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Oropharyngeal swallow physiology and swallowing-related quality of life in underweight patients with concomitant advanced chronic obstructive pulmonary disease
Swallowing impairment (dysphagia) has been associated with COPD and may contribute to exacerbations of this chronic and progressive disease. Further, risk of mortality increases with concomitant presence of cachexia in the COPD population. The purpose of this prospective study was to depict oropharyngeal swallowing physiology in underweight patients with stable but advanced-stage COPD.
Ten underweight patients with stable but advanced COPD underwent a modified barium swallow study. Analysis of oropharyngeal swallowing function was completed using the standardized Modified Barium Swallow Impairment Profile and the Penetration-Aspiration Scale. Scores from the Dysphagia Handicap Index and 10-item Eating Assessment Tool were collected to assess patient perception of swallowing difficulty. Findings were compared to age- and sex-matched healthy controls.
Significantly higher MBSImP oral total scores (
=0.007) were observed in COPD patients compared to matched controls, but no difference was observed in pharyngeal total scores (
=0.105). Patients with COPD had significantly higher maximum PAS scores compared with controls (
=0.030). There was no significant difference in EAT-10 or DHI scores between patients with COPD and controls (
=0.41 and
=0.08, respectively).
Underweight patients with severe but stable COPD present with dysphagia that may not be recognized by the patient. Further investigation is needed to elucidate the interaction between the respiratory-swallowing systems, how muscular weakness may contribute to swallowing impairment, and responsiveness to swallowing treatment.
Journal Article
Expeditionary anthropology : teamwork, travel and the 'science of man'
The origins of anthropology lie in expeditionary journeys. But since the rise of immersive fieldwork, usually by a sole investigator, the older tradition of team-based social research has been largely eclipsed. Expeditionary Anthropology argues that expeditions have much to tell us about anthropologists and the people they studied. The book charts the diversity of anthropological expeditions and analyses the often passionate arguments they provoked. Drawing on recent developments in gender studies, indigenous studies and the history of science, the book argues that even today, the 'science of man' is deeply inscribed by its connections with expeditionary travel.
Book
Scoring the Penetration–Aspiration Scale (PAS) in Two Conditions: A Reliability Study
A widely applied metric for identifying airway invasion events is the Penetration–Aspiration Scale (PAS). PAS scores are often included as primary outcome measures in clinical interventional studies, applied to characterize airway protection in a particular disease, used to establish a normal referent for control group comparisons without dysphagia, and as determinants or predictors of clinical outcomes. Despite the widespread use of the PAS, there is variability in scoring condition. One common method used in research studies includes rater scores applied to each single swallow that occurred during a modified barium swallow study (MBSS) of the same patient. A second common method includes raters scoring single swallow segments that have been spliced from full MBSS from different patients. These single swallow segments are then randomly distributed and the rater is blinded to all swallows that occurred during that patient MBSS. The potential effects of different scoring conditions on rater reliability and score accuracy have not been studied and may have high relevance for the conclusion drawn from the result. The primary aim of this investigation is to determine the impact of two scoring conditions on rater reliability and score accuracy: 1. Contextual, unblinded scoring condition and 2. Randomized, blinded condition. Results of the present study show that no statistically significant differences in PAS rater reliability and score accuracy were found between the two scoring conditions. If findings from this pilot study are reproduced in larger sample sizes, the time and intensity involved in splicing and randomizing MBSS for scoring may not be necessary.
Journal Article
Spectrophotometric Online Detection of Drinking Water Disinfectant: A Machine Learning Approach
The spectra fingerprint of drinking water from a water treatment plant (WTP) is characterised by a number of light-absorbing substances, including organic, nitrate, disinfectant, and particle or turbidity. Detection of disinfectant (monochloramine) can be better achieved by separating its spectra from the combined spectra. In this paper, two major focuses are (i) the separation of monochloramine spectra from the combined spectra and (ii) assessment of the application of the machine learning algorithm in real-time detection of monochloramine. The support vector regression (SVR) model was developed using multi-wavelength ultraviolet-visible (UV-Vis) absorbance spectra and online amperometric monochloramine residual measurement data. The performance of the SVR model was evaluated by using four different kernel functions. Results show that (i) particles or turbidity in water have a significant effect on UV-Vis spectral measurement and improved modelling accuracy is achieved by using particle compensated spectra; (ii) modelling performance is further improved by compensating the spectra for natural organic matter (NOM) and nitrate (NO3) and (iii) the choice of kernel functions greatly affected the SVR performance, especially the radial basis function (RBF) appears to be the highest performing kernel function. The outcomes of this research suggest that disinfectant residual (monochloramine) can be measured in real time using the SVR algorithm with a precision level of ± 0.1 mg L−1.
