Is Electrical Muscle Stimulation Effective in the Progression of Oral Feeding, for Patients with Dysphagia, Caused by a Stroke?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not electrical muscle stimulation is effective in the progression of oral feeding, for patients with dysphagia, caused by a stroke. STUDY DESIGN: Review of 3 randomized controlled trials, published between 2008-2009. DATA SOURCES: All 3 randomized controlled trials were found using the Cochrane database. OUTCOMES MEASURED: All 3 studies measured subjective swallowing function pre- and post-treatment, however, each trial differed in the way they measured this. Permsirivanich et al used a functional oral intake scale (FOIS), or a 7-point scale reflecting the patient’s report of foods safely ingested by mouth, on a consistent basis. Bulow et al determined swallowing function using an alternate 7-point scale, called the actual nutrition scale (ANS). Lim et al measured swallowing function using a third, unnamed, 7-point scale. The percentage of patients progressing from tube feeding to oral feeding was also measured in Lim et al. RESULTS: Bulow et al concluded that no statistically significant difference was found in the therapy effects between neuromuscular electrical stimulation (NMES) and traditional therapy (TT) groups, however, when looking at both groups as a whole, there were significant improvements noted. In Permsirivanich et al, both rehabilitation swallowing therapy (RST) and NMES therapy (combined with diet modification and oral motor exercises) showed positive effects in the treatment of persistent dysphagia in stroke patients, but NMES therapy was significantly superior. Finally, in Lim et al, NMES combined with thermal tactile stimulation (TTS) had a significantly higher score change in swallowing measures (indicating a progression of oral feeding) than those receiving TTS alone.CONCLUSION: As indicated by the 3 studies, NMES therapy, as an adjunct treatment to standard dysphagia treatment, is an effective intervention in the progression of oral feeding, in patients with dysphagia, caused by a stroke. Further studies should be performed to determine if NMES is a valuable therapy alone, or only advantageous when paired with a traditional therapy

Insufficient Effort Responding in Surveys Assessing Self-Regulated Learning: Nuisance or Fatal Flaw?

Despite concerns about their validity, self-report surveys remain the primary data collection method in the research of self-regulated learning (SRL). To address some of these concerns, we took a data set comprised of college students’ self-reported beliefs and behaviours related to SRL, assessed across three surveys, and examined it for instance of a specific threat to validity, insufficient effort responding (IER; Huang, Curran, Keeny, Poposki, & DeShon, 2012). Using four validated indicators of IER, we found the rate of IER to vary between 12-16%. Critically, while we found that students characterised as inattentive and attentive differed in some basic descriptive statistics, the inclusion of inattentive students within the data set did not alter more substantial inferences or conclusions drawn from the data. This study provides the first direct examination of the impact of respondents’ attention on the validity of SRL data generated from self-report surveys

Le recours à l'épisiotomie : déterminants de la pratique des sages-femmes. Étude à la maternité de Port-Royal

Episiotomy: drivers of midwives' practice. Objective: The purpose of this study is to explore maternal or fetal determinants influencing midwives on the use of episiotomy. Materials and methods: This is a single-center case-control study with two groups of patients composed of 103 primiparous and 56 second pares who delivered vaginally at term (> or = 37SA) with a live-born child. Result: Primiparity is still one of the main drivers of episiotomy with a significant increase of the use of episiotomy for women who are between 25 and 29 years old. Moreover, the risk of episiotomy is multiplied by 8.79 in case of past unique c-section (OR=8.79 [1.99, 38.91]). Intact perineum history (OR=0.0513 CI [0.0028, 0.9312]), maternal expulsive efforts with lower-part presentations (OR=0.54 [0.29, 1]), and short duration of maternal expulsive efforts (less than 25 minutes) are factors limiting the risk of episiotomy (OR=0.56 [0.33, 0.96]), whereas duration of maternal expulsive efforts lasting between 25 and 35 minutes increases the risk (OR=2.04, CI [1.12, 3 71]). Conclusion: Even if systematic episiotomy is no longer part of morals, some indications seem to persist and to influence midwives' practice. It is necessary to develop a more regular and multicenter assessment of midwives' practices in order to allow women to have a better approach of this clinical practice. It is also important to provide women objective and impartial information meeting their expectations.Objectif : Cette étude consiste à rechercher des déterminants maternels ou fœtaux influençant la sage-femme sur la pratique de l'épisiotomie. Matériel et méthode : Il s'agit d'une étude monocentrique cas-témoins comparant 2 groupes de 104 primipares et 53 deuxième pares ayant accouchées par voie basse à terme (> ou = 37SA) avec un enfant né vivant. Résultat : La primiparité reste encore l'un des déterminants principaux du recours à l'épisiotomie avec une augmentation significative des épisiotomies pour les femmes de 25 à 29 ans, et un risque d'épisiotomie multiplié par 8,79 en cas d'antécédent unique de césarienne (OR=8,79 [1,99 ; 38,91]). L'antécédent de périnée intact (OR=0.0513 IC [0.0028 ; 0.9312]), le début des efforts expulsifs lorsque les présentations sont parties basses (OR=0,54 [0,29 ; 1]), et les efforts expulsifs durant moins de 25 minutes sont moins à risque d'épisiotomie (OR=0,56 [0,33 ; 0,96]) alors que des efforts expulsifs durant entre 25 et 35 minutes augmentent (OR=2,04 ; IC [1,12 ; 3,71]) la pratique de l'épisiotomie. Conclusion : Certaines indications semblent perdurer et influencer la pratique de l'épisiotomie par les sages-femmes. Il apparaît nécessaire de développer une évaluation plus régulière et multicentrique de cette pratique pour permettre aux femmes de mieux appréhender cet exercice clinique. De plus, il apparaît nécessaire de transmettre une information objective et impartiale aux femmes répondant à leurs attentes

