Translation, and validation of Dysphagia Outcome and Severity Scale (DOSS): Swedish version

BACKGROUND

Swallowing dysfunction (dysphagia) significantly impacts patient and medical outcomes. In Sweden, there is no comprehensive outcome measure for dysphagia that incorporates holistic assessment and dysphagia impact on a person's impairment, function and participation. The Dysphagia Outcome and Severity Scale (DOSS) was developed and validated (in English) and incorporates the World Health Organisation's (WHO) aforementioned, International Classification of Functioning (ICF) aspects. This study translated then evaluated the validity and reliability of the Swedish version, DOSS-S.

METHOD

Translation occurred based on WHO recommendations. The Content Validity Index (CVI) of the translated version (DOSS-S) was assessed twice by 11 (multi-professional) dysphagia experts. Criterion validity and rater reliability was calculated using 18 Speech Pathologists assessing patient cases from International Dysphagia Diet Standardization Initiative-Functional Diet Scale (IDDS-FDS) research.

RESULTS

Very high CVI values (0.96-0.99) for the linguistic correlation, and high CVI values (0.84-0.94) for applicability correlation were achieved. High criterion validity of DOSS-S with IDDSI-FDS was demonstrated (rs = 0.89, p < 0.01), with very high inter and intra rater reliabilities (ICC > 0.90).

CONCLUSION

The DOSS-S demonstrated very high validity values, and very high inter and intra rater reliability. This research contributes to improved dysphagia management by providing interprofessional dysphagia clinicians with a validated scale to identify patient progression, communicate dysphagia status between regions and countries, and document patient outcomes using an ICF framework.

Investigation of the Effects of Dioctyl Sulfosuccinate on the Photodegradation of Benzo[a]Pyrene in Aqueous Solutions under Various Wavelength Regimes

Due to the relatively high concentrations of polycyclic aromatic hydrocarbons (PAHs) in oil samples, oil spills in aquatic ecosystems release significant amounts of PAHs. Although remediation efforts often take place during or immediately after an oil spill incident, a portion of the released PAHs remains in the body of water. A natural phenomenon resulting from the direct exposure of PAHs to sunlight is photodegradation. This article investigates the effect of dioctyl sulfosuccinate (DOSS) on the photodegradation of benzo[a]pyrene (BaP), the most toxic PAH in the priority pollutants list of the US Environmental Protection Agency (EPA). DOSS is a surfactant typically used in the remediation of oil spills. Three lamps with maximum emission wavelengths at 350 nm, 419 nm, and 575 nm were individually and simultaneously used to irradiate aqueous solutions of BaP in the absence and the presence of DOSS. When irradiated with the 419 nm lamp or the 575 lamp, BaP showed no photodegradation. Upon irradiation with the 350 nm lamp and with the simultaneous use of the three lamps, the photodegradation of BaP followed first-order kinetics. Independent of the irradiation wavelength, the presence of DOSS increased the half-life of BaP in the aqueous solution. In the case of the 350 nm lamp, the rate constant of photodegradation in the absence and the presence of DOSS varied from (3.79 ± 0.97) × 10-3 min-1 to (1.10 ± 0.13) × 10-3 min-1, respectively. Under simultaneous irradiation with the lamps, the rate constant of photodegradation varied from (1.12 ± 0.35) × 10-3 min (no DOSS) to (3.30 ± 0.87) × 10-4 (with DOSS). Since the largest rate constants of photodegradation were observed in the absence of DOSS, the longer half-lives of BaP in the presence of surfactant were attributed to the incorporation of PAH molecules into the DOSS micelles.

Evaluation of the association of anticholinergic burden and delirium in older hospitalised patients - A cohort study comparing 19 anticholinergic burden scales

AIMS

A recent review identified 19 anticholinergic burden scales (ABSs) but no study has yet compared the impact of all 19 ABSs on delirium. We evaluated whether a high anticholinergic burden as classified by each ABS is associated with incident delirium.

METHOD

We performed a retrospective cohort study in a Swiss tertiary teaching hospital using data from 2015-2018. Included were patients aged ≥65, hospitalised ≥48 hours with no stay >24 hours in intensive care. Delirium was defined twofold: (i) ICD-10 or CAM and (ii) ICD-10 or CAM or DOSS. Patients' cumulative anticholinergic burden score, calculated within 24 hours after admission, was classified using a binary (<3: low, ≥3: high burden) and a categorical approach (0: no, 0.5-3: low, ≥3: high burden). Association was analysed using multivariable logistic regression.

