Reliability and Confidence of Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) Rating Among Research and Clinical Speech Pathologists Before and After Implementation of a Training Manual: A Multi-site Study.

DIGEST is a validated, open-source method to grade the severity of pharyngeal dysphagia from the modified barium swallow (MBS) study. Dissemination and implementation of DIGEST is rising, making it critical to understand reliability and facilitators of accurate implementation among users. The aim was to assess reliability of the tool among speech-language pathology (SLP) raters practicing at multiple sites before and after review of a DIGEST training manual and evaluate confidence of DIGEST use pre-and post-training. Thirty-two SLPs from 5 sites participated in a blinded longitudinal DIGEST rating study. Raters were provided a standardized training set of MBS (n = 19). Initial SLP ratings (round 1, R1) were followed by a 2-4 week break before raters rated a re-keyed MBS set (round 2, R2). A minimum 4-8 week wash-out period then preceded self-study of the DIGEST training manual which was followed by a final rating (round 3, R3) and a post-manual survey afterwards. Baseline reliability (R1) of overall DIGEST was on average k = 0.70, reflecting agreement in the substantial range. Seventy-five percent of raters (24/32) demonstrated reliability ≥ 0.61 in the substantial to almost perfect range prior to training. Inter-rater reliability significantly improved from R1 to R3 after review of the DIGEST manual, with the largest change in DIGEST-Efficiency (mean change: DIGEST k = .04, p = .009, DIGEST-Safety k = .07, p = 0.03, and DIGEST-Efficiency k = .14, p = 0.009). Although DIGEST reliability at baseline was adequate in the majority of raters, self-study of the DIGEST training manual significantly improved inter-rater reliability and rater confidence using the DIGEST method, particularly when assigning DIGEST-Efficiency grade. These early data show promise that provider training may be useful to aid in fidelity of DIGEST implementation among SLP clinical users with varying DIGEST experience.

The effects of increased fluid viscosity on stationary characteristics of EEG signal in healthy adults.

Electroencephalography (EEG) systems can enable us to study cerebral activation patterns during performance of swallowing tasks and possibly infer about the nature of abnormal neurological conditions causing swallowing difficulties. While it is well known that EEG signals are non-stationary, there are still open questions regarding the stationarity of EEG during swallowing activities and how the EEG stationarity is affected by different viscosities of the fluids that are swallowed by subjects during these swallowing activities. In the present study, we investigated the EEG signal collected during swallowing tasks by collecting data from 55 healthy adults (ages 18-65). Each task involved the deliberate swallowing of boluses of fluids of different viscosities. Using time-frequency tests with surrogates, we showed that the EEG during swallowing tasks could be considered non-stationary. Furthermore, the statistical tests and linear regression showed that the parameters of fluid viscosity, sex, and different brain regions significantly influenced the index of non-stationarity values. Therefore, these parameters should be considered in future investigations which use EEG during swallowing activities.

Baseline characteristics of cervical auscultation signals during various head maneuvers.

Cervical auscultation (CA) is an emerging method of assessing swallowing disorders that is both non-invasive and inexpensive. This technique utilizes microphones to detect acoustic sounds produced by swallowing activity and characterize its behavior. Though some properties of swallowing sounds are known, there is still a need for a complete understanding of the baseline characteristics of cervical auscultation signals as well as how they change due to the patient's head motion, age, and sex. In order to examine these parameters, data was collected from 56 healthy adult participants that performed six different head movement tasks without swallowing. After preprocessing the signal, features were extracted. Dependent variables were time domain, frequency domain and time-frequency domain features. Statistical tests showed that only the skewness and peak frequency were not statistically different for all tasks. The peak frequency results indicate that head movement does not significantly affect the microphone signal, and that it is unnecessary to filter out the lowest frequency components. No sex differences were observed in the extracted features, but several features exhibited age dependence.

Electron self-exchange kinetics in two average-valence dicopper cryptates.

Electron self-exchange rates, reported for two average-valence dicopper cryptates are, at around 10(5) M-1 s-1, at the high end of the range for small-molecule model compounds. The cross-exchange reaction rate, and those for oxidation with [Co(ox)3]3-, are consistent with an outer-sphere reaction mechanism. Despite the necessity for copper-copper bond making and breaking in the course of redox for one of the cryptates, the self-exchange rate is not decreased relative to the other cryptate, showing that this step is not rate limiting.

A penetration-aspiration scale.

The development and use of an 8-point, equal-appearing interval scale to describe penetration and aspiration events are described. Scores are determined primarily by the depth to which material passes in the airway and by whether or not material entering the airway is expelled. Intra- and interjudge reliability have been established. Clinical and scientific uses of the scale are discussed.