Il Pooling-score (P-score): Variabilit\ue0 inter- e intra-individuale nella valutazione endoscopica della gravit\ue0 della disfagia

This study evaluated the intra- and inter-rater reliability of the Pooling score (P-score) in clinical endoscopic evaluation of severity of swal- lowing disorder, considering excess residue in the pharynx and larynx. The score (minimum 4 - maximum 11) is obtained by the sum of the scores given to the site of the bolus, the amount and ability to control residue/bolus pooling, the latter assessed on the basis of cough, raclage, number of dry voluntary or re ex swallowing acts ( 5). Four judges evaluated 30 short lms of pharyngeal transit of 10 solid (1/4 of a cracker), 11 creamy (1 tablespoon of jam) and 9 liquid (1 tablespoon of 5 cc of water coloured with methlyene blue, 1 ml in 100 ml) boluses in 23 subjects (10 M/13 F, age from 31 to 76 yrs, mean age 58.56\ub111.76 years) with different pathologies. The lms were randomly distributed on two CDs, which differed in terms of the sequence of the lms, and were given to judges (after an explanatory ses- sion) at time 0, 24 hours later (time 1) and after 7 days (time 2). The inter- and intra-rater reliability of the P-score was calculated using the intra-class correlation coef cient (ICC; 3,k). The possibility that consistency of boluses could affect the scoring of the lms was considered. The ICC for site, amount, management and the P-score total was found to be, respectively, 0.999, 0.997, 1.00 and 0.999. Clinical evaluation of a criterion of severity of a swallowing disorder remains a crucial point in the management of patients with pathologies that predispose to complications. The P-score, derived from static and dynamic parameters, yielded a very high correlation among the scores attributed by the four judges during observations carried out at different times. Bolus consistencies did not affect the outcome of the test: the analysis of variance, performed to verify if the scores attributed by the four judges to the parameters selected, might be in uenced by the different consistencies of the boluses, was not signi cant. These initial data validate the clinical use of the P-score in the management of patients with deglutition disorders by a multidisciplinary team

Sensitivity of the Atlantic meridional overturning circulation to South Atlantic freshwater anomalies

The sensitivity of the Atlantic Meridional Overturning Circulation (AMOC) to changes in basin integrated net evaporation is highly dependent on the zonal salinity contrast at the southern border of the Atlantic. Biases in the freshwater budget strongly affect the stability of the AMOC in numerical models. The impact of these biases is investigated, by adding local anomaly patterns in the South Atlantic to the freshwater fluxes at the surface. These anomalies impact the freshwater and salt transport by the different components of the ocean circulation, in particular the basin-scale salt-advection feedback, completely changing the response of the AMOC to arbitrary perturbations. It is found that an appropriate dipole anomaly pattern at the southern border of the Atlantic Ocean can collapse the AMOC entirely even without a further hosing. The results suggest a new view on the stability of the AMOC, controlled by processes in the South Atlantic. <br/

On the response of the Antarctic Circumpolar Current transport to climate change in coupled climate models

The CMIP3 (IPCC AR4) models show a consistent intensification and poleward shift of the westerly winds over the Southern Ocean during the 21st century. However, the responses of the Antarctic Circumpolar Currents (ACC) show great diversity in these models, with many even showing reductions in transport. To obtain some understanding of diverse responses in the ACC transport, we investigate both external atmospheric and internal oceanic processes that control the ACC transport responses in these models. While the strengthened westerlies act to increase the tilt of isopycnal surfaces and hence the ACC transport through Ekman pumping effects, the associated changes in buoyancy forcing generally tend to reduce the surface meridional density gradient. The steepening of isopycnal surfaces induced by increased wind forcing leads to enhanced (parameterized) eddy-induced transports that act to reduce the isopycnal slopes. There is also considerable narrowing of the ACC that tends to reduce the ACC transport, caused mainly by the poleward shifts of the subtropical gyres and to a lesser extent by the equatorward expansions of the subpolar gyres in some models. If the combined effect of these retarding processes is larger than that of enhanced Ekman pumping, the ACC transport will be reduced. In addition, the effect of Ekman pumping on the ACC is reduced in weakly stratified models. These findings give insight into the reliability of IPCC-class model predictions of the Southern Ocean circulation, and into the observed decadal-scale steady ACC transport

