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Background:  Pulmonary aspiration is a leading cause of nosocomial infection in the intensive care unit (ICU) and step-down unit (SDU). A key goal is to identify patients who exhibit increased aspiration risk before beginning oral alimentation. This study investigated the success of recommending specific oral diets to ICU and SDU patients based on passing a 3-oz water swallow challenge. Methods:  A referral-based sample of 401 ICU and 92 SDU patients were prospectively analyzed. Amount of liquid and food ingested at the next day's meal 12 hours to 24 hours after passing a 3-oz challenge and specific diet recommendations were accessed electronically from oral intake information entered on each participant's daily care sheets. Drinking and eating success, clinically evident aspiration events, and accuracy of diet order recommendations were recorded. Care providers were blinded to the purpose of the study. Results:  All 401 ICU and 92 SDU patients were successfully drinking thin liquids and eating 12 hours to 24 hours after passing a 3-oz challenge. Mean volume of liquid ingested at the next day's meal was 360 mL ± 181.2 mL for ICU and 356.4 mL ± 173.5 mL for SDU patients. Percent of meal eaten ranged from 10% to 100%. Patient care sheets indicated specific diet recommendations were followed with 100% accuracy. Conclusions:  Successfully recommending specific oral diets for ICU and SDU patients based on passing a 3-oz water swallow challenge was supported. Importantly, when a simple bedside 3-oz challenge administered by a trained provider is passed, specific diet recommendations can be made safely and confidently without the need for further objective dysphagia testing.

Objective. To determine what effect, if any, the presence or absence of a nasogastric (NG) tube in the same person had on the incidence of anterograde aspiration. Design. Case series with planned data collection. Setting. Large, urban, tertiary care teaching hospital. Subjects and Methods. Referred sample of 62 consecutively enrolled adult inpatients for fiber-optic endoscopic evaluation of swallowing (FEES). Group 1 (n = 21) had either small-bore (n = 13) or large-bore (n = 8) NG tubes already in place and had a FEES first with the NG tube in place and a second FEES after NG tube removal. Group 2 (n = 41) did not have an NG tube and had a FEES first without an NG tube and a second FEES after placement of a small-bore NG tube. Time between FEES was approximately 5 minutes. Patients were tested with thin liquid and puree food consistencies. Occurrence of aspiration for each consistency dependent on the presence or absence of an NG tube was recorded. Results. There were no significant differences (P > .05) in aspiration status for both liquid and puree consistencies in the same person dependent on presence or absence of either a small-bore or large-bore NG tube. Conclusions. Since objective swallowing evaluation (eg, FEES) can be performed with an NG tube in place, it is not necessary to remove an NG tube to evaluate for aspiration. Similarly, there is no contraindication to leaving an NG tube in place to supplement oral alimentation until nutritional requirements are achieved.

Purpose: To compare the amplitude, latency, morphology, and threshold of the auditory P300 using standard oddball and omitted paradigms. Research Design: P300 waveforms were measured from the Cz electrode site. Frequent stimuli for both paradigms were 1000 Hz tone bursts. Target stimuli for the standard oddball paradigm were 2000 Hz tone bursts and an omitted stimulus, or silent gap, for the omitted paradigm. Study Sample: Fifteen bilaterally normal-hearing young adults. Results: There were significantly lower amplitudes, poorer morphology, and higher thresholds for the P300 using an omitted paradigm compared to the standard oddball paradigm. Conclusion: These results suggest that the auditory P300 could have a larger exogenous component than traditionally thought.

In the United States, many actors are pushing for the use of grade point average (GPA) as the main placement tool for gatekeeper math and English courses for community college students (Quarles, 2022; Scott-Clayton, 2018; Turk, 2017). One community college system (pseudonymously, SXCC) in a New England state has begun placing students in initial math and English classes based on self-reported GPA. There have been studies on the effects of placement changes of this type (Belfield & Crosta, 2012; Hodara & Cox, 2016; Ngo & Kwon, 2014; Scott-Clayton, 2012). However, studies have not included the effects of these changes on multilingual learners (MLLs).Using a census of every MLL placed in SXCC in the summer and fall of 2020 and the spring of 2021 (N = 12,603), a MANOVA found that MLL students in the SXCC system who were placed using previous placement methods had a higher overall GPA than students placed using self-reported GPA (M = 3.32, SD = 0.740; M = 2.01, SD = 1.27, respectively) and had higher satisfactory academic progress (SAP) (M = 102.98, SD = 51.52; M = 57.66, SD = 55.53, respectively), and took longer to enroll in English 101 (M = 5.11, SD = 3.55; M = 2.36, SD = 1.76, respectively).

First published in 1990, Neptune’s Domain is organized around one unifying theme: the geographic aspects of the new Law of the Sea as expressed primarily in the United Nations Convention on the Law of the Sea. The first two chapters provide essential background information. Chapters 3 through 9 explain relevant provisions of the Convention. The next two chapters cover topics excluded from the Convention, and the last three chapters are more analytical and future-oriented. All students and scholars concerned with the human use of the marine environment will welcome this book, whether they be geographers, political scientists or lawyers. © Martin Ira Glassner 1990. All rights reserved.