Teachers\u27 Perceptions of the Reading Achievement Gap Between High-Achieving Students and Below-Basic Students

Atlantic Avenue Elementary School (AAES) experienced reading achievement gaps between high-performing students and below-basic students within the school reading curriculum and balanced literacy framework. Vygotsky\u27s theories of scaffolding and zone of proximal development served as the framework guiding this project, which used a qualitative case study design to explore reading teachers\u27 perceptions of the ways in which they were addressing this reading achievement gap. Individual interviews, classroom observations, and lesson plans were the sources of the qualitative data collected from 6 reading teachers. The data were coded manually using emerging and constant-comparative strategies to identify common themes. The themes that emerged from the findings were the need for (a) balanced literacy instruction, (b) reading instruction to be taught at individual ability levels, (c) enrichment of students\u27 background knowledge, (d) meaningful reading assessments to drive instruction, and (e) sustainable and informative professional development (PD). A teacher-informed PD plan was developed in the form of a professional learning community. The potential positive social impact of success of this PD at AAES could benefit similar schools in the district, state, and nation

Specific Gaseous Conditions Significantly Improve Lactobacillus casei and Escherichia coli Survival to Freeze Drying and Rehydration

 Background and objective: Presence of oxygen during production and rehydration of freeze-dried starters and probiotics can decrease viability of the bacteria. Indeed, removal of water from cells during freeze-drying can promote dysfunction in anti-oxidative mechanisms, resulting in oxidative stress by accumulation of reactive oxygen species. The aim of this study was to show how atmospheric or less oxidative gaseous conditions affect bacterial survival to freeze-drying and rehydration of two strains, including Lactobacillus casei, a widely used bacteria in biotechnology, and Escherichia coli, a laboratory model bacteria.Material and methods: Lactobacillus casei ATCC 334 and Escherichia coli K12 were freeze dried for 24h in 5% sucrose (m v-1). Two gaseous conditions (an oxygen-free gas and atmospheric air) were used during various steps of the process, including bacterial cultivation, mixing of the bacteria with the protectant and rehydration. Oxygen-free gas condition was obtained with an oxygen-free gas, composed of nitrogen, hydrogen and carbon dioxide (N2H2CO2)and an anaerobic chamber.Results and conclusion: Gaseous conditions included significant effects on bacterial survival rates (P<0.001 for Lactobacillus casei and Escherichia coli). Interestingly, for both bacteria, the optimal combination was atmospheric air during mixing of the bacteria with the lyoprotectant (P<0.001 for Lactobacillus casei and Escherichia coli) and N2H2CO2 during rehydration (P<0.001 for Lactobacillus casei and P<0.05 for Escherichia coli). Management of gaseous conditions during a freeze-drying process and rehydration (atmospheric air during mixing of the bacteria with lyoprotectant and oxygen-free gas during rehydration) enhances survival of the bacteria by preserving them from oxidative stress.Conflict of interest: The authors declare no conflict of interest

La perception gustative des populations autochtone de Yakoutie Arctique (District de Basse-Kolyma) en fonction du régime alimentaire, comparée à celle de populations d'Europe, d'Afrique et du Goroenland

