Normally swallowing occurs completely without effort. Should the act of swallowing for some reason be impaired, it becomes difficult to eat and drink. Dysphagia is the medical term for eating and swallowing disorders. Dysphagia is common in people with dementia, but the prevalence is not yet fully evaluated. The most common cause of death in people with dementia is aspiration pneumonia, which can be caused by dysphagia. In Sweden investigation and treatment of dysphagia are performed by speech and language pathologists (SLPs) but few of them work with dementia care. This study aims to identify the prevalence of dysphagia in people with dementia, living in a nursing home. The screening methods SSA-S and LtL were used to test the swallowing of 38 participants between 68-96 years of age (M = 86 years). To examine the participants’ oral health the risk assessment tool ROAG was used. When tested with the water swallowing test SSA-S 71,1% of the participants showed signs of aspiration, 36,8% had an oral transit time over 5 seconds, measured with LtL and 92% of the participants had an affected oral health, showing one or more symptoms of severity grade 2 according to ROAG. When adding up the results from the two screening tests a total of 86,8% of the participants showed signs of some kind of swallowing difficulty. Correlation analysis did not show any statistically significant correlations between SSA-S, oral transit time, oral health, or age. The present study found that there is a great need for interventions from speech and language pathologists in people with dementia. / Normalt sker sväljning helt utan ansträngning. Skulle sväljningen av någon anledning inte fungera som den ska, blir det svårt att äta och dricka. Den medicinska termen för ät- och sväljsvårigheter är dysfagi. Dysfagi är vanligt hos personer med demens men det är ännu inte helt kartlagt hur vanligt det är. Hos personer med demens är den vanligaste dödsorsaken aspirationspneumoni, vilket kan orsakas av dysfagi. I Sverige är det logopeder som utreder och behandlar dysfagi men det är få som är verksamma inom demensvården. Den här studien syftar till att kartlägga förekomst av dysfagi hos personer med demenssjukdom boende på ett vård- och omsorgsboende. Med screeningmetoderna SSA-S och LtL genomfördes undersökningar av sväljförmågan hos 38 personer mellan 68-96 års ålder (M = 86 år). För att undersöka deltagarnas munhälsa användes riskbedömningsverktyget ROAG. Av deltagarna fick 71,1 % utslag på vattensväljningstestet SSA-S, 36,8 % hade en oral transporttid över 5 sekunder, mätt med LtL och 92 % av deltagarna hade en nedsatt munhälsa med ett eller flera symptom av grad 2 i munhålan, enligt ROAG. Vid sammanräkning av resultaten från de två screeningtesten uppvisade totalt 86,8 % av deltagarna tecken på någon form av sväljsvårighet. Korrelationsberäkningar visade inga statistiskt signifikanta samband mellan resultat på SSA-S, oral transporttid, munhälsa eller ålder. Studien visar på ett stort behov av logopediska insatser hos gruppen personer med demenssjukdom.

