scholarly journals The Risk of Penetration–Aspiration Related to Residue in the Pharynx

2020 ◽  
Vol 29 (3) ◽  
pp. 1608-1617
Author(s):  
Catriona M. Steele ◽  
Melanie Peladeau-Pigeon ◽  
Emily Barrett ◽  
Talia S. Wolkin
Keyword(s):  
Retrospective Analysis ◽  
Reference Data ◽  
Research Data ◽  
Additional Material ◽  
Data Set ◽  
Pharyngeal Residue ◽  
Increased Risk ◽  
New Material ◽  
Thin Liquids ◽  
Penetration Aspiration Scale

Purpose Reference data from healthy adults under the age of 60 years suggest that the 75th and 95th percentiles for pharyngeal residue on swallows of thin liquids are 1% and 3%(C2-4) 2 , respectively. We explored how pharyngeal residue below versus above these values prior to a swallow predicts penetration–aspiration. Method The study involved retrospective analysis of a previous research data set from 305 adults at risk for dysphagia. Participants swallowed six thin boluses and three each of mildly, moderately, and extremely thick barium in videofluoroscopy. Raters measured preswallow residue in %(C2-4) 2 units and Penetration–Aspiration Scale (PAS) scores for each swallow. Swallows were classified as (a) “clean baseline” (with no preswallow residue), (b) “clearing” swallows of residue with no new material added, or (c) swallows of “additional material” plus preswallow residue. Frequencies of PAS scores of ≥ 3 were compared across swallow type by consistency according to residue severity (i.e., ≤ vs. > 1%(C2-4) 2 and ≤ vs. > 3%(C2-4) 2 . Results The data set comprised 2,541 clean baseline, 209 clearing, and 1,722 swallows of additional material. On clean baseline swallows, frequencies of PAS scores of ≥ 3 were 5% for thin and mildly thick liquids and 1% for moderately/extremely thick liquids. Compared to clean baseline swallows, the odds of penetration–aspiration on thin liquids increased 4.60-fold above the 1% threshold and 4.20-fold above the 3% threshold (mildly thick: 2.11-fold > 1%(C2-4) 2 , 2.26-fold > 3%(C2-4) 2 ). PAS scores of ≥ 3 did not occur with clearing swallows of moderately/extremely thick liquids. Lower frequencies of above-threshold preswallow residue were seen for swallows of additional material than for clearing swallows. Compared to clean baseline swallows, the odds of PAS scores of ≥ 3 on swallows of additional material increased ≥ 1.86-fold above the 1% threshold and ≥ 2.15-fold above the 3% threshold, depending on consistency. Conclusion The data suggest that a pharyngeal residue threshold of 1%(C2-4) 2 is a meaningful cut-point for delineating increased risk of penetration–aspiration on a subsequent swallow.

INFORMATIONAL SUPPORT FOR COASTAL FORECAST DEVELOPMENT OF RUSSIAN TIDELESS SEAS

2017 ◽  
Author(s):  
Maxim Kosyan ◽  
Maxim Kosyan
Keyword(s):  
Coastal Waters ◽  
Information Sources ◽  
Reference Data ◽  
Research Data ◽  
Main Element ◽  
Informational Support ◽  
Long Distance ◽  
New Research ◽  
Dynamic Modules ◽  
Russian Research

The goal of the accomplished work was provision of information to the project, targeted at study of forming and evolution processes of accumulative shore forms of tideless seas of Russia under the effect of hydro-, litho- and morphodynamic factors. Project is accomplished by a team of specialists from leading Russian research institutions from year 2014 onwards. Main element of saving research results is information-analytical complex, which is found on the Internet at http://cofore.coastdyn.ru/index_eng.html, consists of static and dynamic modules, system of statistical analysis and management and protection of created resources. Information sources for information-analytical complex consists of: existing databases of reference data from Institute of Oceanology, material gathered from long distance and on-site observations over dynamic of coastal waters and sedimentary transportation; material from conferences and open publications. As project develops it is planned to keep developing complex with new research data and relevant publications.