RESULTS

Over 25 000 patients (mean age 77.9 ± 7.6 years) were included. Of these, (i) 864 (3.3%) and (ii) 2770 (11.0%) developed delirium. Depending on the evaluated ABS, 4-63% of the patients were exposed to at least one anticholinergic drug. Out of 19 ABSs, (i) 14 and (ii) 16 showed a significant association with the outcomes. A patient with a high anticholinergic burden score had odds ratios (ORs) of 1.21 (95% confidence interval [CI]: 1.03-1.42) to 2.63 (95% CI: 2.28-3.03) for incident delirium compared to those with low or no burden.

CONCLUSION

A high anticholinergic burden within 24 hours after admission was significantly associated with incident delirium. Although prospective studies need to confirm these results, discontinuing or substituting drugs with a score of ≥3 at admission might be a targeted intervention to reduce incident delirium.

New Cutoff Scores for Delirium Screening Tools to Predict Patient Mortality

BACKGROUND/OBJECTIVES

Detecting delirium is important to identify patients with a high risk of poor outcomes. Although many different kinds of screening instruments for delirium exist, there is no solid consensus about which methods are the most effective. In addition, it is important to find the most useful tools in predicting outcomes such as mortality.

DESIGN

Retrospective cohort study.

SETTING

University of Iowa Hospitals and Clinics.

PARTICIPANTS

A total of 1,125 adult inpatients (mean age = 67.7; median age = 69).

MEASUREMENTS

Post hoc analyses were performed based on existing data from the Confusion Assessment Method for Intensive Care Unit (CAM-ICU), Delirium Rating Scale-Revised-98 (DRS), and the Delirium Observation Screening Scale (DOSS). Correlation among these scales and relationships between 365-day mortality and each scale were evaluated.

RESULTS

A positive result on the CAM-ICU ("CAM-ICU positive") was associated with higher DRS and DOSS scores. A DRS score = 9/10 was the best cutoff to detect CAM-ICU positive, and DOSS = 2/3 was the best cutoff to detect CAM-ICU positive. CAM-ICU positive was associated with high 365-day mortality. DRS score = 9/10 and DOSS score = 0/1 were found to differentiate mortality risk the most significantly. Higher DRS and DOSS scores significantly coincided with a decrease in a patient's survival rate at 365 days.

CONCLUSION

The best DRS and DOSS cutoff scores to differentiate 365-day mortality risk were lower than those commonly used to detect delirium in the literature. New cutoff scores for the DRS and DOSS might be useful in differentiating risk of mortality among hospital patients.

Effects of the rotigotine transdermal patch versus oral levodopa on swallowing in patients with Parkinson's disease

OBJECTIVES

Abnormal swallowing or dysphagia is a potentially fatal symptom in Parkinson's disease (PD) and is characterized by frequent silent aspiration, which is an unrecognized risk for aspiration pneumonia. While the effects of oral levodopa on swallowing functions remain controversial, several small-scale studies have reported that rotigotine transdermal patch seems effective. The different effects between levodopa and rotigotine may be attributed to continuous dopaminergic stimulation (CDS), however, the absence of direct comparative evidence precludes conclusion.

METHODS

In the present retrospective open-label study of 50 patients with PD, swallowing functions were assessed via videofluoroscopic (VF) examination before and after treatment. Treatment included 2 mg/day rotigotine transdermal patch (N = 29) or 200 mg/day oral levodopa with carbidopa (N = 21) in drug-naïve and add-on groups of patients.

RESULTS

Rotigotine more consistently improved all measures assessed via VF examination. Such effects were similar to those in the drug-naïve and add-on groups. Improvement and responder rates of certain measures were significantly higher in the rotigotine group than in the levodopa group.

CONCLUSIONS

Our finding that rotigotine (levodopa equivalent dose = 60 mg) was more consistently effective than 200 mg/day oral levodopa suggests that CDS is more important in improving swallowing functions.

Characteristics of Hospitalized Patients Screening Positive for Delirium

BACKGROUND

Delirium in the hospitals leads to worse outcomes for patients. There were no previous studies that characterize patients with delirium from multiple hospital locations.

OBJECTIVE

To describe patient characteristics screening positive for delirium and identify any correlations with hospital location and medication use.

DESIGN, SETTINGS, PATIENTS

Retrospective chart review of 227 hospitalized patients from a large, academic, tertiary referral, 2-campus health system. Patients were ≥18 years old and had delirium for at least ≥24 hours. Validated delirium screening tools were utilized.

