Effectiveness of a guided self-help exercise program tailored to patients treated with total laryngectomy:Results of a multi-center randomized controlled trial

Objective: To investigate the effectiveness of a guided self-help exercise program on swallowing, speech, and shoulder problems in patients treated with total laryngectomy (TL). Materials and methods: This randomized controlled trial included patients treated with TL in the last 5 years. Patients were randomized into the intervention group (self-help exercise program with flexibility, range-of-motion and lymphedema exercises and self-care education program) or control group (self-care education program). Both groups completed measurements before and 3 and 6-months after randomization. The primary outcome was swallowing problems (SWAL-QOL). Secondary outcomes were speech problems (SHI), shoulder problems (SDQ), self-management (patient activation: PAM) and health-related quality of life (HRQOL: EORTC QLQ-C30/H&N35). Adherence was defined as moderate-high in case a patient exercised >1 per day. Linear mixed model analyses were conducted to investigate the effectiveness of the intervention and to investigate whether neck dissection, treatment indication (primary/salvage TL), time since treatment, severity of problems, and preferred format (online/booklet) moderated the effectiveness. Results: Moderate-high adherence to the exercise program was 59%. The intervention group (n = 46) reported less swallowing and communication problems over time compared to the control group (n = 46) (p-value = 0.013 and 0.004). No difference was found on speech, shoulder problems, patient activation and HRQOL. Time since treatment moderated the effectiveness on speech problems (p-value = 0.025): patients within 6 months after surgery benefitted most from the intervention. Being treated with a neck dissection, treatment indication, severity of problems and format did not moderate the effectiveness. Conclusion: The guided self-help exercise program improves swallowing and communication. Trial registration. NTR5255

Paleomagnetism of Jurassic Rocks in the Western Sierra Nevada Metamorphic Belt and its Bearing on the Structural Evolution of the Sierra Nevada Block

The western metamorphic belt of the Sierra Nevada consists of two eugeosynclinal terranes separated by the Melones and Sonora faults. Subvertical, bedded Mesozoic volcanic rocks metamorphosed to low greenschist facies predominate to the west, whereas Paleozoic metamorphic rocks of higher grade and greater structural complexity predominate to the east. In order to study the structural development of the faults, 121 samples of basalt and diabase were collected for paleomagnetic analysis from three Jurassic formations, the Logtown Ridge and Penon Blanco formations west of the Melones fault and the Sonora dike swarm to the east of the Sonora fault. A northwesterly, downward directed magnetization occurs in each unit. Three fold tests and a conglomerate test on the two formations west of the faults show that the magnetization is secondary, postdating Nevadan (Late Jurassic) folding and is probably coeval with peak metamorphism. An average of five paleomagnetic poles from the Sierra Nevada, three derived from the secondary magnetizations given herein and two previously published, all of probable Kimmeridgian age, yields λ′=67.2°N, ϕ′=161.2°E, and α95 =6.5°. Southeasterly magnetizations also occur in the Logtown Ridge Formation and Sonora dike swarm. Directions from the Sonora dikes are approximately antipodal to the secondary directions and are reversed; magnetizations from the Logtown Ridge Formation yield similar results only if corrected for the tilt of bedding. The Logtown Ridge magnetizations (tilt-corrected) yield a pole position near to that expected for North America. The data from the Sonora dikes require a tilt correction of 25°-30° toward the south-southwest about a horizontal axis parallel to the regional structure in order to yield a North American pole position. We conclude that the eastern wall rocks of the Melones and Sonora faults have been rotated 25°-30° in response to Nevadan deformation in contrast to the western wall rocks, which have been rotated about 90°

Late cretaceous history of eolian deposition in the mid-pacific mountains, central North Pacific Ocean

