accelerometry signals.

    Science.gov (United States)

    Dudik, Joshua M; Kurosu, Atsuko; Coyle, James L; Sejdić, Ervin

    2015-04-01

    Cervical auscultation with high resolution sensors is currently under consideration as a method of automatically screening for specific swallowing abnormalities. To be clinically useful without human involvement, any devices based on cervical auscultation should be able to detect specified swallowing events in an automatic manner. In this paper, we comparatively analyze the density-based spatial clustering of applications with noise algorithm (DBSCAN), a k-means based algorithm, and an algorithm based on quadratic variation as methods of differentiating periods of swallowing activity from periods of time without swallows. These algorithms utilized swallowing vibration data exclusively and compared the results to a gold standard measure of swallowing duration. Data was collected from 23 subjects that were actively suffering from swallowing difficulties. Comparing the performance of the DBSCAN algorithm with a proven segmentation algorithm that utilizes k-means clustering demonstrated that the DBSCAN algorithm had a higher sensitivity and correctly segmented more swallows. Comparing its performance with a threshold-based algorithm that utilized the quadratic variation of the signal showed that the DBSCAN algorithm offered no direct increase in performance. However, it offered several other benefits including a faster run time and more consistent performance between patients. All algorithms showed noticeable differentiation from the endpoints provided by a videofluoroscopy examination as well as reduced sensitivity. In summary, we showed that the DBSCAN algorithm is a viable method for detecting the occurrence of a swallowing event using cervical auscultation signals, but significant work must be done to improve its performance before it can be implemented in an unsupervised manner. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Effects of oil sands tailings compounds and harsh weather on mortality rates, growth and detoxification efforts in nestling tree swallows (Tachycineta bicolor)

    Energy Technology Data Exchange (ETDEWEB)

    Gentes, Marie-Line [Department of Veterinary Pathology, University of Saskatchewan, 52 Campus Dr., Saskatoon, SK S7N 5B4 (Canada)]. E-mail: marie-line.gentes@usask.ca; Waldner, Cheryl [Department of Large Animal Clinical Sciences, University of Saskatchewan, 52 Campus Dr., Saskatoon, SK S7N 5B4 (Canada)]. E-mail: cheryl.waldner@usask.ca; Papp, Zsuzsanna [Toxicology Research Centre, 44 Campus Dr., Saskatoon, SK S7N 5B3 (Canada)]. E-mail: zsp127@duke.usask.ca; Smits, Judit E.G. [Department of Veterinary Pathology, University of Saskatchewan, 52 Campus Dr., Saskatoon, SK S7N 5B4 (Canada)]. E-mail: judit.smits@usask.ca

    2006-07-15

    Oil sands mining companies in Alberta, Canada, are evaluating the feasibility of using wetlands to detoxify oil sands process material (OSPM) as a reclamation strategy. Reproductive success, nestling growth, survival and ethoxyresorufin-o-deethylase (EROD) activity were measured in tree swallows (Tachycineta bicolor) on experimental wetlands. In 2003, harsh weather triggered a widespread nestling die-off. Mortality rates on the control site reached 48% while they ranged from 59% to 100% on reclaimed wetlands. The odds of dying on the most process-affected sites were more than ten times higher than those on the control site. In 2004, weather was less challenging. Mortality rates were low, but nestlings on reclaimed wetlands weighed less than those on the control site, and had higher EROD activity. These results indicate that compared with reference birds, nestlings from OSPM-impacted wetlands may be less able to withstand additional stressors, which could decrease their chances of survival after fledging. - Under natural stress caused by harsh weather, birds exposed to chemicals from the oil sands extraction process suffered higher mortality than those in control areas.

  3. Effects of oil sands tailings compounds and harsh weather on mortality rates, growth and detoxification efforts in nestling tree swallows (Tachycineta bicolor)

    International Nuclear Information System (INIS)

    Gentes, Marie-Line; Waldner, Cheryl; Papp, Zsuzsanna; Smits, Judit E.G.

    2006-01-01

    Oil sands mining companies in Alberta, Canada, are evaluating the feasibility of using wetlands to detoxify oil sands process material (OSPM) as a reclamation strategy. Reproductive success, nestling growth, survival and ethoxyresorufin-o-deethylase (EROD) activity were measured in tree swallows (Tachycineta bicolor) on experimental wetlands. In 2003, harsh weather triggered a widespread nestling die-off. Mortality rates on the control site reached 48% while they ranged from 59% to 100% on reclaimed wetlands. The odds of dying on the most process-affected sites were more than ten times higher than those on the control site. In 2004, weather was less challenging. Mortality rates were low, but nestlings on reclaimed wetlands weighed less than those on the control site, and had higher EROD activity. These results indicate that compared with reference birds, nestlings from OSPM-impacted wetlands may be less able to withstand additional stressors, which could decrease their chances of survival after fledging. - Under natural stress caused by harsh weather, birds exposed to chemicals from the oil sands extraction process suffered higher mortality than those in control areas

  4. Globalization impacts on local commons: multiscale strategies for socioeconomic and ecological resilience

    Directory of Open Access Journals (Sweden)

    Timothy O. Randhir

    2016-02-01

    Full Text Available Globalization can have substantial impact on local commons byreducing sustainability of ecosystems and their vital services. Without effectivelocal institutions, these resources are at high risk of exploitation, especially tofeed global markets. This study proposes a multiscale ecosystem framework(MEF that incorporates information on ecosystem components, socioeconomicprocesses, and their interactions. This includes inter and intra commoninteractions and multi-scale processes to evaluate inter and intra scale changesin socioeconomic and ecological processes of commons. Local participationand multi-disciplinary information are critical in achieving sustainability. Usinga global dataset of selected indicators, a general decline is observable in localcommons that face globalization. The need for increasing resilience of commonsthrough multi-scale adaptation strategies can inform decisions at the national,state and local levels. Increased resilience through ecosystem-based approach canminimize impacts of globalization using information on multiattribute processes,equity considerations, development of robust institutions, and effective strategiesfor adaptation.

  5. Longitudinal studies on Listeria in smoked fish plants: impact of intervention strategies on contamination patterns.

    Science.gov (United States)

    Lappi, Victoria R; Thimothe, Joanne; Nightingale, Kendra Kerr; Gall, Kenneth; Scott, Virginia N; Wiedmann, Martin

    2004-11-01

    Four ready-to-eat smoked fish plants were monitored for 2 years to study Listeria contamination patterns and the impact of plant-specific Listeria control strategies, including employee training and targeted sanitation procedures, on Listeria contamination patterns. Samples from the processing plant environment and from raw and finished product were collected monthly and tested for Listeria spp. and Listeria monocytogenes. Before implementation of intervention strategies, 19.2% of raw product samples (n = 276), 8.7% of finished product samples (n = 275), and 26.1% of environmental samples (n = 617) tested positive for Listeria spp. During and after implementation of Listeria control strategies, 19.0% of raw product samples (n = 242), 7.0% of finished product samples (n = 244), and 19.5% of environmental samples (n = 527) were positive for Listeria spp. In one of the four fish plants (plant 4), no environmental samples were positive for L. monocytogenes, and this plant was thus excluded from statistical analyses. Based on data pooled from plants 1, 2, and 3, environmental Listeria spp. prevalence was significantly lower (P Listeria prevalence for floor drains was similar before and after implementation of controls (49.6 and 54.2%, respectively). Regression analysis revealed a significant positive relationship (P Listeria control strategies. Molecular subtyping (EcoRI ribotyping) revealed that specific L. monocytogenes ribotypes persisted in three processing plants over time. These persistent ribotypes were responsible for all six finished product contamination events detected in plant 1. Ribotype data also indicated that incoming raw material is only rarely a direct source of finished product contamination. While these data indicate that plant-specific Listeria control strategies can reduce cross-contamination and prevalence of Listeria spp. and L. monocytogenes in the plant environment, elimination of persistent L. monocytogenes strains remains a considerable

  6. Impact of Maintenance Strategies on the Performance Of Industrial Facilities In Selected Industrial Estates In Lagos State, Nigeria

    OpenAIRE

    Oseghale, G.E

    2014-01-01

    The study appraised the facilities and the maintenance management strategies employed in selected industrial estates in Lagos State by identifying and examining facilities maintenance strategies, and determining their impact on the physical condition of the facilities. This was with a view to establishing the optimal strategies. Data were sourced using structured questionnaire administered on the staff of maintenance department of the industrial firms located in the estates, only building mat...

  7. Unilateral Superior Laryngeal Nerve Lesion in an Animal Model of Dysphagia and Its Effect on Sucking and Swallowing

    Science.gov (United States)

    Campbell-Malone, Regina; Holman, Shaina D.; Lukasik, Stacey L.; Fukuhara, Takako; Gierbolini-Norat, Estela M.; Thexton, Allan J.; German, Rebecca Z.

    2013-01-01

    We tested two hypotheses relating to the sensory deficit that follows a unilateral superior laryngeal nerve (SLN) lesion in an infant animal model. We hypothesized that it would result in (1) a higher incidence of aspiration and (2) temporal changes in sucking and swallowing. We ligated the right-side SLN in six 2–3-week-old female pigs. Using videofluoroscopy, we recorded swallows in the same pre- and post-lesion infant pigs. We analyzed the incidence of aspiration and the duration and latency of suck and swallow cycles. After unilateral SLN lesioning, the incidence of silent aspiration during swallowing increased from 0.7 to 41.5 %. The durations of the suck containing the swallow, the suck immediately following the swallow, and the swallow itself were significantly longer in the post-lesion swallows, although the suck prior to the swallow was not different. The interval between the start of the suck containing a swallow and the subsequent epiglottal movement was longer in the post-lesion swallows. The number of sucks between swallows was significantly greater in post-lesion swallows compared to pre-lesion swallows. Unilateral SLN lesion increased the incidence of aspiration and changed the temporal relationships between sucking and swallowing. The longer transit time and the temporal coordinative dysfunction between suck and swallow cycles may contribute to aspiration. These results suggest that swallow dysfunction and silent aspiration are common and potentially overlooked sequelae of unilateral SLN injury. This validated animal model of aspiration has the potential for further dysphagia studies. PMID:23417250

  8. Fluid mechanics of eating, swallowing and digestion - overview and perspectives.

    Science.gov (United States)

    Engmann, Jan; Burbidge, Adam S

    2013-02-26

    From a very simplistic viewpoint, the human digestive system can be regarded as a long tube (with dramatic variations in diameter, cross-section, wall properties, pumping mechanisms, regulating valves and in-line sensors). We single out a few fluid mechanical phenomena along the trajectory of a food bolus from the mouth to the small intestine and discuss how they influence sensorial perception, safe transport, and nutrient absorption from a bolus. The focus is on lubrication flows between the tongue and palate, the oropharyngeal stage of swallowing and effects of flow on absorption in the small intestine. Specific challenges and opportunities in this research area are highlighted.

  9. Clinical investigation on application of water swallowing to MR esophagography

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Jinping, E-mail: zjpmri@163.com [Department of Radiology, Tongling People' s Hospital, Bijiashan Road 468, Tongling 244000, Anhui (China); Hu, Weijian; Zang, Lin [Department of Cardiothoracic Surgery, Tongling People' s Hospital, Bijiashan Road 468, Tongling 244000, Anhui (China); Yao, Yibin; Tang, Yongxiang; Qian, Zhen; Gao, Ping; Wu, Xiaoyan; Li, Shijian [Department of Radiology, Tongling People' s Hospital, Bijiashan Road 468, Tongling 244000, Anhui (China); Xie, Zhenlan; Yuan, Xiaoqing [Department of Pathology, Tongling People' s Hospital, Bijiashan Road 468, Tongling 244000, Anhui (China)

    2012-09-15

    Objective: To verify the clinical outcomes of applying water swallowing to MR esophagography. Methods: Thirty patients confirmed postoperatively or histopathologically with thoracic esophageal carcinoma by endoscopic biopsy and 10 healthy volunteers with normal esophagus underwent respectively conventional magnetic resonance imaging (MRI) detection and water swallowing MR esophagography. Of those patients, 4 underwent second examination after radiotherapy. Assessment on imaging effects of MR esophagography was performed. Assessment on definition on MR esophagography of the tumor in both upper and lower ends, specific localization, tumor size finally measured, coincidence with the gross pathologic types and tumor staging were respectively performed by comparison with conventional MRI. Additionally, we evaluated the outcomes of radiotherapy by comparing the previous MR esophagography with the second one with interventional technique. Results: Of the total 44 images of MR esophagography, 97.7% (43/44) were in high resolution by sagittal view and 81.8% (36/44) by cross-section. 93.3% (56/60) of the MR esophagography were clearly defined with the neoplastic lesion ends in the 30 patients with thoracic esophageal carcinoma, compared with 11.7% (7/60) by conventional MRI. The results were totally different in statistics (P < 0.005). Preoperative conventional MRI detection of the 22 cases in 25 undergone radical resection suggested vague diameter of the primary tumor and impossibly identified it at middle-lower thoracic esophagus in 5, and even failed to confirm gross pathologic types in 19 cases. Yet, MR esophagography with water swallowing represented accurate tumor length (graded as excellent) in 88% (22/25), localization in 100% (25/25), exact gross pathologic types in 88% (22/25), and accuracy for tumor staging in 80.8% (21/26) compared to 92.3% (24/26) by conventional MRI. Therapeutic effects achieved in 4 patients with radiotherapy. Conclusions: MR esophagography

  10. 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

  11. Dose-dependent deterioration of swallowing function after induction chemotherapy and definitive chemoradiotherapy for laryngopharyngeal cancer

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    Haderlein, M.; Semrau, S.; Ott, O.; Speer, S.; Fietkau, R. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); Bohr, C. [University Hospital Erlangen, Department of Otorhinolaryngology, Head and Neck Surgery, Erlangen (Germany)

    2014-02-15

    To evaluate the influence of clinical, treatment- and dose-dependent factors on posttreatment swallowing function after induction chemotherapy and definitive chemoradiotherapy in a group of homogeneously treated laryngopharyngeal cancer patients. From 28 May 2008 to 15 February 2013, 45 patients with borderline inoperable laryngopharyngeal cancer that had responded well to induction chemotherapy were treated with definitive chemoradiotherapy. Median follow-up was 22 months. Swallowing function and clinical data were prospectively analyzed using the EORTC QLQ-C30 questionnaire. Swallowing structures were retrospectively delineated on the original treatment planning CT. Dose-volume histograms were calculated for swallowing structures and D{sub mean}, D{sub max} and V50-V64 values (in 2 Gy increments) were determined for each patient. Tumor volume and infiltration of the swallowing apparatus was defined by CT before induction chemotherapy. Of the 45 patients, 26 (57.8 %) fully regained swallowing function after chemoradiotherapy. A further 12 patients (26.7 %) were able to manage soft, pureed and/or liquid foods; the remaining 7 (15.6 %) were completely dependent on percutaneous endoscopic gastrostomy (PEG). Posttreatment swallowing function was significantly influenced by D{sub mean} to the superior pharyngeal constrictor muscle (PCM, p = 0.041). Correlations between late dysphagia and dose-volume relationships in the superior PCM and soft palate were also observed, which were significant from V60 (p = 0.043) and V58 for the soft palate and superior PCM, respectively. Of the evaluated clinical and tumor-related factors, only alcohol abuse (p = 0.024) had an influence on posttreatment swallowing function. Almost 50 % of patients had deterioration of swallowing function after definitive chemoradiotherapy for laryngopharyngeal cancer. The dose to anatomical structures responsible for swallowing function appears to play a role. Therefore, in selected patients, target

  12. Effect of transcranial direct current stimulation on swallowing apraxia and cortical excitability in stroke patients.

    Science.gov (United States)

    Yuan, Ying; Wang, Jie; Wu, Dongyu; Huang, Xiaobo; Song, Weiqun

    2017-10-01

    Swallowing apraxia is characterized by impaired volitional swallowing but relatively preserved reflexive swallowing. Few studies are available on the effectiveness of behavioral therapy and management of the condition. This study aimed to investigate the effect of transcranial direct current stimulation (tDCS) on swallowing apraxia and cortical activation in stroke patients. The study included three inpatients (age 48-70 years; 1 male, 2 females; duration of stroke, 35-55 d) with post-stroke swallowing apraxia and six age-matched healthy subjects (age 45-65 years; 3 males, 3 females). Treatments were divided into two phases: Phase A and Phase B. During Phase A, the inpatients received three weeks of sham tDCS and conventional treatments. During Phase B, these patients received three weeks of anodal tDCS over the bilateral primary sensorimotor cortex (S 1 M 1 ) of swallowing and conventional treatments. Swallowing apraxia assessments were measured in three inpatients before Phase A, before Phase B, and after Phase B. The electroencephalography (EEG) nonlinear index of approximate entropy (ApEn) was calculated for three patients and six healthy subjects. After tDCS, scores of swallowing apraxia assessments increased, and ApEn indices increased in both stimulated and non-stimulated areas. Anodal tDCS might provide a useful means for recovering swallowing apraxia, and the recovery could be related to increased excitability of the swallowing cortex. Further investigations should explore the relationship between lesion size and/or lesion site and the prognosis of swallowing apraxia. Clinical trial registry: http://www.chictr.org Registration Number: ChiCTR-TRC-14004955.

  13. Effects of carbonated liquid on swallowing dysfunction in dementia with Lewy bodies and Parkinson's disease dementia.

    Science.gov (United States)

    Larsson, Victoria; Torisson, Gustav; Bülow, Margareta; Londos, Elisabet

    2017-01-01

    Swallowing dysfunction is an increasingly recognized problem in patients with dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), which can result in aspiration pneumonia and death. Few studies have examined potential ways of improving swallowing function in this fragile patient group. The aim of this study was to evaluate swallowing dysfunction and carbonated liquid using videofluoroscopy in DLB and PDD patients. A total of 48 patients with DLB and PDD were referred for a clinical examination with videofluoroscopy. Descriptive overall assessments were provided at the time of the examination regarding swallowing function and the effects of different modifications, including carbonated thin liquid (CTL). Additionally, a repeated measures quantitative retrospective analysis has been performed comparing 1) thin liquids; 2) thickened liquids and 3) CTLs, with regard to the quantitative variables 1) pharyngeal transit time (PTT); 2) pharyngeal retention and 3) tracheal penetration. In all, 40/48 (83%) of the patients had a swallowing dysfunction, which was confirmed on videofluoroscopy, with 34/40 (85%) patients having a pharyngeal-type dysfunction. A total of 14/40 (35%) patients with an objective swallowing impairment did not have any subjective swallowing symptoms. Out of the patients with swallowing dysfunction, 87% had an overall improved swallowing function with carbonated liquid. PTT for carbonated liquid (median 633 ms, interquartile range [IQR] 516-786 ms) was quicker than for thin liquid (760 ms, IQR 613-940 ms, P =0.014) and thickened liquid (880.0 ms, IQR 600-1,500 ms, P <0.001). No significant effect was seen in residue or penetration. The majority of patients with DLB or PDD had a swallowing dysfunction, sometimes without subjective swallowing symptoms, which improved with carbonated liquid. This highlights the importance of investigating patients with videofluoroscopy and to carry out a prospective interventional study to further

  14. The impact of metacognitive strategies and self-regulating processes of solving math word problems

    Directory of Open Access Journals (Sweden)

    Eda Vula

    2017-09-01

    Full Text Available This empirical study investigates the impact of metacognitive strategies and self-regulating processes in learners’ achievement on solving math word problems. It specifically analyzes the impact of the linguistic factor and the number of steps and arithmetical operations that learners need to apply during the process of solving math word problems. Two hundred sixty-three learners, of three classes of third graders (N=130 and four classes of fifth graders (N=133 of the elementary cycle from two urban schools of Kosovo, participated in the study. Almost half of the total number of the third and fifth-graderswere exposed to metacognitive instruction. The rest of the learners were included in control classes in which they performed tasks without having been given any specific guidance, based exclusively on traditional methods and respective textbooks. All the learners were tested in math word problems twice, before the intervention and after it. Research findings have shown that metacognitive strategies and self-regulating processes that learners use to control their actions, to reason, and to reflect, are one of the main resources that influence their success in solving a math word problem. Although the difference between the pre-test and the post-test resultswas statistically significant solely with the fifth-grade experimental classes, yet an improved performance was observed in third-grade experimental learners’ classes compared to control classes. Theoretical and practical implications of the research are discussed in the end of the study.

  15. National nursing strategies in seven countries of the Region of the Americas: issues and impact

    Directory of Open Access Journals (Sweden)

    Rebecca O. Shasanmi

    2015-07-01

    Full Text Available OBJECTIVE: To identify and examine the current national nursing strategies and policy impact of workforce development regarding human resources for health in seven selected countries in the Region of the Americas: Argentina, Canada, Costa Rica, Jamaica, Mexico, Peru, and the United States. METHODS: A review of available literature was conducted to identify publicly-available documents that describe the general backdrop of nursing human resources in these seven countries. A keyword search of PubMed was supplemented by searches of websites maintained by Ministries of Health and nursing organizations. Inclusion criteria limited documents to those published in 2008-2013 that discussed or assessed situational issues and/or progress surrounding the nursing workforce. RESULTS: Nursing human resources for health is progressing. Canada, Mexico, and the United States have stronger nursing leadership in place and multisectoral policies in workforce development. Jamaica shows efforts among the Caribbean countries to promote collaborative practices in research. The three selected countries in Central and South America championed networks to revive nursing education. Yet, overall challenges limit the opportunities to impact public health. CONCLUSIONS: The national nursing strategies prioritized multisectoral collaboration, professional competencies, and standardized educational systems, with some countries underscoring the need to align policies with efforts to promote nursing leadership, and others, focusing on expanding the scope of practice to improve health care delivery. While each country wrestles with its specific context, all require proper leadership, multisectoral collaboration, and appropriate resources to educate, train, and empower nurses to be at the forefront.

