Land use effects on soil carbon fractions in the southeastern United States. I. Management-intensive versus extensive grazing

Changes in grassland management intended to increase productivity can lead to sequestration of substantial amounts of atmospheric C in soils. Management-intensive grazing (MiG) can increase forage production in mesic pastures, but potential impacts on soil C have not been evaluated. We sampled four pastures (to 50 cm depth) in Virginia, USA, under MiG and neighboring pastures that were extensively grazed or bayed to evaluate impacts of grazing management on total soil organic C and N pools, and soil C fractions. Total organic soil C averaged 8.4 Mg C ha(-1) (22%) greater under MiG; differences were significant at three of the four sites examined while total soil N was greater for two sites. Surface (0-10 cm) particulate organic matter (POM) C increased at two sites; POM C for the entire depth increment (0-50 cm) did not differ significantly between grazing treatments at any of the sites. Mineral-associated C was related to silt plus clay content and tended to be greater under MiG. Neither soil C:N ratios, POM C, or POM C:total C ratios were accurate indicators of differences in total soil C between grazing treatments, though differences in total soil C between treatments attributable to changes in POM C (43%) were larger than expected based on POM C as a percentage of total C (24.5%). Soil C sequestration rates, estimated by calculating total organic soil C differences between treatments (assuming they arose from changing grazing management and can be achieved elsewhere) and dividing by duration of treatment, averaged 0.41 Mg C ha(-1) year(-1) across the four sites.

Exponentiated gradient algorithms for conditional random fields and max-margin Markov Networks

Log-linear and maximum-margin models are two commonly-used methods in supervised machine learning, and are frequently used in structured prediction problems. Efficient learning of parameters in these models is therefore an important problem, and becomes a key factor when learning from very large data sets. This paper describes exponentiated gradient (EG) algorithms for training such models, where EG updates are applied to the convex dual of either the log-linear or max-margin objective function; the dual in both the log-linear and max-margin cases corresponds to minimizing a convex function with simplex constraints. We study both batch and online variants of the algorithm, and provide rates of convergence for both cases. In the max-margin case, O(1/ε) EG updates are required to reach a given accuracy ε in the dual; in contrast, for log-linear models only O(log(1/ε)) updates are required. For both the max-margin and log-linear cases, our bounds suggest that the online EG algorithm requires a factor of n less computation to reach a desired accuracy than the batch EG algorithm, where n is the number of training examples. Our experiments confirm that the online algorithms are much faster than the batch algorithms in practice. We describe how the EG updates factor in a convenient way for structured prediction problems, allowing the algorithms to be efficiently applied to problems such as sequence learning or natural language parsing. We perform extensive evaluation of the algorithms, comparing them to L-BFGS and stochastic gradient descent for log-linear models, and to SVM-Struct for max-margin models. The algorithms are applied to a multi-class problem as well as to a more complex large-scale parsing task. In all these settings, the EG algorithms presented here outperform the other methods.

Contracted site: Artist on paper, drawing

Traditionally the notion of drawing in-situ has suggested the physical presence of the artist in the environment under scrutiny. The assumption here of enhanced connectivity, however, is hasty in light of the idea that situation implies a relative spatial value determined by the interplay of subject and location, where the possibility of not being “in-situ” is problematic. The fact that traditional drawing in-situ, such as the rendering of landscape, requires a framing of the world “out there” suggests a distance between the perceived object of representation and the drawing surface. Rather than suggesting that some drawing is situated and other sorts of drawing are not, however, I argue that situation or site is variously extended and intensified depending on the nature of mediation between surface and environment. The suggestion here is that site is not so much a precondition as a performative function, developed in the act of drawing and always implicating the drawing surface. In my discussion I focus on specific works by Toba Khedoori and Cameron Robbins. As well, in using my own recent drawing practice as a case study, I argue that the geography of site is delimited neither by horizon nor the boundaries of the paper. Rather, I propose that site and drawing surface coincide in variously intensive and extensive ways.

Probiotics and diarrhoea management in enterally tube fed critically ill patients : what is the evidence?

