An investigation into factors that affect the decision of parents to use blended diets with their gastrostomy-fed children

Children who are unable to swallow safely, have gastric problems or neurological difficulties may require tube feeding via a gastrostomy to meet their nutritional requirements. Usually commercial formula feeds are used however, more families are opting to use blended diets (BD), which may consist of everyday family meals or other foods blended to a smooth consistency and then passed down the feeding tube. The overall impact of BD is not fully understood and there are varying views amongst professionals involved in the care of those using them. The aim of this research is to identify the reasons for and implications of using BD, and establish whether there are any differences between parents who do and do not use BD, and the outcomes for children and young people who do and do not use BD. A mixed methodology is used in the research, with three phases, the first two being qualitative using thematic analysis with data collected from in-depth interviews and blog posts. The information from phases one and two informed the content of the survey used in phase three. The third phase of the research is the quantitative phase. A survey was distributed to families who were and were not using BD. This enabled the researcher to gauge the prevalence of the viewpoints/ themes from the interviews, and to compare views and characteristics of those who were and were not using BD. The qualitative phase revealed a mismatch between the priorities and perceptions of families and clinicians, which was also identified in the literature. The quantitative phase indicates that parents who opt to use BD have a significantly higher level of concerns about commercial formula and see less need for it. Both phases provided anecdotal evidence suggesting BD have physiological benefits to the children and young people using them. These data are parent-reported, and larger scale studies, with more objective outcome measures are now required

Fragile, Handle with Care!: the Preservation of Digital Materials

In this paper, I will address some of the main strategic issues that are of concern to libraries in the area of digital preservation. In the same way that there has been an explosion of information in digital form there is an equal explosion of information on digital preservation and this paper can only therefore take a broad view of the landscape. Much of the paper is based on the excellent background document on digital preservation by Maggie Jones and Neil Beagrie recently published by the British Library on behalf of the UK Digital Preservation Coalition, ‘Preservation Management of Digital Materials: a handbook’

A Comparison of Oxygen Fugacities of Strongly Peraluminous Granites across the Archean–Proterozoic Boundary

We constrain the oxygen fugacity (⁠f_(O2)⁠) of strongly peraluminous granites [SPGs; i.e. granites (sensu lato) generated through the partial melting of sediments] across the Archean–Proterozoic boundary, which coincides roughly with the Great Oxygenation Event (GOE), to understand whether secular changes in atmospheric O_2 levels may be imprinted on the f_(O2) of igneous rocks. SPGs were chosen to maximize the potential effects of sediments in their sources on the f_(O2) of the magmas. We studied 28 Archean (2685–2547 Ma) and 31 Meso- to Paleoproterozoic (1885–1420 Ma) geographically distributed samples from North America, spanning two cratons (Superior and Wyoming) and both orogenic and anorogenic Proterozoic provinces (Trans-Hudson Orogen, Wopmay Orogen, and SW USA). We present an analysis of both new and previously published whole-rock major and trace element data and mineral major element chemistry from the samples. All the studied samples are peraluminous high-silica plutonic rocks (all contain >67 wt % SiO_2, and 92% are true granites with >69 wt % SiO_2), and biotite + muscovite ± garnet ± tourmaline ± sillimanite are the primary aluminous minerals in all samples. Whole-rock major element and trace element abundances of all samples are consistent with derivation by partial melting of aluminous sediments. To constrain the f_(O2) of crystallization of the SPGs, we developed an alphaMELTS-based method that takes advantage of the sensitivity of biotite Fe^T/(Fe^T + Mg) ratios to f_(O2)⁠. This method is able to reproduce experimental and empirical data where biotite compositions and whole-rock compositions, pressures and temperatures of crystallization and f_(O2) are known. For the SPGs in this study, alphaMELTS modeling indicates that 68% of Proterozoic samples crystallized at an f_(O2) between NNO –1 and NNO +1·1 (where NNO is nickel–nickel oxide buffer), whereas the remaining Proterozoic samples (32%) and most of the Archean samples (75%) crystallized at ≤NNO –2. The simplest explanation of these results is that the Proterozoic SPGs were derived from metasedimentary source rocks that on average had more oxidized bulk redox states relative to their Archean counterparts. The bulk redox state of the metasedimentary source rocks of SPGs of all ages is defined by the relative abundances of oxidized (e.g. Fe^(3+) and S^(6+)) and reduced (e.g. organic matter) material. The crystallization of both Archean and Proterozoic samples at f_(O2) values of ≤NNO –2 is consistent with them having their f_(O2) buffered by graphite (formed from organic carbon) in their source regions. However, the dominantly low f_(O2) (≤NNO –2) values of the Archean SPGs plausibly reflects the presence of organic material and relatively reduced metasedimentary rocks in their source region prior to the GOE. In contrast, the elevated f_(O2) values of the majority of the Proterozoic SPGs may reflect enhanced sulfate contents or increased Fe^(3+)/Fe^T in sediments after the GOE, which, in terms of the bulk redox state of their metasedimentary source region, would have offset the reducing nature of organic matter present there

A Comparison of Oxygen Fugacities of Strongly Peraluminous Granites across the Archean–Proterozoic Boundary