  16. Impact of Water Scarcity on the Fenhe River Basin and Mitigation Strategies

    Directory of Open Access Journals (Sweden)

    Weiwei Shao

    2017-01-01

    Full Text Available This study produced a drought map for the Fenhe River basin covering the period from 150 BC to 2012 using regional historical drought records. Based on meteorological and hydrological features, the characteristics and causes of water scarcity in the Fenhe River basin were examined, along with their impact on the national economy and ecological environment. The effects of water scarcity in the basin on the national economy were determined from agricultural, industrial, and domestic perspectives. The impact on aquatic ecosystems was ascertained through an evolution trend analysis of surface water systems, including rivers, wetlands, and slope ecosystems, and subterranean water systems, including groundwater and karst springs. As a result of these analyses, strategies are presented for coping with water scarcity in this basin, including engineering countermeasures, such as the construction of a water network in Shanxi, and the non-engineering approach of groundwater resource preservation. These comprehensive coping strategies are proposed with the aim of assisting the prevention and control of water scarcity in the arid and semi-arid areas of China.

  17. Progress on Protection Strategies to Mitigate the Impact of Renewable Distributed Generation on Distribution Systems

    Directory of Open Access Journals (Sweden)

    Mohamad Norshahrani

    2017-11-01

    Full Text Available The benefits of distributed generation (DG based on renewable energy sources leads to its high integration in the distribution network (DN. Despite its well-known benefits, mainly in improving the distribution system reliability and security, there are challenges encountered from a protection system perspective. Traditionally, the design and operation of the protection system are based on a unidirectional power flow in the distribution network. However, the integration of distributed generation causes multidirectional power flows in the system. Therefore, the existing protection systems require some improvement or modification to address this new feature. Various protection strategies for distribution system have been proposed so that the benefits of distributed generation can be fully utilized. This paper reviews the current progress in protection strategies to mitigate the impact of distributed generation in the distribution network. In general, the reviewed strategies in this paper are divided into: (1 conventional protection systems and (2 modifications of the protection systems. A comparative study is presented in terms of the respective benefits, shortcomings and implementation cost. Future directions for research in this area are also presented.

  18. National climate policies across Europe and their impacts on cities strategies.

    Science.gov (United States)

    Heidrich, O; Reckien, D; Olazabal, M; Foley, A; Salvia, M; de Gregorio Hurtado, S; Orru, H; Flacke, J; Geneletti, D; Pietrapertosa, F; Hamann, J J-P; Tiwary, A; Feliu, E; Dawson, R J

    2016-03-01

    Globally, efforts are underway to reduce anthropogenic greenhouse gas emissions and to adapt to climate change impacts at the local level. However, there is a poor understanding of the relationship between city strategies on climate change mitigation and adaptation and the relevant policies at national and European level. This paper describes a comparative study and evaluation of cross-national policy. It reports the findings of studying the climate change strategies or plans from 200 European cities from Austria, Belgium, Estonia, Finland, France, Germany, Ireland, Italy, Netherlands, Spain and the United Kingdom. The study highlights the shared responsibility of global, European, national, regional and city policies. An interpretation and illustration of the influences from international and national networks and policy makers in stimulating the development of local strategies and actions is proposed. It was found that there is no archetypical way of planning for climate change, and multiple interests and motivations are inevitable. Our research warrants the need for a multi-scale approach to climate policy in the future, mainly ensuring sufficient capacity and resource to enable local authorities to plan and respond to their specific climate change agenda for maximising the management potentials for translating environmental challenges into opportunities. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Economic Impact of the Dutch Gas Hub Strategy on the Netherlands

    International Nuclear Information System (INIS)

    Harris, D.; Bazelon, C.; Humphreys, B.; Dickson, P.

    2010-09-01

    Since the discovery of the Groningen gas field in 1959, the Netherlands has been a key player in the European gas market. The Netherlands has built up a large onshore and offshore Exploration and Production sector, it has a highly developed gas transmission and distribution network, and is a major exporter of gas to other EU Member States. The Netherlands has considerable expertise in all parts of the gas supply chain, and is a world centre for Research and development in natural gas supply and use. More recently construction has begun on terminals to allow the import of Liquid Natural Gas to the Netherlands. However, Dutch gas reserves are now in decline, and the Netherlands will become a net importer of gas around 2025. The Dutch government wishes to capitalise on the existing industry and skills and sustain the Netherlands' place in the European gas industry beyond the life of the existing gas fields. In November 2009 the Minister of Economic Affairs published a paper describing the strategy of turning the Netherlands into a 'Gas Hub' or 'gas roundabout' for north-west Europe. The Dutch government intends that the gas hub would capitalise on the existing skills and industry, increase competition and security of supply in the Dutch gas market, create employment and make a significant contribution to the Dutch economy. The Dutch Ministry of Economic Affairs, Agriculture and Innovation has commissioned The Brattle Group to perform an analysis of the economic impact of the gas hub concept. The study has several aims including: To analyse the current contribution of the Dutch gas sector to the economy; To assess the Strengths, Weaknesses, Opportunities and Threats associated with the gas hub strategy; To quantify the benefits of the gas hub strategy to the Dutch economy. Note that the aim of the study is to define in more detail what a successful Dutch gas hub strategy would look like, to assess the strengths and weakness of the Dutch gas sector in achieving a

  20. Effectiveness of a confinement strategy in reducing pack stock impacts at campsites in the Selway-Bitterroot Wilderness, Idaho

    Science.gov (United States)

    David R. Spildie; David N. Cole; Sarah C. Walker

    2000-01-01

    In 1993, a management program was initiated in the Seven Lakes Basin in the Selway-Bitterroot Wilderness to bring high levels of campsite impact into compliance with management standards. The core of the strategy involved confining use, particularly by stock groups, and restoring certain campsites and portions of campsites. In just five years, campsite impacts were...

  1. Effects of Neuromuscular Electrical Stimulation on Swallowing Functions in Children with Cerebral Palsy: A Pilot Randomised Controlled Trial

    Directory of Open Access Journals (Sweden)

    Woo Jin Song

    2015-06-01

    Conclusion: This study demonstrated that OST and NMES facilitated swallowing functions than OST and sham–NMES in children with CP and dysphagia. Future studies need to utilise video fluoroscopy swallowing study for outcome measurements in a large participant group.

  2. The validation of peer review through research impact measures and the implications for funding strategies.

    Directory of Open Access Journals (Sweden)

    Stephen A Gallo

    Full Text Available There is a paucity of data in the literature concerning the validation of the grant application peer review process, which is used to help direct billions of dollars in research funds. Ultimately, this validation will hinge upon empirical data relating the output of funded projects to the predictions implicit in the overall scientific merit scores from the peer review of submitted applications. In an effort to address this need, the American Institute of Biological Sciences (AIBS conducted a retrospective analysis of peer review data of 2,063 applications submitted to a particular research program and the bibliometric output of the resultant 227 funded projects over an 8-year period. Peer review scores associated with applications were found to be moderately correlated with the total time-adjusted citation output of funded projects, although a high degree of variability existed in the data. Analysis over time revealed that as average annual scores of all applications (both funded and unfunded submitted to this program improved with time, the average annual citation output per application increased. Citation impact did not correlate with the amount of funds awarded per application or with the total annual programmatic budget. However, the number of funded applications per year was found to correlate well with total annual citation impact, suggesting that improving funding success rates by reducing the size of awards may be an efficient strategy to optimize the scientific impact of research program portfolios. This strategy must be weighed against the need for a balanced research portfolio and the inherent high costs of some areas of research. The relationship observed between peer review scores and bibliometric output lays the groundwork for establishing a model system for future prospective testing of the validity of peer review formats and procedures.

  3. The validation of peer review through research impact measures and the implications for funding strategies.

    Science.gov (United States)

    Gallo, Stephen A; Carpenter, Afton S; Irwin, David; McPartland, Caitlin D; Travis, Joseph; Reynders, Sofie; Thompson, Lisa A; Glisson, Scott R

    2014-01-01

    There is a paucity of data in the literature concerning the validation of the grant application peer review process, which is used to help direct billions of dollars in research funds. Ultimately, this validation will hinge upon empirical data relating the output of funded projects to the predictions implicit in the overall scientific merit scores from the peer review of submitted applications. In an effort to address this need, the American Institute of Biological Sciences (AIBS) conducted a retrospective analysis of peer review data of 2,063 applications submitted to a particular research program and the bibliometric output of the resultant 227 funded projects over an 8-year period. Peer review scores associated with applications were found to be moderately correlated with the total time-adjusted citation output of funded projects, although a high degree of variability existed in the data. Analysis over time revealed that as average annual scores of all applications (both funded and unfunded) submitted to this program improved with time, the average annual citation output per application increased. Citation impact did not correlate with the amount of funds awarded per application or with the total annual programmatic budget. However, the number of funded applications per year was found to correlate well with total annual citation impact, suggesting that improving funding success rates by reducing the size of awards may be an efficient strategy to optimize the scientific impact of research program portfolios. This strategy must be weighed against the need for a balanced research portfolio and the inherent high costs of some areas of research. The relationship observed between peer review scores and bibliometric output lays the groundwork for establishing a model system for future prospective testing of the validity of peer review formats and procedures.

  4. Strategies towards Evaluation beyond Scientific Impact. Pathways not only for Agricultural Research

    Directory of Open Access Journals (Sweden)

    Birge M. Wolf

    2013-12-01

    Full Text Available Various research fields, like organic agricultural research, are dedicated to solving real-world problems and contributing to sustainable development. Therefore, systems research and the application of interdisciplinary and transdisciplinary approaches are increasingly endorsed. However, research performance depends not only on self-conception, but also on framework conditions of the scientific system, which are not always of benefit to such research fields. Recently, science and its framework conditions have been under increasing scrutiny as regards their ability to serve societal benefit. This provides opportunities for (organic agricultural research to engage in the development of a research system that will serve its needs. This article focuses on possible strategies for facilitating a balanced research evaluation that recognises scientific quality as well as societal relevance and applicability. These strategies are (a to strengthen the general support for evaluation beyond scientific impact, and (b to provide accessible data for such evaluations. Synergies of interest are found between open access movements and research communities focusing on global challenges and sustainability. As both are committed to increasing the societal benefit of science, they may support evaluation criteria such as knowledge production and dissemination tailored to societal needs, and the use of open access. Additional synergies exist between all those who scrutinise current research evaluation systems for their ability to serve scientific quality, which is also a precondition for societal benefit. Here, digital communication technologies provide opportunities to increase effectiveness, transparency, fairness and plurality in the dissemination of scientific results, quality assurance and reputation. Furthermore, funders may support transdisciplinary approaches and open access and improve data availability for evaluation beyond scientific impact. If they begin to

  5. Institutional Infrastructure for Broader Impacts Engagement - Showcasing Effective Strategies and Approaches from a Large Research Institute

    Science.gov (United States)

    Gold, A. U.; Sullivan, S. B.; Smith, L. K.; Lynds, S. E.

    2014-12-01

    The need for robust scientific and especially climate literacy is increasing. Funding agencies mandate that scientists make their findings and data publically available. Ideally, this mandate is achieved by scientists and educators working together to translate research findings into common knowledge. The Cooperative Institute for Research in Environmental Sciences (CIRES) is the largest research institute at the University of Colorado and home institute to over 500 scientists. CIRES provides an effective organizational infrastructure to support its scientists in broadening their research impact. Education specialists provide the necessary experience, connections, logistical support, and evaluation expertise to develop and conduct impactful education and outreach efforts. Outreach efforts are tailored to the project needs and the scientists' interests. They span from deep engagement efforts with a high time commitment by the scientist thus a high dosage to short presentations by the scientists that reach many people without stimulating a deep engagement and have therefore a low dosage. We use three examples of current successful programs to showcase these different engagement levels and report on their impact: i) deep transformative and time-intensive engagement through a Research Experience for Community College students program, ii) direct engagement during a teacher professional development workshop centered around a newly developed curriculum bringing authentic climate data into secondary classrooms, iii) short-time engagement through a virtual panel discussion about the state of recent climate science topics, the recordings of which were repurposed in a Massive Open Online Course (MOOC). In this presentation, we discuss the challenges and opportunities of broader impacts work. We discuss successful strategies that we developed, stress the importance of robust impact evaluation, and summarize different avenues of funding outreach efforts.

  6. Mercury Contamination in Tree Swallows Nesting at Northern Wisconsin Inland Lakes that Differ in Methylation Potential

    Science.gov (United States)

    Tree swallows (Tachycineta bicolor) are a useful species to assess the bioavailability and effects of trace elements, including mercury, because they will nest in boxes in relatively close proximity to one another. Because tree swallows feed on the aerial stages of benthic aquat...

  7. Evidence-Based Systematic Review: Effects of Neuromuscular Electrical Stimulation on Swallowing and Neural Activation

    Science.gov (United States)

    Clark, Heather; Lazarus, Cathy; Arvedson, Joan; Schooling, Tracy; Frymark, Tobi

    2009-01-01

    Purpose: To systematically review the literature examining the effects of neuromuscular electrical stimulation (NMES) on swallowing and neural activation. The review was conducted as part of a series examining the effects of oral motor exercises (OMEs) on speech, swallowing, and neural activation. Method: A systematic search was conducted to…

  8. Prevalence of Auditory Problems in Children with Feeding and Swallowing Disorders

    Science.gov (United States)

    Rawool, Vishakha Waman

    2017-01-01

    Purpose: Although an interdisciplinary approach is recommended for assessment and management of feeding or swallowing difficulties, audiologists are not always included in the interdisciplinary team. The purpose of this study is to report the prevalence of middle ear and hearing problems in children with feeding and swallowing disorders and to…

  9. Tongue Pressure Modulation during Swallowing: Water versus Nectar-Thick Liquids

    Science.gov (United States)

    Steele, Catriona M.; Bailey, Gemma L.; Molfenter, Sonja M.

    2010-01-01

    Purpose: Evidence of tongue-palate pressure modulation during swallowing between thin and nectar-thick liquids stimuli has been equivocal. This mirrors a lack of clear evidence in the literature of tongue and hyoid movement modulation between nectar-thick and thin liquid swallows. In the current investigation, the authors sought to confirm whether…

  10. Association between swallow perception and esophageal bolus clearance in patients with globus sensation.

    Science.gov (United States)

    Chen, Chien-Lin; Yi, Chih-Hsun; Liu, Tso-Tsai

    2013-04-01

    Globus sensation is common, but its pathogenesis is not yet clear. Our purpose was to investigate subjective perception of swallowing and esophageal motility by combined multichannel intraluminal impedance and manometry (MII-EM) for patients with globus sensation. Combined MII-EM was performed for 25 globus patients and 15 healthy controls. Swallows were abnormal if hypocontractivity or simultaneous contractions occurred. Esophageal bolus transit was incomplete if bolus exit was not found at one or more of all measurement sites. Perception of each swallow was assessed by use of a standardized scoring system, and was enhanced if the score was >1. Few globus patients reported enhanced perception during viscous or solid swallows. Incomplete bolus transit and enhanced perception occurred similarly between viscous and solid boluses. Agreement between enhanced perception and proximal bolus clearance was greater during solid swallows (κ = 0.45, 95 % CI: 0.32-0.58) than during viscous swallows (κ = 0.13, 95 % CI: 0-0.25) (P perception and total bolus clearance was greater during solid swallows (κ = 0.46, 95 % CI: 0.34-0.58) than during viscous swallows (κ = 0.11, 95 % CI: 0-0.22) (P perception is uncommon in patients with globus sensation, although there is a significant association between enhanced esophageal perception and solid bolus clearance. Application of a solid bolus may help better delineation of the interrelationship between the subjective perception of bolus passage and the objective measurement of bolus clearance.

  11. Effects of pacifier and taste on swallowing, esophageal motility, transit, and respiratory rhythm in human neonates.

    Science.gov (United States)

    Shubert, T R; Sitaram, S; Jadcherla, S R

    2016-04-01

    Pacifier use is widely prevalent globally despite hygienic concerns and uncertain mechanistic effects on swallowing or airway safety. The effects of pacifier and taste interventions on pharyngo-esophageal motility, bolus transit, and respiratory rhythms were investigated by determining the upper esophageal sphincter (UES), esophageal body, esophagogastric junction (EGJ) motor patterns and deglutition apnea, respiratory rhythm disturbances, and esophageal bolus clearance. Fifteen infants (six males; median gestation 31 weeks and birth weight 1.4 kg) underwent high-resolution impedance manometry at 43 (41-44) weeks postmenstrual age. Manometric, respiratory, and impedance characteristics of spontaneous swallows, pacifier-associated dry swallowing and taste (pacifier dipped in 3% sucrose)-associated swallowing were analyzed. Linear mixed and generalized estimating equation models were used. Data are presented as mean ± SEM, %, or median (IQR). Pharyngo-esophageal motility, respiratory, and impedance characteristics of 209 swallows were analyzed (85 spontaneous swallows, 63 pacifier- swallows, 61 taste- swallows). Basal UES and EGJ pressures decreased upon pacifier (p pacifier or taste interventions decreases UES and EGJ basal pressure, but has no effects on pharyngo-esophageal motility, airway interactions, or esophageal bolus transit. A decrease in central parasympathetic-cholinergic excitatory drive is likely responsible for the basal effects. © 2016 John Wiley & Sons Ltd.

  12. Functional outcome in acute stroke patients with oropharyngeal Dysphagia after swallowing therapy.

    Science.gov (United States)

    Huang, Kun-Ling; Liu, Ting-Yuan; Huang, Yu-Chi; Leong, Chau-Peng; Lin, Wei-Che; Pong, Ya-Ping

    2014-01-01

    Dysphagia after stroke is associated with mortality and increased pulmonary complications. Swallowing therapies may decrease pulmonary complications and improve patients' quality of life after stroke. This study used clinical swallowing assessments and videofluoroscopy (VFS) to assess the functional recovery of acute stroke patients with dysphagia after different swallowing therapies. We enrolled 29 acute stroke patients with dysphagia and randomly divided them into 3 therapy groups: traditional swallowing (TS), oropharyngeal neuromuscular electrical stimulation (NMES), and combined NMES/TS. All patients were assessed using the clinical functional oral intake scale (FOIS), 8-point penetration-aspiration scale (PAS), and functional dysphagia scale (FDS) of VFS before and after treatment. There were no differences in the clinical parameters and swallowing results of the FOIS and VFS before swallowing treatment among the 3 groups (P > .05). TS therapy and combined therapy both had significant swallowing improvement after therapy according to the FOIS and 8-point PAS (P dysphagia, combined NMES/TS therapy is the most effective swallowing therapy in taking solid diets and thick liquids. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Leaf anthracnose, a new disease of swallow-worts from Russia

    Science.gov (United States)

    Black swallow-wort Vincetoxicum nigrum (L.) Moench (synonym=Cynanchum louiseae Kartesz & Gandhi) and pale swallow-wort Vincetoxicum rossicum (Kleopow) Borhidi (synonym=Cynanchum rossicum (Kleopow) Borhidi) are invasive plants belonging to the family Apocynaceae and are the targets of biological cont...

  14. New biological information on the invasive swallow-worts (Vincetoxicum spp.)

    Science.gov (United States)

    Vincetoxicum nigrum (L.) Moench [Cynanchum louiseae Kartesz & Gandhi] (black swallow-wort) and V. rossicum (Kleopow) Barbar. [Cynanchum rossicum (Kleopow) Borhidi] (pale swallow-wort) are herbaceous perennial vines in the Apocynaceae native to Europe. Both species are considered invasive in their in...

  15. Leaf anthracnose, a new disease of swallow-worts caused by Colletotrichum lineola from Russia

    Science.gov (United States)

    Black swallow-wort Vincetoxicum nigrum (L.) Moench and pale swallow-wort Vincetoxicum rossicum (Kleopow) Borhidi (family Apocynaceae subfamily Asclepiadoideae) are invasive plants and are the targets of biological control efforts to control their spread in the USA. In 2010, diseased leaves of a rela...

  16. Relationships between air swallowing, intragastric air, belching and gastro-oesophageal reflux

    NARCIS (Netherlands)

    Bredenoord, AJ; Weusten, BLAM; Timmer, R; Akkermans, LMA; Smout, AJPM

    Background: With each swallow a certain amount of air is transported to the stomach. The stomach protects itself against excessive distention by swallowed air through belching (gas reflux). The mechanism of belching (transient lower oesophageal sphincter relaxation) is also one of the mechanisms

  17. Relationships between air swallowing, intragastric air, belching and gastro-oesophageal reflux

    NARCIS (Netherlands)

    Bredenoord, A. J.; Weusten, B. L. A. M.; Timmer, R.; Akkermans, L. M. A.; Smout, A. J. P. M.

    2005-01-01

    BACKGROUND: With each swallow a certain amount of air is transported to the stomach. The stomach protects itself against excessive distention by swallowed air through belching (gas reflux). The mechanism of belching (transient lower oesophageal sphincter relaxation) is also one of the mechanisms

  18. Swallowing improvement after levodopa treatment in idiopathic Parkinson's disease: lack of evidence.

    Science.gov (United States)

    Melo, Ailton; Monteiro, Larissa

    2013-03-01

    Swallowing impairment is the main cause of pulmonary infection and death in Parkinson's disease (PD). To date, there is no established effective treatment to restore swallowing function among these subjects. Levodopa is considered the gold standard treatment for motor symptoms in PD but its efficacy in improving oropharyngeal and esophageal dysphagia remains controversial. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Patient-reported symptom questionnaires in laryngeal cancer: Voice, speech and swallowing.

