Swallowing with Noninvasive Positive-Pressure Ventilation (NPPV) in Individuals with Muscular Dystrophy: A Qualitative Analysis.

The purpose of the study is to describe experiences of swallowing with two forms of noninvasive positive-pressure ventilation (NPPV): mouthpiece NPPV (M-NPPV) and nasal bilevel positive airway pressure (BPAP) in people with muscular dystrophy. Ten men (ages 22-42 years; M = 29.3; SD = 7.1) with muscular dystrophy (9 with Duchenne's; 1 with Becker's) completed the Eating Assessment Tool (EAT-10; Ann Otol Rhinol Laryngol 117(12):919-924 [33]) and took part in semi-structured interviews. The interviews were audio recorded, transcribed, and verified. Phenomenological qualitative research methods were used to code (Dedoose.com) and develop themes. All participants affirmed dysphagia symptoms via responses on the EAT-10 (M = 11.3; SD = 6.38; Range = 3-22) and reported eating and drinking with M-NPPV and, to a lesser extent, nasal BPAP. Analysis of interview data revealed three primary themes: (1) M-NPPV improves the eating/drinking experience: Most indicated that using M-NPPV reduced swallowing-related dyspnea. (2) NPPV affects breathing-swallowing coordination: Participants described challenges and compensations in coordinating swallowing with ventilator-delivered inspirations, and that the time needed to chew solid foods between ventilator breaths may lead to dyspnea and fatigue. (3) M-NPPV aids cough effectiveness: Participants described improved cough strength following large M-NPPV delivered inspirations (with or without breath stacking). Although breathing-swallowing coordination is challenging with NPPV, participants reported that eating and drinking is more comfortable than when not using it. Overall, eating and drinking with NPPV delivered via a mouthpiece is preferred and is likely safer for swallowing than with nasal BPAP. M-NPPV (but not nasal BPAP) is reported to improve cough effectiveness, an important pulmonary defense in this population.

Bracketed radioactive seed localization vs bracketed wire-localization in breast surgery.

Multiple localizers placed in a bracketed fashion facilitates excision of radiographically extensive breast lesions. In this study, bracketed radioactive seed localization (bRSL) was compared to bracketed wire localization (bWL). We hypothesized that bRSL would achieve adequate margins and decrease re-operation rates with similar or less specimen volumes (SV) than bWL. Retrospective review identified patients who underwent bracketed breast procedures at an academic medical center. Data collected included patient demographics, tumor features, treatment variables, and surgical outcomes. Wilcoxon rank-sum test and chi-square test were used to compare continuous and categorical data, respectively. A multivariable logistic regression model was used to evaluate the association between re-excision and localization technique after adjusting for clinically relevant variables. Patients who underwent bWL were 3.9 times more likely to undergo re-excision compared to patients in bRSL group (OR=3.9, 95% CI: 2.0-7.4). Initial and total SV did not significantly differ between the two groups (P=.4). Patients were significantly more likely to undergo a mastectomy in the bWL group than in the bRSL group (24% vs 7%; P<.01). For patients undergoing excision of radiologically extensive breast lesions, bRSL serves as an alternative to bWL. In this retrospective study, bRSL was associated with a decreased re-excision rate with similar SV and a lower rate of mastectomy when compared to bWL.

A meta-analysis of acculturation/enculturation and mental health.

This meta-analytic study examined the relationship among the constructs of acculturation, enculturation, and acculturation strategies (i.e., integration, assimilation, separation, marginalization), and mental health. Data from 325 studies (163 journal articles and 162 dissertation studies) were analyzed using a random-effects model, across a broad spectrum of negative mental health (NM: depression, anxiety, psychological distress, and negative affect) and positive mental health (PM: self-esteem, satisfaction with life, and positive affect). Overall, acculturation was favorably associated with both NM (negatively) and PM (positively), whereas enculturation was favorably related only to PM (positively). In fact, enculturation was positively related to anxiety. The specifics of these relations were further examined using the following moderators: (a) researchers' operationalization of acculturation/enculturation (i.e., linearity, dimensionality); (b) contextual influences (i.e., when and where the study was conducted); and (c) sample characteristics (i.e., voluntariness of residency, race, gender, age). Overall, bilinear measures of acculturation indicated a positive association with PM, while unilinear measures did not. External acculturation (e.g., language, behaviors) and internal enculturation (e.g., identity) were most favorably related to mental health. The place of study had differential effects on the relation of enculturation and NM. Acculturation appeared to be especially important to Asian Americans, whereas enculturation was to African Americans. Differential effects of age suggested the need to consider life-span development of needs and social roles in relation to acculturation and enculturation. Both correlational analyses and mean comparisons affirmed that integration was the most favorable acculturation strategy to mental health. Implications for research, practice, and theory are discussed.