Need for needle and syringe programmes in Africa

A narrative review was conducted, drawing on peer reviewed literature and relevant grey literature on injecting drug use in African countries and ethical dilemmas facing harm reduction especially the provision of sterile needles and syringes to injecting drug users. This review aimed at highlighting evidence and the arguments for and against the provision of sterile injecting equipment to people who inject drugs (PWID), and to consider the implications for the African context. The narrative established that high risk injecting drug  practices are common among PWID in many African communities, and soare HIV and hepatitis. Current services for this population in Africa are less pragmatic and inadequate. Needle and syringe programmes are both effective and ethical and should be part of the response to injecting drug use in Africa.Key words: Needle and syringe programmes, injecting drug use, ethics, HI

Relationships Among Subjective and Objective Measures of Tongue Strength and Oral Phase Swallowing Impairments

A growing literature documents the relationship between tongue strength and oral phase swallowing function. Objective measures of strength have been recommended as more valid and reliable than subjective measures for the assessment of tongue function, yet subjective measures remain the more commonly used clinical method for assessing tongue strength. This study assessed the relationships among subjective and objective measures of tongue strength and oral phase swallowing impairments. Both subjective and objective measures of tongue strength were observed to be good predictors of the presence of oral phase swallowing impairments. The specific oral phase swallowing functions of bolus manipulation, mastication, and clearance were moderately correlated with subjective ratings of tongue strength. Experienced and inexperienced raters appeared to judge tongue strength differently, with the ratings of experienced raters being more predictive of swallowing function

Age and Sex Differences in Orofacial Strength

This study explored age- and sex-related differences in orofacial strength. Healthy adult men (N = 88) and women (N = 83) participated in the study. Strength measures were obtained using the Iowa Oral Performance Instrument (IOPI). Anterior and posterior tongue elevation strength measures were obtained using a standard method. Tongue protrusion and lateralization, cheek compression, and lip compression measures utilized adaptors allowing the participant to exert pressure against the bulb in different orientations. Lip and cheek strength measures were greater for men than women, but tongue strength did not differ between sex groups. Strong correlations between age and strength were not observed. However, group comparisons revealed lower tongue protrusion and lateralization strength in the oldest participants. The oldest participants also exhibited lower anterior and posterior tongue elevation strength relative to the middle-age group. Cheek and lip compression strength demonstrated no age-related differences. The current study supplements and corroborates existing literature that shows that older adults demonstrate lower tongue strength than younger adults. Sex differences were noted such that men demonstrated greater lip and cheek strength but not tongue strength. These data add to the literature on normal orofacial strength, allowing for more informed interpretations of orofacial weakness in persons with dysphagia

The effects of oral-motor exercises on swallowing in children: an evidence-based systematic review

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 databases was completed to identify relevant peer-reviewed literature published in English between 1960 and 2007. Experimental or quasi-experimental design studies examining OME as a treatment for children with swallowing disorders were appraised for methodological quality by two assessors and reviewed by a third. Results: Sixteen studies of varying methodological quality were included. No study examining the effects of OME on pulmonary health in children was identified. The included studies incorporated a wide variety of OME, and mixed findings were noted across all of the outcomes targeted in this review. Interpretation: Based on the results of this evidence-based systematic review, there is insufficient evidence to determine the effects of OME on children with oral sensorimotor deficits and swallowing problems. Well-designed studies are needed to provide clinicians with evidence that can be incorporated into the preferences of the client and the clinicians’ knowledge of anatomy, physiology, and neurodevelopment in the management of this group of children

Identifying Evolutionary Significant Units in Spiraea virginiana

Spiraea virginiana Brit. (Rosaceae) is a rare clonal shrub found in isolated populations within the Cumberland, Tennessee, and Ohio River drainages. This species has been listed as federally endangered since June 1990 due to anthropogenically induced habitat loss and population fragmentation as a result of river damming. Reproduction consists of a mixed mating system that is mostly asexual by ramet formation, with occasional dispersal via vegetative fragmentation downstream. Successful sexual reproduction is limited, and could result from self-fertilization or outcrossing. The species does appear to outcompete other shrub species by vigorous rhizome production and its ability to withstand scouring floods.The lack of sexual reproduction could potentially result in an extremely limited effective population size in each river. This study aims to assess the genetic diversity of S. virginiana populations along the New and Cheoah Rivers in North Carolina using eight previously published microsatellite markers. Our results suggest a small effective population size within each of the two rivers. These results are consistent with earlier investigations and could have management implications, possibly treating each river drainage as its own evolutionary significant unit for (ESU)

Evidence-Based Systematic Review (EBSR): The Effects of Oral Motor Interventions on Feeding and Swallowing in Preterm Infants

Purpose: To conduct an evidence-based systematic review and provide an estimate of the effects of oral motor interventions (OMIs) on feeding/swallowing outcomes (both physiological and functional) and pulmonary health in preterm infants. Method: A systematic search of the literature published from 1960 to 2007 was conducted. Articles meeting the selection criteria were appraised by 2 reviewers and vetted by a 3rd for methodological quality. Results: Twelve studies were included and focused on 3 OMIs—nonnutritive sucking (NNS), oral/perioral stimulation, and NNS plus oral/ perioral stimulation. Six studies addressed the effects of OMI on the feeding/swallowing physiology outcomes of feeding efficiency or sucking pressures. Ten studies addressed the functional feeding/swallowing outcomes of oral feeding or weight gain/growth. No studies reported data on pulmonary health. Methodological quality varied greatly. NNS alone and with oral/perioral stimulation showed strong positive findings for improvement in some feeding/swallowing physiology variables and for reducing transition time to oral feeding. Prefeeding stimulation showed equivocal results across the targeted outcomes. None of the OMIs provided consistent positive results on weight gain/growth. Conclusions: Although some OMIs show promise for enhancing feeding/swallowing in preterm infants, methodological limitations and variations in results across studies warrant careful consideration of their clinical use