scholarly journals Mixed Consistencies in Dysphagic Patients: A Myth to Dispel

Dysphagia ◽  
2021 ◽  
Author(s):  
Mozzanica Francesco ◽  
Pizzorni Nicole ◽  
Scarponi Letizia ◽  
Bazzotti Claudia ◽  
Ginocchio Daniela ◽  
...  
Keyword(s):  
Rating Scale ◽  
Pyriform Sinus ◽  
Endoscopic Evaluation ◽  
Pharyngeal Residue ◽  
Food Residue ◽  
Severity Rating ◽  
Vegetable Soup ◽  
Laryngeal Vestibule ◽  
Dysphagic Patients ◽  
Penetration Aspiration Scale

AbstractOnly limited and inconsistent information about the effect of mixed consistencies on swallowing are available. The aim of this study was to evaluate the location of the head of the bolus at the swallow onset, the risk of penetration/aspiration, and the severity of post-swallow pharyngeal residue in patients with dysphagia when consuming mixed consistencies. 20 dysphagic patients underwent a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) testing five different textures: liquid, semisolid, solid, biscuits-with-milk and vegetable-soup. The location of the head of the bolus at the onset of swallowing was rated using a five-points scale ranging from zero (the bolus is behind the tongue) to four (the bolus falls into the laryngeal vestibule), the severity of penetration/aspiration was rated using the Penetration Aspiration Scale (PAS), the amount of pharyngeal residue after the swallow was rated using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) in the vallecula and pyriform sinus. When consuming biscuits-with-milk and liquid the swallow onset occurred more often when the boluses were located in the laryngeal vestibule. Penetration was more frequent with biscuits-with-milk, while aspiration was more frequent with Liquid, followed by biscuits-with-milk and vegetable-soup, Semisolid and Solid. In particular, no differences in penetration and aspiration between liquids and biscuits-with-milk were found as well as among vegetable-soup, semisolid and solid. No significant differences in the amount of food residue after swallowing were demonstrated. The risk of penetration-aspiration for biscuits-with-milk and liquid is similar, while the risk of penetration-aspiration is lower for vegetable-soup than for liquid.

scholarly journals Adaptation of the Clinical Dementia Rating Scale for adults with Down syndrome

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Christina N. Lessov-Schlaggar ◽  
Olga L. del Rosario ◽  
John C. Morris ◽  
Beau M. Ances ◽  
Bradley L. Schlaggar ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Alzheimer Disease ◽  
Rating Scale ◽  
Assessment Instruments ◽  
Clinical Dementia Rating ◽  
Data Set ◽  
Cognitive Domains ◽  
Increased Risk ◽  
Caregiver Questionnaire ◽  
Raven's Progressive Matrices

Abstract Background Adults with Down syndrome (DS) are at increased risk for Alzheimer disease dementia, and there is a pressing need for the development of assessment instruments that differentiate chronic cognitive impairment, acute neuropsychiatric symptomatology, and dementia in this population of patients. Methods We adapted a widely used instrument, the Clinical Dementia Rating (CDR) Scale, which is a component of the Uniform Data Set used by all federally funded Alzheimer Disease Centers for use in adults with DS, and tested the instrument among 34 DS patients recruited from the community. The participants were assessed using two versions of the modified CDR—a caregiver questionnaire and an in-person interview involving both the caregiver and the DS adult. Assessment also included the Dementia Scale for Down Syndrome (DSDS) and the Raven’s Progressive Matrices to estimate IQ. Results Both modified questionnaire and interview instruments captured a range of cognitive impairments, a majority of which were found to be chronic when accounting for premorbid function. Two individuals in the sample were strongly suspected to have early dementia, both of whom had elevated scores on the modified CDR instruments. Among individuals rated as having no dementia based on the DSDS, about half showed subthreshold impairments on the modified CDR instruments; there was substantial agreement between caregiver questionnaire screening and in-person interview of caregivers and DS adults. Conclusions The modified questionnaire and interview instruments capture a range of impairment in DS adults, including subthreshold symptomatology, and the instruments provide complementary information relevant to the ascertainment of dementia in DS. Decline was seen across all cognitive domains and was generally positively related to age and negatively related to IQ. Most importantly, adjusting instrument scores for chronic, premorbid impairment drastically shifted the distribution toward lower (no impairment) scores.

