Complex speech-language therapy interventions for stroke-related aphasia: the RELEASE study incorporating a systematic review and individual participant data network meta-analysis

Background: People with language problems following stroke (aphasia) benefit from speech and language therapy. Optimising speech and language therapy for aphasia recovery is a research priority. Objectives: The objectives were to explore patterns and predictors of language and communication recovery, optimum speech and language therapy intervention provision, and whether or not effectiveness varies by participant subgroup or language domain. Design: This research comprised a systematic review, a meta-analysis and a network meta-analysis of individual participant data. Setting: Participant data were collected in research and clinical settings. Interventions: The intervention under investigation was speech and language therapy for aphasia after stroke. Main outcome measures: The main outcome measures were absolute changes in language scores from baseline on overall language ability, auditory comprehension, spoken language, reading comprehension, writing and functional communication. Data sources and participants: Electronic databases were systematically searched, including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Linguistic and Language Behavior Abstracts and SpeechBITE (searched from inception to 2015). The results were screened for eligibility, and published and unpublished data sets (randomised controlled trials, non-randomised controlled trials, cohort studies, case series, registries) with at least 10 individual participant data reporting aphasia duration and severity were identified. Existing collaborators and primary researchers named in identified records were invited to contribute electronic data sets. Individual participant data in the public domain were extracted. Review methods: Data on demographics, speech and language therapy interventions, outcomes and quality criteria were independently extracted by two reviewers, or available as individual participant data data sets. Meta-analysis and network meta-analysis were used to generate hypotheses. Results: We retrieved 5928 individual participant data from 174 data sets across 28 countries, comprising 75 electronic (3940 individual participant data), 47 randomised controlled trial (1778 individual participant data) and 91 speech and language therapy intervention (2746 individual participant data) data sets. The median participant age was 63 years (interquartile range 53–72 years). We identified 53 unavailable, but potentially eligible, randomised controlled trials (46 of these appeared to include speech and language therapy). Relevant individual participant data were filtered into each analysis. Statistically significant predictors of recovery included age (functional communication, individual participant data: 532, n = 14 randomised controlled trials) and sex (overall language ability, individual participant data: 482, n = 11 randomised controlled trials; functional communication, individual participant data: 532, n = 14 randomised controlled trials). Older age and being a longer time since aphasia onset predicted poorer recovery. A negative relationship between baseline severity score and change from baseline (p < 0.0001) may reflect the reduced improvement possible from high baseline scores. The frequency, duration, intensity and dosage of speech and language therapy were variously associated with auditory comprehension, naming and functional communication recovery. There were insufficient data to examine spontaneous recovery. The greatest overall gains in language ability [14.95 points (95% confidence interval 8.7 to 21.2 points) on the Western Aphasia Battery-Aphasia Quotient] and functional communication [0.78 points (95% confidence interval 0.48 to 1.1 points) on the Aachen Aphasia Test-Spontaneous Communication] were associated with receiving speech and language therapy 4 to 5 days weekly; for auditory comprehension [5.86 points (95% confidence interval 1.6 to 10.0 points) on the Aachen Aphasia Test-Token Test], the greatest gains were associated with receiving speech and language therapy 3 to 4 days weekly. The greatest overall gains in language ability [15.9 points (95% confidence interval 8.0 to 23.6 points) on the Western Aphasia Battery-Aphasia Quotient] and functional communication [0.77 points (95% confidence interval 0.36 to 1.2 points) on the Aachen Aphasia Test-Spontaneous Communication] were associated with speech and language therapy participation from 2 to 4 (and more than 9) hours weekly, whereas the highest auditory comprehension gains [7.3 points (95% confidence interval 4.1 to 10.5 points) on the Aachen Aphasia Test-Token Test] were associated with speech and language therapy participation in excess of 9 hours weekly (with similar gains notes for 4 hours weekly). While clinically similar gains were made alongside different speech and language therapy intensities, the greatest overall gains in language ability [18.37 points (95% confidence interval 10.58 to 26.16 points) on the Western Aphasia Battery-Aphasia Quotient] and auditory comprehension [5.23 points (95% confidence interval 1.51 to 8.95 points) on the Aachen Aphasia Test-Token Test] were associated with 20–50 hours of speech and language therapy. Network meta-analyses on naming and the duration of speech and language therapy interventions across language outcomes were unstable. Relative variance was acceptable (< 30%). Subgroups may benefit from specific interventions. Limitations: Data sets were graded as being at a low risk of bias but were predominantly based on highly selected research participants, assessments and interventions, thereby limiting generalisability. Conclusions: Frequency, intensity and dosage were associated with language gains from baseline, but varied by domain and subgroup. Future work: These exploratory findings require confirmatory study designs to test the hypotheses generated and to develop more tailored speech and language therapy interventions. Study registration: This study is registered as PROSPERO CRD42018110947. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 28. See the NIHR Journals Library website for further project information. Funding was also provided by The Tavistock Trust for Aphasia