MEASUREMENTS

Patients' demographics, inpatient stay information, delirium episodes characteristics, drugs, and palliative and psychiatry teams' involvement.

RESULTS

Most patients were older with a mean age of 64.1 years. The most common primary diagnoses were infection, cardiac, and pulmonary. Average length of delirium was 7.2 days (standard deviation [SD] = 8.2), and average length of stay (LOS) was 18.7 days (median = 10.5, SD = 35.1, 95% confidence interval = 14.1-23). Thirty-day readmission rate was 24.8% (65/262 hospitalizations); 12.8% of patients died in the hospital (29/227). Around one-third of hospitalizations had involvement of palliative care, palliative psychiatry, or general psychiatry team. There was a decrease in the number of medications administered 24 hours after the first recording of delirium compared to the immediate preceding 48 hours. Those hospitalizations where delirium first occurred in the intensive care unit (ICU) did have a longer LOS (average = 22.9, SD = 45.7) than those where delirium first occurred outside the ICU (average = 14.8, SD = 20.5). Patients were likely to have received an opioid within 48 hours in 51% of hospitalizations and to have received benzodiazepines in 16% of hospitalizations.

CONCLUSION

In our study, we found that delirium significantly impacted length of delirium episode, number of episodes of delirium, length of hospital admission, and mortality. The population most sensitive to the impacts of delirium were elderly patients.

Improved oil spill dispersant monitoring in seawater using dual tracers: Dioctyl and monoctyl sulfosuccinates sourced from corexit EC9500A

A high resolution mass spectrometry method was developed for the environmental impact monitoring of oil spill dispersants. Previously reported instability of dioctyl sulfosuccinate (DOSS) dispersant tracer was addressed by the new procedure. The method monitors both DOSS and its degradation product, monooctyl sulfosuccinate (MOSS), by liquid chromatography time-of-flight mass spectrometry. The related isomer, 4-(2-ethylhexyl) 2-sulfobutanedioate, was chromatographically resolved from MOSS but was not a product of DOSS degradation. Using this direct injection method (10 μL), the practical lower limit of quantitation was 0.5 nM for each analyte, a concentration equivalent to 0.22 ng mL^-1, or 0.30 ng mL^-1 including initial dilution factor with acetonitrile. The method was shown applicable to analysis of the dispersants Corexit® EC9500 A, Finasol OSR 52, Slickgone NS, and Slickgone EW for which DOSS is an active ingredient. A marine microcosm study of Corexit EC9500A, together with diluted bitumen (dilbit), at 15 ± 1 °C, provided evidence of the stoichiometric conversion of DOSS to MOSS under conditions reflecting a western Canadian marine environment. The advantage of the developed method is in its ability to extend environmental seawater sample collection time from 4 days for DOSS alone, to 14 days when both DOSS and MOSS are simultaneously analysed and results combined. The collection time is likely extended beyond the 14 day period with cooler temperatures. Preservation of collected seawater samples using sodium hydroxide, converting DOSS into MOSS in situ, was rejected due to stability issues. Addition of disodium ethylenediaminetetraacetic acid did not improve hold times, thus eliminating the theory of cation induced micelle effects causing DOSS loss.

Antioxidant responses and oxidative stress in sheepshead minnow larvae exposed to Corexit 9500® or its component surfactant, DOSS

Large-scale use of dispersants to remediate oil spills has raised concerns about their toxicity to marine organisms. Of particular concern is oxidative stress and resulting membrane damage due to exposure to surfactants in dispersant mixtures. We investigated the potential of the dispersant Corexit 9500^® and one of its major components, the anionic surfactant dioctyl sodium sulfosuccinate (DOSS), to induce oxidative stress in larval sheepshead minnows after 24 and 96h exposures, at two sublethal concentrations, the lesser being environmentally realistic for each compound. Corexit exposures elicited only minimal antioxidant responses for most antioxidant components tested, with increased glutathione peroxidase (GPx) and glutathione S-transferase (GST) activities observed only after 96h and at the higher exposure concentration. In contrast, DOSS induced statistically significant increases in the levels of reactive oxygen species (ROS), GPx, and lipid peroxidation, as well as depleted reduced glutathione (GSH) levels at both time points and concentrations. These data indicate that short-term and environmentally realistic exposures to DOSS can impact antioxidant response capabilities, raising concern about its use in oil dispersants and other high volume use products where environmental releases are likely.