    NARCIS (Netherlands)

    Rinkel, N.P.M.; Verdonck-de Leeuw, I.M.; van den Brakel, N.; de Bree, R.; Eerenstein, S.E.; Aaronson, N.K.; Leemans, C.R.

    2014-01-01

    Objectives To validate questionnaires on voice, speech, and swallowing among laryngeal cancer patients, to assess the need for and use of rehabilitation services, and to determine the association between voice, speech, and swallowing problems, and quality of life and distress. Materials and methods

  20. Patient-reported symptom questionnaires in laryngeal cancer: Voice, speech and swallowing

    NARCIS (Netherlands)

    Rinkel, R.N.P.M.; Verdonck-de Leeuw, I.M.; van den Brakel, N.; de Bree, R.; Eerenstein, S.E.J.; Aaronson, N.K.; Leemans, C.R.

    2014-01-01

    Objectives: To validate questionnaires on voice, speech, and swallowing among laryngeal cancer patients, to assess the need for and use of rehabilitation services, and to determine the association between voice, speech, and swallowing problems, and quality of life and distress. Materials and

  1. Impacts of a national strategy to reduce population salt intake in England: serial cross sectional study.

    Directory of Open Access Journals (Sweden)

    Christopher Millett

    Full Text Available BACKGROUND: The UK introduced an ambitious national strategy to reduce population levels of salt intake in 2003. The aim of this study was to evaluate the impact of this strategy on salt intake in England, including potential effects on health inequalities. METHODS: Secondary analysis of data from the Health Survey for England. Our main outcome measure was trends in estimated daily salt intake from 2003-2007, as measured by spot urine. Secondary outcome measures were knowledge of government guidance and voluntary use of salt in food preparation over this time period. RESULTS: There were significant reductions in salt intake between 2003 and 2007 (-0.175 grams per day per year, p<0.001. Intake decreased uniformly across all other groups but remained significantly higher in younger persons, men, ethnic minorities and lower social class groups and those without hypertension in 2007. Awareness of government guidance on salt use was lowest in those groups with the highest intake (semi-skilled manual v professional; 64.9% v 71.0% AOR 0.76 95% CI 0.58-0.99. Self reported use of salt added at the table reduced significantly during the study period (56.5% to 40.2% p<0.001. Respondents from ethnic minority groups remained significantly more likely to add salt during cooking (white 42.8%, black 74.1%, south Asian 88.3% and those from lower social class groups (unskilled manual 46.6%, professional 35.2% were more likely to add salt at the table. CONCLUSIONS: The introduction a national salt reduction strategy was associated with uniform but modest reductions in salt intake in England, although it is not clear precisely which aspects of the strategy contributed to this. Knowledge of government guidance was lower and voluntary salt use and total salt intake was higher among occupational and ethnic groups at greatest risk of cardiovascular disease.

  2. The U.S. Gas Flooding Experience: CO2 Injection Strategies and Impact on Ultimate Recovery

    Energy Technology Data Exchange (ETDEWEB)

    Nunez-Lopez, Vanessa [The University of Texas at Austin; Hosseini, Seyyed; Gil-Egui, Ramon

    2017-09-29

    The Permian Basin in West Texas and southwestern New Mexico has seen 45 years of oil reserve growth through CO2 enhanced oil recovery (CO2 EOR). More than 60 CO2 EOR projects are currently active in the region’s limestone, sandstone and dolomite reservoirs. Water alternating gas (WAG) has been the development strategy of choice in the Permian for several technical and economic reasons. More recently, the technology started to get implemented in the much more porous and permeable clastic depositional systems of the onshore U.S. Gulf Coast. Continued CO2 injection (CGI), as opposed to WAG, was selected as the injection strategy to develop Gulf Coast oil fields, where CO2 injection volumes are significantly larger (up to 6 times larger) than those of the Permian. We conducted a compositional simulation based study with the objective of comparing the CO2 utilization ratios (volume of CO2 injected to produce a barrel of oil) of 4 conventional and novel CO2 injection strategies: (1) continuous gas injection (CGI), (2) water alternating gas (WAG), (3) water curtain injection (WCI), and (4) WAG and WCI combination. These injection scenarios were simulated using the GEM module from the Computer Modeling Group (CMG). GEM is an advanced general equation-of-state compositional simulator, which includes equation of state, CO2 miscible flood, CO2/brine interactions, and complex phase behavior. The simulator is set up to model three fluid phases including water, oil, and gas. Our study demonstrates how the selected field development strategy has a significant impact on the ultimate recovery of CO2-EOR projects, with GCI injection providing maximum oil recovery in absolute volume terms, but with WAG offering a more balanced technical-economical approach.

  3. Intrarater and interrater reliability for measurements in videofluoroscopy of swallowing

    Energy Technology Data Exchange (ETDEWEB)

    Baijens, Laura, E-mail: laura.baijens@mumc.nl [Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht (Netherlands); Barikroo, Ali, E-mail: a.Barikroo@ufl.edu [Swallowing Research Laboratory, Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL (United States); Pilz, Walmari, E-mail: walmari.pilz@mumc.nl [Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht (Netherlands)

    2013-10-01

    Objective: Intrarater and interrater reliability is crucial to the quality of diagnostic and therapy-effect studies. This paper reports on a systematic review of studies on intrarater and interrater reliability for measurements in videofluoroscopy of swallowing. The aim of this review was to summarize and qualitatively analyze published studies on that topic. Materials and methods: Those published up to March 2013 were found through a comprehensive electronic database search using PubMed, Embase, and The Cochrane Library. Two reviewers independently assessed the studies using strict inclusion criteria. Results: Nineteen studies were included and then qualitatively analyzed. In several of these, methodological problems were found. Moreover, intrarater and interrater reliability varied with the measure applied. A meta-analysis was not carried out as studies were not of sufficient quality to warrant doing so. Conclusion: In order to achieve reliable measurements in videofluoroscopy of swallowing, it is recommended that raters use well-defined guidelines for the levels of ordinal visuoperceptual variables. Furthermore, in order to make the measurements reliable (intrarater and interrater) it is recommended that, following protocolled pre-experimental training, the raters should have maximum consensus about the definition of the measured variables.

  4. Voluntary cough production and swallow dysfunction in Parkinson's disease.

    Science.gov (United States)

    Pitts, Teresa; Bolser, Donald; Rosenbek, John; Troche, Michelle; Sapienza, Christine

    2008-09-01

    Cough is important for airway clearance, particularly if penetration/aspiration of foreign material occurs during swallow. Measures of voluntary cough production from ten male participants with stage II-III Parkinson's disease (PD) who showed no videofluorographic evidence of penetration/aspiration (Group 1) were examined and compared with those of ten male participants with stage II-III PD who showed videofluorographic evidence of penetration/aspiration (Group 2). The degree of penetration/aspiration was expertly judged from the videofluorographic examinations of the participants' sequential swallow of a thin, 30-cc bolus. Measured cough parameters included inspiratory phase duration, inspiratory peak flow, compression phase duration, expiratory peak flow, expiratory rise time, and cough volume acceleration. Results indicated significant group differences for the majority of cough measures, except for inspiratory phase duration and inspiratory peak flow. A modest relationship existed between voluntary cough parameters and penetration/aspiration scores. Decreased ability to adequately clear material from the airway with voluntary cough may exacerbate symptoms resulting from penetration/aspiration, particularly for those with neurodegenerative disease. Measurement of voluntary cough may be useful for the evaluation of airway clearance ability.

  5. Mastication and swallowing: 1. Functions, performance and mechanisms.

    Science.gov (United States)

    Orchardson, Robert; Cadden, Samuel W

    2009-01-01

    The process of mastication involves movements of the tongue, lips and cheeks as well as the more obvious actions of the teeth and jaws. In recent years there have been significant advances in our knowledge of the relationships between these movements in human beings and of how the processes of mastication are related to the associated events of swallowing. In this, the first of two papers, we review the role of mastication in food processing and nutrition and the effect of tooth loss on masticatory performance.The paper also reviews new information on masticatory and swallowing functions in human beings eating naturally. The review relates this knowledge to clinical dentistry, notably to the relevance of a good dentition to the digestive process and practical considerations in the replacement of missing teeth. Dentists should understand the process of mastication because an adequate dentition can facilitate the general health and well-being of their patients.This understanding can also inform the clinical management of patients with a depleted dentition or otherwise impaired masticatory system.

  6. Acquired immuno deficiency syndrome (AIDS) : an impact on marketing strategies in retail food companies in South Africa

    OpenAIRE

    2012-01-01

    M.B.A. The purpose of this research project will be to test the impacts of HIV/AIDS and the manner in which it will influence changes in marketing strategies for Retail Food Companies in the future. The research questions posed are: What do Retail Food Companies perceive the impact of HIV/AIDS to be on their customer profile in the next 5 years? Do Retail Food Companies have marketing strategies in place to address the impact of HIV/AIDS on their primary target market? Do Retail Food Compa...

  7. The Impact of Legal Advocacy Strategies to Advance Roma Health: The Case of Macedonia.

    Science.gov (United States)

    Abdikeeva, Alphia; Covaci, Alina

    2017-12-01

    Across Europe, Roma face exclusion and obstacles in access to health services, resulting in poorer health. While there are legal and policy frameworks for Roma inclusion, implementation often lags behind. Increasing the grassroots capacity of Roma to advocate for accountability in health care and against systemic impediments has been a central focus of Open Society Foundations (OSF) support. This analysis discusses the impact of an OSF-supported legal advocacy project on Roma health rights in Macedonia. The paper uses qualitative indicators to measure the capacity of nongovernmental organizations, accountability for violations, changes in law and practice, and impact on communities. The methodology for assessing the impact of legal advocacy was developed over the course of OSF's legal advocacy project and used to calculate the baseline and conduct the follow-up assessment to track progress across four strategies: legal empowerment, documentation and advocacy, media advocacy, and strategic litigation. Results show that legal advocacy has led to a notable increase in Roma awareness of their health rights. The number of lawsuits has risen dramatically, and cases are increasingly more sophisticated. Although accountability in health care is still the exception rather than the rule, blatant violations have been reduced. Some structural barriers have also been tackled. At the same time, new challenges require continuous and adaptable legal advocacy.

  8. Sequential evaluation of swallowing function in patients with unilateral neck dissection.

    Science.gov (United States)

    Hirai, Hideaki; Omura, Ken; Harada, Hiroyuki; Tohara, Haruka

    2010-07-01

    Neck dissection is the most reliable treatment for cervical lymph node metastases in head and neck cancer. However, it is unknown whether neck dissection can cause dysphagia. The aim of this study was to evaluate swallowing function after neck dissection. By using videofluoroscopic and videoendoscopic methods, swallowing function was evaluated in 17 patients prior to, 1 month after, and 4 months after neck dissection. In comparison with preoperative observations, swallowing function after neck dissection was affected by the following changes: a forward and downward displacement of the hyoid bone at rest and at its highest position, a decrease in the distance traversed by the hyoid bone during swallowing, and an increase in laryngeal penetration. Pharyngeal residue and aspiration were not observed in any of the patients. Although swallowing function is affected by neck dissection, serious clinical problems are not likely to occur. (c) 2009 Wiley Periodicals, Inc.

  9. Soft Electronics Enabled Ergonomic Human-Computer Interaction for Swallowing Training.

    Science.gov (United States)

    Lee, Yongkuk; Nicholls, Benjamin; Sup Lee, Dong; Chen, Yanfei; Chun, Youngjae; Siang Ang, Chee; Yeo, Woon-Hong

    2017-04-21

    We introduce a skin-friendly electronic system that enables human-computer interaction (HCI) for swallowing training in dysphagia rehabilitation. For an ergonomic HCI, we utilize a soft, highly compliant ("skin-like") electrode, which addresses critical issues of an existing rigid and planar electrode combined with a problematic conductive electrolyte and adhesive pad. The skin-like electrode offers a highly conformal, user-comfortable interaction with the skin for long-term wearable, high-fidelity recording of swallowing electromyograms on the chin. Mechanics modeling and experimental quantification captures the ultra-elastic mechanical characteristics of an open mesh microstructured sensor, conjugated with an elastomeric membrane. Systematic in vivo studies investigate the functionality of the soft electronics for HCI-enabled swallowing training, which includes the application of a biofeedback system to detect swallowing behavior. The collection of results demonstrates clinical feasibility of the ergonomic electronics in HCI-driven rehabilitation for patients with swallowing disorders.

  10. Soft Electronics Enabled Ergonomic Human-Computer Interaction for Swallowing Training

    Science.gov (United States)

    Lee, Yongkuk; Nicholls, Benjamin; Sup Lee, Dong; Chen, Yanfei; Chun, Youngjae; Siang Ang, Chee; Yeo, Woon-Hong

    2017-04-01

    We introduce a skin-friendly electronic system that enables human-computer interaction (HCI) for swallowing training in dysphagia rehabilitation. For an ergonomic HCI, we utilize a soft, highly compliant (“skin-like”) electrode, which addresses critical issues of an existing rigid and planar electrode combined with a problematic conductive electrolyte and adhesive pad. The skin-like electrode offers a highly conformal, user-comfortable interaction with the skin for long-term wearable, high-fidelity recording of swallowing electromyograms on the chin. Mechanics modeling and experimental quantification captures the ultra-elastic mechanical characteristics of an open mesh microstructured sensor, conjugated with an elastomeric membrane. Systematic in vivo studies investigate the functionality of the soft electronics for HCI-enabled swallowing training, which includes the application of a biofeedback system to detect swallowing behavior. The collection of results demonstrates clinical feasibility of the ergonomic electronics in HCI-driven rehabilitation for patients with swallowing disorders.

  11. Visual and auditory stimuli associated with swallowing activate mirror neurons: a magnetoencephalography study.

    Science.gov (United States)

    Ushioda, Takashi; Watanabe, Yutaka; Sanjo, Yusuke; Yamane, Gen-Yuki; Abe, Shinichi; Tsuji, Yusuke; Ishiyama, Atushi

    2012-12-01

    In the present study, we evaluated activated areas of the cerebral cortex with regard to the mirror neuron system during swallowing. To identify the activated areas, we used magnetoencephalography. Subjects were ten consenting volunteers. Swallowing-related stimuli comprised an animated image of the left profile of a person swallowing water with laryngeal elevation as a visual swallowing trigger stimulus and a swallowing sound as an auditory swallowing trigger stimulus. As control stimuli, a still frame image of the left profile without an additional trigger was shown, and an artificial sound as a false auditory trigger was provided. Triggers were presented at 3,000 ms after the start of image presentation. The stimuli were combined and presented and the areas activated were identified for each stimulus. With animation and still-frame stimuli, the visual association area (Brodmann area (BA) 18) was activated at the start of image presentation, while with the swallowing sound and artificial sound stimuli, the auditory areas BA 41 and BA 42 were activated at the time of trigger presentation. However, with animation stimuli (animation stimulus, animation + swallowing sound stimuli, and animation + artificial sound stimuli), activation in BA 6 and BA 40, corresponding to mirror neurons, was observed between 620 and 720 ms before the trigger. Besides, there were also significant differences in latency time and peak intensity between animation stimulus and animation + swallowing sound stimuli. Our results suggest that mirror neurons are activated by swallowing-related visual and auditory stimuli.

  12. The Effects of Oral-Motor Exercises on Swallowing in Children: An Evidence-Based Systematic Review

    Science.gov (United States)

    Arvedson, Joan; Clark, Heather; Lazarus, Cathy; Schooling, Tracy; Frymark, Tobi

    2010-01-01

    Aim: The aim of this unregistered evidence-based systematic review was to determine the state and quality of evidence on the effects of oral motor exercises (OME) on swallowing physiology, pulmonary health, functional swallowing outcomes, and drooling management in children with swallowing disorders. Method: A systematic search of 20 electronic…

  13. Adoption into clinical practice of two therapies to manage swallowing disorders: exercise based swallowing rehabilitation and electrical stimulation

    Science.gov (United States)

    Crary, Michael A.; Carnaby, Giselle D.

    2014-01-01

    Purpose of review This article reviews recent literature depicting a shift in dysphagia rehabilitation in adults. Distinguishing rehabilitation from compensation in dysphagia management, a review of basic exercise principles is followed by description of recent publications depicting exercise based therapies. Subsequently, transcutaneous electrical stimulation is reviewed as it may contribute to exercise based dysphagia rehabilitation in adults. Recent findings Surveys have documented extensive variability in the clinical application of dysphagia therapy techniques. Despite this variability, two trends are emerging in dysphagia rehabilitation research: 1- documentation of physiologic plus functional changes within the swallowing mechanism subsequent to therapy; and 2- prophylactic exercise based therapies. In addition, extensive efforts have emerged describing the potential application of transcutaneous electrical stimulation in dysphagia rehabilitation. Though results of these efforts are conflicted, transcutaneous electrical stimulation may serve a useful role as an adjunct to well-developed exercise based rehabilitation for dysphagia. Summary The focus of dysphagia rehabilitation in adults is changing. Current efforts indicate that exercise based therapies should incorporate multiple principles of exercise physiology and document physiologic change within the impaired swallowing mechanism. Transcutaneous electrical stimulation may function as an adjunctive modality; however, current practices should be evaluated to develop additional parameters of stimulation that are focused toward specific dysphagia impairments. PMID:24675153

  14. Adoption into clinical practice of two therapies to manage swallowing disorders: exercise-based swallowing rehabilitation and electrical stimulation.

    Science.gov (United States)

    Crary, Michael A; Carnaby, Giselle D

    2014-06-01

    To review recent literature depicting a shift in dysphagia rehabilitation in adults. Distinguishing rehabilitation from compensation in dysphagia management, a review of basic exercise principles is followed by description of recent publications depicting exercise-based therapies. Subsequently, transcutaneous electrical stimulation (TES) is reviewed as it may contribute to exercise-based dysphagia rehabilitation in adults. Surveys have documented extensive variability in the clinical application of dysphagia therapy techniques. Despite this variability, two trends are emerging in dysphagia rehabilitation research: documentation of physiologic and functional changes within the swallowing mechanism subsequent to therapy; and prophylactic exercise-based therapies. In addition, extensive efforts have emerged describing the potential application of TES in dysphagia rehabilitation. Though results of these efforts are conflicted, TES may serve a useful role as an adjunct to well developed exercise-based rehabilitation for dysphagia. The focus of dysphagia rehabilitation in adults is changing. Current efforts indicate that exercise-based therapies should incorporate multiple principles of exercise physiology and document physiologic change within the impaired swallowing mechanism. TES may function as an adjunctive modality; however, current practices should be evaluated to develop additional parameters of stimulation that are focused toward specific dysphagia impairments.

  15. Impact of management strategies on the global warming potential at the cropping system level.

    Science.gov (United States)

    Goglio, Pietro; Grant, Brian B; Smith, Ward N; Desjardins, Raymond L; Worth, Devon E; Zentner, Robert; Malhi, Sukhdev S

    2014-08-15

    Estimating the greenhouse gas (GHG) emissions from agricultural systems is important in order to assess the impact of agriculture on climate change. In this study experimental data supplemented with results from a biophysical model (DNDC) were combined with life cycle assessment (LCA) to investigate the impact of management strategies on global warming potential of long-term cropping systems at two locations (Breton and Ellerslie) in Alberta, Canada. The aim was to estimate the difference in global warming potential (GWP) of cropping systems due to N fertilizer reduction and residue removal. Reducing the nitrogen fertilizer rate from 75 to 50 kg N ha(-1) decreased on average the emissions of N2O by 39%, NO by 59% and ammonia volatilisation by 57%. No clear trend for soil CO2 emissions was determined among cropping systems. When evaluated on a per hectare basis, cropping systems with residue removal required 6% more energy and had a little change in GWP. Conversely, when evaluated on the basis of gigajoules of harvestable biomass, residue removal resulted in 28% less energy requirement and 33% lower GWP. Reducing nitrogen fertilizer rate resulted in 18% less GWP on average for both functional units at Breton and 39% less GWP at Ellerslie. Nitrous oxide emissions contributed on average 67% to the overall GWP per ha. This study demonstrated that small changes in N fertilizer have a minimal impact on the productivity of the cropping systems but can still have a substantial environmental impact. Crown Copyright © 2014. Published by Elsevier B.V. All rights reserved.

  16. Effect of farming strategies on environmental impact of intensive dairy farms in Italy.

    Science.gov (United States)

    Guerci, Matteo; Bava, Luciana; Zucali, Maddalena; Sandrucci, Anna; Penati, Chiara; Tamburini, Alberto

    2013-08-01

    Agriculture and animal husbandry are important contributors to global emissions of greenhouse (GHG) and acidifying gases. Moreover, they contribute to water pollution and to consumption of non-renewable natural resources such as land and energy. The Life Cycle Assessment (LCA) methodology allows evaluation of the environmental impact of a process from the production of inputs to the final product and to assess simultaneously several environmental impact categories among which GHG emissions, acidification, eutrophication, land use and energy use. The main purpose of this study was to evaluate, using the LCA methodology, the environmental impact of milk production in a sample of 41 intensive Italian dairy farms and to identify, among different farming strategies, those associated with the best environmental performances. The functional unit was 1 kg Fat and Protein Corrected Milk (FPCM). Farms showed characteristics of high production intensity: FPCM, expressed as tonnes per hectare, was 30·8±15·1. Total GHG emission per kg FPCM at farm gate was 1·30±0·19 kg CO2 eq. The main contributors to climate change potential were emissions from barns and manure storage (50·1%) and emissions for production and transportation of purchased feeds (21·2%). Average emission of gases causing acidification to produce 1 kg FPCM was 19·7±3·6 g of SO2 eq. Eutrophication potential was 9·01±1·78 ${\\rm PO}_{\\rm 4}^{{\\rm 3} -} {\\rm eq}.$ per kg FPCM on average. Farms from this study needed on average 5·97±1·32 MJ per kg FPCM from non-renewable energy sources. Energy consumption was mainly due to off-farm activities (58%) associated with purchased factors. Land use was 1·51±0·25 m2 per kg FPCM. The farming strategy based on high conversion efficiency at animal level was identified as the most effective to mitigate the environmental impact per kg milk at farm gate, especially in terms of GHG production and non-renewable energy use per kg FPCM.