Removal of Pollutants from Water Using Untreated and Treated Sawdust and Water Hyacinth

Sawdust and water hyacinth are waste products which have no economical application in Egypt. They even constitute a solid waste as far as the environment is concerned. As-received sawdust and water hyacinth were treated with phosphoric acid, phosphoric acid + urea or phosphoric acid + urea + dimethylformamide. The as-received and treated samples were used for the removal of Methylene Blue, iodine, phenol and ammonia from their aqueous solutions. The optimum conditions for the maximum adsorption of each pollutant were determined. The isotherms obtained obeyed the Freundlich and Langmuir equations in a satisfactory manner. The initial stages of adsorption follow first-order kinetics as predicted from the Lagergren equation. Sawdust and water hyacinth show promising potentialities for the removal of pollutants from water and can, at least, be used as precursors for the preparation of efficient adsorbents for the removal of pollutants from water

Impact of Dietary Oregano Plant Extract Supplementation on Carcass Traits, Physical and Chemical Meat Quality of Broilers

The aim of this experiment was to investigate the impacts of dietary supplementation of extracted oregano essential oils on the physical, chemical properties of meat and the carcass properties of broilers, 180 one day old chicks (Ross 308)  arranged into3 dietary groups with 3 replicates (20 birds for each replicate). The experimental groups as follows: Group 1 (G1) control (basal diet), Group 2 (G2) included basal diet + 300 μl of oregano plant extract per kg of diet,  Group 3 (G3) contained basal diet + 600 µl of oregano plant extract for kg of diet. The period of experiment was 35 days. Results revealed that the % of dressed weight as well as % weight of breast was significantly (P ˂0.05) increased in groups which feeding with essential oil of oregano compared to a control diet. In contrast, there were no significant (P ˃ 0.05) influences of essential oils of oregano on (heart, liver, kidney, spleen, pancreas, gizzard) relative weights and intestinal length. However, supplemented groups with oregano essential oils showed a significant decrease in % of pH, TVN and TBA, as well as a significant (P ˂ 0.05) reductions in % of cooking loss, % of drip loss and shear force of the pectoral muscles when compared to the group feeding control diet. A higher significant increase in WHC was found in the group supplemented with 600 μl of OEO compared to the 300µl OEO and control group. OEO had non-significant influence on breast meat color (a, b, l) compared to the group feeding control diet. In conclusion, the supplementation of essential oils of oregano plant extract can improve carcass quality, physical and chemical meat quality of broiler chickens

Relationship between poultry biosecurity assessments and Escherichia coli prevalence in poultry farms

A crucial first step in preventing the introduction and spread of harmful microorganisms in poultry farms is biosecurity. The objectives of this investigation were to assess biosecurity measures and the prevalence of different E. coli species in commercial chicken farms in Sharkia province, Egypt. Sensitivity of E. coli strains was identified, and their susceptibility to antibiotics and disinfection was evaluated as well. Four farms provided 21 samples each, for a total of 84 samples. Three samples of each were collected for water, feed, litter, cloaca, wall, hand, and foot boots. All the studied farms obtained a "poor biosecurity" grade, meaning that their overall biosecurity score, which is comprised of 40% external and 36.54% internal biosecurity, was less than 50%. Escherichia coli species were found in 79.76% of the samples. It was isolated from water, feed, litter, cloaca, walls, hands, and foot boots with percentages of 91.6; 83.3; 91.6; 100; 58.3; 58.3 and 75%, respectively. Biosecurity level had significant negative correlations with the isolated E. coil species. Escherichia coli O119 was the most common serotype in litter and the cloaca, while E. coli O1 was the most prevalent serotype in walls and hands. Additionally, serotypes for E. coli O26, O159, O128 and O78 were included. According to the patterns of antibiotic sensitivity, amikacin, nitrofurantoin, gentamycin, and levofloxacin showed intermediate sensitivity, whereas E. coli O119 bacteria were highly sensitive to ciprofloxacin. In the absence and presence of organic matter, Virocid, Cid 2000 and finally Virkon S were the most efficient against E. coli O119. According to this study, there were differences in the investigated farms' biosecurity levels in relation to the occurrence of Escherichia coli. To reduce the introduction and persistence of E. coli in poultry farms, several biosecurity practices and management, including stringent cleaning and disinfection measures should be applied