[Dysphagia diagnostics and therapy of acute stroke: federal survey of certified stroke units]. / Dysphagiediagnostik und -therapie des akuten Schlaganfalls : Eine bundesweite Erhebung auf zertifizierten Stroke-Units.

BACKGROUND: Due to malnutrition and aspiration pneumonia dysphagia is associated with increased morbidity and mortality in acute stroke patients. Early detection of patients at risk of dysphagia leading to timely treatment improves the outcome. METHODS: A survey concerning the current state of dysphagia diagnostics and therapy was carried out among certified stoke units in Germany. RESULTS: Of the 163 invited hospitals 51% participated in the study. A standardized dysphagia program lying mainly within the responsibility of speech language therapists (64%) is established in 94%. Main elements are swallowing assessments carried out by nurses (72%) and the clinical swallowing examination (93%). Instrumental diagnostics are available in 55% with videoendoscopy (52%) being more widely used than videofluoroscopy (17%). In the acute stage nutrition with texture modified diets is the primary therapeutic strategy. CONCLUSIONS: Structured programs for the diagnosis and treatment of dysphagia have generally been established but individual strategies differ and differences in the quality of care are obvious.

Analysis of structural and physiological profiles to assess the effects of Cu on biofilm microbial communities.

We investigated the effects of copper on the structure and physiology of freshwater biofilm microbial communities. For this purpose, biofilms that were grown during 4 weeks in a shallow, slightly polluted ditch were exposed, in aquaria in our laboratory, to a range of copper concentrations (0, 1, 3, and 10 microM). Denaturing gradient gel electrophoresis (DGGE) revealed changes in the bacterial community in all aquaria. The extent of change was related to the concentration of copper applied, indicating that copper directly or indirectly caused the effects. Concomitantly with these changes in structure, changes in the metabolic potential of the heterotrophic bacterial community were apparent from changes in substrate use profiles as assessed on Biolog plates. The structure of the phototrophic community also changed during the experiment, as observed by microscopic analysis in combination with DGGE analysis of eukaryotic microorganisms and cyanobacteria. However, the extent of community change, as observed by DGGE, was not significantly greater in the copper treatments than in the control. Yet microscopic analysis showed a development toward a greater proportion of cyanobacteria in the treatments with the highest copper concentrations. Furthermore, copper did affect the physiology of the phototrophic community, as evidenced by the fact that a decrease in photosynthetic capacity was detected in the treatment with the highest copper concentration. Therefore, we conclude that copper affected the physiology of the biofilm and had an effect on the structure of the communities composing this biofilm.

Linking ecological and ecotoxicological techniques to support river rehabilitation.

Human activities in river catchments interfere with natural fluxes of water and materials. Diffuse inputs and point-sources of toxicants have modified the ecological state of riverine communities considerably, and sanitation schemes are now under development for various rivers. To improve analysis, monitoring and prospecting the role of toxicants in river ecosystems a review of the available methods is undertaken. Ecotoxicological techniques are discussed in relation to basic ecological principles that are thought to regulate the functioning of communities. The response to toxicants among species is highly diverse and therefore the choice of test species (e.g. of typical riverine insects as caddisflies or mayflies) is critical, as it is the use of test-batteries. Long-term exposure may lead to developmental disturbances that may be assessed through morphometric techniques like analysis of asymmetry. Multi-generation exposure, although rarely studied, provides a useful insight into the genetic consequences of pollution. Selection for tolerant species or varieties has been experimentally assessed for smaller organisms such as insects, micro-algae, and bacteria. There is also perspective for multivariate analysis of species distribution in relation to pollutant exposure. Furthermore, a system approach to benthic ecology and sediment testing is needed. Such an approach reflects the strong linkage of ecological and ecotoxicological processes. Toxicants are transformed by biological activity; in some cases this alleviates toxicant stress, but in other cases degradation products are toxic as well. The risk of transformation to mutagenic products in the environment is indicated. The re-assessment of some of the classical ecotoxicological techniques is needed to adequately fulfil the needs of ecological recovery programs. To this purpose integration of ecotoxicological and ecological tools is needed.

Ehrlichiosis in Virginia: case reports.

Ehrlichiosis is a disease that should be considered in any case of chills, fever and malaise, with or without a history of tick bites.