  17. Finite element analysis of TAVI: Impact of native aortic root computational modeling strategies on simulation outcomes.

    Science.gov (United States)

    Finotello, Alice; Morganti, Simone; Auricchio, Ferdinando

    2017-09-01

    In the last few years, several studies, each with different aim and modeling detail, have been proposed to investigate transcatheter aortic valve implantation (TAVI) with finite elements. The present work focuses on the patient-specific finite element modeling of the aortic valve complex. In particular, we aim at investigating how different modeling strategies in terms of material models/properties and discretization procedures can impact analysis results. Four different choices both for the mesh size (from  20 k elements to  200 k elements) and for the material model (from rigid to hyperelastic anisotropic) are considered. Different approaches for modeling calcifications are also taken into account. Post-operative CT data of the real implant are used as reference solution with the aim of outlining a trade-off between computational model complexity and reliability of the results. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

  18. Control strategy to limit duty cycle impact of earthquakes on the LIGO gravitational-wave detectors

    Science.gov (United States)

    Biscans, S.; Warner, J.; Mittleman, R.; Buchanan, C.; Coughlin, M.; Evans, M.; Gabbard, H.; Harms, J.; Lantz, B.; Mukund, N.; Pele, A.; Pezerat, C.; Picart, P.; Radkins, H.; Shaffer, T.

    2018-03-01

    Advanced gravitational-wave detectors such as the laser interferometer gravitational-wave observatories (LIGO) require an unprecedented level of isolation from the ground. When in operation, they measure motion of less than 10‑19 m. Strong teleseismic events like earthquakes disrupt the proper functioning of the detectors, and result in a loss of data. An earthquake early-warning system, as well as a prediction model, have been developed to understand the impact of earthquakes on LIGO. This paper describes a control strategy to use this early-warning system to reduce the LIGO downtime by  ∼30%. It also presents a plan to implement this new earthquake configuration in the LIGO automation system.

  19. Strategies used to inhibit postoperative swelling following removal of impacted lower third molar

    Science.gov (United States)

    Sortino, Francesco; Cicciù, Marco

    2011-01-01

    Postoperative swelling following different surgical strategies is an area of great interest. The main part of literature on the topic deals with swelling after extraction of low impacted third molar. In this review, we have analyzed publications of the last 20 years with a pubmed search using the following key words: impacted third molar, swelling third molar, wisdom tooth, edema jaw, corticosteroids and extraction third molar, antibiotic prophylaxis and tooth extraction. Attention has often been focused on corticosteroid therapy administered by diverse routes (orally, IV, IM, topically) and at different time schedules (before or after surgery or both). This investigation revealed how the use of different molecules and dosages makes the obtained results hardly comparable. Similar conclusions can be drawn from studies aimed at evaluating the efficacy of antibiotic therapy administered either before or after surgery. A complete review has also to take into account different surgical strategies used including various flaps, no traumatic osteothomy, and primary or secondary closure. The use of pharmacological therapy and application of an ice pack is critical in the postoperative period and has always provided positive results. However, even if it is difficult to come to definite conclusions, due to the variability of the design of studies analyzed, the postoperative discomfort identified with edema, pain and trismus following wisdom tooth removal is influenced by various factors such as the difficulty of the surgical procedure involved, age and gender of the patient, and experience of the surgeon. The pharmacological therapy when performed with corticosteroids seems to improve control of the postoperative swelling related with this kind of surgeries. PMID:22135686

  20. Strategies used to inhibit postoperative swelling following removal of impacted lower third molar

    Directory of Open Access Journals (Sweden)

    Francesco Sortino

    2011-01-01

    Full Text Available Postoperative swelling following different surgical strategies is an area of great interest. The main part of literature on the topic deals with swelling after extraction of low impacted third molar. In this review, we have analyzed publications of the last 20 years with a pubmed search using the following key words: impacted third molar, swelling third molar, wisdom tooth, edema jaw, corticosteroids and extraction third molar, antibiotic prophylaxis and tooth extraction. Attention has often been focused on corticosteroid therapy administered by diverse routes (orally, IV, IM, topically and at different time schedules (before or after surgery or both. This investigation revealed how the use of different molecules and dosages makes the obtained results hardly comparable. Similar conclusions can be drawn from studies aimed at evaluating the efficacy of antibiotic therapy administered either before or after surgery. A complete review has also to take into account different surgical strategies used including various flaps, no traumatic osteothomy, and primary or secondary closure. The use of pharmacological therapy and application of an ice pack is critical in the postoperative period and has always provided positive results. However, even if it is difficult to come to definite conclusions, due to the variability of the design of studies analyzed, the postoperative discomfort identified with edema, pain and trismus following wisdom tooth removal is influenced by various factors such as the difficulty of the surgical procedure involved, age and gender of the patient, and experience of the surgeon. The pharmacological therapy when performed with corticosteroids seems to improve control of the postoperative swelling related with this kind of surgeries.

  1. Impact of coverage-dependent marginal costs on optimal HPV vaccination strategies

    Directory of Open Access Journals (Sweden)

    Marc D. Ryser

    2015-06-01

    Full Text Available The effectiveness of vaccinating males against the human papillomavirus (HPV remains a controversial subject. Many existing studies conclude that increasing female coverage is more effective than diverting resources into male vaccination. Recently, several empirical studies on HPV immunization have been published, providing evidence of the fact that marginal vaccination costs increase with coverage. In this study, we use a stochastic agent-based modeling framework to revisit the male vaccination debate in light of these new findings. Within this framework, we assess the impact of coverage-dependent marginal costs of vaccine distribution on optimal immunization strategies against HPV. Focusing on the two scenarios of ongoing and new vaccination programs, we analyze different resource allocation policies and their effects on overall disease burden. Our results suggest that if the costs associated with vaccinating males are relatively close to those associated with vaccinating females, then coverage-dependent, increasing marginal costs may favor vaccination strategies that entail immunization of both genders. In particular, this study emphasizes the necessity for further empirical research on the nature of coverage-dependent vaccination costs.

  2. Possible impacts of sea level rise on disease transmission and potential adaptation strategies, a review.

    Science.gov (United States)

    Dvorak, Ana C; Solo-Gabriele, Helena M; Galletti, Andrea; Benzecry, Bernardo; Malone, Hannah; Boguszewski, Vicki; Bird, Jason

    2018-04-18

    Sea levels are projected to rise in response to climate change, causing the intrusion of sea water into land. In flat coastal regions, this would generate an increase in shallow water covered areas with limited circulation. This scenario raises a concern about the consequences it could have on human health, specifically the possible impacts on disease transmission. In this review paper we identified three categories of diseases which are associated with water and whose transmission can be affected by sea level rise. These categories include: mosquitoborne diseases, naturalized organisms (Vibrio spp. and toxic algae), and fecal-oral diseases. For each disease category, we propose comprehensive adaptation strategies that would help minimize possible health risks. Finally, the City of Key West, Florida is analyzed as a case study, due to its inherent vulnerability to sea level rise. Current and projected adaptation techniques are discussed as well as the integration of additional recommendations, focused on disease transmission control. Given that sea level rise will likely continue into the future, the promotion and implementation of positive adaptation strategies is necessary to ensure community resilience. Copyright © 2018 Elsevier Ltd. All rights reserved.

  3. Effective Mitigation and Adaptation Strategies for Public Health Impacts of Heatwaves for Brookline, MA

    Science.gov (United States)

    Jalalzadeh Fard, B.; Hassanzadeh, H.; Bhatia, U.; Ganguly, A. R.

    2016-12-01

    Studies on urban areas show a significant increase in frequency and intensity of heatwaves over the past decades, and predict the same trend for future. Since heatwaves have been responsible for a large number of life losses, urgent adaptation and mitigation strategies are required in the policy and decision making level for a sustainable urban planning. The Sustainability and Data Sciences Laboratory at Northeastern University, under the aegis of Thriving Earth Exchange of AGU, is working with the town of Brookline to understand the potential public health impacts of anticipated heatwaves. We consider the most important social and physical factors to obtain vulnerability and exposure parameters for each census block group of the town. Utilizing remote sensing data, we locate Urban Heat Islands (UHIs) during a recent heatwave event, as the hazard parameter. We then create priority risk map using the risk framework. Our analyses show spatial correlations between the UHIs and social factors such as poverty, and physical factors such as land cover variations. Furthermore, we investigate the future heatwave frequency and intensity increases by analyzing the climate models predictions. For future changes of UHIs, land cover changes are investigated using available predictive data. Also, socioeconomic predictions are carried out to complete the futuristic models of heatwave risks. Considering plausible scenarios for Brookline, we develop different risk maps based on the vulnerability, exposure and hazard parameters. Eventually, we suggest guidelines for Heatwave Action Plans for prioritizing effective mitigation and adaptation strategies in urban planning for the town of Brookline.

  4. How drug life-cycle management patent strategies may impact formulary management.

    Science.gov (United States)

    Berger, Jan; Dunn, Jeffrey D; Johnson, Margaret M; Karst, Kurt R; Shear, W Chad

    2016-10-01

    Drug manufacturers may employ various life-cycle management patent strategies, which may impact managed care decision making regarding formulary planning and management strategies when single-source, branded oral pharmaceutical products move to generic status. Passage of the Hatch-Waxman Act enabled more rapid access to generic medications through the abbreviated new drug application process. Patent expirations of small-molecule medications and approvals of generic versions have led to substantial cost savings for health plans, government programs, insurers, pharmacy benefits managers, and their customers. However, considering that the cost of developing a single medication is estimated at $2.6 billion (2013 dollars), pharmaceutical patent protection enables companies to recoup investments, creating an incentive for innovation. Under current law, patent protection holds for 20 years from time of patent filing, although much of this time is spent in product development and regulatory review, leaving an effective remaining patent life of 7 to 10 years at the time of approval. To extend the product life cycle, drug manufacturers may develop variations of originator products and file for patents on isomers, metabolites, prodrugs, new drug formulations (eg, extended-release versions), and fixed-dose combinations. These additional patents and the complexities surrounding the timing of generic availability create challenges for managed care stakeholders attempting to gauge when generics may enter the market. An understanding of pharmaceutical patents and how intellectual property protection may be extended would benefit managed care stakeholders and help inform decisions regarding benefit management.

  5. Evaluating the impact of field-scale management strategies on sediment transport to the watershed outlet.

    Science.gov (United States)

    Sommerlot, Andrew R; Pouyan Nejadhashemi, A; Woznicki, Sean A; Prohaska, Michael D

    2013-10-15

    Non-point source pollution from agricultural lands is a significant contributor of sediment pollution in United States lakes and streams. Therefore, quantifying the impact of individual field management strategies at the watershed-scale provides valuable information to watershed managers and conservation agencies to enhance decision-making. In this study, four methods employing some of the most cited models in field and watershed scale analysis were compared to find a practical yet accurate method for evaluating field management strategies at the watershed outlet. The models used in this study including field-scale model (the Revised Universal Soil Loss Equation 2 - RUSLE2), spatially explicit overland sediment delivery models (SEDMOD), and a watershed-scale model (Soil and Water Assessment Tool - SWAT). These models were used to develop four modeling strategies (methods) for the River Raisin watershed: Method 1) predefined field-scale subbasin and reach layers were used in SWAT model; Method 2) subbasin-scale sediment delivery ratio was employed; Method 3) results obtained from the field-scale RUSLE2 model were incorporated as point source inputs to the SWAT watershed model; and Method 4) a hybrid solution combining analyses from the RUSLE2, SEDMOD, and SWAT models. Method 4 was selected as the most accurate among the studied methods. In addition, the effectiveness of six best management practices (BMPs) in terms of the water quality improvement and associated cost were assessed. Economic analysis was performed using Method 4, and producer requested prices for BMPs were compared with prices defined by the Environmental Quality Incentives Program (EQIP). On a per unit area basis, producers requested higher prices than EQIP in four out of six BMP categories. Meanwhile, the true cost of sediment reduction at the field and watershed scales was greater than EQIP in five of six BMP categories according to producer requested prices. Copyright © 2013 Elsevier Ltd. All

  6. Antipsychotic-associated weight gain: management strategies and impact on treatment adherence

    Directory of Open Access Journals (Sweden)

    Dayabandara M

    2017-08-01

    Full Text Available Madhubhashinee Dayabandara, Raveen Hanwella, Suhashini Ratnatunga, Sudarshi Seneviratne, Chathurie Suraweera, Varuni A de Silva Department of Psychiatry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka Abstract: Antipsychotic-induced weight gain is a major management problem for clinicians. It has been shown that weight gain and obesity lead to increased cardiovascular and cerebrovascular morbidity and mortality, reduced quality of life and poor drug compliance. This narrative review discusses the propensity of various antipsychotics to cause weight gain, the pharmacologic and nonpharmacologic interventions available to counteract this effect and its impact on adherence. Most antipsychotics cause weight gain. The risk appears to be highest with olanzapine and clozapine. Weight increases rapidly in the initial period after starting antipsychotics. Patients continue to gain weight in the long term. Children appear to be particularly vulnerable to antipsychotic-induced weight gain. Tailoring antipsychotics according to the needs of the individual and close monitoring of weight and other metabolic parameters are the best preventive strategies at the outset. Switching to an agent with lesser tendency to cause weight gain is an option, but carries the risk of relapse of the illness. Nonpharmacologic interventions of dietary counseling, exercise programs and cognitive and behavioral strategies appear to be equally effective in individual and group therapy formats. Both nonpharmacologic prevention and intervention strategies have shown modest effects on weight. Multiple compounds have been investigated as add-on medications to cause weight loss. Metformin has the best evidence in this respect. Burden of side effects needs to be considered when prescribing weight loss medications. There is no strong evidence to recommend routine prescription of add-on medication for weight reduction. Heterogeneity of study methodologies and other

  7. Energy impacts of heat island reduction strategies in the Greater Toronto Area, Canada; FINAL

    International Nuclear Information System (INIS)

    Konopacki, Steven; Akbari, Hashem

    2001-01-01

    In 2000, the Toronto Atmospheric Fund (TAF) embarked on an initiative to quantify the potential benefits of Heat Island Reduction (HIR) strategies (shade trees, reflective roofs and pavements) in reducing cooling energy use in buildings, lowering the ambient air temperature and improve air quality. This report summarizes the efforts of Lawrence Berkeley National Laboratory (LBNL) to assess the impacts of HIR measures on building cooling- and heating-energy use. We discuss our efforts to calculate annual energy savings and peak-power avoidance of HIR strategies in the building sector of the Greater Toronto Area. The analysis is focused on three major building types that offer most saving potentials: residence, office and retail store. Using an hourly building energy simulation model, we quantify the energy saving potentials of (1) using cool roofs on individual buildings[direct effect], (2) planting deciduous shade trees near south and west walls of building[direct effect], (3) planting coniferous wind-shielding vegetation near building[direct effect], (4) ambient cooling by a large-scale program of urban reforestation with reflective building roofs and pavements[indirect effect], (5) and the combined direct and indirect effects. Results show potential annual energy savings of over$11M (with uniform residential and commercial electricity and gas prices of$0.084/kWh and$5.54/GJ) could be realized by ratepayers from the combined direct and indirect effects of HIR strategies. Of that total, about 88 percent was from the direct impact roughly divided equally among reflective roofs, shade trees and wind-shielding, and the remainder (12 percent) from the indirect impact of the cooler ambient air temperature. The residential sector accounts for over half (59 percent) of the total, offices 13 percent and retail stores 28 percent. Savings from cool roofs were about 20 percent, shade trees 30 percent, wind shielding of tree 37 percent, and indirect effect 12 percent. These

  8. Evaluating Swallowing Muscles Essential for Hyolaryngeal Elevation by Using Muscle Functional Magnetic Resonance Imaging

    International Nuclear Information System (INIS)

    Pearson, William G.; Hindson, David F.; Langmore, Susan E.; Zumwalt, Ann C.

    2013-01-01

    Purpose: Reduced hyolaryngeal elevation, a critical event in swallowing, is associated with radiation therapy. Two muscle groups that suspend the hyoid, larynx, and pharynx have been proposed to elevate the hyolaryngeal complex: the suprahyoid and longitudinal pharyngeal muscles. Thought to assist both groups is the thyrohyoid, a muscle intrinsic to the hyolaryngeal complex. Intensity modulated radiation therapy guidelines designed to preserve structures important to swallowing currently exclude the suprahyoid and thyrohyoid muscles. This study used muscle functional magnetic resonance imaging (mfMRI) in normal healthy adults to determine whether both muscle groups are active in swallowing and to test therapeutic exercises thought to be specific to hyolaryngeal elevation. Methods and Materials: mfMRI data were acquired from 11 healthy subjects before and after normal swallowing and after swallowing exercise regimens (the Mendelsohn maneuver and effortful pitch glide). Whole-muscle transverse relaxation time (T2 signal, measured in milliseconds) profiles of 7 test muscles were used to evaluate the physiologic response of each muscle to each condition. Changes in effect size (using the Cohen d measure) of whole-muscle T2 profiles were used to determine which muscles underlie swallowing and swallowing exercises. Results: Post-swallowing effect size changes (where a d value of >0.20 indicates significant activity during swallowing) for the T2 signal profile of the thyrohyoid was a d value of 0.09; a d value of 0.40 for the mylohyoid, 0.80 for the geniohyoid, 0.04 for the anterior digastric, and 0.25 for the posterior digastric-stylohyoid in the suprahyoid muscle group; and d values of 0.47 for the palatopharyngeus and 0.28 for the stylopharyngeus muscles in the longitudinal pharyngeal muscle group. The Mendelsohn maneuver and effortful pitch glide swallowing exercises showed significant effect size changes for all muscles tested, except for the thyrohyoid. Conclusions

  9. Differential Use of Learning Strategies in First-Year Higher Education: The Impact of Personality, Academic Motivation, and Teaching Strategies

    Science.gov (United States)

    Donche, Vincent; De Maeyer, Sven; Coertjens, Liesje; Van Daal, Tine; Van Petegem, Peter

    2013-01-01

    Background. Although the evidence in support of the variability of students' learning strategies has expanded in recent years, less is known about the explanatory base of these individual differences in terms of the joint Influences of personal and contextual characteristics. Aims. Previous studies have often investigated how student learning is…

  10. Design and construction strategies for reducing embodied impacts from buildings – Case study analysis

    DEFF Research Database (Denmark)

    Malmqvist, Tove; Nehasilova, Marie; Moncaster, Alice

    2018-01-01

    The dominance of operational energy and related greenhouse gas (GHG) emissions of most existing build- ings is decreasing in new construction, when primary fossil energy of building operation decreases as re- sult of the implementation of energy efficiency measures as well as a decarbonisation of......, importantly this multiple cross-case analysis has provided rigorous evidence of the considerable potential to reduce embodied impacts in the design and construction of new and refurbished buildings.......The dominance of operational energy and related greenhouse gas (GHG) emissions of most existing build- ings is decreasing in new construction, when primary fossil energy of building operation decreases as re- sult of the implementation of energy efficiency measures as well as a decarbonisation...... of national energy mixes. Stakeholders therefore have a growing interest in understanding the possibilities for reducing em- bodied impacts in buildings. In the IEA EBC project ‘Annex 57’ a broad call for case studies was launched with the aim to identify design strategies for reducing embodied energy and GHG...

  11. Short-lived pollutants in the Arctic: their climate impact and possible mitigation strategies

    Directory of Open Access Journals (Sweden)

    S. Menon

    2008-03-01

    Full Text Available Several short-lived pollutants known to impact Arctic climate may be contributing to the accelerated rates of warming observed in this region relative to the global annually averaged temperature increase. Here, we present a summary of the short-lived pollutants that impact Arctic climate including methane, tropospheric ozone, and tropospheric aerosols. For each pollutant, we provide a description of the major sources and the mechanism of forcing. We also provide the first seasonally averaged forcing and corresponding temperature response estimates focused specifically on the Arctic. The calculations indicate that the forcings due to black carbon, methane, and tropospheric ozone lead to a positive surface temperature response indicating the need to reduce emissions of these species within and outside the Arctic. Additional aerosol species may also lead to surface warming if the aerosol is coincident with thin, low lying clouds. We suggest strategies for reducing the warming based on current knowledge and discuss directions for future research to address the large remaining uncertainties.

  12. Short-lived pollutants in the Arctic: their climate impact and possible mitigation strategies

    Energy Technology Data Exchange (ETDEWEB)

    Menon, Surabi; Quinn, P.K.; Bates, T.S.; Baum, E.; Doubleday, N.; Fiore, A.M.; Flanner, M.; Fridlind, A.; Garrett, T.J.; Koch, D.; Menon, S.; Shindell, D.; Stohl, A.; Warren, S.G.

