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Purpose: The elements of impaired swallowing biomechanics are visually assessed and scored by clinicians using a standardized and validated tool for assessing type and severity of physiological impairments using the Modified Barium Swallow Impairment Profile (MBSImP). However, the functional anatomical correlates that underly noted impairments using MBSImP scoring have not been measured. The purpose of this study was to determine whether differences in MBSImP component scores represent differences in underlying swallowing mechanics as measured by computational analysis of swallowing mechanics (CASM) to better define underlying mechanisms of impairment. Method: A retrospective analysis of modified barium swallow studies from physician-referred adult patients with dysphagia was scored using the MBSImP for laryngeal elevation, anterior hyoid excursion, epiglottic movement, pharyngoesophageal segment opening, and tongue base retraction. A canonical variate analysis (CVA) was performed to determine the movement of anatomical landmarks associated with MBSImP component scores using the CASM method. Mahalanobis distances (D) were then used to detect differences among MBSImP scores for each component assessed. Results: CVA showed significant differences (p < 0.0001) in Mahalanobis distance (D > 1) between MBSImP component scores of 0-1, 0-2, 0-3, or 0-4, as applicable, depending on the component. Discriminant function analyses revealed concomitant increase/worsening in MBSImP score with changes in anatomical positioning of structures. Conclusions: Ratings of swallowing impairment and physiology using the MBSImP have distinct biomechanical correlates with anatomical movements of swallowing. These data further demonstrate how swallowing mechanics are highly interrelated. Understanding these linkages between anatomical and physiological movement within impaired swallowing biomechanics is essential in more specific characterization and treatment of dysphagia.

Purpose: The purpose of this study was to test the feasibility for quantifying changes in oropharyngeal swallowing impairment in response to alteration in bolus viscosity using a reliable and valid method of observational measurement--the Modified Barium Swallow Impairment Profile (MBSImP). Method: This retrospective analysis included a heterogeneous cohort of 119 patients with suspected dysphagia that underwent a videofluoroscopic swallowing study as part of clinical care. Using consensus scoring, two expert clinicians assigned MBSImP scores to components related to oropharyngeal swallowing function between two bolus viscosities (thin liquid and pudding): epiglottic movement, laryngeal elevation, anterior hyoid excursion, tongue base retraction, pharyngeal stripping wave, and pharyngoesophageal segment opening (PESO). Comparisons between the two bolus viscosities were investigated for each component. Results: Higher (worse) scores were observed in the thin-liquid trial compared with the pudding trial for the following MBSImP components: anterior hyoid excursion (p = .03), epiglottic movement (p < .001), pharyngeal stripping wave (p < .001), and PESO (p = .002). Lower (better) scores were observed in the liquid trial compared with the pudding trial for one component--tongue base retraction (Component 15) only (p < .001). Conclusion: These findings provide further evidence for positive influences of viscosity on the swallow mechanism, including influences of sensory feedback on the sensorimotor swallow program. [ABSTRACT FROM AUTHOR]

This article discusses the corrupt leadership of two big-city teachers' unions, the Washington Teachers Union (WTU) and its Miami cousin, United Teachers of Dade (UTD), that took both unions to the brink of despair and financial ruin. While the feds were rifling through union files to build extensive criminal investigations, congress called Sandra Feldman on the carpet: Lawmakers wanted to ask the president of the American Federation of Teachers, the parent organization of the WTU and the UTD, how and why the scandals occurred. Despite the code-blue warning, the organizations appear to have been resuscitated, although the prospects look better for one than the other. George C. Springer, recruited to right the wrongs in the District of Columbia, and Mark Richard, who is at the helm in Miami-Dade County, are the two new leaders who have been given the task of untangling the finances and rebuilding credibility--all within 18 months, as federal law allows. Springer and Richard say they are rebuilding their respective financial houses, restoring credibility with members as well as the public, and generating enthusiasm for the labor movement. Both men have accomplished many of the same things--helping their unions repair finances and communication--while employing many of the same strategies.

