How to evaluate and assess quality of life issues in head and neck cancer patients.

Purpose of review: Review quality of life (QOL) concepts and most common instruments to be used in patients with head and neck cancer, as well as the potential benefits and limitations of information derived from QOL studies. Recent findings: Information from QOL studies can be clinical predictors of prognosis, serve as potential screening and planning tools for clinical care and rehabilitation efforts. Enhancements in computer technology and the advent of tools like HNC specific item prompt list will allow for QOL data to be used more easily. Summary: Patients with malignant head and neck neoplasms can present changes in important vital functions related to the disease and its treatment, usually resulting in a negative impact on their QOL. The application of specific questionnaires can be used to measure such impact and the information derived from QOL studies has the potential

Product leasing: a strategy to allow manufacturers and customers to benefit from elongation of product life

International development means that the number of people who can be considered as consumers is projected to triple by 2030. This is good news but if we consume goods in the same way as people did in the 20th Century it will lead to an unsustainable rise in industrial greenhouse gas emissions and contribute towards material scarcities. The old axioms of maintaining profits by high turnover of low profit margins goods, and boosting demand by releasing new models needs to be reconsidered for a sustainable future. The key point is that people’s needs are met by using goods not just acquiring them. One way of reducing the demand for new goods is to use old ones for longer. This study looked at second hand car data and concluded that cars are scrapped when they have a low market value not when they are worn out. It follows that if the second hand value can be raised, cars could potentially be used for longer. One way of increasing the value of a second hand item to a business is to value it as a future profit generator as well as for its market value. A long term lease model has been considered and found to be potentially beneficial to both the supplier and customer

X-ray diffraction from bone employing annular and semi-annular beams

This is the final version of the article. Available from the publisher via the DOI in this record.There is a compelling need for accurate, low cost diagnostics to identify osteo-tissues that are associated with a high risk of fracture within an individual. To satisfy this requirement the quantification of bone characteristics such as 'bone quality' need to exceed that provided currently by densitometry. Bone mineral chemistry and microstructure can be determined from coherent x-ray scatter signatures of bone specimens. Therefore, if these signatures can be measured, in vivo, to an appropriate accuracy it should be possible by extending terms within a fracture risk model to improve fracture risk prediction.In this preliminary study we present an examination of a new x-ray diffraction technique that employs hollow annular and semi-annular beams to measure aspects of 'bone quality'. We present diffractograms obtained with our approach from ex vivo bone specimens at Mo Kα and W Kα energies. Primary data is parameterized to provide estimates of bone characteristics and to indicate the precision with which these can be determined.We acknowledge gratefully the funding provided by the UK Engineering and Physical Sciences Research Council (EPSRC) grant number EP/K020196/

Product renovation and shared ownership: sustainable routes to satisfying the world's growing demand for goods

It has been estimated that by 2030 the number of people who are wealthy enough to be considered as middle class consumers will have tripled. This will have a dramatic impact on the demands for primary materials and energy. Much work has been carried out on sustainable ways of meeting the World’s energy demands and some work has been carried out on the sustainable production and consumption of goods. It has been estimated that with improvements in design and manufacturing it is possible to reduce the primary material requirements by 30% to produce the current demand for goods. Whilst this is a crucial step on the production side, there will still be a doubling of primary material requirements by the end of the century because of an absolute rise in demand for goods and services. It is therefore clear that the consumption of products must also be explored. This is a key areas of research for the UK INDEMAND centre, which is investigating ways of reducing the UK’s industrial energy demand and demand for energy intensive materials. Our ongoing work shows that two strategies would result in considerable reductions in the demand for primary materials: product longevity and using goods more intensively (which may requires increased durability). Product longevity and durability are not new ideas, but ones that can be applied across a raft of goods as methods of reducing the consumption of materials. With long life products there is a potential risk of outdated design and obsolescence, consequently there is a need to ensure upgradability and adaptability are incorporated at the design stage. If products last longer, then the production of new products can be diverted to emerging markets rather than the market for replacement goods. There are many goods which are only used occasionally; these goods do not normally wear out. The total demand for such could be drastically reduced if they were shared with other people. Sharing of goods has traditionally been conducted between friends or by hiring equipment. The use of modern communication systems and social media could enable the development of sharing co-ops and swap spaces that will increase the utilisation of goods and hence reduce the demand for new goods. This could also increase access to a range of goods for those on low incomes. From a series of workshops it has been found that the principal challenges are sociological rather than technological. This paper contains a discussion of these challenges and explores possible futures where these two strategies have been adopted. In addition, the barriers and opportunities that these strategies offer for consumers and businesses are identified, and areas where government policy could be instigated to bring about change are highlighted

Thermodynamic insights and assessment of the ‘circular economy’

This study analyses the effect on energy use of applying a wide range of circular economy approaches. By collating evidence on specific quantifiable approaches and then calculating and analyzing their combined full supply chain impacts through input-output analysis, it provides a more complete assessment of the overall potential scope for energy savings that these approaches might deliver than provided elsewhere. Assessment is conducted globally, across the EU-27 and in the UK. Overall, the identified opportunities have the potential to save 6%–11% of energy used to support economic activity, worldwide and in the EU, and 5%–8% in the UK. Their potential is equivalent to the total scope for other industrial energy efficiency savings. The potential savings are further divided into those due to sets of approaches relating to food waste, steel production, other materials production, product refurbishment, vehicle provision, construction and other equipment manufacture. Each of these sets of approaches can make a key contribution to the total savings that are possible. Complementary use of energy and exergy metrics illustrates the way in which energy use might change and for the first time provides indication that in most cases other energy efficiency measures are unlikely to be adversely affected by the circular economy approaches. Potential for savings in the energy embodied in each key product input to each major sector is assessed, enabling prioritization of the areas in which the circular economy approaches have the greatest scope for impact and identification of supply chains for which they are underrepresented

Thermodynamic insights and assessment of the ‘circular economy’

This study analyses the effect on energy use of applying a wide range of circular economy approaches. By collating evidence on specific quantifiable approaches and then calculating and analyzing their combined full supply chain impacts through input-output analysis, it provides a more complete assessment of the overall potential scope for energy savings that these approaches might deliver than provided elsewhere. Assessment is conducted globally, across the EU-27 and in the UK. Overall, the identified opportunities have the potential to save 6%–11% of energy used to support economic activity, worldwide and in the EU, and 5%–8% in the UK. Their potential is equivalent to the total scope for other industrial energy efficiency savings. The potential savings are further divided into those due to sets of approaches relating to food waste, steel production, other materials production, product refurbishment, vehicle provision, construction and other equipment manufacture. Each of these sets of approaches can make a key contribution to the total savings that are possible. Complementary use of energy and exergy metrics illustrates the way in which energy use might change and for the first time provides indication that in most cases other energy efficiency measures are unlikely to be adversely affected by the circular economy approaches. Potential for savings in the energy embodied in each key product input to each major sector is assessed, enabling prioritization of the areas in which the circular economy approaches have the greatest scope for impact and identification of supply chains for which they are underrepresented

Patient Concerns Inventory for head and neck cancer: Brazilian cultural adaptation

Objective: The purpose of this study was to translate, culturally validate and evaluate the Patients Concerns Inventory - Head and Neck (PCI- H&N) in a consecutive series of Brazilian patients. Methods: This study included adult patients treated for upper aerodigestive tract (UADT) cancer. The translation and cultural adaptation of the PCI–H&N followed internationally accepted guidelines and included a pretest sample of patients that completed the first Brazilian-Portuguese version of the PCI. The use/feasibility/acceptability of the PCI was tested subsequently in a consecutive series of UADT cancer patients that completed the final Brazilian-Portuguese version of the PCI and a Brazilian-Portuguese version of the University of Washington Quality of Life Questionnaire (UW-QOL). Associations between physical and socio emotional composite scores from the UW-QOL and PCI were analyzed. Results: Twenty patients participated in the pretest survey (translation and cultural adaptation process), and 84 patients were analysed in the cultural validation study. Issues most selected were: fear of cancer returning, dry mouth, chewing/eating, speech/voice/being understood, swallowing, dental health/teeth, anxiety, fatigue/tiredness, taste and fear of adverse events. The three specialists most selected were speech therapist, dentist and psychologist. Statistically significant relationships between PCI and UW-QOL were found. Conclusions: The translation and cultural adaptation of the PCI for Brazilian-Portuguese language was successful, and the results demonstrate its feasibility and usefulness, making this a valuable tool for use within the Brazilian H&N cancer population

The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy.

Abstract This aim of this report is to describe the development and evolution of a new surgical technique for the immediate surgical reconstruction and rapid post-operative prosthodontic rehabilitation with a fixed dental prosthesis following low-level maxillectomy for malignant disease. The technique involves the use of a zygomatic oncology implant perforated micro-vascular soft tissue flap (ZIP flap) for the primary management of maxillary malignancy with surgical closure of the resultant maxillary defect and the installation of osseointegrated support for a zygomatic implant-supported maxillary fixed dental prosthesis. The use of this technique facilitates extremely rapid oral and dental rehabilitation within a few weeks of resective surgery, providing rapid return to function and restoring appearance following low-level maxillary resection, even in cases where radiotherapy is required as an adjuvant treatment post-operatively. The ZIP flap technique has been adopted as a standard procedure in the unit for the management of low-level maxillary malignancy, and this report provides a detailed step-by-step approach to treatment and discusses modifications developed over the treatment of an initial cohort of patients

Mice lacking NF-κB1 exhibit marked DNA damage responses and more severe gastric pathology in response to intraperitoneal tamoxifen administration

Tamoxifen (TAM) has recently been shown to cause acute gastric atrophy and metaplasia in mice. We have previously demonstrated that the outcome of Helicobacter felis infection, which induces similar gastric lesions in mice, is altered by deletion of specific NF-κB subunits. Nfkb1-/- mice developed more severe gastric atrophy than wild-type (WT) mice 6 weeks after H. felis infection. In contrast, Nfkb2-/- mice were protected from this pathology. We therefore hypothesized that gastric lesions induced by TAM may be similarly regulated by signaling via NF-κB subunits. Groups of five female C57BL/6 (WT), Nfkb1-/-, Nfkb2-/- and c-Rel-/- mice were administered 150 mg/kg TAM by IP injection. Seventy-two hours later, gastric corpus tissues were taken for quantitative histological assessment. In addition, groups of six female WT and Nfkb1-/- mice were exposed to 12 Gy γ-irradiation. Gastric epithelial apoptosis was quantified 6 and 48 h after irradiation. TAM induced gastric epithelial lesions in all strains of mice, but this was more severe in Nfkb1-/- mice than in WT mice. Nfkb1-/- mice exhibited more severe parietal cell loss than WT mice, had increased gastric epithelial expression of Ki67 and had an exaggerated gastric epithelial DNA damage response as quantified by γH2AX. To investigate whether the difference in gastric epithelial DNA damage response of Nfkb1-/- mice was unique to TAM-induced DNA damage or a generic consequence of DNA damage, we also assessed gastric epithelial apoptosis following γ-irradiation. Six hours after γ-irradiation, gastric epithelial apoptosis was increased in the gastric corpus and antrum of Nfkb1-/- mice. NF-κB1-mediated signaling regulates the development of gastric mucosal pathology following TAM administration. This is associated with an exaggerated gastric epithelial DNA damage response. This aberrant response appears to reflect a more generic sensitization of the gastric mucosa of Nfkb1-/- mice to DNA damage