Objective: The aim of this literature review is to identify the role of probiotics in the management of enteral tube feeding (ETF) diarrhoea in critically ill patients.---------- Background: Diarrhoea is a common gastrointestinal problem seen in ETF patients. The incidence of diarrhoea in tube fed patients varies from 2% to 68% across all patients. Despite extensive investigation, the pathogenesis surrounding ETF diarrhoea remains unclear. Evidence to support probiotics to manage ETF diarrhoea in critically ill patients remains sparse.---------- Method: Literature on ETF diarrhoea and probiotics in critically ill, adult patients was reviewed from 1980 to 2010. The Cochrane Library, Pubmed, Science Direct, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic databases were searched using specific inclusion/exclusion criteria. Key search terms used were: enteral nutrition, diarrhoea, critical illness, probiotics, probiotic species and randomised clinical control trial (RCT).---------- Results: Four RCT papers were identified with two reporting full studies, one reporting a pilot RCT and one conference abstract reporting an RCT pilot study. A trend towards a reduction in diarrhoea incidence was observed in the probiotic groups. However, mortality associated with probiotic use in some severely and critically ill patients must caution the clinician against its use.---------- Conclusion: Evidence to support probiotic use in the management of ETF diarrhoea in critically ill patients remains unclear. This paper argues that probiotics should not be administered to critically ill patients until further research has been conducted to examine the causal relationship between probiotics and mortality, irrespective of the patient's disease state or projected prophylactic benefit of probiotic administration.

IODP Expedition 339 in the Gulf of Cadiz and off West Iberia : decoding the environmental significance of the Mediterranean outflow water and its global influence

IODP Expedition 339 drilled five sites in the Gulf of Cadiz and two off the west Iberian margin (November 2011 to January 2012), and recovered 5.5 km of sediment cores with an average recovery of 86.4%. The Gulf of Cadiz was targeted for drilling as a key location for the investigation of Mediterranean outflow water (MOW) through the Gibraltar Gateway and its influence on global circulation and climate. It is also a prime area for understanding the effects of tectonic activity on evolution of the Gibraltar Gateway and on margin sedimentation. We penetrated into the Miocene at two different sites and established a strong signal of MOW in the sedimentary record of the Gulf of Cadiz, following the opening of the Gibraltar Gateway. Preliminary results show the initiation of contourite deposition at 4.2–4.5 Ma, although subsequent research will establish whether this dates the onset of MOW. The Pliocene succession, penetrated at four sites, shows low bottom current activity linked with a weak MOW. Significant widespread unconformities, present in all sites but with hiatuses of variable duration, are interpreted as a signal of intensified MOW, coupled with flow confinement. The Quaternary succession shows a much more pronounced phase of contourite drift development, with two periods of MOW intensification separated by a widespread unconformity. Following this, the final phase of drift evolution established the contourite depositional system (CDS) architecture we see today. There is a significant climate control on this evolution of MOW and bottom-current activity. However, from the closure of the Atlantic–Mediterranean gateways in Spain and Morocco just over 6 Ma and the opening of the Gibraltar Gateway at 5.3 Ma, there has been an even stronger tectonic control on margin development, downslope sediment transport and contourite drift evolution. The Gulf of Cadiz is the world's premier contourite laboratory and thus presents an ideal testing ground for the contourite paradigm. Further study of these contourites will allow us to resolve outstanding issues related to depositional processes, drift budgets, and recognition of fossil contourites in the ancient record on shore. The expedition also verified an enormous quantity and extensive distribution of contourite sands that are clean and well sorted. These represent a relatively untapped and important exploration target for potential oil and gas reservoirs.

The city, self, and connections : transyouth and urban social networking in Seoul

The end of the Korean War in 1953 marked the beginning of Seoul’s transformation from the shattered capital city of South Korea to one of the most connected, populous, and fast-changing hubs of global economy. Seoul’s technosocial development has been celebrated nationally and internationally. To the outside, young Koreans’ swift and extensive adoption and adaptation to digital technologies has been a subject of exotification; to adults in Korea, it has been a subject of criticism (see Yoon in this volume). With the understanding that ‘the city is connections,’ it is crucial to study not only the macro-level design of the city as a network (through policy, for example), but also its micro-level construction at the intersection of people, place, and technology. Accordingly, this chapter explores this exact intersection to comprehensively portray the constant renewal of the city as imagined and experienced by young Koreans. The chapter is based on fieldwork conducted in Seoul, South Korea, from 2007 to 2008 as part of a research project on the mobile play culture of Seoul transyouth, the transitional demographic situated between youth and adulthood, and the pioneers of the Korean ‘broadband miracle’ (Hazlett, 2004). The study draws upon transdisciplinary research data including interviews, questionnaires, diaries, and Shared Visual Ethnography (SVE) to render the everyday urban social networking of young Seoulites with and through which they interact to constantly (re)create the city and the self.

