Interventions to promote oral nutritional behaviours in people living with neurodegenerative disorders of the motor system : a systematic review

Background & Aims: Weight loss is common in people with neurodegenerative diseases of the motor system (NDMS), such as Parkinson’s disease and Amyotrophic Lateral Sclerosis, and is associated with reduced quality of life, functional ability and survival. This systematic review aims to identify interventions and intervention components (i.e. behaviour change techniques [BCTs] and modes of delivery [MoDs]) that are associated with increased effectiveness in promoting oral nutritional behaviours that help people with NDMS to achieve a high-calorie diet. Methods: Eight electronic databases including MEDLINE and CINAHL were searched from inception to May 2018. All interventions from included studies were coded for relevant BCTs and MoDs. Methodological quality of studies was assessed using the Cochrane risk of bias tool. Results: Fourteen studies were included. Of these, eight studies reported interventions to assist with swallowing difficulties and six studies reported interventions targeting dietary content. Beneficial effects in managing swallowing difficulties were observed with video assisted swallowing therapy, lung volume recruitment and swallowing management clinics with outpatient support. In contrast, studies reporting effectiveness of chin down posture, use of thickened liquids and respiratory muscle training were inconclusive. Positive effects in interventions targeting dietary content included the use of food pyramid tools, individualised nutritional advice with nutritional interventions, electronic health applications, face-to-face dietary counselling and high fat, high carbohydrate and milk whey protein supplements. Individualised nutritional advice with weekly phone contact did not appear to be effective. Most frequently coded BCTs were ‘instructions on how to perform the behaviour’, ‘self-monitoring’ and ‘behavioural practice/rehearsal’. Most commonly identified MoDs were ‘human’, ‘face-to-face’ and ‘somatic therapy’. However, the robustness of these findings are low due to small number of studies, small sample sizes and large between-study variability. Conclusions: Despite the limited evidence, these findings may help inform the development of more effective interventions to promote oral nutritional behaviours in people with NDMS. However, further research is needed to demonstrate which interventions, or intervention components, yield most benefit

The effect of structural disorder on the hydrogen loading into the graphene/nickel interface

Hybrid materials composed by porous Ni foams coated by graphene appear appealing architectures to be applied in the field of hydrogen storage, where, due to the high surface-to-volume ratio of both components, are expected to be much more performant than their flat counterparts. In order to explore this possibility, in this study we have grown single layer graphene on nickel foams by chemical vapour deposition in ultra-high vacuum and have investigated the interaction with H atoms as a function of the temperature. By using high resolution C1s core level spectroscopy we found that nearly half of the graphene layer interacts with the support almost as strongly as with the flat ordered Ni substrate, whereas the other half is nearly free standing. Such dual electronic and structural coupling drives the hydrogenation of the graphene/foam interface. By using thermal programmed desorption combined with x-ray photoelectron spectroscopy we found that in the weakly interacting graphene regions, even at very low temperatures, H atoms easily intercalate below graphene, and enter in the bulk of the foam, from where they start to desorb around 180 K. This behaviour mimics what happens when dosing H atoms on the bare Ni foam. On the contrary, H intercalation below the strongly interacting graphene regions occurs only for temperatures around and above 200 K. The thermal desorption curves demonstrated that the presence of the graphene layer does not reduce the effectiveness of H loading in the bulk of the foam. On the other hand, it does not even increase significantly the stored amount with respect to the uncoated support, but contributes to stabilizing the stored hydrogen. Although the fundamental aspects of graphene/foam hydrogenation were here investigated in a regime far below the saturation of the bulk absorption, these measurements can be the starting point for further investigations aimed at establishing the ultimate storage capability of these hybrid nano -structured tanks

Patient, carer and healthcare professional perspectives on increasing calorie intake in Amyotrophic Lateral Sclerosis

Objectives Research suggests that higher Body Mass Index is associated with improved survival in people with Amyotrophic Lateral Sclerosis (pwALS). Yet, understanding of the barriers and enablers to increasing calorie intake is limited. This study sought to explore these issues from the perspective of pwALS, informal carers, and healthcare professionals. Methods Interviews with 18 pwALS and 16 informal carers, and focus groups with 51 healthcare professionals. Data were analysed using template analysis and mapped to the COM-B model and Theoretical Domains Framework (TDF). Results All three COM-B components (Capability, Opportunity and Motivation) are important to achieving high calorie diets in pwALS. Eleven TDF domains were identified: Physical skills (ALS symptoms); Knowledge (about high calorie diets and healthy eating); Memory, attention, and decision processes (reflecting cognitive difficulties); Environmental context/resources (availability of informal and formal carers); Social influences (social aspects of eating); Beliefs about consequences (healthy eating vs. high calorie diets); Identity (interest in health lifestyles); Goals (sense of control); Reinforcement (eating habits); and Optimism and Emotion (low mood, poor appetite). Discussion To promote high calorie diets for pwALS, greater clarity around the rationale and content of recommended diets is needed. Interventions should be tailored to patient symptoms, preferences, motivations, and opportunitie

Delivery of nutritional management services to people with amyotrophic lateral sclerosis (ALS).

OBJECTIVES: The aim of this study was to investigate how nutritional management services for people with Amyotrophic Lateral Sclerosis (pwALS) are structured in the UK, in order to gain insight into current practice and identify key barriers and enablers to delivering and providing services. Methods: A three-part, sequential mixed-methods study was conducted that comprised (i) a thematic analysis of data from five focus groups (with 47 ALS health professionals from 41 UK organizations and four service user representatives), (ii) a nationwide cross-sectional survey (281 ALS healthcare professionals) and (iii) a freedom of information request (251 organizations). Results: UK nutritional management services for pwALS are coordinated from specialist (n = 22) and non-specialist care centers (n = 89), with national variability in the organization and delivery of services. Multidisciplinary working was highlighted to facilitate the coordination of nutritional care. However, the need to provide evidence-based continuing education for HCPs was evident. Overall, the lack of clear guidelines on the nutritional management of people with ALS was identified as a key barrier to the delivery of effective nutritional care, as was the lack of transparency and consistency in the commissioning of nutritional services. Further concerns over the timeliness of the dietetic intervention and equity of access and provision were raised. Conclusions: Our findings suggest that development of guidelines for nutritional management, particularly at diagnosis and pre-gastrostomy, could drive standardization of high quality nutritional care for pwALS. Such guidance has the potential to reduce inequalities in geographical provision by providing clarity for those commissioning specialist nutrition services