Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analyses of Randomised Controlled Trials—Part I: Pharyngeal and Neuromuscular Electrical Stimulation

Objective. To assess the effects of neurostimulation (i.e., neuromuscular electrical stimulation (NMES) and pharyngeal electrical stimulation (PES)) in people with oropharyngeal dysphagia (OD). Methods. Systematic literature searches were conducted to retrieve randomised controlled trials in four electronic databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of included studies was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Results. In total, 42 studies reporting on peripheral neurostimulation were included: 30 studies on NMES, eight studies on PES, and four studies on combined neurostimulation interventions. When conducting meta analyses, significant, large and significant, moderate pre-post treatment effects were found for NMES (11 studies) and PES (five studies), respectively. Between-group analyses showed small effect sizes in favour of NMES, but no significant effects for PES. Conclusion. NMES may have more promising effects compared to PES. However, NMES studies showed high heterogeneity in protocols and experimental variables, the presence of potential moderators, and inconsistent reporting of methodology. Therefore, only conservative generalisations and interpretation of meta-analyses could be made. To facilitate comparisons of studies and determine intervention effects, there is a need for more randomised controlled trials with larger population sizes, and greater standardisation of protocols and guidelines for reporting

The submarine Congo Canyon as a conduit for microplastics to the deep sea

The increasing plastic pollution of the world’s oceans represents a serious threat to marine ecosystems and has become a well-known topic garnering growing public attention. The global input of plastic waste into the oceans is estimated to be approximately 10 million tons per year and predicted to rise by one order of magnitude by 2025. More than 90% of the plastic that enters the oceans is thought to end up on the seafloor, and seafloor sediment samples show that plastics are concentrated in confined morphologies and sedimentary environments such as submarine canyons. These canyons are occasionally flushed by powerful gravity-driven sediment flows called turbidity currents, which transport vast volumes of sediment to the deep sea and deposit sediment in deep-sea fans. As such, turbidity currents may also transport plastics present in the canyon and bury plastics in deep-sea fans. These fans may therefore act as sinks for seafloor plastics. Here we present a comprehensive dataset showing the spatial distribution of microplastics in seafloor sediments from the Congo Canyon, offshore West Africa. Multicores taken from 16 locations along the canyon, sampled different sedimentary sub-environments including the canyon thalweg, canyon terraces, and distal lobe. Microplastics were extracted from the sediments by density separation and the polymer type, size, and shape of all individual microplastic particles were analysed using laser-direct infrared-spectroscopy (LDIR). Microplastic number concentrations in the sediments of the distal lobe are significantly higher than in the canyon, indicating that the Congo Canyon system is a highly efficient conduit for microplastic transport to the deep sea. Moreover, microplastic concentrations of >20,000 particles per kg of dry sediment were recorded in the lobe, which represent some of the highest ever recorded microplastic number concentrations in seafloor sediments. This shows that deep-sea fans can serve as hotspots and potential terminal sinks for seafloor microplastics

Effect of remote ischemic conditioning on atrial fibrillation and outcome after coronary artery bypass grafting (RICO-trial)

Background: Pre- and postconditioning describe mechanisms whereby short ischemic periods protect an organ against a longer period of ischemia. Interestingly, short ischemic periods of a limb, in itself harmless, may increase the ischemia tolerance of remote organs, e.g. the heart (remote conditioning, RC). Although several studies have shown reduced biomarker release by RC, a reduction of complications and improvement of patient outcome still has to be demonstrated. Atrial fibrillation (AF) is one of the most common complications after coronary artery bypass graft surgery (CABG), affecting 27-46% of patients. It is associated with increased mortality, adverse cardiovascular events, and prolonged in-hospital stay. We hypothesize that remote ischemic pre- and/or post-conditioning reduce the incidence of AF following CABG, and improve patient outcome.Methods/design: This study is a randomized, controlled, patient and investigator blinded multicenter trial. Elective CABG patients are randomized to one of the following four groups: 1) control, 2) remote ischemic preconditioning, 3) remote ischemic postconditioning, or 4) remote ischemic pre- and postconditioning. Remote conditio

'What about swallowing?' Diagnostic performance of daily clinical practice compared with the Eating Assessment Tool-10

In daily clinical practice, patients are frequently asked about their swallowing as part of the patient-clinician interview. This study compares the diagnostic performance of a single open question 'What about swallowing?' (usual care) with the Eating Assessment Tool (EAT-10) as reference test in screening for oropharyngeal dysphagia (OD). 303 outpatients at risk of OD were recruited at three university hospitals: 162 men and 141 women with a mean age of 70 years. All data were retrieved by phone. To identify patients at risk of dysphagia, two different cut-off scores for the EAT-10 total score were retrieved from the literature. The diagnostic performance of the single question was determined by comparing dichotomized answers to the single question (no problems versus difficulties in swallowing) with the EAT-10 as reference test. Sensitivity, specificity, positive and negative predictive values ranged between 0.75–0.76, 0.75–0.84, 0.93–0.97 and 0.38–0.43, respectively. Mostly, the results of this exploratory study indicate a sufficient diagnostic performance of the single question in identifying patients who are at risk of dysphagia when using the EAT-10 questionnaire as a reference test. Further research, is, however, necessary to provide additional psychometric data on Functional Health Status (FHS) questionnaires including the single question using either FEES or VFS as gold standard or reference test

Menu-engineering in restaurants - adapting portion sizes on plates to enhance vegetable consumption: a real-life experiment

