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

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

(Table 1) Magnetozone boundaries, age and sedimentation rate at DSDP Hole 93-605

Natural Remanent Magnetization (NRM) was measured for regularly spaced samples from the 620-m-thick, lower middle Eocene to upper Maestrichtian section of DSDP Site 605. The total NRM of the Eocene chalks was too low (5-50 µA/m) to establish a reliable magnetic polarity stratigraphy. However, the results from the somewhat more clayrich Paleocene-upper Maestrichtian section are useful. A fourfold quality classification of the results of progressive demagnetization studies aided in determining the polarity of the original remanence. Two types (1 and 2a) showed a Characteristic Remanent Magnetization (ChRM) direction with reversed and normal polarity, respectively; the third type (2b) can be interpreted as having a reversed ChRM, which could not be cleaned, whereas the fourth type (3) is considered to be unreliable. The Site 605 magnetic polarity stratigraphy compares well with published sections, adding important detail to the correlation with planktonic microfossil zones and, hence, to the resolution of this portion of the time scale (C24-C32 on the Berggren et al., 1985, scale). The Cretaceous/Tertiary boundary occurs in a reversed polarity zone that has been correlated with Subchron C29r. We suspect the presence of an unconformity at the boundary between lithostratigraphic Units Va and IV a location which is also the level of Reflection Horizon A*