    2007-09-24

    Several short-lived pollutants known to impact Arctic climate may be contributing to the accelerated rates of warming observed in this region relative to the global annually averaged temperature increase. Here, we present a summary of the short-lived pollutants that impact Arctic climate including methane, tropospheric ozone, and tropospheric aerosols. For each pollutant, we provide a description of the major sources and the mechanism of forcing. We also provide the first seasonally averaged forcing and corresponding temperature response estimates focused specifically on the Arctic. The calculations indicate that the forcings due to black carbon, methane, and tropospheric ozone lead to a positive surface temperature response indicating the need to reduce emissions of these species within and outside the Arctic. Additional aerosol species may also lead to surface warming if the aerosol is coincident with thin, low lying clouds. We suggest strategies for reducing the warming based on current knowledge and discuss directions for future research to address the large remaining uncertainties.

  13. Impact of eccentricity build-up and graveyard disposal Strategies on MEO navigation constellations

    Science.gov (United States)

    Radtke, Jonas; Domínguez-González, Raúl; Flegel, Sven K.; Sánchez-Ortiz, Noelia; Merz, Klaus

    2015-12-01

    the second disposal strategy on all payloads from all MEO navigation constellations are investigated. Long-term simulations over 200 years of the overall space debris environment using the tool LUCA (Long-Term Utility for Collision Analysis) are performed. Furthermore, a reference scenario was implemented. This reference scenario mimics the disposal strategies used up to the current date by active constellations (GPS and GLONASS), and proposes similar approaches for the future constellations (Galileo and BeiDou). The results of these simulations are analysed with regard to flux and collision probabilities. To this end, intra-constellation impacts between disposed and active satellites are shown, as well as inter-constellation impacts between disposed satellites from other constellations and active payloads. Additionally, the impact of eccentricity build-up disposal on other orbital regimes such as LEO and GEO is analysed. For all performed analyses, a special focus is put on the Galileo constellation.

  14. Combined neuromuscular electrical stimulation (NMES) with fiberoptic endoscopic evaluation of swallowing (FEES) and traditional swallowing rehabilitation in the treatment of stroke-related dysphagia.

    Science.gov (United States)

    Sun, Shu-Fen; Hsu, Chien-Wei; Lin, Huey-Shyan; Sun, Hsien-Pin; Chang, Ping-Hsin; Hsieh, Wan-Ling; Wang, Jue-Long

    2013-12-01

    Dysphagia is common after stroke. Neuromuscular electrical stimulation (NMES) and fiberoptic endoscopic evaluation of swallowing (FEES) for the treatment of dysphagia have gained in popularity, but the combined application of these promising modalities has rarely been studied. We aimed to evaluate whether combined NMES, FEES, and traditional swallowing rehabilitation can improve swallowing functions in stroke patients with moderate to severe dysphagia. Thirty-two patients with moderate to severe dysphagia poststroke (≥3 weeks) were recruited. Patients received 12 sessions of NMES for 1 h/day, 5 days/week within a period of 2-3 weeks. FEES was done before and after NMES for evaluation and to guide dysphagic therapy. All patients subsequently received 12 sessions of traditional swallowing rehabilitation (50 min/day, 3 days/week) for 4 weeks. Primary outcome measure was the Functional Oral Intake Scale (FOIS). Secondary outcome measures included clinical degree of dysphagia, the patient's self-perception of swallowing ability, and the patient's global satisfaction with therapy. Patients were assessed at baseline, after NMES, at 6-month follow-up, and at 2-year follow-up. Twenty-nine patients completed the study. FOIS, degree of dysphagia, and patient's self-perception of swallowing improved significantly after NMES, at the 6-month follow-up, and at the 2-year follow-up (p rehabilitation showed promise for improving swallowing functions in stroke patients with moderate-to-severe dysphagia. The benefits were maintained for up to 2 years. The results are promising enough to justify further studies.

  15. Impact of management strategies on the global warming potential at the cropping system level

    Energy Technology Data Exchange (ETDEWEB)

    Goglio, Pietro; Grant, Brian B.; Smith, Ward N. [Eastern Cereal and Oilseed Research Centre, Agriculture and Agri-Food Canada, K.W. Neatby Building, Ottawa, Ontario K1A 0C6 (Canada); Desjardins, Raymond L., E-mail: ray.desjardins@agr.gc.ca [Eastern Cereal and Oilseed Research Centre, Agriculture and Agri-Food Canada, K.W. Neatby Building, Ottawa, Ontario K1A 0C6 (Canada); Worth, Devon E. [Eastern Cereal and Oilseed Research Centre, Agriculture and Agri-Food Canada, K.W. Neatby Building, Ottawa, Ontario K1A 0C6 (Canada); Zentner, Robert [Swift Current Research Station, Swift Current, Saskatchewan S0E 1A0 (Canada); Malhi, Sukhdev S. [Melfort Research Farm, PO Box 1240, Melfort, Saskatchewan S0E 1A0 (Canada)

    2014-08-15

    Estimating the greenhouse gas (GHG) emissions from agricultural systems is important in order to assess the impact of agriculture on climate change. In this study experimental data supplemented with results from a biophysical model (DNDC) were combined with life cycle assessment (LCA) to investigate the impact of management strategies on global warming potential of long-term cropping systems at two locations (Breton and Ellerslie) in Alberta, Canada. The aim was to estimate the difference in global warming potential (GWP) of cropping systems due to N fertilizer reduction and residue removal. Reducing the nitrogen fertilizer rate from 75 to 50 kg N ha{sup −1} decreased on average the emissions of N{sub 2}O by 39%, NO by 59% and ammonia volatilisation by 57%. No clear trend for soil CO{sub 2} emissions was determined among cropping systems. When evaluated on a per hectare basis, cropping systems with residue removal required 6% more energy and had a little change in GWP. Conversely, when evaluated on the basis of gigajoules of harvestable biomass, residue removal resulted in 28% less energy requirement and 33% lower GWP. Reducing nitrogen fertilizer rate resulted in 18% less GWP on average for both functional units at Breton and 39% less GWP at Ellerslie. Nitrous oxide emissions contributed on average 67% to the overall GWP per ha. This study demonstrated that small changes in N fertilizer have a minimal impact on the productivity of the cropping systems but can still have a substantial environmental impact. - Highlights: • LCA was combined with DNDC model to estimate the GWP of a cropping system. • N{sub 2}O, NO and NH{sub 3} flux increased by 39% under the higher fertilizer rate. • A change from 75 to 50 kg N ha{sup −1} reduced the GWP per ha and GJ basis by 18%. • N{sub 2}O emissions contributed 67% to the overall GWP of the cropping system. • Small changes in N fertilizer can have a substantial environmental impact.

  16. Impact of attenuation correction strategies on the quantification of High Resolution Research Tomograph PET studies

    International Nuclear Information System (INIS)

    Velden, Floris H P van; Kloet, Reina W; Berckel, Bart N M van; Molthoff, Carla F M; Jong, Hugo W A M de; Lammertsma, Adriaan A; Boellaard, Ronald

    2008-01-01

    In this study, the quantitative accuracy of different attenuation correction strategies presently available for the High Resolution Research Tomograph (HRRT) was investigated. These attenuation correction methods differ in reconstruction and processing (segmentation) algorithms used for generating a μ-image from measured 2D transmission scans, an intermediate step in the generation of 3D attenuation correction factors. Available methods are maximum-a-posteriori reconstruction (MAP-TR), unweighted OSEM (UW-OSEM) and NEC-TR, which transforms sinogram values back to their noise equivalent counts (NEC) to restore Poisson distribution. All methods can be applied with or without μ-image segmentation. However, for MAP-TR a μ-histogram is a prior during reconstruction. All possible strategies were evaluated using phantoms of various sizes, simulating preclinical and clinical situations. Furthermore, effects of emission contamination of the transmission scan on the accuracy of various attenuation correction strategies were studied. Finally, the accuracy of various attenuation corrections strategies and its relative impact on the reconstructed activity concentration (AC) were evaluated using small animal and human brain studies. For small structures, MAP-TR with human brain priors showed smaller differences in μ-values for transmission scans with and without emission contamination (<8%) than the other methods (<26%). In addition, it showed best agreement with true AC (deviation <4.5%). A specific prior designed to take into account the presence of small animal fixation devices only very slightly improved AC precision to 4.3%. All methods scaled μ-values of a large homogeneous phantom to within 4% of the water peak, but MAP-TR provided most accurate AC after reconstruction. However, for clinical data MAP-TR using the default prior settings overestimated the thickness of the skull, resulting in overestimations of μ-values in regions near the skull and thus in incorrect

  17. Characterizing functional connectivity patterns during saliva swallows in different head positions.

    Science.gov (United States)

    Jestrović, Iva; Coyle, James L; Sejdić, Ervin

    2015-07-24

    The anatomical rationale and efficacy of the chin tuck in improving airway protection for some people with swallowing disorders have been well researched and established. However, there are still open questions regarding whether brain activity for swallowing control is altered while performing this chin-tuck maneuver. In this study, we collected EEG signals from 55 healthy adults while swallowing in the neutral and chin-tuck head positions. The time-frequency based synchrony measure was used to form brain networks. We investigated both the small-world properties of these brain networks and differences among the constructed brain networks for the two head positions during swallowing tasks. We showed that brain networks for swallowing in both head positions exhibit small-world properties. Furthermore, we showed that swallowing in the chin-tuck head position affects brain networks in the Alpha and Gamma frequency bands. According to these results, we can tell that the parameter of head position should be considered in future investigations which utilize EEG signals during swallowing activity.

  18. Kinematic and temporal factors associated with penetration-aspiration in liquid swallowing

    Science.gov (United States)

    Molfenter, Sonja M.; Steele, Catriona M.

    2015-01-01

    In this study, we undertook careful analysis of 13 quantitative physiological variables related to oropharyngeal swallowing from a sample of 42 subacute patients referred for dysphagia assessment. Each patient underwent videofluoroscopic swallowing examination in which they swallowed up to 5 boluses of 22% w/v ultra-thin liquid barium suspension administered by teaspoon. Our goal was to determine whether scores on thirteen kinematic or temporal parameters of interest were independently associated with the presence of penetration-aspiration in the final compiled dataset of 178 swallows. Participants were classified as aspirators, based on the presence of at least one swallow demonstrating a penetration-aspiration scale score ≥ 3. The parameters of interest included: six kinematic parameters for capturing hyoid position; three swallow durations (laryngeal closure duration; hyoid movement duration; upper esophageal sphincter (UES) opening duration); and four swallow intervals (laryngeal closure to UES opening; bolus dwell time in the pharynx prior to laryngeal closure; stage transition duration; and pharyngeal transit time). Mixed model repeated measures ANOVAs were conducted to determine the association between each parameter and aspiration status. Only one of the 13 parameters tested distinguished aspirators from non-aspirators: aspirators demonstrated significantly shorter UES opening duration. Additionally, a trend towards reduced maximum superior position of the hyoid was seen in aspirators. Limitations and future considerations are discussed. PMID:24445381

  19. Assessment of swallowing and its disorders—A dynamic MRI study

    Energy Technology Data Exchange (ETDEWEB)

    Vijay Kumar, K.V., E-mail: vijaykumarkv@yahoo.in [Department of Speech, Language and Hearing Sciences, SRU (India); Shankar, V., E-mail: drshankarv@yahoo.co.in [Department of Neurology, SRU (India); Santosham, Roy, E-mail: santoshamroy@yahoo.com [Department of Radiology and Imaging Sciences, SRU (India)

    2013-02-15

    Magnetic resonance imaging overcomes the limitations of videofluoroscopy in assessing without radiation exposure. The clinical utility of dynamic MRI for swallowing disorders is not well documented. This study demonstrates the feasibility of using dynamic MRI in assessment of swallowing disorders. Ten normal and three brainstem lesion patients participated in this study. GE Signa HDxt 1.5 Tesla MRI scanner with head-and-neck coil as a receiver and fast imaging employing steady state acquisition sequence was used. The swallow was analyzed in terms of symmetry and amplitude of movements of velum, faucial pillars, tongue, epiglottis and cricopharyngeous and images from the sagittal, coronal and axial planes. In sagittal plane posterior movement of tongue and its compression on velum, elevation of hyoid bone, elevation of larynx and lid action of epiglottis, in the coronal view the symmetrical movements of the faucial pillars and pharyngeal constrictor muscles and in axial plane three anatomical landmarks were targeted based on their role in swallowing, viz. velum, epiglottis and cricopharyngeous were studied. In brainstem lesion individuals, posterior movement of tongue, and elevation of larynx were not seen. Asymmetrical movements of faucial pillars and cricopharyngeous muscle were appreciated in the dynamic MRI. This demonstrates that, dynamic MRI is an efficient tool to understand the swallowing physiology and helps the speech language pathologist in modifying the swallowing maneuvers. Dynamic MRI is an effective tool in assessing swallowing and its disorders. This muscle specific information is not appreciated in videofluoroscopy and this information is necessary to modify the therapy maneuvers.

  20. Swallowing and deep brain stimulation in Parkinson’s disease: A systematic review

    Science.gov (United States)

    Troche, Michelle S.; Brandimore, Alexandra E.; Foote, Kelly D.; Okun, Michael S.

    2013-01-01

    The purpose of this review is to assess the current state of the literature on the topic of deep brain stimulation (DBS) and its effects on swallowing function in Parkinson’s disease (PD). Pubmed, Cochrane review, and web of science searches were completed on all articles addressing DBS that contained a swallowing outcome measure. Outcome measures included the penetration/aspiration scale, pharyngeal transit time, oropharyngeal residue, drooling, aspiration pneumonia, death, hyolaryngeal excursion, epiglottic inversion, UPDRS scores, and presence of coughing/throat clearing during meals. The search identified 13 studies specifically addressing the effects of DBS on swallowing. Critical assessment of the 13 identified peer-reviewed publications revealed nine studies employing an experimental design, (e.g. “on” vs. “off”, pre- vs. post-DBS) and four case reports. None of the nine experimental studies were found to identify clinically significant improvement or decline in swallowing function with DBS. Despite these findings, several common threads were identified across experimental studies and will be examined in this review. Additionally, available data demonstrate that, although subthalamic nucleus (STN) stimulation has been considered to cause more impairment to swallowing function than globus pallidus internus (GPi) stimulation, there are no experimental studies directly comparing swallowing function in STN vs. GPi. Moreover, there has been no comparison of unilateral vs. bilateral DBS surgery and the coincident effects on swallowing function. This review includes a critical analysis of all experimental studies and discusses methodological issues that should be addressed in future studies. PMID:23726461

  1. Swallowing and deep brain stimulation in Parkinson's disease: a systematic review.

    Science.gov (United States)

    Troche, Michelle S; Brandimore, Alexandra E; Foote, Kelly D; Okun, Michael S

    2013-09-01

    The purpose of this review is to assess the current state of the literature on the topic of deep brain stimulation (DBS) and its effects on swallowing function in Parkinson's disease (PD). Pubmed, Cochrane review, and web of science searches were completed on all articles addressing DBS that contained a swallowing outcome measure. Outcome measures included the penetration/aspiration scale, pharyngeal transit time, oropharyngeal residue, drooling, aspiration pneumonia, death, hyolaryngeal excursion, epiglottic inversion, UPDRS scores, and presence of coughing/throat clearing during meals. The search identified 13 studies specifically addressing the effects of DBS on swallowing. Critical assessment of the 13 identified peer-reviewed publications revealed nine studies employing an experimental design, (e.g. "on" vs. "off", pre- vs. post-DBS) and four case reports. None of the nine experimental studies were found to identify clinically significant improvement or decline in swallowing function with DBS. Despite these findings, several common threads were identified across experimental studies and will be examined in this review. Additionally, available data demonstrate that, although subthalamic nucleus (STN) stimulation has been considered to cause more impairment to swallowing function than globus pallidus internus (GPi) stimulation, there are no experimental studies directly comparing swallowing function in STN vs. GPi. Moreover, there has been no comparison of unilateral vs. bilateral DBS surgery and the coincident effects on swallowing function. This review includes a critical analysis of all experimental studies and discusses methodological issues that should be addressed in future studies. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Swallowing disturbances in Parkinson's disease: a multivariate analysis of contributing factors.

    Science.gov (United States)

    Cereda, Emanuele; Cilia, Roberto; Klersy, Catherine; Canesi, Margherita; Zecchinelli, Anna Lena; Mariani, Claudio Bruno; Tesei, Silvana; Sacilotto, Giorgio; Meucci, Nicoletta; Zini, Michela; Isaias, Ioannis Ugo; Cassani, Erica; Goldwurm, Stefano; Barichella, Michela; Pezzoli, Gianni

    2014-12-01

    Swallowing disturbances are an important issue in Parkinson's disease (PD) as several studies have shown that they are associated with increased risk of aspiration pneumonia and mortality. Information about factors related to swallowing disturbances, such as disease duration, age at assessment and concomitant dementia, is limited and would be useful for their management. All consecutive PD out-patients evaluated at a movement disorders clinic over a 7-year period (2007-2014), were included in the present retrospective study. Presence of symptomatic swallowing disturbances was assessed using the specific item of the Non Motor Symptom Questionnaire. In the whole PD population (N = 6462), prevalence of symptomatic swallowing disturbances was 11.7% (95%CI, 10.9-12.5). Multivariable logistic regression analysis (adjusted for education) disclosed a significant interaction between disease duration and gender (P = 0.009). In both gender strata, swallowing disturbances were significantly associated with longer disease duration and dementia (P disease duration (P disease duration (P disease duration and dementia all seem to contribute to the occurrence of swallowing disturbances independently. However, the role played by these factors in sub-groups of patients stratified by gender and concomitant dementia suggests that swallowing disturbances are likely related to different neuro-degenerative patterns within the brain. The underlying mechanisms deserve further investigation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Dysphagia in Lewy body dementia - a clinical observational study of swallowing function by videofluoroscopic examination.

    Science.gov (United States)

    Londos, Elisabet; Hanxsson, Oskar; Alm Hirsch, Ingrid; Janneskog, Anna; Bülow, Margareta; Palmqvist, Sebastian

    2013-10-07

    Dysphagia, which can result in aspiration pneumonia and death, is a well-known problem in patients with dementia and Parkinson's disease. There are few studies on dysphagia in patients with dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), especially studies objectively documenting the type of swallowing dysfunction. The aim of this study was therefore to investigate the prevalence, and define the actual swallowing dysfunction according to a videofluoroscopic swallowing examination (VFSE) in patients with DLB and PDD. Eighty-two consecutive patients with DLB or PDD in a clinical follow-up program were asked about symptoms of dysphagia. Those experiencing dysphagia were examined with VFSE. Prevalence and type of swallowing dysfunction was recorded. Twenty-six patients (32%) reported symptoms of dysphagia such as swallowing difficulties or coughing. Twenty-four (92%) of these had a documented swallowing dysfunction on VFSE. Eighty-eight percent suffered from pharyngeal dysfunction. Almost all DLB or PDD patients with subjective signs of dysphagia had pathologic results on VFSE, the majority of pharyngeal type. This type of dysphagia has not been reported in DLB before. The results have clinical implications and highlight the importance of asking for and examining swallowing function to prevent complications such as aspiration.

  4. Nursing swallow screens: why is testing water only not enough?

    Science.gov (United States)

    Ellis, Allison Loftiss; Hannibal, Ruth Renee

    2013-10-01

    The speech-language pathologist (SLP) standardized a Nursing Bedside Swallowing Screen (NBSS) tool for all patients admitted to the hospital. The adults engaged in the NBSS before oral intake (i.e., medication included) as part of the Brain Attack Pathway for patients with neurological symptoms. If the patient failed the NBSS in the emergency department (ED), then the screen was repeated again after the patient had been admitted before the SLP dysphagia evaluation. Fifty-three male and female patients ranging from 34 to 96 years old with an initial diagnosis of stroke or transient ischemic attack (TIA) admitted during an 8-week time period from April 25, 2010, to June 19, 2010, were included in this study. There were 32 women and 17 men including 27 strokes and 22 TIAs tested. As a whole, the NBSS and SLP dysphagia evaluation results were consistent with each other for 40 of 46 patients (86.96% perfect agreement). The NBSS had 74% of sensitivity (34 of 46) with the nursing and the speech pathologist in agreement with the patients passing the swallow screen. Accurate identification of aspiration with the patients failing the NBSS was evident with the nursing and speech pathology assessment, which resulted in 83% of sensitivity (10 of 12). The positive predictive value with the corresponding identification of aspiration with the staff was 96% (44 of 46). The naturalistic observation of the patients exhibited internal consistency reliability between the two disciplines. Extraneous variables affecting the results included spontaneous resolution of stroke or TIA symptoms or the patient's decline in neurological status. For more insights from the authors, see Supplemental Digital Content 1, at http://links.lww.com/JNN/A9.

  5. New Swallowing Evaluation Using Piezoelectricity in Normal Individuals.

    Science.gov (United States)

    Sogawa, Yuichiro; Kimura, Shinji; Harigai, Toru; Sakurai, Naoki; Toyosato, Akira; Nishikawa, Taro; Inoue, Makoto; Murasawa, Akira; Endo, Naoto

    2015-12-01

    This study aimed to elucidate the relationship between the piezoelectric waveform latency, hyoid bone movement, surface electromyogram (sEMG), and the pharyngeal transit time (PTT) during swallowing. Forty-one healthy subjects were divided into three age groups: younger (20-39 years, n = 8), middle-aged (40-59 years, n = 9), and older (60-79 years, n = 24). Motion analysis of the hyoid bone using videofluorography (VF), waveform analysis of the front neck using piezoelectric films, and sEMG of the suprahyoid muscle group were performed simultaneously. Latencies of the three movement phases were defined as upward (VFS1), forward (VFS2), and returning to starting position (VFS3). The three phases of the piezoelectric waveform-from wave initiation of the negative wave to the start of the second deep negative wave; from the start of the second deep negative wave to the start of the last positive wave (SLPW); and from the SLPW to the end of the last positive wave-were defined as PS1, PS2, and PS3, respectively. VFS1-3 and PS1-3 were significantly correlated. VFS1 and PS1 latencies were significantly longer with thick liquid than with thin liquid. VFS2, PS1, and PS2 latencies were longer in the older group than in the other two groups. The start of PS1 was nearly equal to those of sEMG and VFS1. Bolus arrival time in the valleculae was statistically equal to the end of the PS1 with both thin and thick liquids. To establish the swallowing screening using Piezoelectric film, further investigation is necessary in the dysphagia patients.