Eolian dust preserved in deep-sea sediment can provide a direct historical record of global atmospheric circulation. Data from a reasonably complete Upper Cretaceous section of pelagic sediments recovered at DSDP Site 463 in the central North Pacific provides a good record of eolian activity during the time period between about 112 and 66 m.y. ago. We have isolated the eolian component from these sediments, determined its mass accumulation rate and combined these data with the mineralogy of the inorganic fraction determined by others to construct a record of eolian deposition. Volcanic input is significant during Aptian-Albian and Maastrichtian times, otherwise continentally derived minerals dominate. Mass accumulation rates of the continental eolian component range from over 500 mg/cm2/103yr during the late Albian to a low of 5 mg/cm2/103yr during Coniacian time. (For comparison, the upper Miocene to Pleistocene rate averages about 20 mg/cm2/103yr.) The temporal pattern of Late Cretaceous eolian accumulation of Site 463 generally matches known changes in sea level, suggesting that source availability is the dominant control of eolian sedimentation during that time.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24203/1/0000462.pd

Tajik Basin: A composite record of sedimentary basin evolution in response to tectonics in the Pamir

Investigation of a >6‐km‐thick succession of Cretaceous to Cenozoic sedimentary rocks in the Tajik Basin reveals that this depocentre consists of three stacked basin systems that are interpreted to reflect different mechanisms of subsidence associated with tectonics in the Pamir Mountains: a Lower to mid‐Cretaceous succession, an Upper Cretaceous–Lower Eocene succession and an Eocene–Neogene succession. The Lower to mid‐Cretaceous succession consists of fluvial deposits that were primarily derived from the Triassic Karakul–Mazar subduction–accretion complex in the northern Pamir. This succession is characterized by a convex‐up (accelerating) subsidence curve, thickens towards the Pamir and is interpreted as a retroarc foreland basin system associated with northward subduction of Tethyan oceanic lithosphere. The Upper Cretaceous to early Eocene succession consists of fine‐grained, marginal marine and sabkha deposits. The succession is characterized by a concave‐up subsidence curve. Regionally extensive limestone beds in the succession are consistent with late stage thermal relaxation and relative sea‐level rise following lithospheric extension, potentially in response to Tethyan slab rollback/foundering. The Upper Cretaceous–early Eocene succession is capped by a middle Eocene to early Oligocene (ca. 50–30 Ma) disconformity, which is interpreted to record the passage of a flexural forebulge. The disconformity is represented by a depositional hiatus, which is 10–30 Myr younger than estimates for the initiation of India–Asia collision and overlaps in age with the start of prograde metamorphism recorded in the Pamir gneiss domes. Overlying the disconformity, a >4‐km‐thick upper Eocene–Neogene succession displays a classic, coarsening upward unroofing sequence characterized by accelerating subsidence, which is interpreted as a retro‐foreland basin associated with crustal thickening of the Pamir during India–Asia collision. Thus, the Tajik Basin provides an example of a long‐lived composite basin in a retrowedge position that displays a sensitivity to plate margin processes. Subsidence, sediment accumulation and basin‐forming mechanisms are influenced by subduction dynamics, including periods of slab‐shallowing and retreat

Public access to research data in language documentation: Challenges and possible strategies

The Open Access Movement promotes free and unfettered access to research publications and, increasingly, to the primary data which underly those publications. As the field of documentary linguistics seeks to record and preserve culturally and linguistically relevant materials, the question of how openly accessible these materials should be becomes increasingly important. This paper aims to guide researchers and other stakeholders in finding an appropriate balance between accessibility and confidentiality of data, addressing community questions and legal, institutional, and intellectual issues that pose challenges to accessible dat

Managing impacts of major projects: An analysis of the enbridge gateway pipeline proposal

Enbridge, a major pipeline company, has proposed a new pipeline termed the Gateway Project to transport increased crude oil production in the Alberta oil sands to market. The Gateway Project would include construction of a 1,100- 1,300-kilometer crude oil pipeline from northern Alberta to British Columbia\u27s (B.C.) north coast and a marine terminal to transport crude oil on tankers from the pipeline to U.S. and Asian markets. This report provides an overview of potential environmental impacts, socioeconomic effects, and institutional issues associated with the Gateway Project on Coastal First Nations in B.C. Pipelines, ports, and tankers have potential to create detrimental environmental effects and socioeconomic impacts on communities. In addition, an evaluation of current regulatory and approval processes for pipeline, port, and tanker projects reveals several deficiencies. To address these issues, Enbridge and Coastal First Nations should engage in a comprehensive impact and benefits agreement (IBA) negotiation and implementation process