PHAryngeal electrical STimulation for early decannulation in TRACheotomised stroke patients with neurogenic dysphagia (PHAST-TRAC): a prospective randomised single-blinded trial

Background Dysphagia after stroke is common, especially in severely affected, tracheotomised patients. In a pilot trial, pharyngeal electrical stimulation (PES) improved swallowing function in this group of patients. The PHAryngeal electrical STimulation for early decannulation in TRACheotomised stroke patients with neurogenic dysphagia trial (PHAST-TRAC) was designed to replicate and extend this single-centre experience. Methods Patients with recent stroke who required tracheotomy were randomised to receive three days of PES or sham. All patients had the stimulation catheter inserted; sham treatment was applied by connecting the base station to a simulator box instead of the catheter. Randomisation was done via a computerised interactive system with randomisation (stratified by site) in blocks of 4 patients per site. Patients and investigators applying PES were not masked. The primary-endpoint was assessed blinded to treatment assignment by a separate investigator at each site. The primary outcome was readiness for decannulation 24-72 hours post-treatment, assessed using fiberoptic endoscopic evaluation of swallowing and based on a standardised protocol including absence of massive saliva, presence of spontaneous swallows and laryngeal sensation. We planned a sequential statistical analysis of superiority for the primary endpoint. Interim analyses were to be performed after primary outcome data were available for 50 patients (futility), 70 patients, and every additional 10 patients thereafter up to 140. Analysis was by intention-to-treat. The trial was registered as ISRCTN18137204. Findings From 29th May 2015 to 5th July 2017, 69 patients (PES 35, sham 34) from 9 sites (7 acute care hospitals, 2 rehabilitation facilities) in Germany, Austria and Italy were included: PES group mean age 61.7 (SD 13.0) years, 8 (23%) patients with haemorrhagic stroke, median time onset to randomisation 28.0 [IQR 20, 49] days; sham group age 66.8 (10.3) years, 12 (35%) patients with haemorrhagic stroke, onset to randomisation 28.0 [18, 40] days). The Independent Data & Safety Monitoring Board recommended to stop the trial early for efficacy after 70 patients had been recruited and primary endpoint data of 69 patients were available. This decision was approved by the steering committee. PES was associated with more patients being ready for decannulation as compared to sham: 17 (49%) vs. 3 (9%), odds ratio (OR) 7.00 (2.41-19.88), p=0.00082). No patient required recannulation within 48 hours or during their documented follow-up period up to 30 days or hospital discharge. Adverse events (AEs) were reported in 24 patients (69%) of the PES group and 24 patients (71%) of the sham group. The number of patients with at least one serious adverse event (SAE) did not differ between the groups: 10 (29%) vs. 8 (23%), OR 1.3 (0.44-3.83), p=0.7851). 7 patients (20%) from the PES group and 3 patients (9%) from the sham group died during the study period. None of the patient deaths or SAEs reported were judged to be PES-treatment- or investigational device-related. Interpretation PES increased the proportion of patients with stroke and subsequent tracheotomy who were ready for decannulation in this study population, many of whom received PES within a month of their stroke. Future trials should confirm whether PES is beneficial in tracheostomised patients who receive stimulation similarly early after stroke and explore its effects in other cohorts

There or not there? A multidisciplinary review and research agenda on the impact of transparent barriers on human perception, action, and social behavior

Contains fulltext : 145066.pdf (publisher's version ) (Open Access)Through advances in production and treatment technologies, transparent glass has become an increasingly versatile material and a global hallmark of modern architecture. In the shape of invisible barriers, it defines spaces while simultaneously shaping their lighting, noise, and climate conditions. Despite these unique architectural qualities, little is known regarding the human experience with glass barriers. Is a material that has been described as being simultaneously there and not there from an architectural perspective, actually there and/or not there from perceptual, behavioral, and social points of view? In this article, we review systematic observations and experimental studies that explore the impact of transparent barriers on human cognition and action. In doing so, the importance of empirical and multidisciplinary approaches to inform the use of glass in contemporary architecture is highlighted and key questions for future inquiry are identified.17 p

Decadal Changes of Organic Carbon, Nitrogen, and Acidity of Austrian Forest Soils

Repeated soil surveys provide opportunities to quantify the effect of long-term environmental change. In recent decades, the topics of forest soil acidification as a consequence of acidic deposition, the enrichment of forest ecosystems with nitrogen, and the loss of carbon due to climate change have been discussed. We used two forest soil surveys that were 20 years apart, in order to establish the direction and magnitude of changes in soil carbon, nitrogen, and soil acidity. Soils have been initially sampled in the late 1980s. The plots were revisited twenty years later. Archived soil samples from the first survey were reanalyzed with the same protocol as the new samples. We found changes in the stocks of soil organic carbon, soil nitrogen, and soil pH. However, the changes were inconsistent. In general, as many sites have gained soil organic carbon, as sites have lost carbon. Most soils have been slightly enriched with nitrogen. The soil pH has not changed significantly. We conclude that changes in the evaluated soil chemical properties are mainly driven by forest management activities and ensuing forest stand dynamics, and atmospheric deposition. We have no convincing evidence that climate change effects have already changed the soil organic carbon stock, irrespective of bedrock type

Modeling of Nitrogen Dynamics in an Austrian Alpine Forest Ecosystem on Calcareous Soils: A Scenario-Based Risk Assessment under Changing Environmental Conditions

We modeled the behavior of an Austrian alpine forest ecosystem on calcareous soils under changing climate and atmospheric nitrogen deposition scenarios. The change of nitrate leaching, emission rates of nitrogen compounds, and forest productivity were calculated using four process-oriented models for the periods 1998–2002 and 2048–2052. Each model reflects with high detail a segment of the ecosystem: PnET-N-DNDC (photosynthesis-evapotranspiration-nitrification-denitrification-decomposition; shortterm nitrogen cycling), BROOK90 (water balance for small and homogenous forest watersheds), HYDRUS (water flux in complex and heterogenous soils), and PICUS v1.3 (forest productivity). The nitrogen balance model (NBM) combines the individual results into a comprehensive picture and extends the specific values beyond the limits of the individual models. The evaluation of the findings was outlined with TRACE, a model enabling a long-term prognosis of nitrogen cycling in annual time steps