Static load modelling and voltage stability indices

This paper analyzes the performance of some of the widely used voltage stability indices, namely, singular value, eigenvalue, and loading margin with different static load models. Well-known ZIP model is used to represent loads having components with different power to voltage sensitivities. Studies are carried out on a 10-bus power system and the New England 39-bus power system models. The effects of variation of load model on the performance of the voltage stability indices are discussed. The choice of voltage stability index in the context of load modelling is also suggested in this paper.

The speed paradox : the misalignment between driver attitudes and speeding behaviour

This paper reports on a study investigating preferred driving speeds and frequency of speeding of 320 Queensland drivers. Despite growing community concern about speeding and extensive research linking it to road trauma, speeding remains a pervasive, and arguably, socially acceptable behaviour. This presents an apparent paradox regarding the mismatch between beliefs and behaviours, and highlights the necessity to better understand the factors contributing to speeding. Utilising self-reported behaviour and attitudinal measures, results of this study support the notion of a speed paradox. Two thirds of participants agreed that exceeding the limit is not worth the risks nor is it okay to exceed the posted limit. Despite this, more than half (58.4%) of the participants reported a preference to exceed the 100km/hour speed limit, with one third preferring to do so by 10 to 20 km/hour. Further, mean preferred driving speeds on both urban and open roads suggest a perceived enforcement tolerance of 10%, suggesting that posted limits have limited direct influence on speed choice. Factors that significantly predicted the frequency of speeding included: exposure to role models who speed; favourable attitudes to speeding; experiences of punishment avoidance; and the perceived certainty of punishment for speeding. These findings have important policy implications, particularly relating to the use of enforcement tolerances.

Part 1. Chemical and Physical Restraints in the Management of Mechanically Ventilated Patients in the ICU: Contributing Factors

Chemical and physical restraints are frequently used in the intensive care unit (ICU) to control agitated patients and to prevent self-harm and unplanned extubations. Published work relating to the numerous issues of the care and treatment strategies for these patients remains conflicting and unclear. Literature regarding sedation and chemical restraint reveals a trend towards management with lighter sedation, use of sedation assessment tools and sedation protocols. It remains unclear which treatment is best for agitated and delirious patients, and the evidence on the effect of sedation is conflicting. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. The purpose of this paper is to provide a summary of the existing literature on the use of physical and chemical restraints in the ICU setting. In Part 1 of this two-part paper, the evidence on chemical and physical restraints is explored with specific focus on definition of terms, unplanned

Part 2. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: A patient perspective

An important goal of the care for the mechanically ventilated patient is to minimize patient discomfort and anxiety. This is partly achieved by frequent use of chemical and physical restraints. The majority of patients in intensive care will receive some form of sedation. The goal and use of sedation has changed considerably over the past few decades with literature evidencing trends toward overall lighter sedation levels and daily interruption of sedation. Conversely, the use of physical restraint for the ventilated patient in ICU differs considerably between nations and continents. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. Recent literature suggests minimal use of physical restraint in the ICU, and that reduction programmes have been initiated. However, very few papers illuminate the patient's experience of physical and chemical restraints as a treatment strategy. In Part 1 of this two-part review, the evidence on chemical and physical restraints was explored with specific focus on definitions of terms, unplanned extubation, agitation, delirium as well as the impact of nurse–patient ratios in the ICU on these issues. This paper, Part 2, examines the evidence related to chemical and physical restraints from the mechanically ventilated patient's perspective.