Sand patties provide evidence for the presence of Deepwater Horizon oil on the beaches of the West Florida Shelf

The ecological consequences of the Deepwater Horizon (DWH) oil spill are both long-term and pervasive. The distribution of toxicity and mutagenicity in the Gulf of Mexico suggests oil from the DWH spill could have contaminated the West Florida Shelf (WFS). We utilized polycyclic aromatic hydrocarbon (PAH) analysis to determine presence and potential origin of oil contaminants in beach sand patty samples. PAH profiles from WFS beaches were statistically significantly similar to DWH contaminated samples from the Northeast Gulf of Mexico (Gulf Shores, AL; Ft. Pickens, FL). Dioctyl sodium sulfosuccinate (DOSS), a major component of Corexit 9500 dispersant was also detected in the sediments. DOSS concentrations ranged from 1.6 to 5.5ngg(-1) dry weight. Additionally, two samples from DWH oil contaminated beaches were acutely toxic and one WFS beach sediment sample was mutagenic. These observations provide support for the theory that DWH oil made its way onto beaches of the WFS.

Phase and sedimentation behavior of oil (octane) dispersions in the presence of model mineral aggregates

Adsorption of suspended particles to the interface of surfactant-dispersed oil droplets can alter emulsion phase and sedimentation behavior. This work examines the effects of model mineral aggregates (silica nanoparticle aggregates or SNAs) on the behavior of oil (octane)-water emulsions prepared using sodium bis(2-ethylhexyl) sulfosuccinate (DOSS). Experiments were conducted at different SNA hydrophobicities in deionized and synthetic seawater (SSW), and at 0.5mM and 2.5mM DOSS. SNAs were characterized by thermogravimetric analysis (TGA) and dynamic light scattering (DLS), and the emulsions were examined by optical and cryogenic scanning electron microscopy. In deionized water, oil-in-water emulsions were formed with DOSS and the SNAs did not adhere to the droplets or alter emulsion behavior. In SSW, water-in-oil emulsions were formed with DOSS and SNA-DOSS binding through cation bridging led to phase inversion to oil-in-water emulsions. Droplet oil-mineral aggregates (OMAs) were observed for hydrophilic SNAs, while hydrophobic SNAs yielded quickly sedimenting agglomerated OMAs.

Regioselective syntheses of [13C]4-labelled sodium 1-carboxy-2-(2-ethylhexyloxycarbonyl)ethanesulfonate and sodium 2-carboxy-1-(2-ethylhexyloxycarbonyl)ethanesulfonate from [13C]4-maleic anhydride

The entitled monohydrolysis products, also known as α-ethylhexyl and β-ethylhexyl sulfosuccinate (EHSS), of the surfactant diisooctyl sulfosuccinate (DOSS) were synthesized in stable isotope-labelled form from [(13)C]4 -maleic anhydride. Sodium [(13)C]4 -1-carboxy-2-(2-ethylhexyloxycarbonyl)ethanesulfonate (α-EHSS) was prepared by the method of Larpent by reaction of 2-ethylhexan-1-ol with [(13)C]4 -maleic anhydride followed by regioselective conjugate addition of sodium bisulfite to the resulting monoester (38% overall yield). The regiochemical outcome of bisulfite addition was confirmed by a combination of (13)C/(13)C (incredible natural abundance double quantum transfer) and (1)H/(13)C (heteronuclear multiple-bond correlation (HMBC)) NMR spectral correlation experiments. Sodium [(13)C]4 -2-carboxy-1-(2-ethylhexyloxycarbonyl)ethanesulfonate (β-EHSS) was prepared in four steps by reaction of 4-methoxybenzyl alcohol with [(13)C]4 -maleic anhydride, regioselective sodium bisulfite addition, N,N'-dicyclohexylcarbodiimide-mediated esterification with 2-ethylhexan-1-ol, and p-methoxybenzyl ester deprotection with trifluoroacetic acid (13% overall yield). The regiochemical outcome of the second synthesis was confirmed by a combination of (1)JCC scalar coupling constant analysis and (1)H/(13)C (HMBC) NMR spectral correlation. The materials prepared are required as internal standards for the liquid chromatography-mass spectrometry (LC-MS)/MS trace analysis of the degradation products of DOSS, the anionic surfactant found in Corexit, the oil dispersant used during emergency response efforts connected to the Deepwater Horizon oil spill of April 2010.