Glucose enhancement of recognition memory: differential effects on effortful processing but not aspects of 'remember-know' responses

The administration of a glucose drink has been shown to enhance cognitive performance with effect sizes comparable with those from pharmaceutical interventions in human trials. In the memory domain, it is currently debated whether glucose facilitation of performance is due to differential targeting of hippocampal memory or whether task effort is a more important determinant. Using a placebo-controlled, double-blind, crossover 2(Drink: glucose/placebo) × 2(Effort: ± secondary task) design, 20 healthy young adults' recognition memory performance was measured using the 'remember-know' procedure. Two high effort conditions (one for each drink) included secondary hand movements during word presentation. A 25 g glucose or 30 mg saccharine (placebo) drink was consumed 10 min prior to the task. The presence of a secondary task resulted in a global impairment of memory function. There were significant Drink × Effort interactions for overall memory accuracy but no differential effects for 'remember' or 'know' responses. These data suggest that, in some circumstances, task effort may be a more important determinant of the glucose facilitation of memory effect than hippocampal mediation. This article is part of a Special Issue entitled 'Cognitive Enhancers'.

Cancer patients' perceptions of the barriers and facilitators to patient participation in symptom management during an episode of admission

BACKGROUND:: Symptoms by definition are subjective, and patients' role in their assessment and management will impact on patient outcomes; thus, symptom management is an area of acute care practice where facilitation of patient participation is vital if quality outcomes are to be achieved. OBJECTIVE:: This study originated from a large multimethod research program exploring patient participation in symptom management in an acute oncology setting. The purpose of this article is to explore patients' perceptions of the barriers and facilitators to participating in their symptom management during an episode of admission to an acute oncology ward and the relationships between these perceptions and patients' preference for participation. METHODS:: One hundred seventy-one cancer inpatients consented and completed an interview-administered questionnaire. Patients' preference for participation was measured using the Control Preference Scale. Responses to open-ended survey questions were evaluated using content analysis. RESULTS:: Ten categories were identified in the analyses of patient perceptions of the barriers and facilitators to participating in care decisions relating to their symptoms. Patients, irrespective of their Control Preference, reported multiple barriers and facilitators to participating in their symptom management. CONCLUSIONS:: Patients overall perceived information as the most critical component of participation. Irrespective of patients' preference for participation, there were similarities in the barriers and facilitators to the operationalization of participation in the acute care setting reported. IMPLICATIONS FOR PRACTICE:: Understanding patient perceptions of barriers and facilitators of participating in symptom management has provided important insights into person and system factors in the acute care sector impacting quality patient symptom outcomes.

Patient participation in pulmonary interventions to reduce postoperative pulmonary complications following cardiac surgery.

BACKGROUND: Clinical interventions aimed at reducing the incidence of postoperative pulmonary complications necessitate patient engagement and participation in care. Patients' ability and willingness to participate in care to reduce postoperative complications is unclear. Further, nurses' facilitation of patient participation in pulmonary interventions has not been explored. OBJECTIVE: To explore patients' ability and willingness to participate in pulmonary interventions and nurses' facilitation of pulmonary interventions. DESIGN: Single institution, case study design. Multiple methods of data collection were used including preadmission (n=130) and pre-discharge (n=98) patient interviews, naturalistic observations (n=48) and nursing focus group interviews (n=2). SETTING: A cardiac surgical ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. PARTICIPANTS: One hundred and thirty patients admitted for cardiac surgery via the preadmission clinic during a 1-year period and 40 registered nurses who were part of the permanent workforce on the cardiac surgical ward. OUTCOME MEASURES: Patients' understanding of their role in pulmonary interventions and patients' preference for and reported involvement in pulmonary management. Nurses' facilitation of patients to participate in pulmonary interventions. RESULTS: Patients displayed a greater understanding of their role in pulmonary interventions after their surgical admission than they did at preadmission. While 55% of patients preferred to make decisions about deep breathing and coughing exercises, three-quarters of patients (75%) reported they made decisions about deep breathing and coughing during their surgical admission. Nurses missed opportunities to engage patients in this aspect of pulmonary management. CONCLUSIONS: Patients appear willing to take responsibility for pulmonary management in the postoperative period. Nurses could enhance patient participation in pulmonary interventions by ensuring adequate information and education is provided. Facilitation of patients' participation in their recovery is a fundamental aspect of care delivery in this context.