Post-tensioning and its effect on multi-level formwork load distribution

Multi-level concrete buildings requrre substantial temporary formwork structures to support the slabs during construction. The primary function of this formwork is to safely disperse the applied loads so that the slab being constructed, or the portion of the permanent structure already constructed, is not overloaded. Multi-level formwork is a procedure in which a limited number of formwork and shoring sets are cycled up the building as construction progresses. In this process, each new slab is supported by a number of lower level slabs. The new slab load is, essentially, distributed to these supporting slabs in direct proportion to their relative stiffness. When a slab is post-tensioned using draped tendons, slab lift occurs as a portion of the slab self-weight is balanced. The formwork and shores supporting that slab are unloaded by an amount equivalent to the load balanced by the post-tensioning. This produces a load distribution inherently different from that of a conventionally reinforced slab. Through , theoretical modelling and extensive on-site shore load measurement, this research examines the effects of post-tensioning on multilevel formwork load distribution. The research demonstrates that the load distribution process for post-tensioned slabs allows for improvements to current construction practice. These enhancements include a shortening of the construction period; an improvement in the safety of multi-level form work operations; and a reduction in the quantity of form work materials required for a project. These enhancements are achieved through the general improvement in safety offered by post-tensioning during the various formwork operations. The research demonstrates that there is generally a significant improvement in the factors of safety over those for conventionally reinforced slabs. This improvement in the factor of safety occurs at all stages of the multi-level formwork operation. The general improvement in the factors of safety with post-tensioned slabs allows for a shortening of the slab construction cycle time. Further, the low level of load redistribution that occurs during the stripping operations makes post-tensioned slabs ideally suited to reshoring procedures. Provided the overall number of interconnected levels remains unaltered, it is possible to increase the number of reshored levels while reducing the number of undisturbed shoring levels without altering the factors of safety, thereby, reducing the overall quantity of formwork and shoring materials.

Design and implementation of sensor networks for the observation and research of harmful algal blooms in southern California coastal waters

Harmful Algal Blooms (HABs) have become an important environmental concern along the western coast of the United States. Toxic and noxious blooms adversely impact the economies of coastal communities in the region, pose risks to human health, and cause mortality events that have resulted in the deaths of thousands of fish, marine mammals and seabirds. One goal of field-based research efforts on this topic is the development of predictive models of HABs that would enable rapid response, mitigation and ultimately prevention of these events. In turn, these objectives are predicated on understanding the environmental conditions that stimulate these transient phenomena. An embedded sensor network (Fig. 1), under development in the San Pedro Shelf region off the Southern California coast, is providing tools for acquiring chemical, physical and biological data at high temporal and spatial resolution to help document the emergence and persistence of HAB events, supporting the design and testing of predictive models, and providing contextual information for experimental studies designed to reveal the environmental conditions promoting HABs. The sensor platforms contained within this network include pier-based sensor arrays, ocean moorings, HF radar stations, along with mobile sensor nodes in the form of surface and subsurface autonomous vehicles. FreewaveTM radio modems facilitate network communication and form a minimally-intrusive, wireless communication infrastructure throughout the Southern California coastal region, allowing rapid and cost-effective data transfer. An emerging focus of this project is the incorporation of a predictive ocean model that assimilates near-real time, in situ data from deployed Autonomous Underwater Vehicles (AUVs). The model then assimilates the data to increase the skill of both nowcasts and forecasts, thus providing insight into bloom initiation as well as the movement of blooms or other oceanic features of interest (e.g., thermoclines, fronts, river discharge, etc.). From these predictions, deployed mobile sensors can be tasked to track a designated feature. This focus has led to the creation of a technology chain in which algorithms are being implemented for the innovative trajectory design for AUVs. Such intelligent mission planning is required to maneuver a vehicle to precise depths and locations that are the sites of active blooms, or physical/chemical features that might be sources of bloom initiation or persistence. The embedded network yields high-resolution, temporal and spatial measurements of pertinent environmental parameters and resulting biology (see Fig. 1). Supplementing this with ocean current information and remotely sensed imagery and meteorological data, we obtain a comprehensive foundation for developing a fundamental understanding of HAB events. This then directs labor- intensive and costly sampling efforts and analyses. Additionally, we provide coastal municipalities, managers and state agencies with detailed information to aid their efforts in providing responsible environmental stewardship of their coastal waters.