scholarly journals Altitude and risk of sudden unexpected infant death in the United States

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Richard Johnston ◽  
Xiaohan Yan ◽  
Tatiana M. Anderson ◽  
Edwin A. Mitchell
Keyword(s):  
United States ◽  
Logistic Regression ◽  
Infant Death ◽  
The United States ◽  
Sudden Infant ◽  
Data Set ◽  
Live Births ◽  
Sudden Unexpected Infant Death ◽  
Increased Risk ◽  
Unexpected Infant Death

AbstractThe effect of altitude on the risk of sudden infant death syndrome (SIDS) has been reported previously, but with conflicting findings. We aimed to examine whether the risk of sudden unexpected infant death (SUID) varies with altitude in the United States. Data from the Centers for Disease Control and Prevention (CDC)’s Cohort Linked Birth/Infant Death Data Set for births between 2005 and 2010 were examined. County of birth was used to estimate altitude. Logistic regression and Generalized Additive Model (GAM) were used, adjusting for year, mother’s race, Hispanic origin, marital status, age, education and smoking, father’s age and race, number of prenatal visits, plurality, live birth order, and infant’s sex, birthweight and gestation. There were 25,305,778 live births over the 6-year study period. The total number of deaths from SUID in this period were 23,673 (rate = 0.94/1000 live births). In the logistic regression model there was a small, but statistically significant, increased risk of SUID associated with birth at > 8000 feet compared with < 6000 feet (aOR = 1.93; 95% CI 1.00–3.71). The GAM showed a similar increased risk over 8000 feet, but this was not statistically significant. Only 9245 (0.037%) of mothers gave birth at > 8000 feet during the study period and 10 deaths (0.042%) were attributed to SUID. The number of SUID deaths at this altitude in the United States is very small (10 deaths in 6 years).

scholarly journals RESTING HEART RATE MODERATES THE RELATIONSHIP BETWEEN NEUROPSYCHIATRIC SYMPTOMS, MCI, AND ALZHEIMER’S DISEASE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S641-S641
Author(s):  
Shanna L Burke
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Heart Rate ◽  
Relative Risk ◽  
Neuropsychiatric Symptoms ◽  
Cognitive Status ◽  
Resting Heart Rate ◽  
Data Set ◽  
Increased Risk ◽  
The Relationship

Abstract Little is known about how resting heart rate moderates the relationship between neuropsychiatric symptoms and cognitive status. This study examined the relative risk of NPS on increasingly severe cognitive statuses and examined the extent to which resting heart rate moderates this relationship. A secondary analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was undertaken, using observations from participants with normal cognition at baseline (13,470). The relative risk of diagnosis with a more severe cognitive status at a future visit was examined using log-binomial regression for each neuropsychiatric symptom. The moderating effect of resting heart rate among those who are later diagnosed with mild cognitive impairment (MCI) or Alzheimer’s disease (AD) was assessed. Delusions, hallucinations, agitation, depression, anxiety, elation, apathy, disinhibition, irritability, motor disturbance, nighttime behaviors, and appetite disturbance were all significantly associated (p&lt;.001) with an increased risk of AD, and a reduced risk of MCI. Resting heart rate increased the risk of AD but reduced the relative risk of MCI. Depression significantly interacted with resting heart rate to increase the relative risk of MCI (RR: 1.07 (95% CI: 1.00-1.01), p&lt;.001), but not AD. Neuropsychiatric symptoms increase the relative risk of AD but not MCI, which may mean that the deleterious effect of NPS is delayed until later and more severe stages of the disease course. Resting heart rate increases the relative risk of MCI among those with depression. Practitioners considering early intervention in neuropsychiatric symptomology may consider the downstream benefits of treatment considering the long-term effects of NPS.

scholarly journals A Physical Activity Reference Data-Set Recorded from Older Adults Using Body-Worn Inertial Sensors and Video Technology—The ADAPT Study Data-Set

