Nurses' knowledge of stroke-related oropharyngeal dysphagia in the Eastern Cape, South Africa.

BACKGROUND: Early identification of stroke-related oropharyngeal dysphagia (OPD) using screening by nurses can prevent adverse patient outcomes in lower middle-income countries. Nurses are essential in the OPD management team and should ideally be able to screen and prioritise dysphagia management in stroke patients. OBJECTIVE: The aim of this research was to describe nurses' practices related to identification and management of patients with stroke-related OPD. METHODS: Qualified nurses from various healthcare levels in the Eastern Cape, South Africa were invited to complete a previously published hard copy survey on the signs and symptoms, complications and management of stroke-related OPD. A sample of 130 participants completed the survey. RESULTS: The mean scores of correct responses for each section were: 8.7/13 (66.7%) for signs and symptoms, 4.7/10 (47.3%) for complications and 3.8/7 (54.2%) for management practices. Statistically, there were no differences between the levels of healthcare for the signs and symptoms section and the complications section. Regarding management of OPD, secondary-level (S) nurses demonstrated significantly better knowledge than primary-level (P) and tertiary-level (T) nurses (S-P: p = 0.022; S-T: p = 0.010). Secondary-level nurses also scored significantly higher across all three sections (S-P: p = 0.044; S-T: p = 0.025) than those at the other levels. CONCLUSIONS: The study found that nurses across all levels of healthcare had only moderate knowledge regarding identification and management of stroke-related OPD. Interdisciplinary collaboration between nurses and speech-language therapists may improve nurses' knowledge in identification and management of stroke-related OPD in lower middle-income settings such as South Africa.

The effect of age of cochlear implantation on vocal characteristics in children.

BACKGROUND: Early cochlear implantation aids auditory feedback and supports better communication and self-monitoring of the voice. The objective of this study was to determine whether the age of cochlear implantation has an impact on vocal development in children implanted before age 4. METHOD AND PROCEDURES: The study consisted of 19 participants in total. All implant recipients (experimental group) were 3-5 years post-implantation, including four prelingual (0-2 years) and five perilingual (2-4 years) implant recipients. The control group consisted of 10 children whose hearing was within normal limits between the ages 3-6 years and 10 months, which was compared to the experimental group. Established paediatric norms were used for additional comparison. A questionnaire was used to gather information from each of the participant's caregivers to determine whether other personal and contextual factors had an impact on voice production. An acoustic analysis was conducted for each participant using the Multi-Dimensional Voice Program of the Computerized Speech Lab. RESULTS: When the experimental group and the control group were compared, similar results were yielded for fundamental frequency and short-term perturbation (jitter and shimmer). More variability was noted in long-term frequency and amplitude measures, with significantly higher differences, and therefore further outside the norms, in the prelingual group when compared to the perilingual and control groups. CONCLUSION: In this study, age of implantation did not impact vocal characteristics. Further research should include larger sample sizes, with participants that are age and gender matched.

Mechanically assisted 3D ultrasound guided prostate biopsy system.

There are currently limitations associated with the prostate biopsy procedure, which is the most commonly used method for a definitive diagnosis of prostate cancer. With the use of two-dimensional (2D) transrectal ultrasound (TRUS) for needle-guidance in this procedure, the physician has restricted anatomical reference points for guiding the needle to target sites. Further, any motion of the physician's hand during the procedure may cause the prostate to move or deform to a prohibitive extent. These variations make it difficult to establish a consistent reference frame for guiding a needle. We have developed a 3D navigation system for prostate biopsy, which addresses these shortcomings. This system is composed of a 3D US imaging subsystem and a passive mechanical arm to minimize prostate motion. To validate our prototype, a series of experiments were performed on prostate phantoms. The 3D scan of the string phantom produced minimal geometric distortions, and the geometric error of the 3D imaging subsystem was 0.37 mm. The accuracy of 3D prostate segmentation was determined by comparing the known volume in a certified phantom to a reconstructed volume generated by our system and was shown to estimate the volume with less then 5% error. Biopsy needle guidance accuracy tests in agar prostate phantoms showed that the mean error was 2.1 mm and the 3D location of the biopsy core was recorded with a mean error of 1.8 mm. In this paper, we describe the mechanical design and validation of the prototype system using an in vitro prostate phantom. Preliminary results from an ongoing clinical trial show that prostate motion is small with an in-plane displacement of less than 1 mm during the biopsy procedure.

Identification and analysis of rhizobial plasmid origins of transfer.

Twelve Rhizobium leguminosarum isolates from France, Germany and the UK, each carrying between four and seven plasmids, were screened by PCR using primers designed to amplify partial traA and traC genes and the intergenic spacer (igs) between them, which is expected to contain oriT (the nick site for conjugal transfer). Five strains, 1062, RES-2, RES-6, RES-7 and RES-9, generated oriT-containing PCR fragments. Sequencing identified three types that are related to but different from other rhizobial plasmid oriT sequences in the database. Sequence comparisons revealed conserved motifs in the igs, including a 14-bp putative nic site, a stem-loop and a tra box. The RES-2, RES-6 and RES-9 PCR products were used as probes in Southern hybridisation studies to screen the 12 strains for related sequences. Eleven strains contain at least one homologous sequence, but of the 64 plasmids present among the 12 strains only 17 hybridised to the oriT probes. Four sequence variants of the repC plasmid replication initiation gene have previously been described in these strains, but there is no correlation between repC and oriT sequence distributions, and there is evidence for recombination to generate different repC-oriT combinations. Three plasmids, pYK32, pYK36 and pYK39, containing the oriT amplified from RES-2, RES-6 and RES-9, respectively, were constructed for functional analysis of the oriT sequence variation. Each plasmid was transformed into R. leguminosarum strains 1062, RES-2 and RES-9 to generate nine donor-plasmid combinations, and their mobilisation frequencies into Escherichia coli and Agrobacterium tumefaciens measured following biparental matings. All three plasmid constructs were mobilised at a similar frequency (10(-7) to 10(-8) per recipient) by each donor strain, suggesting that there is no discrimination by the transfer proteins between the different oriT sequences.