RESUMEN
Many residents in Skilled Nursing Facilities (SNFs) present with dysphagia and receive altered diets or liquids to minimize the risk of complications. Limited access to timely instrumental evaluations of swallow may impede the best management of these dysphagic residents. De-identified FEES reports completed by a mobile FEES company during a single month, January 2019, were reviewed. Descriptive statistics were used to summarize the pre-study diet/liquid levels and the post-study diet/liquid recommendations. FEES reports (n = 952) were reviewed. Before the FEES evaluation, 209 residents were receiving only non-oral nutrition. After the FEES evaluation, 76% of these residents were recommended to receive oral nutrition. Before the FEES evaluation, 442 (46%) residents were receiving thickened liquids, after the FEES evaluation, 244 (26%) were recommended to have a less restrictive liquid level. Before the FEES evaluation, 576 (60%) residents were receiving altered food texture, after the FEES evaluation, 413 (43%) were recommended to have a less restrictive food texture. The percentage of residents recommended to receive thin liquids increased from 32 to 68% and those recommended to receive a regular diet increased from 18 to 34%. These data indicate that access to instrumental swallow evaluations in the SNF setting generally resulted in lifting liquid and diet restrictions for many residents in the cohort reviewed and potentially improved their quality of life.
RESUMEN
To fully understand and predict the impact of nanotechnologies, a truly multidisciplinary approach is required. However, the practicalities relating to how innovation, commercialisation, risk assessment, informatics, and governance in nanotechnology should intersect remain somewhat of a black box. To begin to shed light on this intersection, we identify a need to place 'purpose' at the heart of the nanotechnology innovation ecosystem. There is a growing appetite for responsible, sustainable, and purposeful innovation from business, financiers, regulators, consumers, and other stakeholders - an appetite that we foresee will permeate all spheres of commercialisation, including that of nanotechnology. Ultimately, nanotechnologies will only have the ability to sustainably address the global challenges of the 21st century if they are developed and implemented with purpose, and in full consideration of their social and environmental impacts. We (re)define purpose as it relates to sustainable nanotechnology innovation, in an effort to create a more-broadly shared language that can bridge the diverse stakeholder needs and perspectives that are required to address these challenges. To enable innovation, standardisation, promote interdisciplinarity, increase transparency, and enhance regulatory and corporate accountability, we propose a four stage, principles-based framework for purposeful nanotechnology development. This framework offers a practical way forward for nanotechnology innovation, shedding light on how nano-impact can be approached by multidisciplinary teams and describing how interrelated systems and stakeholders can interact successfully to achieve shared goals.