Journal Article
Respiratory Phase and Lung Volume Patterns During Swallowing in Healthy Adults: A Systematic Review and Meta-Analysis
Purpose: The coordination of respiration with swallowing is critical for facilitation of airway protection and the efficiency of movements that propel ingested material through the upper aerodigestive tract. Confirmation of a predominant pattern in healthy adults provides a platform for comparison to aberrant patterns observed in the population with swallowing impairment (dysphagia). Method: A comprehensive search of published research in MEDLINE via PubMed 1946-2018, Embase 1947-2018, and Proquest Dissertations & Theses Global 1861-2018 was completed. Results: Thirty-seven articles meeting inclusion criteria were selected for data extraction, and the findings were reviewed. In addition, a meta-analysis of the data was completed. A significantly higher occurrence (p < 0.001) of expiration prior to and following the swallow was found when compared to 3 other patterns. The predominance of the pattern was influenced by increases in bolus volume when controlling for participant sample size. Conclusion: Determination of this predominant pattern provides a normative framework for evaluating respiratory-swallow coordination in adults across the age span and highlights the relevance for assessing and incorporating respiratory swallowing coordination during assessment and interventions.
Journal Article
MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard
The aim of this study was to test reliability, content, construct, and external validity of a new modified barium swallowing study (MBSS) tool (MBSImp) that is used to quantify swallowing impairment. Multiple regression, confirmatory factor, and correlation analyses were used to analyze 300 in- and outpatients with heterogeneous medical and surgical diagnoses who were sequentially referred for MBS exams at a university medical center and private tertiary care community hospital. Main outcome measures were the MBSImp and index scores of aspiration, health status, and quality of life. Inter- and intrarater concordance were 80% or greater for blinded scoring of MBSSs. Regression analysis revealed contributions of eight of nine swallow types to impressions of overall swallowing impairment (
p
≤ 0.05). Factor analysis revealed 13 significant components (loadings ≥ 0.5) that formed two impairment groupings (oral and pharyngeal). Significant correlations were found between Oral and Pharyngeal Impairment scores and Penetration-Aspiration Scale scores, and indexes of intake status, nutrition, health status, and quality of life. The MBSImp demonstrated clinical practicality, favorable inter- and intrarater reliability following standardized training, content, and external validity. This study reflects potential for establishment of a new standard for quantification and comparison of oropharyngeal swallowing impairment across patient diagnoses as measured on MBSS.
Journal Article
The One-Year Attributable Cost of Post-stroke Dysphagia
With the recent emphasis on evidence-based practice and healthcare reform, understanding the cost of dysphagia management has never been more important. It is helpful for clinicians to understand and objectively report the costs associated with dysphagia when they advocate for their services in this economy. Having carefully estimated cost of illness, inputs are needed for cost-effectiveness analyses that help support the value of treatments. This study sought to address this issue by examining the 1-year cost associated with a diagnosis of dysphagia post-stroke in South Carolina. Furthermore, this study investigated whether ethnicity and residence differences exist in the cost of dysphagia post-stroke. Data on 3,200 patients in the South Carolina Medicare database from 2004 who had ICD-9 codes for ischemic stroke, 434 and 436, were retrospectively included in this study. Differences between persons with and without dysphagia post-stroke were compared with respect to age, gender, ethnicity, mortality, length of stay, comorbidity, rurality, discharge disposition, and cost to Medicare. Univariate analyses and a gamma-distributed generalized linear multivariable model with a log link function were completed. We found that the 1-year cost to Medicare for persons with dysphagia post ischemic stroke was $4,510 higher than that for persons without dysphagia post ischemic stroke when controlling for age, comorbidities, ethnicity, and proportion of time alive. Univariate analysis revealed that rurality, ethnicity, and gender were not statistically significantly different in comparisons of individuals with or without dysphagia post-stroke. Post-stroke dysphagia significantly increases post-stroke medical expenses. Understanding the expenditures associated with post-stroke dysphagia is helpful for optimal allocation and use of resources. Such information is needed to conduct cost-effectiveness studies.
Journal Article