Sensors ◽  
2017 ◽  
Vol 17 (3) ◽  
pp. 559 ◽  
Author(s):  
Alan Bourke ◽  
Espen Ihlen ◽  
Ronny Bergquist ◽  
Per Wik ◽  
Beatrix Vereijken ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Reference Data ◽  
Inertial Sensors ◽  
Study Data ◽  
Video Technology ◽  
Data Set

Influence of tranexamic acid use on venous thromboembolism risk in patients undergoing surgery for spine tumors

2021 ◽  
pp. 1-11
Author(s):  
Zach Pennington ◽  
Jeff Ehresman ◽  
Andrew Schilling ◽  
James Feghali ◽  
Andrew M. Hersh ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Tranexamic Acid ◽  
Vertebral Column ◽  
Comprehensive Cancer Center ◽  
Primary Study ◽  
High Dose ◽  
Data Set ◽  
Web Based ◽  
Spine Tumors ◽  
Increased Risk

OBJECTIVE Patients with spine tumors are at increased risk for both hemorrhage and venous thromboembolism (VTE). Tranexamic acid (TXA) has been advanced as a potential intervention to reduce intraoperative blood loss in this surgical population, but many fear it is associated with increased VTE risk due to the hypercoagulability noted in malignancy. In this study, the authors aimed to 1) develop a clinical calculator for postoperative VTE risk in the population with spine tumors, and 2) investigate the association of intraoperative TXA use and postoperative VTE. METHODS A retrospective data set from a comprehensive cancer center was reviewed for adult patients treated for vertebral column tumors. Data were collected on surgery performed, patient demographics and medical comorbidities, VTE prophylaxis measures, and TXA use. TXA use was classified as high-dose (≥ 20 mg/kg) or low-dose (< 20 mg/kg). The primary study outcome was VTE occurrence prior to discharge. Secondary outcomes were deep venous thrombosis (DVT) or pulmonary embolism (PE). Multivariable logistic regression was used to identify independent risk factors for VTE and the resultant model was deployed as a web-based calculator. RESULTS Three hundred fifty patients were included. The mean patient age was 57 years, 53% of patients were male, and 67% of surgeries were performed for spinal metastases. TXA use was not associated with increased VTE (14.3% vs 10.1%, p = 0.37). After multivariable analysis, VTE was independently predicted by lower serum albumin (odds ratio [OR] 0.42 per g/dl, 95% confidence interval [CI] 0.23–0.79, p = 0.007), larger mean corpuscular volume (OR 0.91 per fl, 95% CI 0.84–0.99, p = 0.035), and history of prior VTE (OR 2.60, 95% CI 1.53–4.40, p < 0.001). Longer surgery duration approached significance and was included in the final model. Although TXA was not independently associated with the primary outcome of VTE, high-dose TXA use was associated with increased odds of both DVT and PE. The VTE model showed a fair fit of the data with an area under the curve of 0.77. CONCLUSIONS In the present cohort of patients treated for vertebral column tumors, TXA was not associated with increased VTE risk, although high-dose TXA (≥ 20 mg/kg) was associated with increased odds of DVT or PE. Additionally, the web-based clinical calculator of VTE risk presented here may prove useful in counseling patients preoperatively about their individualized VTE risk.

scholarly journals Epidemiology and Outcomes of Nontyphoidal Salmonella Bacteremias from England, 2004 to 2015

2018 ◽  
Vol 57 (1) ◽  
Author(s):  
Shannon Katiyo ◽  
Berit Muller-Pebody ◽  
Mehdi Minaji ◽  
David Powell ◽  
Alan P. Johnson ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
High Morbidity ◽  
First Line ◽  
Data Set ◽  
Content Type ◽  
Increased Risk ◽  
Resistance Patterns ◽  
Prolonged Hospital ◽  
Antibiotic Resistance Patterns ◽  
Emergence Of Resistance