Interprofessional interactions influence nurses' adoption of handover improvement

Aim: The purpose of this study was to explore clinician experiences of adopting quality improvement tools to standardise interprofessional (anaesthetist-to-nurse) handover communication when patients arrive in the post-anaesthetic care unit (PACU). Method: In this study, factors that impacted PACU nurses' adoption of the quality improvement tools were explored using pre- and postimplementation, semi-structured focus group interviews. Interview data was analysed using the PARiHS¹ (context, evidence and facilitation) framework as a deductive analysis tool. Results: PACU nurses recognised that PACU handover from anaesthetists to PACU nurses was suboptimal and described the tools as useful for their practice. However, PACU nurses frequently cited fear of anaesthetists' reactions as reasons not to insist on the use of the handover improvement tools. PACU nurses at Hospital 2 identified lacking "authority" (Hospital 2 FG 2) in the OR as hindering their willingness to use the tools against these behaviours. In comparison, visible support from leadership at Hospital 1 was described as encouraging nurses to be "assertive" (Hospital 1 FG 2) and take charge of their patients' care. Conclusion: PACU nurses perceived the handover tools were useful and helped them identify gaps in handover practice; however, PACU nurses described difficult relationships as hindering communication effectiveness and discouraging their adoption of the tools. However, strong leadership and organisational support of change emerged as essential to mitigate the effects of these difficult relationships.

Experience and the artist's body : resisting the Uber-artist construct in socially engaged performance

Looking back over the past 20 years of my practice, the vista is littered with ambiguities of process and form within socially engaged performance. Sifting through the debris, one question arises: what have I been doing?; another might be: what have I been making? What feels relevant to me is the aggregate of my experiences; the who I am. With the current sector creep towards instrumentalising arts for social agendas, the value and relevance of experience ebbs. Demands on artists extend well beyond aesthetic skill, process facilitation and project management. In this essay, I critique the risk within socially engaged practice of art becoming subservient to social agendas and consider how the shift towards an uber-artist construct renders the sector unsustainable.

Nurse plant effects of a dominant shrub (Duma florulenta) on understorey vegetation in a large, semi-arid wetland in relation to flood frequency and drying

 Questions: Do nurse plant interactions significantly influence understorey vegetation diversity in a large, semi-arid, shrub-dominated wetland? How do the modes and net effects of nurse plant interactions vary spatially along a flood frequency gradient, and temporally in response to drying? Location: Narran Lakes Ramsar site, New South Wales, Australia. Methods: Microhabitat characteristics, understorey vegetation and germinable soil seed banks were investigated in shrub and open habitats across a flood frequency gradient in a large, semi-arid wetland dominated by open shrubland under productive conditions following floodwater recession and again following 6 mo of drought. Split-plot ANOVA and multivariate analyses were used to determine the effects of shrubs on microhabitat character, understorey vegetation cover, species diversity, richness and composition and germinable soil seed banks. Results: Microhabitat characteristics, including canopy cover, litter cover and soil character, all differed between shrub and open habitats, especially in the most frequently flooded sites. Under productive conditions following flooding, lignum shrubs suppressed understorey vegetation cover but increased species richness at the site scale across the flood frequency gradient and, in the most frequently flooded sites, supported higher species density at a microhabitat scale. Under dry conditions, lignum shrubs had a positive effect on understorey vegetation cover, species richness and species density across the flood frequency gradient, but particularly in frequently flooded sites. A significant difference in soil seed bank composition between shrub and open habitats was only observed in frequently flooded sites. Conclusions: Nurse plant interactions appear to play an important role in determining understorey vegetation diversity in the lignum shrubland of the Narran Lakes wetland system. The modes and net effects of these nurse plant interactions vary in space and time in relation to flood history and drying. Positive interactions, probably involving microhabitat amelioration, appear to be particularly important to plant diversity and abundance under dry conditions. Under more favourable wetter conditions, lignum shrubs also contribute to understorey vegetation diversity by facilitating the establishment of different species than those dominating open habitats. Our findings have implications for the management of perennial shrubs and hydrological regimes in such wetlands.

The impact of socially responsible human resource management on employees' organizational citizenship behaviour: the mediating role of organizational identification

Based on insights from social exchange and social identity theories, this paper examines the influence of three dimensions of socially responsible human resource management (SR-HRM), namely legal compliance HRM, employee-oriented HRM and general CSR facilitation HRM, on employees' organizational citizenship behaviour (OCB). Structural equation modelling of dyadic data collected from Chinese employees and their direct supervisors in three phases revealed that whilst organizational identification fully mediated the relationship between employee-oriented HRM and employee OCB, general CSR facilitation HRM had a direct effect on employee OCB. In contrast, legal compliance HRM neither influenced employee OCB directly, nor indirectly through organizational identification. The findings highlight the important but complex role played by SR-HRM in eliciting positive employee work outcomes, and contribute to our knowledge of the mechanisms underlying this relationship.