International audienceThresholds of taste recognition have been determined among a Yakutian population sample (n =109), including Yakuts (n =47), some people belonging to aborigenal ethnic minorities of the North (n = 38, including 20 Evens, 14 Yukagirs, 3 Chukchi and 1 Nenets), and 24 persons of other origin (Russians, Ukrainians, etc.), using a blind protocol with solutions of pure (or purified) substances, including oak tanin and tannic acid. Significant differences for sugars perception have been found when comparing the results with those obtained (with a similar protocol) in various European countries and in Africa. These differences are discussed in relation to the environmental conditions and dietary adaptations. In this context, the reactions to sodium chloride, although partly analogous in the Yakutian population sample and among the Inuit of Greenland, do not present the same degree of acuity. This difference could result of an environmental continental adaptive trend, whereas the Inuit have adapted to the arctic coast environmental conditions.Des tests en simple aveugle ont permis de mettre en évidence les seuils de reconnaissance gustative d'une série de produits purifiés, incluant le tannin de chêne et l'acide tannique, sur un échantillon de population (n = 109) de Yakoutie arctique, comprenant des Yakoutes (n =47), des personnes appartenant aux minorités autochtones du Grand Nord (n = 38, soit : 20 Evènes, 14 Youkaguirs, 3 Tchouktches et 1 Nénétse), ainsi que 24 personnes d'autres origines (Russes, Ukrainiens, etc.). Le même type de test ayant été effectué dans plusieurs pays d'Europe ainsi qu'en Afrique, nous avons mis en évidence des différences régionales significatives, portant en particulier sur la perception des sucres, discutées en fonction du milieu et des adaptations au régime alimentaire. Dans ce contexte, la perception du chlorure de sodium par les populations de Yakoutie n'est que partiellement comparable à celle des Inuit du Groenland, car la très grande acuité de perception de ces derniers n'a pas été retrouvée, ce qui impliquerait une adaptation au milieu continental plutôt qu'aux régions côtières arctiques

Foods of the Mediterranean diet: Garlic and Mediterranean legumes

The Mediterranean diet is a dietary regime derived from the one followed by the ancient civilizations of the Mediterranean region. It is characterized by many healthy constituents, among which are cereals, legumes, fruits, vegetables, olives, and white meat. Many studies suggest that this dietary regime is the key to obtaining a healthy and long life, like that of the Mediterranean peoples. Despite its popularity among health professionals, this diet is still confined to a certain geographical area of the world. Due to globalization and the modern busy lifestyle, this cultural diet is losing ground even in its home region, with more and more people embracing the so-called Western diet. An awareness of health benefits of the individual components of the Mediterranean diet will therefore draw attention from all over the world to this healthy and affordable dietary pattern, which can not only improve the overall health, but also reduce the risk of developing chronic and infectious diseases. In this regard, garlic and Mediterranean legumes present a huge repertoire of phytochemicals having both nutritive and nutraceutical properties, which therefore should be included in our daily dietary routines in moderate proportions. This narrative review aims at summarizing the principal components and health benefits of the Mediterranean diet, in particular of garlic and legume

Anderson-Fabry’s Disease: A Rare but Treatable Case of Fever of Unknown Origin

Anderson-Fabry’s disease (AFD) is a rare, X-linked lysosomal storage disorder caused by the complete deficiency or attenuated activity of the enzyme α-galactosidase A, leading to progressive systemic intracellular accumulation of glycosphingolipids and subsequent cellular dysfunction, inflammation and fibrosis. Fever is a frequently misinterpreted symptom in the early stages of the disease, leading to diagnostic delay. We present the case of a 35-year-old man admitted to our Periodic Fever Research Centre for long-lasting recurrent episodes of fever of unknown origin. After extensive assessment, we diagnosed AFD associated with a novel GLA mutation. We started enzyme replacement therapy with clinical benefit and complete remission of fever

Foods of the Mediterranean diet: Lacto-fermented food, the food pyramid and food combinations

The Mediterranean diet proved to be one of the healthiest diets in the word. It has several beneficial effects and it prevents many non-communicable diseases, such as cancer, cardiovascular diseases, and obesity. Before being a culinary regime, the Mediterranean diet is characterized by specific cultural heritages and traditions, also influencing the lifestyle of the populations. The Mediterranean diet follows the so-called food pyramid, comprising several food combinations. Indeed, it is mainly composed by vegetables, fish and dairy products, while red meat and sweets are poorly consumed. Processed foods are mainly avoided, apart from lacto-fermented ones, the first processed foods consumed by humans. Food fermentation by microorganisms not only improves the functionality of bioactive metabolites, but also increases the shelf life and organoleptic properties of the food. Lactic acid bacteria play a vital role in transforming the food constituents, thereby enhancing their nutritional and functional properties. In addition, these foods introduce beneficial bacteria into gut microbiota, thus maintaining a healthy gut microbiome and corresponding gut-brain axis, thus providing an overall improvement in health and a reduced risk of non-communicable diseases and metabolic disorders. This review will focus on the Mediterranean diet, on its characterising food pyramid and food combinations, and on lacto-fermented foods, one of the components of the Mediterranean diet with the most beneficial effects