Effects of Thickening Agents on the Mucociliary Transport Function: Comparison by the Type of Thickening Agents and the Viscosity of Thickened Water

The version of record of this article, first published in Dysphagia, is available online at Publisher’s website: https://doi.org/10.1007/s00455-024-10704-3.Thickening agents effectively prevent liquid aspiration, but their impact on the ease of discharging aspirated liquids from the trachea remains unclear due to alterations in the physical properties of liquids. This study clarifies the effects of thickening agents, comprising various raw materials, on mucociliary transport function, focusing on the viscosities of thickened waters. The subjects were 23 healthy adults. Five types of saccharin solution were prepared: a solution without a thickening agent, a starch-based nectar-like solution, a starch-based honey-like solution, a xanthan-gum-based nectar-like solution, and a xanthan-gum-based honey-like solution. Using these five types of saccharin solutions randomly, each subject underwent five trials of the saccharine dye test to evaluate the mucociliary transport function of the respiratory tract. The saccharin time was defined as the time from the placement of the saccharin solution on the nasal vestibule of the subject to when the subject reported that they became aware of the sweetness. The saccharin transit times for all samples of thickened water were longer compared to those of water without a thickening agent (p < 0.01). A comparison between thickened water samples with different viscosities showed that the saccharin transit time was longer when thickened water samples with high viscosity were prepared using the same thickening agent (p < 0.01). This suggests that while thickening reduces aspiration, the use of thickening agents may increase the difficulty in discharging aspirated fluids from the trachea

Comparison of Saccharin Time in Nursing Home Residents With and Without Pneumonia: A Preliminary Study

ackground/Aim: Although mucociliary clearance is important for preventing pneumonia, its association with the onset of pneumonia is unclear. The aim of this study is to examine the association between saccharin test results as a potential measure of mucociliary clearance and history of pneumonia in nursing home residents. Patients and Methods: Ninety elderly nursing home residents (elderly group) were selected, 35 of whom had a history of pneumonia. Twenty-five healthy adults (adult group) were also investigated to provide baseline values for this study. We conducted the saccharin test to evaluate mucociliary clearance and compared the saccharin time (ST) between those with and without history of pneumonia. Results: Mean ST in the adult group was 12±6 min. The ST in the pneumonia group was significantly longer than that in the non-pneumonia group (32±23 min vs. 17±13 min) (p<0.05). Conclusion: Impaired mucociliary clearance is a factor in the development of pneumonia among nursing home residents

The Same Problem, the Same Approach to Solve and the Different Target for Solution – Toyota and Volvo Uddevalla

Since the end of 20th century, competition in the same markets among globalized auto companies has become more intense. Vehicles have mainly been manufactured in the country or region for sale. Competition in the same country or region therefore mainly means competition of production system efficiency.For this reason, we focus here on comparing various kinds of production systems. As you know it has become widely accepted in the mainstream that Toyota production system is the most up-to-date and efficient production system and Uddevalla 1989-1992 the converse. The latter is regarded as the out-of-date craftsman production system. However, in our research, we, joint co-authors from Japan and Sweden, have found quite interesting facts that contradict the mainstream view. We found that both Toyota and Volvo Uddevalla 1989-1992 faced the same shortage of young workers in the 1980s and took the same approach to solve it. This approach was a work-focused improvement, and the concrete tools for solving it were four similar or identical work-focused devices. They were a reintroduction of contextual meaning in operations, the grouping of parts based on contextual meaning, kit systems based on parts grouping, and embedding various kinds of buffers in the line to absorb fluctuations in work pace. Therefore the functions of these four work-focused devices were very different because each had a different target. Firstly, the common characteristic of three of the work-focused devices, excluding buffers, was contextual meaning. However, this contextual meaning functioned differently at Toyota and Uddevalla 89-92. In the case of Toyota, its aim was to exclude Inner Dialogue in labour process and ensure a certain level of efficiency and work quality regardless of the worker\u27s competence and attentiveness. It thus functions as a tool to create objective devices to achieve efficiency and work quality independent of a worker’s body and mind.A comment; this publication is a part of the authours\u27 long-term (several decades) cooperation with\ua0these particular\ua0Japanese\ua0research colleagues (see other publications registered in Chalmers Public Library CPL)

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to &lt; 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of &amp; GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P &lt; 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo