If an objective swallowing assessment reveals that a particular patient is at risk of aspirating liquids into the trachea while drinking, speech and language therapists may prescribe a commercial "thickening agent" to mix into their drinks. If used correctly, these can help to reduce the risk of aspiration. This study compared the palatability of the five main thickening agents currently available on prescription in the UK. Eight patients, three therapists, and ten therapy students blind-tested three different nonalcoholic drink flavors, thickened with each of the five thickening agents. Their perceptual rating of each of these drinks was recorded using 5-point visual analog scales. Significant differences between the visual analog scale scores for each of the thickening agents was found, independent of the drink flavor. There was no significant difference between the patient and the therapist results. By offering the more palatable thickening agents in drink flavors that patients enjoy, we would hope to improve compliance with speech and language therapy recommendations, thereby reducing the patient's risk of aspiration.
Background Older adults want to live at home as long as possible, even in the face of circumstances that limit their autonomy. Home care services reflect this emergent preference, allowing older adults to ‘age in place’ in familiar settings rather than receiving care for chronic health conditions or ageing needs in an institutionalized setting. Numerous social factors, generally studied in isolation, have been associated with home care utilization. Even so, social circumstances are complex and how these factors collectively influence home care use patterns remains unclear. Objectives To provide a broad and comprehensive overview of the social factors influencing home care utilization; and to evaluate the influence of discrete social factors on patterns of home care utilization in community-dwelling older adults in high-income countries. Methods A scoping review was conducted of six electronic databases for records published between 2010 and 2020; additional records were obtained from hand searching review articles, reference lists of included studies and documents from international organisations. A narrative synthesis was presented, complemented by vote counting per social factor, harvest plots and an evaluation of aggregated findings to determine consistency across studies. Results A total of 2,365 records were identified, of which 66 met inclusion criteria. There were 35 discrete social factors grouped into four levels of influence using a socio-ecological model (individual, relationship, community and societal levels) and grouped according to outcome of interest (home care propensity and intensity). Across all studies, social factors consistently showing any association (positive, negative, or equivocal in pattern) with home care propensity were: age, ethnicity/race, self-assessed health, insurance, housing ownership, housing problems, marital status, household income, children, informal caregiving, social networks and urban/rural area. Age, education, personal finances, living arrangements and housing ownership were associated with home care intensity, also with variable patterns in utilization. Additional community and societal level factors were identified as relevant but lacking consistency across the literature; these included rurality, availability of community services, methods of financing home care systems, and cultural determinants. Conclusion This is the first literature review bringing together a wide range of reported social factors that influence home care utilization. It confirms social factors do influence home care utilization in complex interactions, distinguishes level of influences at which these factors affect patterns of use and discusses policy implications for home care reform.
Until recently, popcorn and dent corn (Zea mays L.) were considered analogous in their seasonal developmental patterns. Differences in the rates of seasonal floral development may be important in the relative susceptibility of the respective types of corn to stress. Although several researchers have considered that a relationship exists between the number of leaves emerged on a corn plant and inflorescence development, no intensive attempts to investigate floral development relative to leaf stage have been reported. This is an essential criterion if numeric staging systems are to be developed for use with regression techniques to model corn floral development relative to stress and consequent grain production. The objectives of this pilot study were to relate floral development to external leaf stage, and to compare the rate of floral development between a popcorn and its assumed analogue, a dent corn. Plants of two greenhouse‐grown corn cultivars, ‘Iopop 12’ and ‘B73 ✕ Mo17’, were sampled at intervals from emergence of the third leaf to that of the 13th leaf. The shoot apex and uppermost pistillate inflorescence were excised and examined fresh in a scanning electron microscope (SEM) or fixed and prepared for SEM examination using traditional techniques. Staminate and pistillate spikelet development in B73 ✕ Mo17 and in Iopop 12 followed a similar sequence; but, relative to leaf stages, Iopop 12 tended to lag one to two emerged‐leaf stages behind B73 ✕ Mo17. With respect to emerged‐leaf stages, B73 ✕ Mo17 and Iopop 12, respectively, developed as follows: tassel initiation at fourth vs. fifth, ear initiation at sixth vs. eighth, and pistillate silk formation at 11th vs. 13th. Staminate and pistillate spikelet organogenesis followed a similar sequence both within and between cultivars, with initiation of two bisexual florets and subsequent abortion of appropriate floral organs to form unisexual florets. One floret developed in each pistillate spikelet, whereas two developed in each taminate spikelet. Elongation of the apical dome to 0.4 mm was considered to be the most definitive indicator of tassel and ear initiation. The appearance of the ligule above the auricles of the previous leaf was considered the most definitive indicator of leaf‐blade emergence.
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