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Kendrea L Garand,1 Charlie Strange,2 Luca Paoletti,2 Theresa Hopkins-Rossabi,3 Bonnie Martin-Harris3 1Department of Speech Pathology and Audiology, College of Allied Health Professions, University of South Alabama, Mobile, AL 36688, USA; 2Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; 3Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL 60208, USA Background: Swallowing impairment (dysphagia) has been associated with COPD and may contribute to exacerbations of this chronic and progressive disease. Further, risk of mortality increases with concomitant presence of cachexia in the COPD population. The purpose of this prospective study was to depict oropharyngeal swallowing physiology in underweight patients with stable but advanced-stage COPD. Patients and methods: Ten underweight patients with stable but advanced COPD underwent a modified barium swallow study. Analysis of oropharyngeal swallowing function was completed using the standardized Modified Barium Swallow Impairment Profile and the Penetration–Aspiration Scale. Scores from the Dysphagia Handicap Index and 10-item Eating Assessment Tool were collected to assess patient perception of swallowing difficulty. Findings were compared to age- and sex-matched healthy controls. Results: Significantly higher MBSImP oral total scores (P=0.007) were observed in COPD patients compared to matched controls, but no difference was observed in pharyngeal total scores (P=0.105). Patients with COPD had significantly higher maximum PAS scores compared with controls (P=0.030). There was no significant difference in EAT-10 or DHI scores between patients with COPD and controls (P=0.41 and P=0.08, respectively). Conclusion: Underweight patients with severe but stable COPD present with dysphagia that may not be recognized by the patient. Further investigation is needed to elucidate the interaction between the respiratory–swallowing systems, how muscular weakness may contribute to swallowing impairment, and responsiveness to swallowing treatment. Keywords: COPD, swallowing impairment, MBSImP, dysphagia, underweight

The aim of this Symposium was to develop a consensus based, bulbar assessment protocol for implementation within NEALS clinics.A one-day symposium, held in April 2017, was organized into Speech and Swallowing sections to establish summary recommendations for the assessment of bulbar dysfunction within each group.Summary recommendations included speech referrals and AAC evaluations at initial visit, CNS-BFS, maximum sustained phonation, and speaking rate. Dysarthria evaluation included the speech subsystem involvement of respiration, phonation, resonance, and articulation. Specific recommendations for swallowing were established for each of the following domains: dietary/oral intake, airway defense physiologic capacity, swallow safety screen, patient-reported swallow-related outcomes, oral sensorimotor exam, and pulmonary function. Practice parameters focused upon patient education and unresolved questions included the use of videofluoscopy, monitoring diet progression, and swallow safety screening.The working goal is to establish a clinical bulbar protocol, designed to be incorporated within ALS clinics and ultimately to formulate a best practice set of bulbar ALS guidelines, available for implementation throughout the international ALS community.

On 3 November 1993 a new higher‐resolution version of the regional forecast system was implemented into operations at the Canadian Meteorological Centre. The changes include modifications to the regional data assimilation system and to the regional finite‐element (RFE) forecast model. The main features of the new version of the RFE model include an increase in resolution from 100 to 50 km and to 25 σ levels in the vertical. The fields that describe the surface characteristics are generated directly on the 50‐km grid of the model from high‐resolution global geophysical datasets, yielding more details and a much better definition of the orography and coastlines. The new RFE model also includes an improved package of physical parametrizations, notably for condensation and radiation processes. The major changes to the data assimilation are a higher‐resolution analysis, and the assimilation of humidity profiles retrieved from satellite imagery. The new system is evaluated using performance statistics,...