We constrain the oxygen fugacity (⁠f_(O2)⁠) of strongly peraluminous granites [SPGs; i.e. granites (sensu lato) generated through the partial melting of sediments] across the Archean–Proterozoic boundary, which coincides roughly with the Great Oxygenation Event (GOE), to understand whether secular changes in atmospheric O_2 levels may be imprinted on the f_(O2) of igneous rocks. SPGs were chosen to maximize the potential effects of sediments in their sources on the f_(O2) of the magmas. We studied 28 Archean (2685–2547 Ma) and 31 Meso- to Paleoproterozoic (1885–1420 Ma) geographically distributed samples from North America, spanning two cratons (Superior and Wyoming) and both orogenic and anorogenic Proterozoic provinces (Trans-Hudson Orogen, Wopmay Orogen, and SW USA). We present an analysis of both new and previously published whole-rock major and trace element data and mineral major element chemistry from the samples. All the studied samples are peraluminous high-silica plutonic rocks (all contain >67 wt % SiO_2, and 92% are true granites with >69 wt % SiO_2), and biotite + muscovite ± garnet ± tourmaline ± sillimanite are the primary aluminous minerals in all samples. Whole-rock major element and trace element abundances of all samples are consistent with derivation by partial melting of aluminous sediments. To constrain the f_(O2) of crystallization of the SPGs, we developed an alphaMELTS-based method that takes advantage of the sensitivity of biotite Fe^T/(Fe^T + Mg) ratios to f_(O2)⁠. This method is able to reproduce experimental and empirical data where biotite compositions and whole-rock compositions, pressures and temperatures of crystallization and f_(O2) are known. For the SPGs in this study, alphaMELTS modeling indicates that 68% of Proterozoic samples crystallized at an f_(O2) between NNO –1 and NNO +1·1 (where NNO is nickel–nickel oxide buffer), whereas the remaining Proterozoic samples (32%) and most of the Archean samples (75%) crystallized at ≤NNO –2. The simplest explanation of these results is that the Proterozoic SPGs were derived from metasedimentary source rocks that on average had more oxidized bulk redox states relative to their Archean counterparts. The bulk redox state of the metasedimentary source rocks of SPGs of all ages is defined by the relative abundances of oxidized (e.g. Fe^(3+) and S^(6+)) and reduced (e.g. organic matter) material. The crystallization of both Archean and Proterozoic samples at f_(O2) values of ≤NNO –2 is consistent with them having their f_(O2) buffered by graphite (formed from organic carbon) in their source regions. However, the dominantly low f_(O2) (≤NNO –2) values of the Archean SPGs plausibly reflects the presence of organic material and relatively reduced metasedimentary rocks in their source region prior to the GOE. In contrast, the elevated f_(O2) values of the majority of the Proterozoic SPGs may reflect enhanced sulfate contents or increased Fe^(3+)/Fe^T in sediments after the GOE, which, in terms of the bulk redox state of their metasedimentary source region, would have offset the reducing nature of organic matter present there

Development of an International SMA Bulbar Assessment for Inter-professional Administration

BACKGROUND: Progressive weakness can affect bulbar muscles in individuals with moderate to severe forms of spinal muscular atrophy (SMA). The paucity of standardized, valid bulbar assessments capturing clinically significant deficits in SMA impedes the ability to monitor function, facilitate intervention, or detect treatment response. OBJECTIVE: To fill this void, an international multidisciplinary team gathered to develop an agreed upon consensus-derived assessment of bulbar function in SMA for inter-professional administration to enhance our ability to monitor disease progression, support clinical management, and evaluate treatment effects. METHODS: Fifty-six international clinicians experienced in SMA were invited and engaged using the Delphi method over multiple rounds of web-based surveys to establish consensus. RESULTS: Serial virtual meetings occurred with 42 clinicians (21 speech and language therapists, 11 physical therapists, 5 neurologists, 4 occupational therapists, and 1 dentist). Seventy-two validated assessments of bulbar function were identified for potential relevance to individuals with SMA (32 accessible objective, 11 inaccessible objective, 29 patient-reported outcomes). Delphi survey rounds (n = 11, 15, 15) achieved consensus on individual items with relevance and wording discussed. Key aspects of bulbar function identified included: oral intake status, oral facial structure and motor strength, swallowing physiology, voice & speech, and fatigability. CONCLUSIONS: Multidisciplinary clinicians with expertise in bulbar function and SMA used Delphi methodology to reach consensus on assessments/items considered relevant for SMA across all age groups. Future steps include piloting the new scale moving towards validation/reliability. This work supports the advancement of assessing bulbar function in children and adults with SMA by a variety of professionals

Research priorities to improve the health of children and adults with dysphagia: a National Institute of Health Research and Royal College of Speech and Language Therapists research priority setting partnership

Objective To conduct the first UK-wide research priority setting project informing researchers and funders of critical knowledge gaps requiring investigation to improve the health and well-being of patients with eating, drinking and swallowing disorders (dysphagia) and their carers. Design A priority setting partnership between the National Institute of Health Research (NIHR) and the Royal College of Speech and Language Therapists using a modified nominal group technique. A steering group and NIHR representatives oversaw four project phases: (1) survey gathering research suggestions, (2) verification and aggregation of suggestions with systematic review research recommendations, (3) multistakeholder workshop to develop research questions, (4) interim priority setting via an online ranking survey and (5) final priority setting. Setting UK health services and community. Participants Patients with dysphagia, carers and professionals who work with children and adults with dysphagia from the UK. Results One hundred and fifty-six speech and language therapists submitted 332 research suggestions related to dysphagia. These were mapped to 88 research recommendations from systematic reviews to form 24 ‘uncertainty topics’ (knowledge gaps that are answerable by research). Four patients, 1 carer and 30 healthcare professionals collaboratively produced 77 research questions in relation to these topics. Thereafter, 387 patients, carers and professionals with experience of dysphagia prioritised 10 research questions using an interim prioritisation survey. Votes and feedback for each question were collated and reviewed by the steering and dysphagia reference groups. Nine further questions were added to the long-list and top 10 lists of priority questions were agreed. Conclusion Three top 10 lists of topics grouped as adults, neonates and children, and all ages, and a further long list of questions were identified by patients, carers and healthcare professionals as research priorities to improve the lives of those with dysphagia