Sensory Input Pathways and Mechanisms in Swallowing: A Review

Over the past 20 years, research on the physiology of swallowing has confirmed that the oropharyngeal swallowing process can be modulated, both volitionally and in response to different sensory stimuli. In this review we identify what is known regarding the sensory pathways and mechanisms that are now thought to influence swallowing motor control and evoke its response. By synthesizing the current state of research evidence and knowledge, we identify continuing gaps in our knowledge of these mechanisms and pose questions for future research

Timing and causes of forest fire at the K–Pg boundary

We report K–Pg-age deposits in Baja California, Mexico, consisting of terrestrial and shallow-marine materials re-sedimented onto the continental slope, including corals, gastropods, bivalves, shocked quartz grains, an andesitic tuff with a SHRIMP U–Pb age (66.12 ± 0.65 Ma) indistinguishable from that of the K–Pg boundary, and charred tree trunks. The overlying mudstones show an iridium anomaly and fungal and fern spores spikes. We interpret these heterogeneous deposits as a direct result of the Chicxulub impact and a mega-tsunami in response to seismically-induced landsliding. The tsunami backwash carried the megaflora offshore in high-density flows, remobilizing shallow-marine fauna and sediment en route. Charring of the trees at temperatures up to > 1000 °C took place in the interval between impact and arrival of the tsunami, which on the basis of seismic velocities and historic analogues amounted to only tens of minutes at most. This constrains the timing and causes of fires and the minimum distance from the impact site over which fires may be ignited

Telemedicine consultation to the general ICU

Early implementations of intensive care unit (ICU) telemedicine, or tele-ICU, focused on using remote intensivists to alleviate intensivist staffing shortages and to meet national ICU staffing standards. With decreasing technology acquisition and implementation costs and improved technological capabilities, the use cases for ICU telemedicine consultations have expanded. Traditional tele-ICU consultation includes ICU patient triage for improved hospital system resource allocation and continuous monitoring of critically ill patients to promote early interventions that prevent patient deterioration. With the widespread adoption of electronic medical records, integration of medical devices, and sensorization of the environment, the boundaries of ICU tele-consulting will rapidly expand. This expansion should allow a wide array of specialist consultation for patients within an ICU while also extending the ability of intensivists to tele-consult on patients not located in the ICU. Such activities have the potential to expand the reach of ICU care beyond the walls of the ICU, leading to improved care of patients who are trending toward critical illness and thus preventing the need for ICU admission. The barriers to more universal use of telemedicine for critical care consultations include staffing needs, existing work processes, and the attitudes and perceptions of ICU staff. Models for telemedicine implementations are highly variable and depend on the resources and use cases of individual healthcare systems. At this time there is no single optimal model of ICU telemedicine. As models continue to mature and evolve, the value that telemedicine brings to critically ill patients, providers, and healthcare systems will be better established