An educational intervention to promote healthy lifestyles in preschool children: a cluster-RCT

OBJECTIVE: Promoting four healthy behaviours among preschool children:⩾4 servings of fruit and vegetables/day, ⩾2 h/day of active play, ⩽1 h per day of TV-watching and 0 sugar sweetened beverages/day. METHODS: We conducted a c-RCT on 425 3-year-old children at 16 childcare centres based in Cesena, Italy. We randomly allocated eight childcare centres (199 children) to the intervention group and eight childcare centres (226 children) to the control group. All the randomized childcare centres completed our study protocol. Parents recorded their children's target behaviours at home over 3 Saturdays, at baseline and at follow-up. Then trained nurses measured children's weight and height. We conducted a 6-month-long intervention trial in local health care centres where nurses and primary care pediatricians, respectively, conducted two subsequent motivational interviews with parents to encourage children's healthy behaviours at home. At the same time, teachers involved children in learning experiences about healthy behaviours. Our primary outcome is a children's combined health behaviour score (CHBS) at home. Our secondary outcomes measure the BMI z-score and the percentage of children that show a BMI trajectory crossing upward. After collecting the CHBS and BMI data at baseline as well as at 1- and 2-year follow-ups, we performed an Intent-to-Treat (ITT) analysis. RESULTS: After 2 years from baseline, 48.4% of intervention group children showed a low-risk CHBS in comparison with 28.0% of control group children. A multilevel analysis showed that they were by far more likely to achieve low-risk scores (adjusted OR: 3.41; 95% CI: 1.48-7.88; P=0.004). Our BMI outcomes showed no significant difference between groups. CONCLUSIONS: A multidimensional educational intervention, which consists of motivational interviews with parents and teacher-led learning experiences for children, improved preschool children's CHBS in the long term without influencing the outcomes of BMI z-score and BMI increase.In September 2012, OROGEL S.p.A., a company based in via Dismano 2600, I-47522, Cesena, Forlì Cesena, Italy, granted €10 000 in support of our educational intervention. This sponsor had no role in designing and conducting our study; collecting, managing, analysing and interpreting its data; and preparing, reviewing and approving our paper

On Pacific Subtropical Cell Variability over the Second Half of the Twentieth Century

Abstract The evolution of the Pacific subtropical cells (STC) is presented for the period 1948–2007. Using ocean models of different resolutions forced with interannually varying atmospheric forcing datasets, the mechanisms responsible for the observed STC weakening and late recovery during the period of study are analyzed. As a result of the STC weakening (strengthening), warming (cooling) trends are found in the equatorial Pacific sea surface temperatures (SSTs). Model results agree well with observed estimates of STC transport, STC convergence, and equatorial SST anomalies. It is shown that subtropical atmospheric variability is the primary driver of the STC and equatorial SST low-frequency evolution and is responsible for both the slowdown during the second half of the twentieth century and the rebound at the end of the century. Subtropically forced STC variability is identified as a major player in the generation of equatorial Pacific decadal SST anomalies, pacing tropical Pacific natural climate variability on interdecadal time scales, as observed in historical records. The natural mode of variability has implications for the evolution of equatorial SST in the coming decades under the concomitant effects of climate change

Ester content of blueberry fruit can be ruled by tailored controlled atmosphere storage management