Most Texans would rather sell a favorite horse than vote for a tax hike that promises bigger government. Yet San Antonio Mayor Julian Castro has not only persuaded his constituents to spend $248 million to pay for an unusual and ambitious preschool program for poor 4-year-olds, but he is also going to open doors in August--a mere nine months after people asked for it. The city partnered with seven of the 15 local school districts within its borders to launch the "Pre-K 4 SA" program since the November election that authorized a tax increase for preschool programs. Mr. Castro aims to deliver what he deems are gold-standard academics to 22,400 children over eight years, in addition to intensive professional development for staff members and extensive parental supports. The action will take place in four new or retrofitted 50,000-square-foot state-of-the-art school buildings located at the corners of San Antonio's highways for easy access.

Background: Following salvage total laryngectomy (STL) with microvascular‐free tissue transfer (MFTT), patients are at high risk for swallowing dysfunction, but risk factors for persistent gastrostomy tube (G‐tube) dependence are unknown. Methods: Retrospective review of 33 patients who underwent STL with MFTT. Results: A total oral diet was achieved by 81% of patients with ≥6 months of postoperative follow‐up. Approximately 27% of patients were G‐tube dependent preoperatively with 67% achieving a total oral diet postoperatively. Factors associated with persistent G‐tube dependence included pT4 tumor, pN2+ status, more extensive pharyngectomy, and re‐irradiation. Strictures occurred in 30% of patients and were associated with more extensive pharyngectomy and tubed reconstruction. Conclusions: For patients undergoing STL with MFTT, the majority of patients achieve a total oral diet regardless of their preoperative swallowing function. Advanced‐stage recurrent tumors and increased extent of pharyngectomy contribute to poorer swallowing outcomes. [ABSTRACT FROM AUTHOR]

Libraries face new challenges in an era of reconciliation with Indigenous peoples as First Nations, Métis and Inuit communities are reclaiming their voices and building a new framework for its relationship with other Canadians. In order for libraries to begin the process of responding to the Truth and Reconciliation Commission's 94 Calls to Action, library staff should educate themselves on the role that the library has played in the marginalization of Indigenous peoples. As 2017 marked both the 150th anniversary of Confederation and the 140th anniversary of the Indian Act, it is an appropriate time to reflect on the relationship between Indigenous peoples and settlers, especially in the context of library. This paper aims to introduce some of the systems that define settler-Indigenous relationships and proposes solidarity and relationship building as a path towards reconciliation. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Determine swallowing mechanics associated with the first and second epiglottic movements, that is, movement to horizontal and full inversion, respectively, to provide a clinical interpretation of impaired epiglottic function.Study Design: Retrospective cohort study.Methods: A heterogeneous cohort of patients with swallowing difficulties was identified (n = 92). Two speech-language pathologists reviewed 5-mL thin and 5-mL pudding videofluoroscopic swallow studies per subject, and assigned epiglottic component scores of 0 = complete inversion, 1 = partial inversion, and 2 = no inversion, forming three groups of videos for comparison. Coordinates mapping minimum and maximum excursion of the hyoid, pharynx, larynx, and tongue base during pharyngeal swallowing were recorded using ImageJ software. A canonical variate analysis with post hoc discriminant function analysis of coordinates was performed using MorphoJ software to evaluate mechanical differences between groups. Eigenvectors characterizing swallowing mechanics underlying impaired epiglottic movements were visualized.Results: Nineteen of 184 video swallows were rejected for poor quality (n = 165). A Goodman-Kruskal index of predictive association showed no correlation between epiglottic component scores and etiologies of dysphagia (λ = .04). A two-way analysis of variance by epiglottic component scores showed no significant interaction effects between sex and age (f = 1.4, P = .25). Discriminant function analysis demonstrated statistically significant mechanical differences between epiglottic component scores: 1 and 2, representing the first epiglottic movement (Mahalanobis distance = 1.13, P = .0007); and 0 and 1, representing the second epiglottic movement (Mahalanobis distance = 0.83, P = .003). Eigenvectors indicate that laryngeal elevation and tongue base retraction underlie both epiglottic movements.Conclusions: Results suggest that reduced tongue base retraction and laryngeal elevation underlie impaired first and second epiglottic movements. The styloglossus, hyoglossus, and long pharyngeal muscles are implicated as targets for rehabilitation in dysphagic patients with impaired epiglottic inversion.Level Of Evidence: 2b Laryngoscope, 126:1854-1858, 2016. [ABSTRACT FROM AUTHOR]