  6. [Feeding, eating, and swallowing disorders in infants and children : An overview].

    Science.gov (United States)

    Schwemmle, C; Arens, C

    2017-07-31

    Swallowing is a dynamic process that requires more than 30 muscles in the recruitment/coordination of the lips, tongue, palate, pharynx, larynx and esophagus. The eating and swallowing procedure is learned in sensitive or critical periods: when a certain degree of maturation has been achieved, the appropriate stimulus permits a certain milestone of development to occur. The swallowing procedure occurs in three main stages oral, pharyngeal, and esophageal. Therefore, swallowing disorders may present in any, some, or all of these stages in addition to feeding problems. Adult dysphagia, or difficulty swallowing, has long been reported in the literature. Infants and children also experience feeding disorders and swallowing problems, either because of developmental disorders, syndromes, behavioral or neurological conditions, respiratory problems, and/or gastroesophageal reflux, eosinophilic esophagitis or anatomical deficits. Feeding problems or dysphagia are seen in up to 25% of all children; approximately 40% of prematurely born infants have swallowing disorders, up to 64-78% with developmental disorders and up to 99% with cerebral palsy. Diagnostic options include health status, broad social environment, parent-child interactions, and parental concerns. Evaluation of dysphagia and feeding disorders involves a multifactorial approach. Imaging studies may include videofluoroscopy and/or fiberoptic evaluation of swallowing (FEES). Successful oral feeding must be measured in quality of meal time experiences with best possible oral sensorimotor skills and safe swallowing while not jeopardizing a child's functional health status or the parent-child relationship. An interdisciplinary team approach enables coordinated global assessment and therapy planning.

  7. Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy

    Directory of Open Access Journals (Sweden)

    Simon Roh

    2016-04-01

    Full Text Available Background: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy. Methods: Patients who underwent esophagectomy from January 2000 to December 2013 at our institution were investigated. Barium swallow was routinely done between days 5–7 to detect a leak. These results were compared to clinically determined leaks (defined by neck wound infection requiring jejunal feeds and or parenteral nutrition during the postoperative period. The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was determined. Results: A total of 395 esophagectomies were performed (mean age, 62.2 years. The indications for the esophagectomy were as follows: malignancy (n=320, high-grade dysplasia (n=14, perforation (n=27, benign stricture (n=7, achalasia (n=16, and other (n=11. A variety of techniques were used including transhiatal (n=351, McKeown (n=35, and Ivor Lewis (n=9 esophagectomies. Operative mortality was 2.8% (n=11. Three hundred and sixty-eight patients (93% underwent barium swallow study after esophagectomy. Clinically significant anastomotic leak was identified in 36 patients (9.8%. Barium swallow was able to detect only 13/36 clinically significant leaks. The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. Conclusion: Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.

  8. Swallowing function after laryngeal cleft repair: more than just fixing the cleft.

    Science.gov (United States)

    Osborn, Alexander J; de Alarcon, Alessandro; Tabangin, Meredith E; Miller, Claire K; Cotton, Robin T; Rutter, Michael J

    2014-08-01

    To evaluate and describe the swallowing function in children after laryngeal cleft repair. Ten-year (2002-2012) retrospective chart review. Academic tertiary care pediatric otolaryngology practice. Records of 60 children who had surgical repair of laryngeal cleft (ages 2 weeks-14 years) and postoperative functional endoscopic evaluation of swallowing or videofluoroscopic swallow studies were examined retrospectively. Twenty-nine children had one postoperative swallow evaluation, 19 children had two, 4 children had three, 5 children had four, and 3 children had five. Median time to the first evaluation was 10.8 weeks (interquartile range [IQR]: 36.5, 231). On the final swallow evaluation, 34 (57%) children demonstrated normal swallowing parameters, 12 (20%) children showed penetration, and 14 (23%) children showed aspiration. Forty-three (72%) children were able to take everything by mouth normally or with minor behavioral modifications, 11 (18%) children required thickened fluids, and six (10%) children were kept nil per os (NPO). Mean improvement on the penetration-aspiration (pen-asp) scale was 2.13. On multivariable analysis, neurodevelopmental issues and gastronomy tube use were associated with the need for NPO status. Despite a high rate of surgical success, a substantial minority of children have persistent swallowing dysfunction after laryngeal cleft repair. Swallowing dysfunction after repair is multifactorial and arises from concomitant neurologic, anatomic, or other comorbidities that contribute to oropharyngeal and pharyngeal dysphagia. Based on our results, we recommend a testing schedule for postoperative swallowing evaluations after cleft repair. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  9. The swallowing side effects of botulinum toxin type A injection in spasmodic dysphonia.

    Science.gov (United States)

    Holzer, S E; Ludlow, C L

    1996-01-01

    Botulinum toxin type A (BOTOX) injection of the thyroarytenoid muscle is used to control speech symptoms in patients with adductor spasmodic dysphonia. Transient difficulty in swallowing liquids is a common treatment side effect. Laryngeal movement durations were measured during swallowing in 13 adductor spasmodic dysphonia patients undergoing treatment and in 6 normal control subjects in order to determine the following: 1. whether, prior to the injection, laryngeal movement durations were longer in the spasmodic dysphonia patients than in the control subjects; 2. whether movement durations increased following the injections; 3. whether preinjection swallowing difficulties related to postinjection swallowing measurements and postinjection patient reports of swallowing problems. A piezoelectric movement transducer was shown to be accurate for noninvasive measurement of laryngeal movement duration in relation to muscle onset and offset for hyoid elevation and relaxation. Before botulinum toxin type A injection, no significant differences in swallowing duration were found between the patient and control groups. Four patients with swallowing complaints prior to injection had longer laryngeal movement durations than the other spasmodic dysphonia patients and the control subjects. Following injection, laryngeal movement durations increased in the patients with spasmodic dysphonia, and eight patients reported dysphagia for an average of 2 weeks. Relationships were found between the patients' initial reports of swallowing problems and increased laryngeal movement durations before and after botulinum toxin type A injection. Those patients initially reporting swallowing difficulties had severe dysphagia for 2 weeks after the injection. Patient reports of dysphagia prior to injection may indicate a greater likelihood of significant dysphagia following thyroarytenoid injection with botulinum toxin type A.

  10. Sex allocation according to multiple sexually dimorphic traits of both parents in the barn swallow (Hirundo rustica).

    Science.gov (United States)

    Romano, A; Romano, M; Caprioli, M; Costanzo, A; Parolini, M; Rubolini, D; Saino, N

    2015-06-01

    Parents should differentially invest in sons or daughters depending on the sex-specific fitness returns from male and female offspring. In species with sexually selected heritable male characters, highly ornamented fathers should overproduce sons, which will be more sexually attractive than sons of less ornamented fathers. Because of genetic correlations between the sexes, females that express traits which are under selection in males should also overproduce sons. However, sex allocation strategies may consist in reaction norms leading to spatiotemporal variation in the association between offspring sex ratio (SR) and parental phenotype. We analysed offspring SR in barn swallows (Hirundo rustica) over 8 years in relation to two sexually dimorphic traits: tail length and melanin-based ventral plumage coloration. The proportion of sons increased with maternal plumage darkness and paternal tail length, consistently with sexual dimorphism in these traits. The size of the effect of these parental traits on SR was large compared to other studies of offspring SR in birds. Barn swallows thus manipulate offspring SR to overproduce 'sexy sons' and potentially to mitigate the costs of intralocus sexually antagonistic selection. Interannual variation in the relationships between offspring SR and parental traits was observed which may suggest phenotypic plasticity in sex allocation and provides a proximate explanation for inconsistent results of studies of sex allocation in relation to sexual ornamentation in birds. © 2015 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2015 European Society For Evolutionary Biology.

  11. Offspring sexual dimorphism and sex-allocation in relation to parental age and paternal ornamentation in the barn swallow.

    Science.gov (United States)

    Saino, N; Ambrosini, R; Martinelli, R; Calza, S; Møller, A P; Pilastro, A

    2002-08-01

    We analysed the morphology of nestling barn swallows (Hirundo rustica) in relation to their sex, and laying and hatching order. In addition, we studied sex-allocation in relation to parentage, parental age and expression of a secondary sexual character of fathers. Molecular sexing was conducted using the sex chromosome-linked avian CHD1 gene. Sex of the offspring was not associated with laying or hatching order. None of nine morphological, serological and immunological variables varied in relation to offspring sex. Sexual dimorphism did not vary in relation to parental age and expression of a paternal secondary sexual character. The proportion of sons declined with brood size. Individual males and females had a similar proportion of sons during consecutive breeding years. The proportion of sons of individual females declined with age, but increased with the expression of a secondary sexual character of their current mate. The generalized lack of variation in sexual dimorphism among nestlings may suggest that barn swallows do not differentially invest in sons vs. daughters. Alternatively, male offspring may require different parental effort compared to their female siblings in order to attain the same morphological state. The lack of variation in offspring sexual dimorphism with paternal ornamentation suggests no adjustment of overall parental effort in relation to reproductive value of the two sexes. However, male-biased sex ratio among offspring of highly ornamented males may represent an adaptive sex-allocation strategy because the expression of male ornaments is heritable and highly ornamented males are at a sexual selection advantage.

  12. Impact of Conflict Management Strategies on the Generation Mechanism of Miners' Unsafe Behavior Tendency

    Science.gov (United States)

    Li, Ji-Zu; Zhang, Ya-Ping; Liu, Xiao-Guang; Liu, Yao-Long; Wang, Tian-Ri

    2017-01-01

    In this paper, we examine the relationship between the generation mechanism of miners' unsafe behavior tendency and conflict management strategies, including cooperative conflict management strategy, competitive conflict management strategy and avoidant conflict management strategy. Miners from 3 collieries in Shanxi province completed a…

  13. Planning for Increased Bioenergy use - Strategies for Minimising Environmental Impacts and Analysing the Consequences

    International Nuclear Information System (INIS)

    Jonsson, Anna

    2006-08-01

    There are several goals aimed at increasing the use of renewable energy in the Swedish energy system. Bioenergy is one important renewable energy source and there is a potential to increase its use in the future. This thesis aimed to develop and analyse strategies and tools that could be used when planning for conversion to bioenergy-based heating systems and the building of new residential areas with bioenergy-based heating. The goal was to enable the increase of bioenergy and simultaneously minimise the negative health effects caused by emissions associated with the combustion of bioenergy. The thesis consists of two papers. Paper I concerned existing residential areas and conversion from electric heating and individual heating systems, such as firewood and oil boilers, to more modern and low-emitting pellet techniques and small-scale district heating. Paper II concerned new residential areas and how to integrate bioenergy-based heating systems that cause impacts on local air quality into the physical planning process through using Geographical Information Systems (GIS) and a meteorological dispersion model, ALARM. The results from Paper I indicated that it was possible to convert areas currently using electric heating to pellet techniques and small-scale district heating without degrading local air quality. Furthermore, it was possible to decrease high emissions caused by firewood boilers by replacing them with pellet boilers. The results from Paper II highlighted that GIS and ALARM were advantageous for analysing local air quality characteristics when planning for new residential areas and before a residential area is built: thus, avoiding negative impacts caused by bioenergy-based combustion. In conclusion, the work procedures developed in this thesis can be used to counteract negative impacts on local air quality with increasing use of bioenergy in the heating system. Analysis of potentially negative aspects before conversion to bioenergy-based heating

  14. Impact of educational strategies in positioning Samarium-153 EDTMP as a treatment for metastatic bone pain

    International Nuclear Information System (INIS)

    Seminario, C.; Morales, R.; Castro, M.; Cano, R.A.; Mendoza, G.

    2005-01-01

    , which has finished in December 2004. Three television spots were delivered to public: 'Hello, Doctor', which has a morning audience and in two interviews in news programs, with high rating performance. Five interviews were given in radio programs, one of them was for a feminine audience, three for general public and the other two with national impact. In every program a web page, an e-mail and a telephone number were given for consultation. In Nuclear Medicine Centers in Lima telephone calls have been received since the beginning of the campaign every day, up to date. In a year, a monthly conference was delivered to physicians. Samarium EDTMP treatment increased substantially after the campaign. The more significant means in mass media for changing management were patient education, continuous meetings with specialists and one of the television spots used ('Hello, doctor'), which continues to be delivered in the closed circuit TV network of the social security system. We conclude that repetitive educational strategies have a positive impact in delivering radiopharmaceuticals for bone pain palliation to patients with bone metastases

  15. Strategies to enhance the impact of research on human resources for health on policy making

    Directory of Open Access Journals (Sweden)

    Taghreed Adam

    2011-06-01

    Full Text Available Despite global recognition of the importance of human resources for health (HRH in achieving health system goals, very little is known about what works, for whom and under what circumstances, especially for low-income and middleincome countries. Several important events and reports have called for increased funding and capacity for HRH research in recent years and several initiatives have started as a result. Progress has been slow, however. The following strategies can be most valuable in ensuring the relevance of the generated evidence for decision making and its contribution to stronger health systems. The first is to promote national processes to set priorities for HRH research with active participation from decision makers. The second is to make conscious efforts to scale up primary research to address priority questions and to develop sustainable mechanisms to evaluate the impact of current or new HRH strategies to feed into the policy making process. The third is to invest in the development of systematic reviews to synthesize available evidence and in the adaptation of the underlying methods to make them more responsive to the type of questions and the nature of research involving HRH issues. The fourth and most important is to consistently use a systems approach in framing and addressing research questions. While a narrow approach may be more attractive and simple, health systems and the problems facing them are not. Increasing the body of evidence that takes into account the complexity of health systems, and particularly human resources for health, will advance knowledge in this area and will make big strides in the quality and usefulness of the generated evidence.

  16. Type of learning task impacts performance and strategy selection in decision making.

    Science.gov (United States)

    Pachur, Thorsten; Olsson, Henrik

    2012-09-01

    In order to be adaptive, cognition requires knowledge about the statistical structure of the environment. We show that decision performance and the selection between cue-based and exemplar-based inference mechanisms can depend critically on how this knowledge is acquired. Two types of learning tasks are distinguished: learning by comparison, by which the decision maker learns which of two objects has a higher criterion value, and direct criterion learning, by which the decision maker learns an object's criterion value directly. In three experiments, participants were trained either with learning by comparison or with direct criterion learning and subsequently tested with paired-comparison, classification, and estimation tasks. Experiments 1 and 2 showed that although providing less information, learning by comparison led to better generalization (at test), both when generalizing to new objects and when the task format at test differed from the task format during training. Moreover, learning by comparison enabled participants to provide rather accurate continuous estimates. Computational modeling suggests that the advantage of learning by comparison is due to differences in strategy selection: whereas direct criterion learning fosters the reliance on exemplar processing, learning by comparison fosters cue-based mechanisms. The pattern in decision performance reversed when the task environment was changed from a linear (Experiments 1 and 2) to a nonlinear structure (Experiment 3), where direct criterion learning led to better decisions. Our results demonstrate the critical impact of learning conditions for the subsequent selection of decision strategies and highlight the key role of comparison processes in cognition. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Antimicrobial Resistance: Its Surveillance, Impact, and Alternative Management Strategies in Dairy Animals

    Science.gov (United States)

    Sharma, Chetan; Rokana, Namita; Chandra, Mudit; Singh, Brij Pal; Gulhane, Rohini Devidas; Gill, Jatinder Paul Singh; Ray, Pallab; Puniya, Anil Kumar; Panwar, Harsh

    2018-01-01

    Antimicrobial resistance (AMR), one among the most common priority areas identified by both national and international agencies, is mushrooming as a silent pandemic. The advancement in public health care through introduction of antibiotics against infectious agents is now being threatened by global development of multidrug-resistant strains. These strains are product of both continuous evolution and un-checked antimicrobial usage (AMU). Though antibiotic application in livestock has largely contributed toward health and productivity, it has also played significant role in evolution of resistant strains. Although, a significant emphasis has been given to AMR in humans, trends in animals, on other hand, are not much emphasized. Dairy farming involves surplus use of antibiotics as prophylactic and growth promoting agents. This non-therapeutic application of antibiotics, their dosage, and withdrawal period needs to be re-evaluated and rationally defined. A dairy animal also poses a serious risk of transmission of resistant strains to humans and environment. Outlining the scope of the problem is necessary for formulating and monitoring an active response to AMR. Effective and commendably connected surveillance programs at multidisciplinary level can contribute to better understand and minimize the emergence of resistance. Besides, it requires a renewed emphasis on investments into research for finding alternate, safe, cost effective, and innovative strategies, parallel to discovery of new antibiotics. Nevertheless, numerous direct or indirect novel approaches based on host–microbial interaction and molecular mechanisms of pathogens are also being developed and corroborated by researchers to combat the threat of resistance. This review places a concerted effort to club the current outline of AMU and AMR in dairy animals; ongoing global surveillance and monitoring programs; its impact at animal human interface; and strategies for combating resistance with an extensive

  18. Antimicrobial Resistance: Its Surveillance, Impact, and Alternative Management Strategies in Dairy Animals

    Directory of Open Access Journals (Sweden)

    Chetan Sharma

    2018-01-01

    Full Text Available Antimicrobial resistance (AMR, one among the most common priority areas identified by both national and international agencies, is mushrooming as a silent pandemic. The advancement in public health care through introduction of antibiotics against infectious agents is now being threatened by global development of multidrug-resistant strains. These strains are product of both continuous evolution and un-checked antimicrobial usage (AMU. Though antibiotic application in livestock has largely contributed toward health and productivity, it has also played significant role in evolution of resistant strains. Although, a significant emphasis has been given to AMR in humans, trends in animals, on other hand, are not much emphasized. Dairy farming involves surplus use of antibiotics as prophylactic and growth promoting agents. This non-therapeutic application of antibiotics, their dosage, and withdrawal period needs to be re-evaluated and rationally defined. A dairy animal also poses a serious risk of transmission of resistant strains to humans and environment. Outlining the scope of the problem is necessary for formulating and monitoring an active response to AMR. Effective and commendably connected surveillance programs at multidisciplinary level can contribute to better understand and minimize the emergence of resistance. Besides, it requires a renewed emphasis on investments into research for finding alternate, safe, cost effective, and innovative strategies, parallel to discovery of new antibiotics. Nevertheless, numerous direct or indirect novel approaches based on host–microbial interaction and molecular mechanisms of pathogens are also being developed and corroborated by researchers to combat the threat of resistance. This review places a concerted effort to club the current outline of AMU and AMR in dairy animals; ongoing global surveillance and monitoring programs; its impact at animal human interface; and strategies for combating resistance

  19. Current assessment and treatment strategies of dysphagia in head and neck cancer patients: a systematic review of the 2012/13 literature

    NARCIS (Netherlands)

    Kraaijenga, S. A. C.; van der Molen, L.; van den Brekel, M. W. M.; Hilgers, F. J. M.

    2014-01-01

    Dysphagia, or swallowing impairment, is a serious sequel of head and neck cancer (HNC) and its treatment. This review focuses on the rapidly growing literature published during the past 2 years about the current assessment and treatment strategies of dysphagia in HNC patients. Functional swallowing

  20. Impacts of Storm Surge Mitigation Strategies on Aboveground Storage Tank Chemical Spill Transport

    Science.gov (United States)

    Do, C.; Bass, B. J.; Bernier, C.; Samii, A.; Dawson, C.; Bedient, P. B.

    2017-12-01

    The Houston Ship Channel (HSC), located in the hurricane-prone Houston-Galveston region of the upper Texas Coast, is one of the busiest waterways in the United States and is home to one of the largest petrochemical complexes in the world. Due to the proximity of the HSC to Galveston Bay and the Gulf of Mexico, chemical spills resulting from storm surge damage to aboveground storage tanks (ASTs) pose serious threats to the environment, residential communities, and national/international markets whose activities in the HSC generate billions of dollars annually. In an effort to develop a comprehensive storm surge mitigation strategy for Galveston Bay and its constituents, Rice University's Severe Storm Prediction, Education, and Evacuation from Disasters Center proposed two structural storm surge mitigation concepts, the Mid Bay Structure (MBS) and the Lower Bay Structure (LBS) as components of the Houston-Galveston Area Protection System (H-GAPS) project. The MBS consists of levees along the HSC and a navigational gate across the channel, and the LBS consists of a navigation gate and environmental gates across Bolivar Road. The impacts of these two barrier systems on the fate of AST chemical spills in the HSC have previously been unknown. This study applies the coupled 2D SWAN+ADCIRC model to simulate hurricane storm surge circulation within the Gulf of Mexico and Galveston Bay due to a synthetic storm which results in approximately 250-year surge levels in Galveston Bay. The SWAN+ADCIRC model is run using high-resolution computational meshes that incorporate the MBS and LBS scenarios, separately. The resulting wind and water velocities are then fed into a Lagrangian particle transport model to simulate the spill trajectories of the ASTs most likely to fail during the 250-year proxy storm. Results from this study illustrate how each storm surge mitigation strategy impacts the transport of chemical spills (modeled as Lagrangian particles) during storm surge as

  1. Redundancy in electronic health record corpora: analysis, impact on text mining performance and mitigation strategies.