Theropods are obligate bipedal dinosaurs that appeared 230 Ma and are still extant as birds. Their history is characterized by extreme variations in body mass, with gigantism evolving convergently between many lineages. However, no quantification of hindlimb functional morphology has shown whether these body mass increases led to similar specializations between distinct lineages. Here we studied femoral shape variation across 41 species of theropods (n = 68 specimens) using a high-density 3D geometric morphometric approach. We demonstrated that the heaviest theropods evolved wider epiphyses and a more distally located fourth trochanter, as previously demonstrated in early archosaurs, along with an upturned femoral head and a mediodistal crest that extended proximally along the shaft. Phylogenetically informed analyses highlighted that these traits evolved convergently within six major theropod lineages, regardless of their maximum body mass. Conversely, the most gracile femora were distinct from the rest of the dataset, which we interpret as a femoral specialization to “miniaturization” evolving close to Avialae (bird lineage). Our results support a gradual evolution of known “avian” features, such as the fusion between lesser and greater trochanters and a reduction of the epiphyseal offset, independent from body mass variations, which may relate to a more “avian” type of locomotion (more knee than hip driven). The distinction between body mass variations and a more “avian” locomotion is represented by a decoupling in the mediodistal crest morphology, whose biomechanical nature should be studied to better understand the importance of its functional role in gigantism, miniaturization, and higher parasagittal abilities.

Context: Authors of previous research at a public university in New England, where the current study takes place, showed that approximately one-third of undergraduate students have experienced some aspect of food insecurity. More recent investigators at this university revealed that students who were members of a sport team were 4 times more likely to be food insecure than their peers who were not on a sport team. The estimated prevalence of student-athlete food insecurity from other previous research studies ranged from 14% to 32%. Objective: To understand the contributing factors to food insecurity among collegiate athletes. Design: Qualitative study. Setting: A public university in New England. Patients or Other Participants: Data are presented for 10 collegiate athletes who experienced some level of food insecurity according to the United States Department of Agriculture Six-Item Short Form. Data Collection and Analysis: Data were collected using a brief demographic questionnaire and semistructured interviews. Results: Contributing factors were a lack of time, special dietary needs, limited campus dining options, and limited access to transportation or kitchens. Coping strategies were managing time and resources, buying cheaper foods, and skipping meals. Food insecurity negatively affected students' athletic performance. The athletes struggled to balance their athletic and academic schedules and obtain a diet that allowed them to meet their performance goals. Conclusions: Additional and innovative programming is needed to support food-insecure student-athletes. © by the National Athletic Trainers' Association, Inc.

Background: Perceptions of the US healthcare system can impact individuals' healthcare utilization, including vaccination intentions. This study examined the association between perceived racial-ethnic inequities in COVID-19 healthcare and willingness to receive the COVID-19 vaccine. Methods: This study used data from REACH-US, a nationally representative online survey of a large, diverse sample of U.S. adults (N=5145 January 26, 2021-March 3, 2021). Confirmatory factor and regression analyses examined a latent factor of perceived racial-ethnic inequities in COVID-19 healthcare, whether the factor was associated with willingness to receive the COVID-19 vaccine, and whether associations varied across racial-ethnic groups reported as probit estimates (B) and 95% confidence intervals (CIs). Results: Perceived racial-ethnic inequities in COVID-19 healthcare were highest among Black/African American adults (mean latent factor score: 0.65 ± 0.43) and lowest among White adults (mean latent factor score: 0.04 ± 0.67). Black/African American (B = -0.08; 95% CI = -0.19, 0.03) and Native Hawaiian/Pacific Islander (B = -0.08; 95% CI = -0.23, 0.07) adults who perceived greater racial-ethnic inequities in COVID-19 healthcare were less willing than participants who perceived lower inequities. In contrast, American Indian/Alaska Native (B = 0.15; 95% CI = -0.01, 0.30), Asian (B = 0.20; 95% CI = 0.08, 0.31), Hispanic/Latino (English language preference) (B = 0.22; 95% CI = 0.01, 0.43), Multiracial (B = 0.23; 95% CI = 0.09, 0.36), and White (B = 0.31; 95% CI = 0.19, 0.43) adults who perceived greater racial-ethnic inequities in COVID-19 healthcare were more willing to receive the COVID-19 vaccine than participants perceiving higher inequities. Conclusions: Greater perceived racial-ethnic inequities in COVID-19 healthcare were associated with less willingness to receive the COVID-19 vaccine among Black/African American and Native Hawaiian/Pacific Islander adults. © 2024 Lippincott Williams and Wilkins. All rights reserved.

Convolutional neural network (CNN) based deep learning is used to analyze spectral data collected by visible resonance Raman (VRR) spectroscopy to distinguish human glioma tumors from healthy brain tissues using binary classification and identify the cancer grades of the glioma tumors using multi-class classification. Classification was performed using both raw spectral data and baseline-subtracted data for comparison. The classification using both datasets yielded high accuracy, with the results obtained from baseline subtracted spectra slightly better than that obtained from raw spectra. The study showed VRR combined with deep learning provides a robust molecular diagnostic tool for accurately distinguishing glioma tumors from normal tissues and glioma tumor tissues at different cancer grades. Deep learning aided VRR technique may be used for in-situ intraoperative diagnosis of brain cancer. It may help a surgeon to identify cancer margins and even cancer grades during surgery. © COPYRIGHT SPIE. Downloading of the abstract is permitted for personal use only.