Predictors of Swallowing Outcomes in Patients with Combat-Injury Related Dysphagia

Background: Traumatic injuries, such as those from combat-related activities, can lead to complicated clinical presentations that may include dysphagia. Methods: This retrospective observational database study captured dysphagia-related information for 215 US military service members admitted to the first stateside military treatment facility after sustaining combat-related or combat-like traumatic injuries. A multidimensional relational database was developed to document the nature, course, and management for dysphagia in this unique population and to explore variables predictive of swallowing recovery using Bayesian statistical modeling and inferential statistical methods. Results: Bayesian statistical modeling revealed the importance of maxillofacial fractures and soft tissue loss as primary predictors of poor swallowing outcomes. The presence of traumatic brain injury (TBI), though common, did not further complicate dysphagia outcomes. A more detailed examination and rating of videofluoroscopic swallow studies from a subset of 161 participants supported greater impairment for participants with maxillofacial trauma and no apparent relationship between having sustained a TBI and swallow functioning. Conclusion: These analyses revealed that maxillofacial trauma is a stronger indicator than TBI of dysphagia severity and slower or incomplete recovery following combat-related injuries. Level of evidence: Therapeutic/Care Management study, level IV

MAP1B Interaction with the FW Domain of the Autophagic Receptor Nbr1 Facilitates Its Association to the Microtubule Network

Selective autophagy is a process whereby specific targeted cargo proteins, aggregates, or organelles are sequestered into double-membrane-bound phagophores before fusion with the lysosome for protein degradation. It has been demonstrated that the microtubule network is important for the formation and movement of autophagosomes. Nbr1 is a selective cargo receptor that through its interaction with LC3 recruits ubiquitinated proteins for autophagic degradation. This study demonstrates an interaction between the evolutionarily conserved FW domain of Nbr1 with the microtubule-associated protein MAP1B. Upon autophagy induction, MAP1B localisation is focused into discrete vesicles with Nbr1. This colocalisation is dependent upon an intact microtubule network as depolymerisation by nocodazole treatment abolishes starvation-induced MAP1B recruitment to these vesicles. MAP1B is not recruited to autophagosomes for protein degradation as blockage of lysosomal acidification does not result in significant increased MAP1B protein levels. However, the protein levels of phosphorylated MAP1B are significantly increased upon blockage of autophagic degradation. This is the first evidence that links the ubiquitin receptor Nbr1, which shuttles ubiquitinated proteins to be degraded by autophagy, to the microtubule network

Taste Manipulation and Swallowing Mechanics in Trauma-Related Sensory-Based Dysphagia

Purpose: This study explored the effects of highconcentration taste manipulation trials on swallow function in persons with sensory-based dysphagia. Method: Dysphagia researchers partnered with clinical providers to prospectively identify traumatically injured U.S. military service members (N = 18) with sensorybased dysphagia as evidenced by delayed initiation and/or decreased awareness of residue/penetration/ aspiration. Under videofluoroscopy, participants swallowed trials of 3 custom-mixed taste stimuli: unflavored (40% weight/volume [wt/vol] barium sulfate in distilled water), sour (2.7%wt/vol citric acid in 40% wt/vol barium suspension), and sweet–sour (1.11% wt/vol citric acid plus 8% wt/vol sucrose in 40% wt/vol barium suspension). Trials were analyzed and compared via clinical rating tools (the Modified Barium Swallow Impairment Profile [Martin-Harris et al., 2008] and the Penetration-Aspiration Scale [Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996]). Additionally, a computational analysis of swallowing mechanics (CASM) was applied to a subset of 9 swallows representing all 3 tastants from 3 participants. Results: Friedman’s tests for the 3 stimuli revealed significantly (p \u3c .05) improved functional ratings for Penetration-Aspiration Scale and pharyngoesophageal opening. CASM indicated differences in pharyngeal swallowing mechanics across all tastant comparisons (p ≤ .0001). Eigenvectors revealed increased tongue base retraction, hyoid elevation, and pharyngeal shortening for sweet–sour and, to a lesser extent, sour than for unflavored boluses. Conclusion: Advantageous changes in certain parameters of oropharyngeal swallowing physiology were noted with high-intensity tastants per both clinical ratings and subsequent CASM, suggesting potential therapeutic application for taste manipulation

Dysphagia Management and Research in an Acute-Care Military Treatment Facility: The Role of Applied Informatics