    Science.gov (United States)

    Cohen, Raphael; Elhadad, Michael; Elhadad, Noémie

    2013-01-16

    The increasing availability of Electronic Health Record (EHR) data and specifically free-text patient notes presents opportunities for phenotype extraction. Text-mining methods in particular can help disease modeling by mapping named-entities mentions to terminologies and clustering semantically related terms. EHR corpora, however, exhibit specific statistical and linguistic characteristics when compared with corpora in the biomedical literature domain. We focus on copy-and-paste redundancy: clinicians typically copy and paste information from previous notes when documenting a current patient encounter. Thus, within a longitudinal patient record, one expects to observe heavy redundancy. In this paper, we ask three research questions: (i) How can redundancy be quantified in large-scale text corpora? (ii) Conventional wisdom is that larger corpora yield better results in text mining. But how does the observed EHR redundancy affect text mining? Does such redundancy introduce a bias that distorts learned models? Or does the redundancy introduce benefits by highlighting stable and important subsets of the corpus? (iii) How can one mitigate the impact of redundancy on text mining? We analyze a large-scale EHR corpus and quantify redundancy both in terms of word and semantic concept repetition. We observe redundancy levels of about 30% and non-standard distribution of both words and concepts. We measure the impact of redundancy on two standard text-mining applications: collocation identification and topic modeling. We compare the results of these methods on synthetic data with controlled levels of redundancy and observe significant performance variation. Finally, we compare two mitigation strategies to avoid redundancy-induced bias: (i) a baseline strategy, keeping only the last note for each patient in the corpus; (ii) removing redundant notes with an efficient fingerprinting-based algorithm. (a)For text mining, preprocessing the EHR corpus with fingerprinting yields

  2. 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.

  3. Impact of movement training on upper limb motor strategies in persons with shoulder impingement syndrome

    Directory of Open Access Journals (Sweden)

    Roy Jean-Sébastien

    2009-05-01

    Full Text Available Abstract Background Movement deficits, such as changes in the magnitude of scapulohumeral and scapulathoracic muscle activations or perturbations in the kinematics of the glenohumeral, sternoclavicular and scapulothoracic joints, have been observed in people with shoulder impingement syndrome. Movement training has been suggested as a mean to contribute to the improvement of the motor performance in persons with musculoskeletal impairments. However, the impact of movement training on the movement deficits of persons with shoulder impingement syndrome is still unknown. The aim of this study was to evaluate the short-term effects of supervised movement training with feedback on the motor strategies of persons with shoulder impingement syndrome. Methods Thirty-three subjects with shoulder impingement were recruited. They were involved in two visits, one day apart. During the first visit, supervised movement training with feedback was performed. The upper limb motor strategies were evaluated before, during, immediately after and 24 hours after movement training. They were characterized during reaching movements in the frontal plane by EMG activity of seven shoulder muscles and total excursion and final position of the wrist, elbow, shoulder, clavicle and trunk. Movement training consisted of reaching movements performed under the supervision of a physiotherapist who gave feedback aimed at restoring shoulder movements. One-way repeated measures ANOVAs were run to analyze the effect of movement training. Results During, immediately after and 24 hours after movement training with feedback, the EMG activity was significantly decreased compared to the baseline level. For the kinematics, total joint excursion of the trunk and final joint position of the trunk, shoulder and clavicle were significantly improved during and immediately after training compared to baseline. Twenty-four hours after supervised movement training, the kinematics of trunk, shoulder

  4. A narrative review of binge eating disorder in adolescence: prevalence, impact, and psychological treatment strategies.

    Science.gov (United States)

    Marzilli, Eleonora; Cerniglia, Luca; Cimino, Silvia

    2018-01-01

    Binge eating disorder (BED) represents one of the most problematic clinical conditions among youths. Research has shown that the developmental stage of adolescence is a critical stage for the onset of eating disorders (EDs), with a peak prevalence of BED at the age of 16-17 years. Several studies among adults with BED have underlined that it is associated with a broad spectrum of negative consequences, including higher concern about shape and weight, difficulties in social functioning, and emotional-behavioral problems. This review aimed to examine studies focused on the prevalence of BED in the adolescent population, its impact in terms of physical, social, and psychological outcomes, and possible strategies of psychological intervention. The review of international literature was made on paper material and electronic databases ProQuest, PsycArticles, and PsycInfo, and the Scopus index were used to verify the scientific relevance of the papers. Epidemiological research that examined the prevalence of BED in adolescent samples in accordance with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition showed a prevalence ranging from 1% to 4%. More recently, only a few studies have investigated the prevalence of BED, in accordance with the Diagnostic and Statistical Manual of Disorders, Fifth Edition criteria, reporting a prevalence of ~1%-5%. Studies that focused on the possible impact that BED may have on physical, psychological, and social functioning showed that adolescents with BED have an increased risk of developing various adverse consequences, including obesity, social problems, substance use, suicidality, and other psychological difficulties, especially in the internalizing area. Despite the evidence, to date, reviews on possible and effective psychological treatment for BED among young population are rare and focused primarily on adolescent females.

  5. A narrative review of binge eating disorder in adolescence: prevalence, impact, and psychological treatment strategies

    Science.gov (United States)

    Marzilli, Eleonora; Cerniglia, Luca; Cimino, Silvia

    2018-01-01

    Binge eating disorder (BED) represents one of the most problematic clinical conditions among youths. Research has shown that the developmental stage of adolescence is a critical stage for the onset of eating disorders (EDs), with a peak prevalence of BED at the age of 16–17 years. Several studies among adults with BED have underlined that it is associated with a broad spectrum of negative consequences, including higher concern about shape and weight, difficulties in social functioning, and emotional-behavioral problems. This review aimed to examine studies focused on the prevalence of BED in the adolescent population, its impact in terms of physical, social, and psychological outcomes, and possible strategies of psychological intervention. The review of international literature was made on paper material and electronic databases ProQuest, PsycArticles, and PsycInfo, and the Scopus index were used to verify the scientific relevance of the papers. Epidemiological research that examined the prevalence of BED in adolescent samples in accordance with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition showed a prevalence ranging from 1% to 4%. More recently, only a few studies have investigated the prevalence of BED, in accordance with the Diagnostic and Statistical Manual of Disorders, Fifth Edition criteria, reporting a prevalence of ~1%–5%. Studies that focused on the possible impact that BED may have on physical, psychological, and social functioning showed that adolescents with BED have an increased risk of developing various adverse consequences, including obesity, social problems, substance use, suicidality, and other psychological difficulties, especially in the internalizing area. Despite the evidence, to date, reviews on possible and effective psychological treatment for BED among young population are rare and focused primarily on adolescent females. PMID:29379325

  6. Alignment of business and information strategies and its impact on business performance

    DEFF Research Database (Denmark)

    Johansson, Björn; Sudzina, Frantisek; Pucihar, Andreja

    2014-01-01

    between business strategy, information strategy, and revenue growth shows that there is a significant relationship between alignment and revenue growth in Slovenia, and this link is positive. Managers should aim to align business and information strategies in order to achieve better business performance.......Alignment between business strategy and information strategy has been focused on for several years with research suggesting different explanations to how this alignment influences a firm’s performance. This article presents results from an investigation of firms in Slovenia about how business...... people perceived their business strategy and information strategy to be aligned. Respondents’ statements from the questionnaire survey on their perceived alignment between business strategy and information strategy were checked against the firms’ revenue growth. The analysis of perceived alignment...

  7. Meta-Cognitive Awareness of Writing Strategy Use among Iranian EFL Learners and Its Impact on Their Writing Performance

    Directory of Open Access Journals (Sweden)

    Muhammad Azizi

    2017-03-01

    Full Text Available It is believed that by improving students’ meta-cognitive awareness of elements of language, learning can be enhanced. Therefore, this study consisted of two main objectives. First, it aimed at examining meta-cognitive awareness of writing strategy use among Iranian EFL learners. Using a Friedman test to check if there was any significant difference among the participants in their use of writing strategies, it was found that the differences among the strategies were not significant. The second objective of the study was to examine the impact of the participants’ meta-cognitive awareness of writing strategy use on their L2 writing performance. This was answered using two statistical techniques, namely Pearson correlation and Multiple Regression. Using Pearson Correlation, it was found that there was a significant relationship between writing performance and all writing strategy categories (planning, monitoring, evaluation, and self-awareness. Moreover, using Multiple Regression, it was found that the p–value was significant only for evaluation strategy category, but not for the rest. That is, it was found that strategy categories such as planning, monitoring, and self-awareness did not predict students’ writing performance. The result of this study responds to the ongoing problems students have in their meta-cognitive awareness of writing strategy use which can contribute to raising proficiency levels in shorter time frames.

  8. Frequency of dysmenorrhoea, its impact and management strategies adopted by medical students.

    Science.gov (United States)

    Yasir, Saadia; Kant, Bushra; Dar, Muhammad Farooq

    2014-01-01

    Dysmenorrhea is quite frequent and may affect the daily activities especially during the early years of adolesence. This study aimed to evaluate the prevalence of dysmenorrhoea, its impact, and the management strategies adopted. This cross-sectional study was done with 356 consenting females studying at Mohiuddin Islamic University, Mirpur Azad Kashmir, between 18-25 years of age, with regular menstrual cycles and normal abdomino-pelvic ultrasound and not taking any medication. Information was gathered regarding age, residence, menstrual history, body mass index (BMI), associated symptoms, remedies used and days lost. A total of 56.1% females had dysmenorrhoea. The mean age of participants was 21.01±1.54 years, mean age of menarche was 12.9±1.65 years, mean duration of menstrual flow was 4.75±1.27 days and mean BMI was 24.1±1.6. 17% of the participants were dieting and 26% had daily milk intake. 25% reported being absent due to pain and number of days lost was 1.5±1.0 days. Common symptoms associated with the dysmenorrhoea were difficulty concentrating in 65%, less involvement in social activities and sleep affected in 64%, mood disturbances in 58% and headache in 56%. Household remedies for dysmenorrhea were used by 43% and 66% used analgesics and only 4% sought medical advice for pain. Dysmenorrhoea is a very common problem affecting academic performance and limiting daily activities requiring appropriate intervention.

  9. Impacts of calibration strategies and ensemble methods on ensemble flood forecasting over Lanjiang basin, Southeast China

    Science.gov (United States)

    Liu, Li; Xu, Yue-Ping

    2017-04-01

    Ensemble flood forecasting driven by numerical weather prediction products is becoming more commonly used in operational flood forecasting applications.In this study, a hydrological ensemble flood forecasting system based on Variable Infiltration Capacity (VIC) model and quantitative precipitation forecasts from TIGGE dataset is constructed for Lanjiang Basin, Southeast China. The impacts of calibration strategies and ensemble methods on the performance of the system are then evaluated.The hydrological model is optimized by parallel programmed ɛ-NSGAII multi-objective algorithm and two respectively parameterized models are determined to simulate daily flows and peak flows coupled with a modular approach.The results indicatethat the ɛ-NSGAII algorithm permits more efficient optimization and rational determination on parameter setting.It is demonstrated that the multimodel ensemble streamflow mean have better skills than the best singlemodel ensemble mean (ECMWF) and the multimodel ensembles weighted on members and skill scores outperform other multimodel ensembles. For typical flood event, it is proved that the flood can be predicted 3-4 days in advance, but the flows in rising limb can be captured with only 1-2 days ahead due to the flash feature. With respect to peak flows selected by Peaks Over Threshold approach, the ensemble means from either singlemodel or multimodels are generally underestimated as the extreme values are smoothed out by ensemble process.

  10. Impact of technology on women: strategies for non-formal education.

    Science.gov (United States)

    Mohsin, S

    2000-01-01

    This article focuses on the impact of technology on women and its implications for nonformal education in developing countries. It describes how poverty and illiteracy created a distinctive gender bias in terms of women's participation in the labor force and health. Compared to men, women have lower levels of literacy, are poorer, and have more limited access to nontraditional skills. Moreover, illiteracy is associated with socioeconomic exploitation and deprivation suffered by women. It is therefore essential to identify how functional nonformal education (NFE) can help change the lives of women. To define, NFE is an integrated approach to education and training outside the formal system. It includes literacy, skills development, collaborative group activities, information, and training on issues of everyday life and work for improved health, status, and sustainable economic development. Following a discussion of the external factors that influence technology, the paper will focus on access to use of technology in two areas, namely, health and work opportunities, with emphasis on environment in both areas. It also outlines the role and responsibilities of NFE actors, the necessary infrastructures, and the barriers faced by women. Finally, the paper sets out the objectives of NFE programs, factors that determine the use of technology, strategies for NFE, and the challenges ahead.

  11. The Impact of Trampling on Reef Macrobenthos in Northeastern Brazil: How Effective are Current Conservation Strategies?

    Science.gov (United States)

    Santos, Gleice S.; Burgos, Douglas C.; Lira, Simone M. A.; Schwamborn, Ralf

    2015-10-01

    Tropical reefs are used for intensive tourism in various parts of the world. However, few studies have investigated the effect of regular trampling on these fragile ecosystems. The aim of this study was to assess the effect of different conservation strategies (open access, partial protection, and total long-term closure) on intertidal reef tops in Porto de Galinhas and Tamandaré, Pernambuco State, Brazil. Analysis of the macrobenthic community was performed with photo transects and image analysis (CPCe). Twenty-seven transects were surveyed from January to August 2012, in intensively impacted (I) open-access sites, in partially protected (P) sites with occasional, illegal trampling, and in a permanently closed (C) site. In I sites, total live cover was half the cover found in adjacent P sites. The area of bare rock averaged 53.6 and 25.0 % in I and P sites, respectively. In the C site, the area of bare rock was only 19.8 %. In I and P sites, macroalgae ( Palisada perforata) were dominating, while in the C site, the zoanthid Zoanthus sociatus was most abundant. Shell-bearing vermetids ( Petaloconchus varians) and bivalves ( Isognomon bicolor) were more abundant at the C site, being possible bioindicators for areas with zero or little trampling. Twelve years of total closure produced near-pristine communities in the C site, dominated by zoanthids and fragile mollusks. This study showed that trampling has severe and long-lasting consequences for the structure of these ecosystems.

  12. Evaluating the impact of Internet provision on students' information-gathering strategies

    Directory of Open Access Journals (Sweden)

    Julia Meek

    1998-12-01

    Full Text Available Universities may invest millions of pounds in the provision of computer hardware without ever seriously considering the educational results such investment may deliver. Equally, academics may be committed to the use of IT in teaching and learning because it is expected of them (cf. Dearing, 1997, and rarely give serious consideration to the impact which the effective use of IT may have on student learning (Lauillard, 1993. The use of the WWW to deliver material in support of university teaching is still in its infancy, yet already two distinct approaches to its use can be seen. The first approach uses the WWW passively to deliver existing lecture notes in a technologically impressive and, perhaps more importantly, highly convenient fashion. The second approach attempts to shape the material delivered to maximize the teaching and learning potential of the WWW and to develop students' skills in the use of the medium. But which approach works more effectively? And how does one balance the needs of an academic community pressured by the Research Assessment Exercise with the need to develop effective teaching and learning strategies which maximize the potential of IT for the academic community, for the students and for their future employers?

  13. Sediment impact assessment of check-dam removal strategies on a mountain river in Taiwan

    Science.gov (United States)

    Kuo, W.; Wang, H.; Stark, C. P.

    2011-12-01

    Dam removal is important for reconnecting river habitats and restoring the free flow of water and sediment, so managing accumulated sediments is crucial in dam removal planning as the cost and potential impacts of dam removal can vary substantially depending on local conditions. A key uncertainty in dam removal is the fate of reservoir sediment stored upstream of the dam. Release of impounded sediment could raise downstream bed elevations leading to flooding, increase lateral channel mobility leading to bank erosion, and potentially bury downstream ecologically sensitive habitats if the sediment is fine. The ability to predict the sediment impacts of dam removal in highly sediment-filled systems is thus increasingly important as the number of such dam-removal cases is growing. Due to the safety concerns and the need for habitat restoration for the Formosan landlocked salmon, the Shei-Pa National Park in Taiwan removed the 15m high Chijiawan "No. 1 Check Dam" in late May 2011. During the planning process prior to removal, we conducted field surveys, numerical simulations, and flume experiments to determine sediment impacts and to suggest appropriate dam removal strategies. We collected river-bed topography and sediment bulk samples in 2010 to establish the channel geometry and grain-size distribution for modeling input. The scaled flume experiment was designed to provide insights on how and if the position of a notch location and size would affect the rate and amount of reservoir erosion under particular discharges. Observations indicated that choices of notch location can force the river to migrate differently. For long-term prediction, we used the quasi-two-dimensional numerical model NETSTARS (Network of Stream Tube model for Alluvial River Simulation) to simulate the channel responses. These simulations indicated that high suspended sediment concentrations would be the most likely major concern in the first year, while concerns for downstream sediment deposition

  14. Environmental impact assessment of different end-of-life LCD management strategies.

    Science.gov (United States)

    Amato, Alessia; Rocchetti, Laura; Beolchini, Francesca

    2017-01-01

    The strong growth of the electrical and electronic equipment production combined with its short lifespan are causing the production of a significant amount of waste to treat. In particular, the present paper focuses on end-of-life liquid crystal displays (LCDs) for their significant content of valuable materials, like plastic, glass and metals that could be recovered after dismantling. In the recent literature, traditional LCD recycling processes are combined with innovative treatments, which allow to recover critical raw materials, such as indium. In this context, we have evaluated the environmental impact of four different strategies of end-of-life LCD management: the disposal in landfilling sites, the incineration, the traditional recycling treatment and an innovative process also addressed to the recovery of indium. The traditional recycling treatment resulted to be the best scenario for the environment. Indeed, a life cycle assessment study gave following environmental burdens (if negative they are credits): 18, 81, -68, -60kg CO 2 -equiv. and 0.08, 0.01, -0.25, -0.18mol H + -equiv., for the four scenarios in the categories of global warming and acidification, respectively. The limit of the variability of LCD composition was overcome including additional literature data in the study. In order to improve the innovative process sustainability, a system of water recirculation was optimized with a consequent impact decrease of 35% in the global warming category. Nevertheless, this action should be combined with an increase of indium concentration in the panel because the low metal content represents the bottleneck of the overall approach. In this regard, a sensitivity analysis showed that an increase of at least five times in indium concentration in the waste is needed to observe an advantage of the innovative vs the traditional recycling process, when the impact category of climate change is considered. As a whole, the life cycle assessment was confirmed as a key

  15. A narrative review of binge eating disorder in adolescence: prevalence, impact, and psychological treatment strategies

    Directory of Open Access Journals (Sweden)

    Marzilli E

    2018-01-01

    Full Text Available Eleonora Marzilli,1 Luca Cerniglia,2 Silvia Cimino1 1Department of Dynamic and Clinical Psychology, Psychology and Medicine Faculty, Sapienza – University of Rome, 2Department of Psychology, Psychology Faculty, International Telematic University Uninettuno, Rome, Italy Abstract: Binge eating disorder (BED represents one of the most problematic clinical conditions among youths. Research has shown that the developmental stage of adolescence is a critical stage for the onset of eating disorders (EDs, with a peak prevalence of BED at the age of 16–17 years. Several studies among adults with BED have underlined that it is associated with a broad spectrum of negative consequences, including higher concern about shape and weight, difficulties in social functioning, and emotional-behavioral problems. This review aimed to examine studies focused on the prevalence of BED in the adolescent population, its impact in terms of physical, social, and psychological outcomes, and possible strategies of psychological intervention. The review of international literature was made on paper material and electronic databases ProQuest, PsycArticles, and PsycInfo, and the Scopus index were used to verify the scientific relevance of the papers. Epidemiological research that examined the prevalence of BED in adolescent samples in accordance with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition showed a prevalence ranging from 1% to 4%. More recently, only a few studies have investigated the prevalence of BED, in accordance with the Diagnostic and Statistical Manual of Disorders, Fifth Edition criteria, reporting a prevalence of ~1%–5%. Studies that focused on the possible impact that BED may have on physical, psychological, and social functioning showed that adolescents with BED have an increased risk of developing various adverse consequences, including obesity, social problems, substance use, suicidality, and other psychological difficulties

  16. The Impact of Perceived Barriers, Academic Anxiety, and Resource Management Strategies on Achievement in First-Year Community College Students

    Science.gov (United States)

    Heller, Monica L.; Cassady, Jerrell C.

    2017-01-01

    The current study explored the impact of internal and external barriers (e.g., academic anxiety, employment) that place subgroups of college students at risk for academic failure in the first year. The mitigating potential of academic resource management strategies (e.g., time-study environment) was also examined. In a sample of 885 first-semester…

  17. The European Employment Strategy and National Core Executives: Impacts on activation reforms in the Netherlands and Germany.

    NARCIS (Netherlands)

    Stiller, S.; van Gerven-Haanpää, Minna Marja-Leena

    2012-01-01

    The European Employment Strategy (EES) has opened up new dynamics of Europeanization in the area of social policy. This article proposes to pay more attention to national core executives and their strategic use of the EES when considering its impact. Through core executives, the EES may not only

  18. Impact of Text-Mining and Imitating Strategies on Lexical Richness, Lexical Diversity and General Success in Second Language Writing

    Science.gov (United States)

    Çepni, Sevcan Bayraktar; Demirel, Elif Tokdemir

    2016-01-01

    This study aimed to find out the impact of "text mining and imitating" strategies on lexical richness, lexical diversity and general success of students in their compositions in second language writing. The participants were 98 students studying their first year in Karadeniz Technical University in English Language and Literature…

  19. Global History. A Curriculum Guide. Second Semester. Theme V: The Industrial Revolution Had Global Impact. Teacher Strategies. Experimental Edition.

