USING ‘NUTRITIONAL NARRATIVE’ AND FOCUS GROUPS TO UNDERSTAND HOW NUTRITIONAL CARE CAN BETTER PRIORITISED FOR OLDER PEOPLE IN HOSPITAL SETTINGS

Introduction: Poor nutritional status among older people is well documented with 40% of older people reported as malnourished on hospital admission. Poor nutrition contributes to increased infection, poorer patient outcomes and death and longer hospital stays. In this study, we assessed the ‘nutrition narrative’ from older hospital patients together with nutrition knowledge among nursing and medical staff and students.
Methods: The study used a convenience sample of older people (30, mean age 82 years) in two large geographically separate city hospitals. Patients mentally alert and consenting, gave a recorded ‘nutrition narrative’ to get a sense of how they felt their nutritional needs were being met in hospital. Main themes were identified by grounded analysis framework. Focus groups were recruited from medical/nursing teachers and students to assess their working knowledge of nutrition and the nutritional needs of the older patient group.
Results: Analysis of the ‘nutrition narrative’ suggested several themes (i) staff should listen to patients' needs/wishes in discussion with themselves and family members (ii) staff should continue to encourage and progress a positive eating experience (iii) staff should monitor food eaten/or not eaten and increase regular monitoring of weight. The focus groups with medical and nursing students suggested a limited knowledge about nutritional care of older people and little understanding about roles or cross-talk about nutrition across the multidisciplinary groups.
Conclusions: The ‘nutrition narrative’ themes suggested that the nutritional experience of older people in hospital can and must be improved. Nursing and medical staff providing medical and nursing care need better basic knowledge of nutrition and nutritional assessment, an improved understanding of the roles of the various multidisciplinary staff and of hospital catering pathways. Care professionals need to prioritise patient nutrition much more highly and recognise nutritional care as integral to patient healing and recovery

An experimental and numerical investigation into the seismic performance of a multi-storey concentrically braced plan irregular structure

In this investigation, the seismic torsional response of a multi-storey concentrically braced frame (CBF) plan irregular structure is evaluated numerically and experimentally through a series of hybrid tests. CBF structures have become popular in seismic design because they are one of the most efficient types of steel structures to resist earthquake loading. However, their response under plan irregular conditions has received little focus mostly in part
due to their complex behaviour under seismic loading conditions. The majority of research on the seismic response of plan irregular structures is based purely on numerical investigations. This paper provides much needed experimental investigation of the seismic response of a CBF plan irregular structure with the aim of characterising the response of this class of structure. The effectiveness of the Eurocode 8 torsional effects provision as a method of designing for
low levels of mass eccentricity is evaluated. Results indicate that some of the observations made by purely numerical models are valid in that; torsionally stiff structures perform well and the stiff side of the structure is subjected to a greater ductility demand compared to the flexible side of the structure. The Eurocode 8 torsional effects provision is shown to be adequate in terms of ductility and interstorey drift however the structure performs poorly
in terms of floor rotation. Importantly, stiffness eccentricity occurs when the provision is applied to the structure when no mass eccentricity exists and results in a significant increase in floor rotations.

Seismic Assessment of a Steel Braced Plan Mass Symmetric/Asymmetric Building Structure

This paper presents a seismic response investigation into a code designed concentrically braced frame structure that is subjected to but not designed for in-plan mass eccentricity. The structure has an accidental uneven distribution of mass in plan resulting in an increased torsional component of vibration. The level of inelasticity that key structural elements in plan mass asymmetric structures are subjected to is important when analysing their ability to sustain uneven seismic demands. In-plan mass asymmetry of moment resisting frame and shear wall type structures have received significant investigation, however, the plan asymmetric response of braced frame type structures is less well understood. A three-dimensional non-linear time history analysis (NLTHA) model is created to capture the torsional response of the plan mass asymmetric structure to quantify the additional ductility demand, interstorey drifts and floor rotations. Results show that the plan mass asymmetric structure performs well in terms of ductility demand, but poorly in terms of interstorey drifts and floor rotations when compared to the plan mass symmetric structure. New linear relationships are developed between the normalised ductility demand and normalised slenderness of the bracing on the sides of the plan mass symmetric/asymmetric structures that the mass is distributed towards and away from.