Implementing low intensity CBT in case management of clients with severe mental illness

In a previous chapter (Dean and Kavanagh, Chapter 37), the authors made a case for applying low intensity (LI) cognitive behaviour therapy (CBT) to people with serious mental illness (SMI). As in other populations, LI CBT interventions typically deal with circumscribed problems or behaviours. LI CBT retains an emphasis on self-management, has restricted content and segment length, and does not necessarily require extensive CBT training. In applying these interventions to SMI, adjustments may be needed to address cognitive and symptomatic difficulties often faced by these groups. What may take a single session in a less affected population may require several sessions or a thematic application of the strategy within case management. In some cases, the LI CBT may begin to appear more like a high-intensity (HI) intervention, albeit simple and with many LI CBT characteristics still retained. So, if goal setting were introduced in one or two sessions, it could clearly be seen as an LI intervention. When applied to several different situations and across many sessions, it may be indistinguishable from a simple HI treatment, even if it retains the same format and is effectively applied by a practitioner with limited CBT training. ----- ----- In some ways, LI CBT should be well suited to case management of patients with SMI. treating staff typically have heavy workloads, and find it difficult to apply time-consuming treatments (Singh et al. 2003). LI CBT may allow provision of support to greater numbers of service users, and allow staff to spend more time on those who need intensive and sustained support. However, the introduction of any change in practice has to address significant challenges, and LI CBT is no exception. ----- ----- Many of the issues that we face in applying LI CBT to routine case management in a mnetal health service and their potential solutions are essentially the same as in a range of other problem domains (Turner and Sanders 2006)- and, indeed, are similar to those in any adoption of innovation (Rogers 2003). Over the last 20 years, several commentators have described barriers to implementing evidence-based innovations in mental health services (Corrigan et al. 1992; Deane et al. 2006; Kavanagh et al. 1993). The aim of the current chapter is to present a cognitive behavioural conceptualisation of problems and potential solutions for dissemination of LI CBT.

A probability-based approach for assessing the relationship between crash accidents and pavement properties

Skid resistance is a condition parameter characterising the contribution that a road makes to the friction between a road surface and a vehicle tyre. Studies of traffic crash histories around the world have consistently found that a disproportionate number of crashes occur where the road surface has a low level of surface friction and/or surface texture, particularly when the road surface is wet. Various research results have been published over many years and have tried to quantify the influence of skid resistance on accident occurrence and to characterise a correlation between skid resistance and accident frequency. Most of the research studies used simple statistical correlation methods in analysing skid resistance and crash data.----- ------ Preliminary findings of a systematic and extensive literature search conclude that there is rarely a single causation factor in a crash. Findings from research projects do affirm various levels of correlation between skid resistance and accident occurrence. Studies indicate that the level of skid resistance at critical places such as intersections, curves, roundabouts, ramps and approaches to pedestrian crossings needs to be well maintained.----- ----- Management of risk is an integral aspect of the Queensland Department of Main Roads (QDMR) strategy for managing its infrastructure assets. The risk-based approach has been used in many areas of infrastructure engineering. However, very limited information is reported on using risk-based approach to mitigate crash rates related to road surface. Low skid resistance and surface texture may increase the risk of traffic crashes.----- ----- The objectives of this paper are to explore current issues of skid resistance in relation to crashes, to provide a framework of probability-based approach to be adopted by QDMR in assessing the relationship between crash accidents and pavement properties, and to explain why the probability-based approach is a suitable tool for QDMR in order to reduce accident rates due to skid resistance.

Malnutrition and clinical outcomes in elderly patients from a Singapore acute hospital