Zielsetzung In den Industrieländern stellt der Schlaganfall nach kardiovaskulären und Krebs – erkrankungen die dritthäufigste Krankheitsgruppe dar. Im Hinblick auf die Therapie des akuten Schlaganfalls muss die bildgebende Diagnostik schnell und einfach das Ausmaß der zerebralen Ischämie beschreiben können. Ziel dieser Studie war die Einführung und die Validierung eines CT – Protokolls, welches die Diagnostik des akuten Schlaganfalls verbessern soll. Zu diesem CT – Protokoll gehören ein Nativ – CT des Schädels, eine CT – Perfusionsuntersuchung und eine CT – Angiographie. Zusätzlich wollte diese Arbeit herausfinden, ob es physiologische Unterschiede zwischen der grauen Substanz und der weißen Substanz gibt, deren Kenntnis entscheidend für die Auswertung von computertomographischen Perfusionsuntersuchungen sind. Material und Methoden Insgesamt wurden 101 Patienten (Alter von 14 – 94 Jahre, mittleres Alter 69 Jahre) mit einem 8 – bzw. 16 – Zeilen – MSCT (Light Speed Ultra oder Light Speed pro 16, GE Healthcare), die zur Abklärung einer zerebralen Ischämie zum CT vorgestellt wurden, untersucht. Zuerst wurde eine native CT – Serie akquiriert. In der Untersuchung der zerebralen Perfusion wurde eine 2 cm breite Schicht über 60 sec mit 20 intermittierenden Aufnahmen während einer Injektion von 40 ml Kontrastmittel (Iopromid, Jodgehalt von 370 mg) aufgezeichnet. Daran an schloss sich eine CT – Angiographie Untersuchung. Zur Bestimmung des regionalen zerebralen Blutflusses, des regionalen zerebralen Blutvolumens und der mittleren Verweildauer wurden definierte Messfelder (Regions of Interests, ROIs) bestimmt und mit der kontralateralen Hemisphäre verglichen. Ergebnisse Es konnte gezeigt werden, dass der regionale zerebrale Blutfluss und das Blutvolumen im Bereich der Hirnrinde höher sind als im Hirnmark. Insgesamt wurden 66 Patienten mit einer zerebralen Ischämie wurden gefunden. Bei 22 dieser Patienten konnte ein Infarktgeschehen in der Nativ – CT diagnostiziert werden. Diese Ischämien ließen sich auch in der CT – Perfusion mit reduziertem regionalem zerebralem Blutfluss und verlängerter mittlerer Verweildauer nachweisen. Zusätzlich fanden sich 44 Patienten von 101 Untersuchten, die in der CT – Perfusion ein Perfusionsdefizit aufwiesen. Bei diesen Patienten ließ sich kein entsprechendes Korrelat in der Nativ – CT nachweisen. Für 38 dieser 44 Patienten konnte eine CTA durchgeführt werden, wovon für 35 Patienten ein Korrelat zwischen der CT – Perfusion und der CTA gefunden werden konnte. Schlussfolgerung Die Ergebnisse dieser Arbeit zeigen, dass es physiologische Unterschiede zwischen der Hirnrinde und dem Hirnmark gibt, deren Kenntnis für die Bewertung computertomographischer Perfusionsuntersuchungen eine wesentliche Interpretationshilfe darstellt. In Bezug auf die Diagnostik des akuten Schlaganfalls mit der Nativ – CT konnte diese Arbeit zeigen, dass der Nachweis von Infarktfrühzeichen eingeschränkt ist. Mit Hilfe der CT – Perfusion ist es möglich, anhand von zerebralen Perfusionswerten den Schweregrad und die Ausdehnung der zerebralen Ischämie zu bestimmen. Die CT – Angiographie zeigt eine gute Korrelation zur CT – Perfusion, es lassen sich zuverlässig Gefäßverschlüsse darstellen. Im Hinblick auf das weitere Therapievorgehen geben diese Methoden eine wichtige Hilfestellung, etwa zur Überlegung, ob man eine Lysetherapie durchführen sollte oder nicht. / Purpose Stroke is the third – leading cause of death in developed countries, following cardiovascular disease and cancer. There is a need for an easily and rapidly performed technique to detect cerebral ischemia in the first hours after its occurrence. The purpose of this study was the introduction and validation of a Stroke protocol which includes an unenhanced CT scan, a CT Perfusion and a CT Angiography. Furthermore, the purpose of this study was to determine if there is a difference between Perfusion parameters in gray and white matter, which are necessary to know while performing perfusion maps. Data and Methodology A total of 101 patients (age range 14 – 94, average age 69 years) were examined using multiple row CT (8 / 16 row multiple detector, light ultra speed or light speed 16, GE medical systems) for diagnosing cerebral ischemia. First a series of native images was acquired. During the examination of cerebral perfusion a 2 cm wide slab was recorded for 60 sec with 20 intermittent scans following injection of 40 ml of contrast medium with an iodine content of 370 mg / ml. By defining Regions of Interests (ROIs) regional cerebral blood flow (CBF), regional cerebral blood volume (CBV) and mean transit time (MTT) were calculated. Results Physiological regional cerebral blood flow and cerebral blood volume in gray matter were higher than in white matter. In total 66 patients with a cerebral ischemia were found. The unenhanced CT detected 22 patients with cerebral ischemia, which were confirmed by CT Perfusion in all cases. These ischemic areas revealed reduced regional CBF and extended MTT. Furthermore an ischemia correlative was discovered by perfusion analysis for 44 patients (out of 101 investigated) where the extent of the cerebral ischemia had not been visible by unenhanced CT. For 38 out of 44 patients with cerebral ischemia we were able to perform a CTA. For 35 out of these 38 patients, we found a sizable correlation between perfusion maps and CTA. Conclusion There are physiological differences for CT Perfusion parameters between gray and white matter, which are necessary to know for the interpretation of perfusion maps. However, this examination was able to show that unenhanced CT is not always capable of showing early CT signs. With the help of CT perfusion it is possible to detect the extent of acute cerebral ischemia. Furthermore, CT Angiography shows a sizable correlation compared to CT Perfusion. In conjunction, these methods give important Information for the early diagnosis and the therapeutic strategy of ischemic brain injury.

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.

This dissertation integrates a process-based hydrological investigation with an ongoing paired-catchment study to better understand how forest harvest impacts catchment function at multiple scales. We do this by addressing fundamental questions related to the stocks, flows and transit times of water. Isotope tracers are used within a top-down catchment intercomparison framework to investigate the role of geology in controlling streamwater mean transit time and their scaling relationships with the surrounding landscape. We found that streams draining catchments with permeable bedrock geology at the Drift Creek watershed in the Oregon Coast Range had longer mean transit times than catchments with poorly permeable bedrock at the HJ Andrews Experimental Forest in the Oregon Cascades. We also found that differences in permeability contrasts within the subsurface controlled whether mean transit time scaled with indices of catchment topography (for the poorly permeable bedrock) or with catchment area (for the permeable bedrock). We then investigated the process-reasons for the observed differences in mean transit time ranges and scaling behavior using a detailed, bottom-up approach to characterize subsurface water stores and fluxes. We found that the mean transit times in catchments underlain by permeable bedrock were influenced by multiple subsurface storage pools with different groundwater ages, whereas storage in the poorly permeable catchments was limited to the soil profile and that resulted in quick routing of excess water to the stream at the soil bedrock interface, leading to mean transit times that were closely related to flowpath lengths and gradients. Finally, we examined how and where forest trees interacted with subsurface storage during the growing season using a forest manipulation experiment, where we tested the null hypothesis that near-stream trees alone influenced daily fluctuations in streamflow. We felled trees within this zone for two 2.5 ha basins and combined this with isotopic tracing of tree xylem water to test if water sources utilized by trees actively contributed to summer streamflow. We rejected our null hypotheses and found that diel fluctuations in streamflow were not generated exclusively in the near-stream zone. We were unable to link, isotopically, the water sources trees were utilizing to water that was contributing to streamflow. Our results provide new process-insights to how water is stored, extracted, and discharged from our forested catchments in Western Oregon that will help better explain how forest removal influences streamflow across multiple scales and geological conditions. / Graduation date: 2012