Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta‐analysis

IntroductionNurses and other nonspecialists in dysphagia are often trained to screen swallowing poststroke. There are many basic tools that test water only, they are usually conservative, and patients that fail the test remain nil by mouth until a speech and language therapy assessment. More comprehensive tests also allow nonspecialists to recommend modified oral intake. Little is known about the accuracy, clinical utility and cost‐effectiveness of these tests.MethodsFollowing PRISMA guidelines, a systematic review was conducted to describe comprehensive swallowing tests that are available for use in acute stroke by nurses or other nonspecialists in dysphagia. A meta‐analysis was performed to evaluate accuracy and the clinical utility of the tests was considered. Searches and analyses, conducted by two reviewers, included MEDLINE, Embase, trial registries and grey literature up to December 2018. Validated studies were assessed for quality and risk of bias using QUADAS‐2.ResultsTwenty studies were included, describing five different tests, three of which had undergone validation. The tests varied in content, recommendations and use. There was no test superior in accuracy and clinical utility. Three studies validating the Gugging Swallow Screen provided sufficient data for meta‐analysis, demonstrating high sensitivity; 96% (95% CI 0.90–0.99), but low specificity, 65% (95% CI 0.47–0.79), in line with many water swallow tests. Results should be interpreted with caution as study quality and applicability to the acute stroke population was poor.ConclusionsThere is no comprehensive nurse dysphagia assessment tool that has robustly demonstrated good accuracy, clinical utility and cost‐effectiveness in acute stroke.Relevance to Clinical PracticeNurses and other clinicians can develop competencies in screening swallowing and assessing for safe oral intake in those with poststroke dysphagia. It is important to use a validated assessment tool that demonstrates good accuracy, clinical utility and cost‐effectiveness

Validation of a Novel Immunoline Assay for Patient Stratification according to Virulence of the Infecting Helicobacter pylori Strain and Eradication Status

Helicobacter pylori infection shows a worldwide prevalence of around 50%. However, only a minority of infected individuals develop clinical symptoms or diseases. The presence of H. pylori virulence factors, such as CagA and VacA, has been associated with disease development, but assessment of virulence factor presence requires gastric biopsies. Here, we evaluate the H. pylori recomLine test for risk stratification of infected patients by comparing the test score and immune recognition of type I or type II strains defined by the virulence factors CagA, VacA, GroEL, UreA, HcpC, and gGT with patient's disease status according to histology. Moreover, the immune responses of eradicated individuals from two different populations were analysed. Their immune response frequencies and intensities against all antigens except CagA declined below the detection limit. CagA was particularly long lasting in both independent populations. An isolated CagA band often represents past eradication with a likelihood of 88.7%. In addition, a high recomLine score was significantly associated with high-grade gastritis, atrophy, intestinal metaplasia, and gastric cancer. Thus, the recomLine is a sensitive and specific noninvasive test for detecting serum responses against H. pylori in actively infected and eradicated individuals. Moreover, it allows stratifying patients according to their disease state

Trade in live reptiles, its impact on wild populations, and the role of the European market

Of the 10,272 currently recognized reptile species, the trade of fewer than 8% are regulated by the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) and the European Wildlife Trade Regulations (EWTR). However, the International Union for Conservation of Nature (IUCN) Red List has assessed 45% of the world's reptile species and determined that at least 1390 species are threatened by “biological resource use”. Of these, 355 species are intentionally targeted by collectors, including 194 non-CITES-listed species. Herein we review the global reptile pet trade, its impacts, and its contribution to the over-harvesting of species and populations, in light of current international law. Findings are based on an examination of relevant professional observations, online sources, and literature (e.g., applicable policies, taxonomy [reptile database], trade statistics [EUROSTAT], and conservation status [IUCN Red List]). Case studies are presented from the following countries and regions: Australia, Central America, China, Galapagos Islands (Ecuador), Germany, Europe, India, Indonesia (Kalimantan), Islamic Republic of Iran, Japan, Madagascar, Mexico, New Zealand, the Philippines, South Africa, Sri Lanka, Vietnam, Western Africa, and Western Asia. The European Union (EU) plays a major role in reptile trade. Between 2004 and 2014 (the period under study), the EU member states officially reported the import of 20,788,747 live reptiles. This review suggests that illegal trade activities involve species regulated under CITES, as well as species that are not CITES-regulated but nationally protected in their country of origin and often openly offered for sale in the EU. Further, these case studies demonstrate that regulations and enforcement in several countries are inadequate to prevent the overexploitation of species and to halt illegal trade activities

Taking Two-Photon Excitation to Exceptional Path-Lengths in Photonic Crystal Fiber

The well-known, defining feature of two-photon excitation (TPE) is the tight, three-dimensional confinement of excitation at the intense focus of a laser beam. The extremely small excitation volume, on the order of 1 μm3 (1 femtoliter), is the basis of far-reaching applications of TPE in fluorescence imaging, photodynamic therapy, nanofabrication, and three-dimensional optical memory. Paradoxically, the difficulty of detecting photochemical events in such a small volume is a barrier to the development of the two-photon-activated molecular systems that are essential to the realization of such applications. We show, using two-photon-excited fluorescence to directly visualize the excitation path, that confinement of both laser beam and sample solution within the 20 μm hollow core of a photonic crystal fiber permits TPE to be sustained over an extraordinary path-length of more than 10 cm, presenting a new experimental paradigm for ultrasensitive studies of two-photon-induced processes in solution. (Figure Presented).We are grateful to the Koerber Foundation (Germany) and the EPSRC (UK) for financial support. G.O.S.W. is a recipient of an EPSRC Prize Postdoctoral Fellowshi

Pneumonia in Patients with Acute Stroke: Derivation of a Clinical Prediction Rule

Background: Pneumonia is a common and dangerous consequence of acute stroke. Others have derived pneumonia prediction scores to guide management but included information on swallowing function, which may not be routinely available at the time of hospital admission. Methods: We conducted a retrospective cohort study to identify predictors of pneumonia incidence (identified by ICD-9 codes 480-486.99 or 507.xx) among 1,924 patients treated for acute stroke at Harborview Medical Center in Seattle, WA, based upon information available only at admission and without information on swallowing function. Risk estimates were determined after adjustment for age. Multivariate associations were determined using logistic regression, with beta coefficients for the predictor variables providing weights for each item in a prediction score. Results: Pneumonia occurred in 291 (15%). Independent predictors of pneumonia, and their contribution to the pneumonia score were the following: Age over 75 years (2 pts); male (1 pt); National Institutes of Health Stroke Scale score over 10 (2 pts); receipt of mechanical ventilation (4 pts); history of coronary artery disease (1 pt); lack of diabetes (1 pt); and history of chronic obstructive pulmonary disease (1 pt). The resulting 12-point score had an area under the receiver operating characteristic curve of 0.79 (95% confidence interval 0.76 to 0.81). Conclusion: Our pneumonia prediction score achieved fair discriminatory accuracy despite not including information of swallowing function. However, there may be limited clinical utility of a tool to screen for pneumonia in patients with acute stroke that is only as accurate as this one