ABSTRACT Nontyphoidal Salmonella (NTS) bacteremia causes hospitalization and high morbidity and mortality. We linked Gastrointestinal Bacteria Reference Unit (GBRU) data to the Hospital Episode Statistics (HES) data set to study the trends and outcomes of NTS bacteremias in England between 2004 and 2015. All confirmed NTS isolates from blood from England submitted to GBRU between 1 January 2004 and 31 December 2015 were deterministically linked to HES records. Adjusted odds ratios (AOR), proportions, and confidence intervals (CI) were calculated to describe differences in age, sex, antibiotic resistance patterns, and serotypes over time. Males, neonates, and adults above 65 years were more likely to have NTS bacteremia (AOR, 1.54 [95% CI, 1.46 to 1.67]; 2.57 [95% CI, 1.43 to 4.60]; and 3.56 [95% CI, 3.25 to 3.90], respectively). Proportions of bacteremia increased from 1.41% in 2004 to 2.67% in 2015. Thirty-four percent of all blood isolates were resistant to a first-line antibiotic, and 1,397 (56%) blood isolates were linked to an HES record. Of the patients with NTS bacteremia, 969 (69%) had a cardiovascular condition and 155 (12%) patients died, out of which 120 (77%) patients were age 65 years and above. NTS bacteremia mainly affects older people with comorbidities placing them at increased risk of prolonged hospital stay and death. Resistance of invasive NTS to first-line antimicrobial agents appeared to be stable in England, but the emergence of resistance to last-resort antibiotics, such as colistin, requires careful monitoring.

scholarly journals Utility of intraoperative electromyography in placing C7 pedicle screws

2020 ◽  
Vol 32 (6) ◽  
pp. 891-899 ◽  
Author(s):  
Jonathan J. Rasouli ◽  
Brooke T. Kennamer ◽  
Frank M. Moore ◽  
Alfred Steinberger ◽  
Kevin C. Yao ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Pedicle Screw ◽  
Thoracolumbar Spine ◽  
Pedicle Screws ◽  
Neurological Injury ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Data Set ◽  
Subaxial Cervical Spine ◽  
Increased Risk

OBJECTIVEThe C7 vertebral body is morphometrically unique; it represents the transition from the subaxial cervical spine to the upper thoracic spine. It has larger pedicles but relatively small lateral masses compared to other levels of the subaxial cervical spine. Although the biomechanical properties of C7 pedicle screws are superior to those of lateral mass screws, they are rarely placed due to increased risk of neurological injury. Although pedicle screw stimulation has been shown to be safe and effective in determining satisfactory screw placement in the thoracolumbar spine, there are few studies determining its utility in the cervical spine. Thus, the purpose of this study was to determine the feasibility, clinical reliability, and threshold characteristics of intraoperative evoked electromyographic (EMG) stimulation in determining satisfactory pedicle screw placement at C7.METHODSThe authors retrospectively reviewed a prospectively collected data set. All adult patients who underwent posterior cervical decompression and fusion with placement of C7 pedicle screws at the authors’ institution between January 2015 and March 2019 were identified. Demographic, clinical, neurophysiological, operative, and radiographic data were gathered. All patients underwent postoperative CT scanning, and the position of C7 pedicle screws was compared to intraoperative neurophysiological data.RESULTSFifty-one consecutive C7 pedicle screws were stimulated and recorded intraoperatively in 25 consecutive patients. Based on EMG findings, 1 patient underwent intraoperative repositioning of a C7 pedicle screw, and 1 underwent removal of a C7 pedicle screw. CT scans demonstrated ideal placement of the C7 pedicle screw in 40 of 43 instances in which EMG stimulation thresholds were > 15 mA. In the remaining 3 cases the trajectories were suboptimal but safe. When the screw stimulation thresholds were between 11 and 15 mA, 5 of 6 screws were suboptimal but safe, and in 1 instance was potentially dangerous. In instances in which the screw stimulated at thresholds ≤ 10 mA, all trajectories were potentially dangerous with neural compression.CONCLUSIONSIdeal C7 pedicle screw position strongly correlated with EMG stimulation thresholds > 15 mA. In instances, in which the screw stimulates at values between 11 and 15 mA, screw trajectory exploration is recommended. Screws with thresholds ≤ 10 mA should always be explored, and possibly repositioned or removed. In conjunction with other techniques, EMG threshold testing is a useful and safe modality in determining appropriate C7 pedicle screw placement.

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