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Background To reduce the risk of long-term swallowing complications after radiation, swallowing exercises may be helpful. Both the rate of adherence to swallowing exercises and its impact on future swallowing function are unknown. Methods In all, 109 patients with oropharyngeal cancer beginning radiation were tracked for 2 years to determine adherence to swallowing exercises. Participants completed the MD Anderson Dysphagia Inventory (MDADI) 1–2 years after treatment, to assess self-reported swallowing function. Adherence, demographics, tumor, and treatment variables were multivariably regressed onto the MDADI physical subscale score. Results In accord with speech pathologist documentation, 13% of the participants were fully adherent and 32% were partially adherent. Adherence was associated with the Physical MDADI Subscale score in the multivariate model (p = .01). Conclusions The majority of patients with head and neck cancer are nonadherent to swallowing exercise regimens and may benefit from supportive care strategies to optimize their adherence. © 2013 Wiley Periodicals, Inc. Head Neck 35: 1707–1712, 2013

The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care providers, educators, the public, patients, and families. The main focus of stakeholder engagement should address some core interventions geared towards improving knowledge and awareness, strengthening skills and attitudes about palliative care. These interventions include educating health and allied healthcare professionals on the palliative care-related problems of patients and best practices for care, explaining palliative care as a clinical and holistic discipline and demonstrating its effectiveness, the need to include palliative care into national policies, strategic plans, training curriculums of healthcare professionals and the engagement of patients, families, and communities. Interventions from a five-year programme that was aimed at strengthening the health system of Namibia through the integration of palliative care for people living with HIV and AIDS and cancer in Namibia are shared. This article illustrates how a country can implement the World Health Organisation’s public health strategy for developing palliative care services, which recommends four pillars: government policy, education, drug availability, and implementation.

An accurate characterisation of the organic dyes used in artworks, especially those made of paper, is an important factor in designing safe conservation treatments. In the case of synthetic organic dyes used in modern works of art, for example, one frequently encountered difficulty is that some of these dyes are not still commercially available. Recognizing this problem, the authors of this paper present the results of an analysis of UV–Vis–NIR fibre optic reflectance spectra of 82 samples of dyed paper prepared with 41 dyes. The samples come from a historic book, The Dyeing of Paper in the Pulp , which was published by Interessen-Gemeinschaft (I.G.) Farbenindustrie in 1925. The dyes used in the paper pulp belong to the azo compounds, acridine, anthraquinone, azine, diphenylmethane, indigoid, methine, nitro, quinoline, thiazine, triphenylmethane, sulphur and xanthene classes.

Re-distributed manufacturing (RDM) has the potential to be beneficial to business and society through creating jobs, reducing the environmental impacts of production, and improving organizational and societal resilience to future disturbances. The potential impacts of RDM for a city-region are complex and their exploration requires the consideration of a wide range of issues—societal, technical, logistical, and environmental. This paper discusses the use of an approach called Integrated Assessment to carry out an initial scoping of the issues. A research framework for RDM, and the key themes from a workshop that explored the causal relationships between different types of resilience, sustainability, and the manufacturing sectors are presented.

Purpose The purpose of this paper is to outline the work of a service provider, service user and carer group created to develop a strategy for service user and carer co-production. Design/methodology/approach A reflective narrative account is given of the process through which the group formed and began to develop a working model aimed at shaping a cultural shift towards more co-produced services. The paper has been co-produced and includes the collaborative voices of service users, carers, multi-disciplinary staff, third-sector representatives, managers and colleagues from associated services. Findings The model developed outlines three stages for services to work through in order to achieve meaningful and sustainable co-produced services. The importance of developing associated policies related to such areas as recruitment, payment, support and training is also outlined. Challenges to co-production are noted along with suggested approaches to overcoming these. Originality/value The ethos of co-production is relatively new in the UK and so knowledge of the process and model may help guide others undertaking similar work.

In recent years, it seems like everything from weather to fuel prices has become more volatile, adding new stresses to electric systems which are already running at or near their peak capacity. What has received less attention is the opportunity and value of investments that both lower demand and help mitigate price volatility in the market. Rachel Freeman looks at approaches to balancing supply-side investments with appropriate demand-side investments, and argues that these investments are an important and necessary factor in any well-functioning electricity system.

To reduce the risk of long-term swallowing complications after radiation, swallowing exercises may be helpful. Both the rate of adherence to swallowing exercises and its impact on future swallowing function are unknown.In all, 109 patients with oropharyngeal cancer beginning radiation were tracked for 2 years to determine adherence to swallowing exercises. Participants completed the MD Anderson Dysphagia Inventory (MDADI) 1-2 years after treatment, to assess self-reported swallowing function. Adherence, demographics, tumor, and treatment variables were multivariably regressed onto the MDADI physical subscale score.In accord with speech pathologist documentation, 13% of the participants were fully adherent and 32% were partially adherent. Adherence was associated with the Physical MDADI Subscale score in the multivariate model (p = .01).The majority of patients with head and neck cancer are nonadherent to swallowing exercise regimens and may benefit from supportive care strategies to optimize their adherence.

Simulations of pedal positioning, using Jack modelling software, were conducted to determine, for 1 st percentile female to 99 th percentile male, the optimal fore/aft positioning of the accelerator pedal for joint comfort, and the resulting consequences on strength and comfort for brake pedal use. The results produced a range of acceptable pedal positions for 99% of the population at seat heights between 15 cm and 25 cm above the floor. Pedal positions could not be located at seat heights above 25 cm due to ankle angle comfort constraints. The discrepancies between several comfort threshold studies reported in the literature are discussed relative to the practical value of recommended comfort ranges. Recommendations are made for additional facilities in the simulation software, which would assist users in performing these types of research investigations and analyses.