Neuromuscular Treatments for Speech and Swallowing: A Tutorial

Despite the proliferation of oral motor therapies, much controversy exists regarding the application and benefit of neuromuscular treatments (NMTs) such as strength training for alleviating dysarthria and/or dysphagia. Not only is limited empirical support available to validate the use of NMTs, but clinicians may also lack the foundational information needed to judge the theoretical soundness of unstudied treatment strategies. This tutorial reviews the theoretical foundations for several NMTs, including active exercises, passive exercises, and physical modalities. It highlights how these techniques have been used to address neuromuscular impairments in the limb musculature and explores potential applications to the speech and swallowing musculature. Key issues discussed in relation to active exercise are the selection of treatment targets (e.g., strength, endurance, power, range of motion), specificity of training, progression, and recovery. Factors influencing the potential effectiveness of passive exercises and physical modalities are presented, along with discussion of additional issues contributing to the controversy surrounding oral motor therapies

Development Of Microsatellite Markers To Evaluate Current Species Boundaries Between Liatris Helleri Porter And Liatris Turgida (Gaiser) (Asteraceae)

Liatris helleri Porter is a perennial herb endemic to high elevation rock outcrop communities in northwest North Carolina that has been protected under the Endangered Species Act since 1987. The degree of relation between Liatris helleri Porter and its conger Liatris turgida Gaiser has become a point of taxonomic contention. Previous morphological and genetic studies have suggested the possibility that these taxa do not fall discretely into separate taxonomic treatments, which has led to unclear species boundaries. The current solution for this taxonomic issue has been to subsume L. turgida populations under the L. helleri epithet, with a possibility that these taxa are separable at a varietal level. This has brought L. helleri’s status of federal protection into question and resolution of this issue is needed to provide land managers and conservationists with accurate delineations of these taxa. This study provides high-resolution microsatellite data to address the degree of relation between L. helleri and L. turgida. The results of this study identify a genetically distinct metapopulation of L. helleri, areas of admixture, and genetic diversity estimates for both species. Based on these findings we argue for the continued protected status of L. helleri (with a reduced range) and for a reevaluation of the protected status of L. turgida in North Carolina

The Role Of Social Support In Breastfeeding Experiences Among Rural Women In Southern Appalachia

Objectives: The objectives of this study are: 1) to describe breastfeeding experiences and level of social support received among WIC participants in southern Appalachia, 2) to examine perceived types and effectiveness of social support received including emotional, instrumental, informational, and appraisal.Design, Setting, and Participants: Data was collected using a semi structured qualitative interview (n = 7). Breastfeeding and postpartum WIC participants were recruited to participate via the placement of flyers in three WIC clinics in western North Carolina. ASU IRB approved the study.Outcome Measures and Analysis: A semi-structured interview was conducted to assess breastfeeding experiences, barriers, and level of support received. Interviews were transcribed verbatim. Grounded theory approach (Glaser, 1967) was applied and themes were organized as they emerged. Interviews were coded using Nvivo software (QSR International, 2013).Results: Each interview lasted approximately one hour. The mean age was 29 and the average monthly income was $1,723. Participants reported a high level of support from partners (e.g. husbands), professionals (e.g. lactation consultants and WIC), and the maternal grandmother of the infant. Commonly reported themes included receipt of professional support (11 mentions), difficulty breastfeeding (13 mentions), and desire to breastfeed for health benefits and bonding (27 mentions).Conclusions and Implications: The interview results indicated that even with strong social support, obstacles such as sexist social norms still exist for breastfeeding mothers. Professionals specializing in breastfeeding, such as WIC staff and lactation consultants, tended to be more helpful than other health professionals Partners were a strong source of support for married mothers, and tended to have input on breastfeeding duration. Emotional, appraisal, and informational support were perceived as effective support for breastfeeding initiation and duration

Evidence-based systematic review: Effect of neuromuscular electrical stimulation on swallowing and neural activation

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 identify relevant studies published in peer-reviewed journals from 1960 to 2007. All studies meeting the exclusion/inclusion criteria were appraised for quality and categorized as efficacy or exploratory research based on predetermined criteria. Results: Out of 899 citations initially identified for the broad review of OMEs, 14 articles relating to NMES qualified for inclusion. Most of the studies (10/14) were considered exploratory research, and many had significant methodological limitations. Conclusions: This systematic review reveals that surface NMES to the neck has been most extensively studied with promising findings, yet high-quality controlled trials are needed to provide evidence of efficacy. Surface NMES to the palate, faucial pillars, and pharynx has been explored in Phase I research, but no evidence of efficacy is currently available. Intramuscular NMES has been investigated in a single Phase I exploratory study. Additional research is needed to document the effects of such protocols on swallowing performance