    Science.gov (United States)

    New York City Board of Education, Brooklyn, NY. Div. of Curriculum and Instruction.

    Designed to assist teachers and supervisors in the implementation of the global history course, this bulletin presents learning activities which include the rationale, performance objectives, and teaching strategies related to Theme V entitled, "The Industrial Revolution Had Global Impact." This theme has seven subthemes: (1)…

  20. The Impact of Interface on ESL Reading Comprehension and Strategy Use: A Comparison of E-Books and Paper Texts

    Science.gov (United States)

    Isaacson, Sarah A.

    2017-01-01

    The use of e-books in postsecondary education is projected to increase, yet many English as a second language (ESL) institutions have not yet incorporated e-books into their curricula, in part due to a dearth of research regarding their potential impacts on ESL reading comprehension and strategy use. This study fills a gap in the existing research…

  1. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies : management strategies and economic impact

    NARCIS (Netherlands)

    Jensen, S. B.; Pedersen, A. M. L.; Vissink, A.; Andersen, E.; Brown, C. G.; Davies, A. N.; Dutilh, J.; Fulton, J. S.; Jankovic, L.; Lopes, N. N. F.; Mello, A. L. S.; Muniz, L. V.; Murdoch-Kinch, C. A.; Nair, R. G.; Napenas, J. J.; Nogueira-Rodrigues, A.; Saunders, D.; Stirling, B.; von Bueltzingsloewen, I.; Weikel, D. S.; Spijkervet, F. K. L.; Brennan, M. T.; Elting, L.

    This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction and xerostomia induced by cancer therapies and to determine the quality of evidence-based management recommendations. The electronic databases of MEDLINE/PubMed and

  2. Kinematic MRI using short TR single shot fast spin echo (SSFSE) in evaluating swallowing

    International Nuclear Information System (INIS)

    Isogai, Satoshi; Takehara, Yasuo; Isoda, Haruo; Kodaira, Nami; Masunaga, Hatsuko; Ozawa, Fukujirou; Kaneko, Masao; Nozaki, Atsushi; Kabasawa, Hiroyuki

    1999-01-01

    The utility of short TR single shot fast spin echo (SSFSE) MR imaging for evaluating swallowing was determined. Five healthy volunteers underwent kinematic MR imaging of swallowing with a 1.5 T MR scanner using the short TR (300 ms) SSFSE sequence. Twenty phases of sagittal sections were acquired within 6 sec, where the temporal resolution was 300 ms. For oral contrast medium, we used prune yogurt juice with Fe added. The image contrast of short TR SSFSE was found to be somewhere like that of T1-weighted images. In all cases, both the buccal and pharyngeal stages of swallowing were successfully depicted. The Fe-added prune yogurt juice performed as a positive contrast medium and helped determine anatomical structures in the buccal stage. Short TR (300 ms) SSFSE was useful in evaluating swallowing. The combined use of Fe-added prune yogurt juice was helpful in enhancing the surface of the oropharynx. (author)

  3. Time-Frequency Analysis and Hermite Projection Method Applied to Swallowing Accelerometry Signals

    Directory of Open Access Journals (Sweden)

    Ervin Sejdić

    2010-01-01

    Full Text Available Fast Hermite projections have been often used in image-processing procedures such as image database retrieval, projection filtering, and texture analysis. In this paper, we propose an innovative approach for the analysis of one-dimensional biomedical signals that combines the Hermite projection method with time-frequency analysis. In particular, we propose a two-step approach to characterize vibrations of various origins in swallowing accelerometry signals. First, by using time-frequency analysis we obtain the energy distribution of signal frequency content in time. Second, by using fast Hermite projections we characterize whether the analyzed time-frequency regions are associated with swallowing or other phenomena (vocalization, noise, bursts, etc.. The numerical analysis of the proposed scheme clearly shows that by using a few Hermite functions, vibrations of various origins are distinguishable. These results will be the basis for further analysis of swallowing accelerometry to detect swallowing difficulties.

  4. Randomized trial of two swallowing assessment approaches in patients with acquired brain injury

    DEFF Research Database (Denmark)

    Kjaersgaard, Annette; Nielsen, Lars Hedemann; Sjölund, Bengt H.

    2014-01-01

    OBJECTIVE: To examine whether patients assessed for initiation of oral intake only by Facial-Oral Tract Therapy had a greater risk of developing aspiration pneumonia during neurorehabilitation than patients assessed by Fibreoptic Endoscopic Evaluation of Swallowing. DESIGN: Randomized controlled ...

  5. Lost and found…Tracking a swallowed denture: Role of radiology

    Directory of Open Access Journals (Sweden)

    Yogita Khalekar

    2017-01-01

    Full Text Available Denture ingestion or aspiration is a problem requiring awareness of different specialists including dentists, surgeons, otolaryngologists, and anesthesiologists for prevention, early diagnosis and adequate treatment. Complications of swallowed dentures include hollow viscous necrosis, perforation, and penetration to neighbouring organs leading to fistulae, bleeding and obstruction. Here, we present the case of a 65 year old female patient who swallowed the denture, which was detected by barium swallow and removed by endoscopy. Hence, the management of swallowed denture needs a multidisciplinary approach with the help of a dentist, otolaryngologist and anesthesiologists. Dentists should recommend patients to visit them for planned check ups or revisit them in case of denture dislodgement or loosening as soon as possible to prevent such life threatening events.

  6. Assessing Development Impacts Associated with Low Emission Development Strategies: Lessons Learned from Pilot Efforts in Kenya and Montenegro

    Energy Technology Data Exchange (ETDEWEB)

    Cox, S. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Katz, J. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Wurtenberger, L. [Energy Research Centre of the Netherlands (ECN), Petten (Netherlands)

    2014-01-01

    Low emission development strategies (LEDS) articulate economy-wide policies and implementation plans designed to enable a country to meet its long-term development objectives while reducing greenhouse gas emissions. A development impact assessment tool was developed to inform an analytically robust and transparent prioritization of LEDS actions based on their economic, social, and environmental impacts. The graphical tool helps policymakers communicate the development impacts of LEDS options and identify actions that help meet both emissions reduction and development goals. This paper summarizes the adaptation and piloting of the tool in Kenya and Montenegro. The paper highlights strengths of the tool and discusses key needs for improving it.

  7. The Effect of Bolus Volume on Hyoid Kinematics in Healthy Swallowing

    Directory of Open Access Journals (Sweden)

    Ahmed Nagy

    2014-01-01

    Full Text Available Hyoid movement in swallowing is biomechanically linked to closure of the laryngeal vestibule for airway protection and to opening of the upper esophageal sphincter. Studies suggest that the range of hyoid movement is highly variable in the healthy population. However, other aspects of hyoid movement such as velocity remain relatively unexplored. In this study, we analyze data from a sample of 20 healthy young participants (10 male to determine whether hyoid movement distance, duration, velocity, and peak velocity vary systematically with increases in thin liquid bolus volume from 5 to 20 mL. The temporal correspondence between peak hyoid velocity and laryngeal vestibule closure was also examined. The results show that maximum hyoid position and peak velocity increase significantly for 20 mL bolus volumes compared to smaller volumes, and that the timing of peak velocity is closely linked to achieving laryngeal vestibule closure. This suggests that generating hyoid movements with increased power is a strategy for handling larger volumes.

  8. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact

    DEFF Research Database (Denmark)

    Jensen, Siri Beier; Pedersen, Anne Marie Lynge; Vissink, Arjan

    2010-01-01

    This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction and xerostomia induced by cancer therapies and to determine the quality of evidence-based management recommendations. The electronic databases of MEDLINE/PubMed and E......This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction and xerostomia induced by cancer therapies and to determine the quality of evidence-based management recommendations. The electronic databases of MEDLINE......, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. There is evidence that salivary gland hypofunction and xerostomia induced by cancer therapies can be prevented or symptoms be minimized to some degree, depending on the type of cancer treatment...... formulas, submandibular gland transfer, acupuncture, hyperbaric oxygen treatment, management strategies in pediatric cancer populations, and the economic consequences of salivary gland hypofunction and xerostomia...

  9. The Impact of Teaching Instructional and Environmental Strategies on Iranian EFL Young Learner’s Grammar Achievement

    Directory of Open Access Journals (Sweden)

    Negar Sadeghi Hariri

    2016-11-01

    Full Text Available The present study attempted to investigate the possible effects of Instructional (INS and Environmental (ENS strategies on Iranian EFL young learners' grammar achievement. For this purpose, 82 female language young learners ranged between 8 to 12 years of age were selected and randomly assigned into INS, ENS and Control groups in this study. After taking EPT, INS and ENS groups received EFL grammar structures accompanied by INS and ENS strategies, respectively, while Control group received only conventional instructions to English grammar. After conducting the treatment, all participants took a grammar post-test. The Null hypotheses 1 and 2 in this study assumed that the INS and the ENS strategies had no impact on Iranian EFL young learners’ grammar achievement. They were successfully rejected due to different performance of INS and ENS groups from Control group on the post-test. Statistical results did support the superiority of INS over ENS strategies. Therefore, the researcher was able to rectify that INS strategies caused higher impact on the young learners’ grammar achievement than ENS strategies. She concluded her work with some pedagogical implications and recommended topics for further research.

  10. Impact of the national biotechnology strategy on the South African biopharma industry

    CSIR Research Space (South Africa)

    Msomi, N

    2008-11-17

    Full Text Available The national biotechnology strategy was published in 2001. The process followed for drafting the strategy is as follows: involvement of experts; wider consultation with stakeholders and adoption and publication. The mandate for the BRICs...

  11. Aspiration of barium contrast medium in an elderly man with disordered swallowing

    OpenAIRE

    Bağcı Ceyhan, B.; Çelikel, T.; Koç, M.; Ahıskalı, R.; Biren, T.; Ataizi Çelikel, Ç.

    1995-01-01

    The aspiration of contrast medium during the investigation of gastrointestinal diseases is a well recognized hazard, particularly in patients with swallowing disorders. A case is reported in which accidental aspiration of contrast barium occurred owing to disordered swallowing in an elderly man. The infiltration on chest x-ray persisted 2 years after barium contrast aspiration. Inflammatory reaction and retractile, granular material observed in lung biopsy specimens suggested barium-induced p...

  12. Effect of aging on oral and swallowing function after meal consumption

    Directory of Open Access Journals (Sweden)

    Hiramatsu T

    2015-01-01

    Full Text Available Tetsuya Hiramatsu,1,2 Hideyuki Kataoka,3 Mari Osaki,4 Hiroshi Hagino3,4 1Department of Speech Pathology and Audiology, Matsue Co-medical College, Matsue, Japan; 2Graduate School of Medical Sciences, Tottori University, 3School of Health Science, Faculty of Medicine, Tottori University, 4Rehabilitation Division, Tottori University Hospital, Yonago, Japan Background/purpose: Dysphagia may worsen due to fatigue of the infrahyoid and suprahyoid muscle groups as a result of repetitive swallowing during a meal. We investigated the hypothesis that meal consumption may reduce tongue strength and endurance in older adults (OAs.Methods: Tongue–palate pressure, oral diadochokinesis, repetitive saliva swallowing, and surface electromyography activity before and after a meal were measured in 23 young adults (YAs and 23 OA volunteers.Results: There was a statistically significant difference in both tongue pressure and the number of voluntary swallows between YAs and OAs. Peak tongue pressure was significantly lower in OAs than YAs both before and after meal consumption. The most notable finding was that the first time interval (the time from test initiation to the beginning of the first swallow was prolonged after meal consumption only in OAs, whereas the first time interval showed no difference between YAs and OAs before meal consumption with reference to the repetitive saliva swallowing test. The initiation of swallowing was prolonged by both meal consumption and aging; there was a significant interaction between these two factors. The number of repetitions of the monosyllable/pa/was statistically similar between YAs and OAs before meal consumption, but it was significantly lower in OAs after meal consumption.Conclusion: Aging leads to declining tongue pressure and motor function of the lips. It is possible that swallowing function declines in older individuals when meal consumption is prolonged, especially at the end of mealtime, as a result of their

  13. Adapting Human Videofluoroscopic Swallow Study Methods to Detect and Characterize Dysphagia in Murine Disease Models

    OpenAIRE

    Lever, Teresa E.; Braun, Sabrina M.; Brooks, Ryan T.; Harris, Rebecca A.; Littrell, Loren L.; Neff, Ryan M.; Hinkel, Cameron J.; Allen, Mitchell J.; Ulsas, Mollie A.

    2015-01-01

    This study adapted human videofluoroscopic swallowing study (VFSS) methods for use with murine disease models for the purpose of facilitating translational dysphagia research. Successful outcomes are dependent upon three critical components: test chambers that permit self-feeding while standing unrestrained in a confined space, recipes that mask the aversive taste/odor of commercially-available oral contrast agents, and a step-by-step test protocol that permits quantification of swallow physi...

  14. Coping strategies and social support in the family impact of cleft lip and palate and parents' adjustment and psychological distress.

    Science.gov (United States)

    Baker, Sarah R; Owens, Jan; Stern, Melanie; Willmot, Derrick

    2009-05-01

    To examine the role of parents' coping strategies and social support in the family impact of cleft lip and palate (CLP) and levels of adjustment and psychological distress and to investigate whether a child's age, type of cleft, or other reported medical problems influenced such outcomes. A cross-sectional study. One hundred three parents of children or young adults with CLP recruited from families attending a multidisciplinary cleft lip and palate clinic. Family impact, psychological distress, and positive adjustment were assessed using validated psychological questionnaires. Findings indicated that while there were many impacts of a child's CLP, negative outcomes (family impact, psychological distress) were not high. In contrast, parents reported high levels of positive adjustment or stress-related growth as a result of their child's condition. Participants also reported high levels of social support and relied more on the use of approach rather than avoidance-oriented coping strategies. Having more support from friends and family was associated with less negative family impact, lower psychological distress, and better adjustment. Greater use of approach coping was associated with more positive adjustment; whereas, avoidant coping was associated with a greater family impact and more psychological distress. Having a younger child and/or a child with medical problems in addition to CLP was associated with a greater impact on the family. How parents cope with their child's condition and the levels of support received may have implications for caregivers, the family unit, and the delivery of more family-oriented CLP services.

  15. What Is the Impact of Online Resource Materials on Student Self-Learning Strategies?

    Science.gov (United States)

    Dowell, David John; Small, Felicity A.

    2011-01-01

    The purpose of this article is to examine how students are incorporating online resources into their self-regulated learning strategies. The process of developing these learning strategies and the importance of these strategies has been widely researched, but there has been little empirical research into how the students are affected by online…

  16. Taste and Temperature in Swallowing Transit Time after Stroke

    Directory of Open Access Journals (Sweden)

    Paula C. Cola

    2012-09-01

    Full Text Available Background: Oropharyngeal dysphagia is common in individuals after stroke. Taste and temperature are used in dysphagia rehabilitation. The influence of stimuli, such as taste and temperature, on swallowing biomechanics has been investigated in both healthy individuals and in individuals with neurological disease. However, some questions still remain unanswered, such as how the sequence of offered stimuli influences the pharyngeal response. The goal of the present study was to determine the influence of the sequence of stimuli, sour taste and cold temperature, on pharyngeal transit time during deglutition in individuals after stroke. Methods: The study included 60 individuals with unilateral ischemic stroke, 29 males and 31 females, aged 41–88 years (mean age: 66.2 years examined 0–50 days after ictus (median: 6 days, with mild to moderate oropharyngeal dysphagia. Exclusion criteria were hemorrhagic stroke patients, patients with decreased level of consciousness, and clinically unstable patients, as confirmed by medical evaluation. The individuals were divided into two groups of 30 individuals each. Group 1 received a nonrandomized sequence of stimuli (i.e. natural, cold, sour, and sour-cold and group 2 received a randomized sequence of stimuli. A videofluoroscopic swallowing study was performed to analyze the pharyngeal transit time. Four different stimuli (natural, cold, sour, and sour-cold were offered. The images were digitalized and specific software was used to measure the pharyngeal transit time. Since the values did not present regular distribution and uniform variances, nonparametric tests were performed. Results: Individuals in group 1 presented a significantly shorter pharyngeal transit time with the sour-cold stimulus than with the other stimuli. Individuals in group 2 did not show a significant difference in pharyngeal transit time between stimuli. Conclusions: The results showed that the sequence of offered stimuli influences

  17. Stakeholders' participatory diagnosis of climate change impacts on subsistence agriculture in Sikkim, India, for identifying adaptation strategies

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    Azhoni, A.; Goyal, M. K.

    2017-12-01

    Narrowing the gap between research, policy making and implementing adaptation remains a challenge in many parts of the world where climate change is likely to severely impact subsistence agriculture. This research aims to narrow this gap by matching the adaptation strategies being framed by policy makers and perspectives of consultants and researchers which are expected to be implemented by development agencies farmers in the state of Sikkim in India. Our case study examined the framing and implementation of State Action Plan on Climate Change through semi-structured interviews carried out with decision makers in the State Government, Scientific Organisations, consultants, local academia, implementing and development agencies, and farmers for whom the adaptation strategies are targeted. Using Social Network and Stakeholder Analysis approach, this research unravels the complexities of perceiving climate change impacts, identifying adaptation strategies, and implementing climate change adaptation strategies. While farmers are less aware about the global phenomenon of climate change impacts for their subsistence livelihood, their knowledge of the local conditions and their close interaction with the State Government Agriculture Department provides them an access to new and high value crops. Although important steps are initiated through the Sikkim State Action Plan on Climate Change it is yet to deliver effective means of adaptation implementation and identifying the networks of close coordination between the various implementing agencies will likely to pay rich dividends. While Sikkim being a small and hilly state with specific contextual challenges of climate change impacts, the results from this study highlights how the internal and external networks between various types of stakeholders informs decision makers in identifying local impacts of climate change and plan adaptation strategies.

  18. The Impact of Corporate Sustainability Strategies on the Financial Performance of Romanian Companies in the Context of Green Marketing

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    Marian Siminică

    2015-08-01

    Full Text Available The current research paper aims at making a comprehensive analysis of the current green marketing initiatives adopted by the top performing Romanian companies, in order to understand the determinant factors that influence their green approach and to evaluate the impact of the sustainability strategies implemented on their financial performance. The research of business sustainability strategies in 31 top performing companies in Romania is conducted by analyzing their green marketing initiatives, the ability to communicate online current and past Corporate Sustainability (CS actions (substantive action and their future commitments towards green marketing (symbolic action. The authors also analyzed the impact of companies’ dimensions on their green performance and commitment, substantiating that the size of a company is a significant influential factor. The analysis of the impact of substantive and symbolic action on the financial performance of the companies shows that there is not a significant correlation between these indicators.

  19. A model experiment to study swallowing of spherical and elongated particles

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    Marconati Marco

    2017-01-01

    Full Text Available Swallowing disorders are not uncommon among elderly and people affected by neurological diseases. For these patients the ingestion of solid grains, such as pharmaceutical oral solid formulations, could result in choking. This generally results in a low compliance in taking solid medications. The effect of the solid medication size on the real or perceived ease of swallowing is still to be understood from the mechanistic viewpoint. The interplay of the inclusion shape and the rheology of the liquid being swallowed together with the medication is also not fully understood. In this study, a model experiment was developed to study the oropharyngeal phase of swallowing, replicating the dynamics of the bolus flow induced by the tongue (by means of a roller driven by an applied force. Experiments were performed using a wide set of solid inclusions, dispersed in a thick Newtonian liquid. Predictions for a simple theory are compared with experiments. Results show that an increase in the grain size results in a slower dynamics of the swallowing. Furthermore, the experiments demonstrated the paramount role of shape, as flatter and more streamlined inclusions flow faster than spherical. This approach can support the design of new oral solid formulations that can be ingested more easily and effectively also by people with mild swallowing disorders.

  20. Digital cineradiographic study of swallowing in patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Lo Re, G; Galia, M; La Grutta, L; Russo, S; Runza, G; Taibbi, A; D'Agostino, T; Lo Greco, V; Bartolotta, T V; Midiri, M; Cardinale, A E; De Maria, M; Lagalla, R

    2007-12-01

    This study was performed to evaluate the usefulness of digital cineradiography in detecting swallowing disorders in dysphagic patients affected by amyotrophic lateral sclerosis (ALS) with a view to planning an adequate therapeutic approach. From January 2005 to September 2006, 23 patients (10 men and 13 women; mean age 41.3+/-8.6 years) affected by ALS were evaluated with digital cineradiography to assess the grade of dysphagia. All patients were classified using the Hillel ALS Severity Scale (ALSSS). All examinations were performed with radiocontrolled equipment provided with a digital C-arm. The cineradiographic technique enabled us to differentiate patients with disorders of the oral (17/23) and/or pharyngeal (19/23) swallowing phase from those without swallowing dysfunction (4/23). In 14/23 patients, passage of contrast medium into the upper airways was observed during swallowing, whereas in 5/23 cases, aspiration of contrast medium into the lower airways was recorded. The videofluoroscopic swallowing study has high diagnostic capabilities in the evaluation of swallowing disorders, as it is able to identify the degree and causes of impairment. In addition, the study proved useful for planning speech therapy and for follow-up in patients with ALS.