This study examines the effects of controlled atmosphere (CA) storage with high CO2 concentration (16 KPa) on the volatile organic compound (VOC) profile of blueberries (Vaccinium spp.), considering their genetic variability. The research focuses on the denovo production of esters and their association with fermentation related VOCs, employing complementary analytical techniques for comprehensive VOC profiling: direct injection mass spectrometry using Proton Transfer Reaction - Time of Flight - Mass Spectrometry (PTR-ToF-MS) and gas chromatography utilizing Solid-phase microextraction coupled to gas chromatography-mass spectrometry (SPME/GC-MS). In the first experiment, PTR-ToF-MS and SPME/GC-MS were applied to analyze the volatilome of seven blueberry cultivars under regular (RA) and controlled (CA) atmosphere storage conditions for 42 days. In the second experiment, 39 cultivars were tested to evaluate genetic variability in response to CA storage using PTR-ToF-MS. The third experiment focused on the effect of different oxygen concentrations during storage (1, 7, and 12 kPa O2), studying four cultivars using PTR-ToF-MS. Results of the three experiments revealed high variability among Vaccinium genotypes for all quality traits, which was amplified during storage, particularly under modified atmosphere conditions. CA storage generally enhanced the positive effects of cold storage by reducing texture decay and water loss and improving VOC profiles. Several ester compounds were synthesized de novo under low oxygen conditions, possibly as a response to hypoxic stress. The study concludes that CA storage offers potential to enhance postharvest fruit quality beyond shelf-life extension. The increase in fruity ester compounds during storage may improve blueberries' organoleptic properties. However, the variability in responses among cultivars needs tailored storage protocols. This research provides valuable insights for market segmentation and breeding programs aimed at enhancing blueberry quality and storability, while also validating PTR-ToF-MS as a rapid phenotyping tool for blueberry assessmen

High-throughput analysis of food volatilome by direct injection mass spectrometry

Rapid, non-invasive and real-time analysis of food volatilome by direct injection mass spectrometry (DIMS) techniques contributes to the evaluation of food quality. Among DIMS application, we report three case studies show the potential of the PTR-ToF-MS technique in product characterization and process monitorin

Challenges and opportunities for improved understanding of regional climate dynamics

Dynamical processes in the atmosphere and ocean are central to determining the large-scale drivers of regional climate change, yet their predictive understanding is poor. Here, we identify three frontline challenges in climate dynamics where significant progress can be made to inform adaptation: response of storms, blocks and jet streams to external forcing; basin-to-basin and tropical–extratropical teleconnections; and the development of non-linear predictive theory. We highlight opportunities and techniques for making immediate progress in these areas, which critically involve the development of high-resolution coupled model simulations, partial coupling or pacemaker experiments, as well as the development and use of dynamical metrics and exploitation of hierarchies of models

Role of the Seasonal Cycle in the Subduction Rates of Upper–Southern Ocean Waters

Abstract A kinematic approach is used to diagnose the subduction rates of upper–Southern Ocean waters across seasonally migrating density outcrops at the base of the mixed layer. From an Eulerian viewpoint, the term representing the temporal change in the mixed layer depth (which is labeled as the temporal induction in this study; i.e., Stemp = ∂h/∂t where h is the mixed layer thickness, and t is time) vanishes over several annual cycles. Following seasonally migrating density outcrops, however, the temporal induction is attributed partly to the temporal change in the mixed layer thickness averaged over a density outcrop following its seasonally varying position and partly to the lateral movement of the outcrop position intersecting the sloping mixed layer base. Neither the temporal induction following an outcrop nor its integral over the outcrop area vanishes over several annual cycles. Instead, the seasonal eddy subduction, which arises primarily because of the subannual correlations between the seasonal cycles of the mixed layer depth and the outcrop area, explains the key mechanism by which mode waters are transferred from the mixed layer to the underlying pycnocline. The time-mean exchange rate of waters across the base of the mixed layer is substantially different from the exchange rate of waters across the fixed winter mixed layer base in mode water density classes. Nearly 40% of the newly formed Southern Ocean mode waters appear to be diapycnally transformed within the seasonal pycnocline before either being subducted into the main pycnocline or entrained back to the mixed layer through lighter density classes

014 * RIGHT ANTERIOR MINI-THORACOTOMY FOR ISOLATED AORTIC VALVE REPLACEMENT: TEN-YEAR EXPERIENCE IN 484 PATIENTS

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