Abstract Background The aim of this research was to investigate whether increased portion sizes of vegetables and decreased portion sizes of meat on main dishes increased the amount of vegetables consumed in a real-life restaurant setting without affecting customer satisfaction. The participants were unaware of the experiment. Methods A cross-over design was used in which three restaurants were randomly assigned to a sequence of an intervention and control condition. In the intervention period, the vegetable portion sizes on the plates of main dishes were doubled (150 g of vegetables instead of 75 g) and the portion sizes of meat on the plates were reduced by an average of 12.5%. In the control period, the portion sizes of the main dishes were maintained as usual. In total, 1006 observations and questionnaires were included. Results Vegetable consumption from plates was significantly higher during the intervention period (M = 115.5 g) than during the control period (M = 61.7 g). Similarly, total vegetable consumption (including side dishes) was significantly higher during the intervention period (M = 178.0 g) than during the control period (M = 137.0 g). Conversely, meat consumption was significantly lower during the intervention period (M = 183.1 g) than during the control period (M = 211.1 g). Satisfaction with the restaurant visit did not differ between the intervention period (M = 1.27) and control period (M = 1.35). Satisfaction with the main dish was significantly lower during the intervention period (M = 1.25) than during the control period (M = 1.38), although in both cases, the scores indicated that participants remained (very) satisfied with their main dish. Conclusions This study showed that increasing vegetable portions in combination with decreasing meat portions (unknowingly to the consumer) increased the amount of vegetables consumed and decreased the amount of meat consumed. Furthermore, despite the changes in portion sizes, participants remained satisfied with their restaurant visit and main dish. The findings of this study suggest that modifying portion size in restaurants is an effective tool for stimulating vegetable consumption and consequently healthy and sustainable diets

IGH gene usage for productive IGH for pooled IgG, IgA and IgM

<p>IGHV, IGHD and IGHJ gene usage was quantified from pooled IGH rearrangements from 8 subject sampled by pyrosequencing. The pooled data includes IGH associated with all IGHC genes other than IgE and IgD.</p

Sediment Volume and Grain-Size Partitioning Between Submarine Channel−Levee Systems and Lobes: An Experimental Study

The width and depth of submarine channels change progressively as the channels evolve. This is inferred to act as an important control on the rate of sediment loss due overbank and in-channel deposition. Understanding the downstream extraction of sediment from turbidity currents is important for the prediction of grain-size trends and volume distribution in the stratigraphy. However, the partitioning of sediment by individual turbidity currents as a function of channel dimensions has not been investigated previously. We present a series of physical experiments studying the link between channel dimensions and the resulting partitioning of sediment volume and grain size between sub-environments. The experimental set-up consists of a slope (11°) with a straight pre-formed channel and a horizontal basin floor. An identical flow was released repeatedly into channels with different dimensions, resulting in various styles of overspill, erosion, and deposition under varying degrees of channel confinement. The fraction of sediment that was bypassed through the channel to the basin floor varied between 67% and 89%, depending on the amount of levee and in-channel deposition. The volume of levee deposition correlates well with channel depth. A large channel depth relative to flow thickness limits the amount of overspill. The amount of in-channel deposition correlates well with channel width/depth (W/D) ratio, where low-W/D-ratio channels have less deposition. We compare the experiments to natural system to show that the same patterns of volume and grain-size partitioning are present at different scales. The experiments provide snapshots of different phases of evolution of natural submarine channels. Natural submarine channels in an early evolution phase are inferred to be shallow and the experiments demonstrate that this results in significant sediment loss to levee deposition along the channel. The process of levee deposition preferentially extracts the fine-grained sediment fraction, which overspills from the channel. Therefore, we predict that the initial sediment pulse that reaches the basin floor is coarse grained and volumetrically small. As the channel matures and deepens, it will bypass more sediment with a mix of grain sizes to the basin floor

Sediment Volume and Grain-Size Partitioning Between Submarine Channel−Levee Systems and Lobes: An Experimental Study

The width and depth of submarine channels change progressively as the channels evolve. This is inferred to act as an important control on the rate of sediment loss due overbank and in-channel deposition. Understanding the downstream extraction of sediment from turbidity currents is important for the prediction of grain-size trends and volume distribution in the stratigraphy. However, the partitioning of sediment by individual turbidity currents as a function of channel dimensions has not been investigated previously. We present a series of physical experiments studying the link between channel dimensions and the resulting partitioning of sediment volume and grain size between sub-environments. The experimental set-up consists of a slope (11°) with a straight pre-formed channel and a horizontal basin floor. An identical flow was released repeatedly into channels with different dimensions, resulting in various styles of overspill, erosion, and deposition under varying degrees of channel confinement. The fraction of sediment that was bypassed through the channel to the basin floor varied between 67% and 89%, depending on the amount of levee and in-channel deposition. The volume of levee deposition correlates well with channel depth. A large channel depth relative to flow thickness limits the amount of overspill. The amount of in-channel deposition correlates well with channel width/depth (W/D) ratio, where low-W/D-ratio channels have less deposition. We compare the experiments to natural system to show that the same patterns of volume and grain-size partitioning are present at different scales. The experiments provide snapshots of different phases of evolution of natural submarine channels. Natural submarine channels in an early evolution phase are inferred to be shallow and the experiments demonstrate that this results in significant sediment loss to levee deposition along the channel. The process of levee deposition preferentially extracts the fine-grained sediment fraction, which overspills from the channel. Therefore, we predict that the initial sediment pulse that reaches the basin floor is coarse grained and volumetrically small. As the channel matures and deepens, it will bypass more sediment with a mix of grain sizes to the basin floor