Purpose: This report describes the development and preliminary analysis of a database for traumatically injured military service members with dysphagia. Methods: A multidimensional database was developed to capture clinical variables related to swallowing. Data were derived from clinical records and instrumental swallow studies, and ranged from demographics, injury characteristics, swallowing biomechanics, medications, and standardized tools (e.g.. Glasgow Coma Scale, Penetration-Aspiration Scale). Bayesian Belief Network modeling was used to analyze the data at intermediate points, guide data collection, and predict outcomes. Predictive models were validated with independent data via receiver operating characteristic curves. Results: The first iteration of the model (n = 48) revealed variables that could be collapsed for the second model (n = 96). The ability to predict recovery from dysphagia improved from the second to third models (area under the curve = 0.68 to 0.86). The third model, based on 161 cases, revealed “initial diet restrictions” as first-degree, and “Glasgow Coma Scale, intubation history, and diet change” as second-degree associates for diet restrictions at discharge. Conclusion: This project demonstrates the potential for bioinformatics to advance understanding of dysphagia. This database in concert with Bayesian Belief Network modeling makes it possible to explore predictive relationships between injuries and swallowing function, individual variability in recovery, and appropriate treatment options

Examining Biomechanical Correlates to Playing-Related Musculoskeletal Disorders in Professional Guitarists

Playing-related musculoskeletal disorders (PRMDs) are painful conditions that may hinder musicians’ ability to play their instruments, affecting them financially, emotionally, and physically (Kenny & Ackermann, 2015; Zaza et al.,1998). Biomechanical risk factors associated with occupational health disorders include repetitive anatomical movements (Candia et al., 2006), excessive force exerted on the upper-body (Chiang et al., 1993), awkward postures (Blanco et al., 2017), and inefficient muscular contraction patterns while playing (Horisawa, 2013). Despite the high prevalence of PRMDs in guitarists, research on biomechanical correlates of PRMDs is limited (Fjellman-Wiklund & Chesky, 2006). Previous research also suggests that biological females experience significantly greater rates of PRMDs than biological males (Ajidahun et al., 2017; Baadjou et al., 2016; Kok et al., 2018; Ranelli et al., 2011), yet little research investigates why this disparity exists. Therefore, the present research aims to investigate potential mechanisms underlying PRMDs in guitarists and this sex-based disparity. Participants will answer a modified Nordic Musculoskeletal Questionnaire (NMQ; Kuorinka et al., 1987) to assess the presence, location, and frequency of PRMD pain. We will utilize the combination of a novel force-measuring guitar, Vicon motion capture system, and electromyography to compare finger force and torque, posture, muscular activation and co-contraction, and variability in playing technique between male and female guitarists with and without symptoms of PRMDs. We hypothesize that biological females and those with PRMDs will exert higher finger contact forces and joint torques, more joint torques in unnatural anatomical positions, greater muscle co-activation, and decreased variability in contact forces and joint torques.Gemstone Honors College, Neuromechanics Research Core, Peabody Institute of The Johns Hopkins University, Launch UMD donor

A Four-Year Multi-Center Retrospective Observational Study of Pediatric Emergency Medical Services Utilization in a Large Metropolitan Health System

Study Objectives: The COVID-19 pandemic has significantly decreased pediatric emergency department (ED) utilization. The objective of this study was to quantify the characteristics of pediatric EMS utilization both before and during the COVID-19 pandemic in a metropolitan health care system. Methods: We performed a multi-center, retrospective observational study of all pediatric ED visits between 1/1/2018 and 12/31/2021, that presented to one of nine EDs within our health system. The data were sorted by mode of arrival; children arriving to the ED via EMS, or arrival by other means. Data collection included a variety of demographic and clinical variables. We compared overall pediatric ED patients’ arrival methods as well as ED and EMS volumes by year using a binomial test with a null hypothesis that the population proportion equals 50%. Analysis compared ED mode of arrival, admission rate, and Emergency Severity Index (ESI) triage scores using chi-square tests. Results: There were 201,313 pediatric ED encounters for 118,744 unique patients meeting the inclusion criteria. There were 8,815 (4.38%) children who arrived via EMS compared to 192,498 (95.62%) children who arrived by other means (p \u3c 0.0001). Children who arrived via EMS had a higher admission rate of 22.27% (1963) compared to 5.9% (11,351, p \u3c 0.0001). ESI among children arriving via EMS was higher, with 44.3% (3847) having ESI 1 or 2 triage scores compared to 8.8% (16,790) for children arriving by other means (p \u3c 0.0001). Overall pediatric ED mortality was 0.03% (61 deaths), with 86.9% (53) of those children arriving via EMS (p \u3c 0.0001). Pediatric ED and EMS volumes in 2018 and 2019 pre-pandemic were 127,652 ED visits and 5,306 EMS visits, respectively, compared to 73,661 and 3,509 visits in 2020 and 2021. This represents a 42.3% overall reduction in pediatric ED visits (p \u3c 0.0001) and a 33.9% reduction in pediatric EMS visits (p \u3c 0.0001). Conclusion: Approximately 5% of pediatric ED encounters in our health system arrived via EMS. These children appeared to have higher acuity presentations and required inpatient services more often than children who arrived by other means. Pediatric ED and EMS encounters have decreased substantially since the onset of the pandemic

OApen Me

Graduate students in the School of Information and Library Science collaborated on this zine as the conclusion of a three-part workshop on Open Access for library and information science professionals