63 research outputs found

    Design and implementation of Pharyngeal electrical Stimulation for early de-cannulation in TRACheotomized (PHAST-TRAC) stroke patients with neurogenic dysphagia: a prospective randomized single-blinded interventional study

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    Rationale: Ongoing dysphagia in stroke patients weaned from mechanical ventilation often requires long-term tracheotomy to protect the airway from aspiration. In a recently reported single-centre pilot study, a significantly larger proportion (75%) of tracheotomized dysphagic stroke patients regained sufficient control of airway management allowing tracheotomy tube removal (decannulation) 24–72 h after pharyngeal electrical stimulation (PES) compared to controls who received standard therapy over the same time period (20%). Aim: To assess the safety and efficacy of PES in accelerating dysphagia rehabilitation and enabling decannulation of tracheotomized stroke patients. Design: International multi-centre prospective randomized controlled single-blind trial in approximately 126 ICU patients (the 90th percentile of the calculated maximum sample size). Study outcomes: Primary outcome: proportion of stroke patients considered safe for decannulation 24–72 h after PES compared to control patients who do not receive PES. Key secondary outcomes focus on: dysphagia severity, decannulation rates, decannulation rate after a repeat PES treatment in patients persistently dysphagic after an initial PES treatment, stroke severity, duration of ICU-stay, occurrence of adverse events including pneumonia and need for recannulation over 30 days or until hospital discharge (if earlier). Discussion: Dysphagia and related airway complications are reported as one of the main reasons for stroke patients remaining tracheotomized once successfully weaned from ventilation. This study will evaluate if PES can improve airway safety sufficiently enough to allow earlier tracheotomy tube removal

    Has Scots pine (Pinus sylvestris) co-evolved with Dothistroma septosporum in Scotland? Evidence for spatial heterogeneity in the susceptibility of native provenances

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    Spatial heterogeneity in pathogen pressure leads to genetic variation in, and evolution of, disease-related traits among host populations. In contrast, hosts are expected to be highly susceptible to exotic pathogens as there has been no evolution of defence responses. Host response to pathogens can therefore be an indicator of a novel or endemic pathosystem. Currently, the most significant threat to native British Scots pine (Pinus sylvestris) forests is Dothistroma needle blight (DNB) caused by the foliar pathogen Dothistroma septosporum which is presumed to be exotic. A progeny–provenance trial of 6-year-old Scots pine, comprising eight native provenances each with four families in six blocks, was translocated in April 2013 to a clear-fell site in Galloway adjacent to a DNB-infected forest. Susceptibility to D. septosporum, measured as DNB severity (estimated percentage nongreen current-year needles), was assessed visually over 2 years (2013–2014 and 2014–2015; two assessments per year). There were highly significant differences in susceptibility among provenances but not among families for each annual assessment. Provenance mean susceptibility to D. septosporum was negatively and significantly associated with water-related variables at site of origin, potentially due to the evolution of low susceptibility in the host in response to high historical pathogen pressure
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