Older adults, especially those acutely ill, are vulnerable to developing malnutrition due to a range of risk factors. The high prevalence and extensive consequences of malnutrition in hospitalised older adults have been reported extensively. However, there are few well-designed longitudinal studies that report the independent relationship between malnutrition and clinical outcomes after adjustment for a wide range of covariates. Acutely ill older adults are exceptionally prone to nutritional decline during hospitalisation, but few reports have studied this change and impact on clinical outcomes. In the rapidly ageing Singapore population, all this evidence is lacking, and the characteristics associated with the risk of malnutrition are also not well-documented. Despite the evidence on malnutrition prevalence, it is often under-recognised and under-treated. It is therefore crucial that validated nutrition screening and assessment tools are used for early identification of malnutrition. Although many nutrition screening and assessment tools are available, there is no universally accepted method for defining malnutrition risk and nutritional status. Most existing tools have been validated amongst Caucasians using various approaches, but they are rarely reported in the Asian elderly and none has been validated in Singapore. Due to the multiethnicity, cultural, and language differences in Singapore older adults, the results from non-Asian validation studies may not be applicable. Therefore it is important to identify validated population and setting specific nutrition screening and assessment methods to accurately detect and diagnose malnutrition in Singapore. The aims of this study are therefore to: i) characterise hospitalised elderly in a Singapore acute hospital; ii) describe the extent and impact of admission malnutrition; iii) identify and evaluate suitable methods for nutritional screening and assessment; and iv) examine changes in nutritional status during admission and their impact on clinical outcomes. A total of 281 participants, with a mean (+SD) age of 81.3 (+7.6) years, were recruited from three geriatric wards in Tan Tock Seng Hospital over a period of eight months. They were predominantly Chinese (83%) and community-dwellers (97%). They were screened within 72 hours of admission by a single dietetic technician using four nutrition screening tools [Tan Tock Seng Hospital Nutrition Screening Tool (TTSH NST), Nutritional Risk Screening 2002 (NRS 2002), Mini Nutritional Assessment-Short Form (MNA-SF), and Short Nutritional Assessment Questionnaire (SNAQ©)] that were administered in no particular order. The total scores were not computed during the screening process so that the dietetic technician was blinded to the results of all the tools. Nutritional status was assessed by a single dietitian, who was blinded to the screening results, using four malnutrition assessment methods [Subjective Global Assessment (SGA), Mini Nutritional Assessment (MNA), body mass index (BMI), and corrected arm muscle area (CAMA)]. The SGA rating was completed prior to computation of the total MNA score to minimise bias. Participants were reassessed for weight, arm anthropometry (mid-arm circumference, triceps skinfold thickness), and SGA rating at discharge from the ward. The nutritional assessment tools and indices were validated against clinical outcomes (length of stay (LOS) >11days, discharge to higher level care, 3-month readmission, 6-month mortality, and 6-month Modified Barthel Index) using multivariate logistic regression. The covariates included age, gender, race, dementia (defined using DSM IV criteria), depression (defined using a single question “Do you often feel sad or depressed?”), severity of illness (defined using a modified version of the Severity of Illness Index), comorbidities (defined using Charlson Comorbidity Index, number of prescribed drugs and admission functional status (measured using Modified Barthel Index; MBI). The nutrition screening tools were validated against the SGA, which was found to be the most appropriate nutritional assessment tool from this study (refer section 5.6) Prevalence of malnutrition on admission was 35% (defined by SGA), and it was significantly associated with characteristics such as swallowing impairment (malnourished vs well-nourished: 20% vs 5%), poor appetite (77% vs 24%), dementia (44% vs 28%), depression (34% vs 22%), and poor functional status (MBI 48.3+29.8 vs 65.1+25.4). The SGA had the highest completion rate (100%) and was predictive of the highest number of clinical outcomes: LOS >11days (OR 2.11, 95% CI [1.17- 3.83]), 3-month readmission (OR 1.90, 95% CI [1.05-3.42]) and 6-month mortality (OR 3.04, 95% CI [1.28-7.18]), independent of a comprehensive range of covariates including functional status, disease severity and cognitive function. SGA is therefore the most appropriate nutritional assessment tool for defining malnutrition. The TTSH NST was identified as the most suitable nutritional screening tool with the best diagnostic performance against the SGA (AUC 0.865, sensitivity 84%, specificity 79%). Overall, 44% of participants experienced weight loss during hospitalisation, and 27% had weight loss >1% per week over median LOS 9 days (range 2-50). Wellnourished (45%) and malnourished (43%) participants were equally prone to experiencing decline in nutritional status (defined by weight loss >1% per week). Those with reduced nutritional status were more likely to be discharged to higher level care (adjusted OR 2.46, 95% CI [1.27-4.70]). This study is the first to characterise malnourished hospitalised older adults in Singapore. It is also one of the very few studies to (a) evaluate the association of admission malnutrition with clinical outcomes in a multivariate model; (b) determine the change in their nutritional status during admission; and (c) evaluate the validity of nutritional screening and assessment tools amongst hospitalised older adults in an Asian population. Results clearly highlight that admission malnutrition and deterioration in nutritional status are prevalent and are associated with adverse clinical outcomes in hospitalised older adults. With older adults being vulnerable to risks and consequences of malnutrition, it is important that they are systematically screened so timely and appropriate intervention can be provided. The findings highlighted in this thesis provide an evidence base for, and confirm the validity of the current nutrition screening and assessment tools used among hospitalised older adults in Singapore. As the older adults may have developed malnutrition prior to hospital admission, or experienced clinically significant weight loss of >1% per week of hospitalisation, screening of the elderly should be initiated in the community and continuous nutritional monitoring should extend beyond hospitalisation.