Implementing guidelines to routinely prevent chronic vascular disease in primary care: the preventive evidence into practice cluster randomised controlled trial

Objective: To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease. Setting: 32 urban general practices in 4 Australian states. Randomisation: Stratified randomisation of practices. Participants: 122 general practitioners (GPS) and practice nurses (PNs) were recruited at baseline and 97 continued to 12 months. 21 848 patient records were audited for those aged 40-69 years who attended the practice in the previous 12 months without heart disease, stroke, diabetes, chronic renal disease, cognitive impairment or severe mental illness. Intervention: The practice level intervention over 6 months included small group training of practice staff, feedback on audited performance, practice facilitation visits and provision of patient education and referral information. Outcome measures: Primary: 1. Change in proportion of patients aged 40-69 years with smoking status, alcohol intake, body mass index (BMI), waist circumference (WC), blood pressure (BP) recorded and for those aged 45-69 years with lipids, fasting blood glucose and cardiovascular risk in the medical record. 2. Change in the level of risk for each factor. Secondary: change in self-reported frequency and confidence of GPS and PNs in assessment. Results: Risk recording improved in the intervention but not the control group for WC (OR 2.52 (95% CI 1.30 to 4.91)), alcohol consumption (OR 2.19 (CI 1.04 to 4.64)), smoking status (OR 2.24 (1.17 to 4.29)) and cardiovascular risk (OR 1.50 (1.04 to 2.18)). There was no change in recording of BP, lipids, glucose or BMI and no significant change in the level of risk factors based on audit data. The confidence but not reported practices of GPS and PNs in the intervention group improved in the assessment of some risk factors. Conclusions: This intervention was associated with improved recording of some risk factors but no change in the level of risk at the follow-up audit. Trial registration number: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000578808, results.

How feasible are lifestyle modification programs for disease prevention in general practice?

Vascular disease is a leading cause of death and disability. While it is preventable, little is known about the feasibility or acceptability of implementing interventions to prevent vascular disease in Australian primary health care. We conducted a cluster randomised controlled trial assessing prevention of vascular disease in patients aged 40–65 by providing a lifestyle modification program in general practice. Interviews with 13 general practices in the intervention arm of this trial examined their views on implementing the lifestyle modification program in general practice settings. Qualitative study, involving thematic analysis of semi-structured interviews with 11 general practitioners, four practice nurses and five allied health providers between October 2009 and April 2010. Providing brief lifestyle intervention fitted well with routine health-check consultations; however, acceptance and referral to the program was dependent on the level of facilitation provided by program coordinators. Respondents reported that patients engaged with the advice and strategies provided in the program, which helped them make lifestyle changes. Practice nurse involvement was important to sustaining implementation in general practice, while the lack of referral services for people at risk of developing vascular disease threatens maintenance of lifestyle changes as few respondents thought patients would continue lifestyle changes without long-term follow up. Lifestyle modification programs to prevent vascular disease are feasible in general practice but must be provided in a flexible format, such as being offered out of hours to facilitate uptake, with ongoing support and follow up to assist maintenance. The newly formed Medicare Locals may have an important role in facilitating lifestyle modification programs for this target group.

Moving towards a more integrated approach to chronic disease prevention in Australian general practice

There is increasing evidence that prevention of chronic disease is possible and that primary care can contribute to this. This paper aims to explore the development of policies and programs to improve chronic disease prevention via behavioural risk factor management in Australian general practice and the impact of these between 2001 and the present. This involved a review of policy initiatives and developments in Australian general practice, drawing on published research over this period. Behavioural risk factor management has not been comprehensively implemented in the way in which it was originally envisaged under the SNAP (Smoking, Nutrition, Alcohol and Physical Activity) framework, with initiatives and programs emerging over time in a much less planned way, including Lifescripts and more recently the 45 - 49 year health check. There has been a gradual development in capacity, especially in relation to workforce, education and training, educational materials, financial and decision support with divisions of general practice emerging to play a key facilitation role. Despite this, important gaps remain especially in relation to the use of team approaches within and outside the practice including access to referral services and programs.

Helping someone with problem drinking: mental health first aid guidelines - a Delphi expert consensus study.

BACKGROUND: Alcohol is a leading risk factor for avoidable disease burden. Research suggests that a drinker's social network can play an integral role in addressing hazardous (i.e., high-risk) or problem drinking. Often however, social networks do not have adequate mental health literacy (i.e., knowledge about mental health problems, like problem drinking, or how to treat them). This is a concern as the response that a drinker receives from their social network can have a substantial impact on their willingness to seek help. This paper describes the development of mental health first aid guidelines that inform community members on how to help someone who may have, or may be developing, a drinking problem (i.e., alcohol abuse or dependence). METHODS: A systematic review of the research and lay literature was conducted to develop a 285-item survey containing strategies on how to help someone who may have, or may be developing, a drinking problem. Two panels of experts (consumers/carers and clinicians) individually rated survey items, using a Delphi process. Surveys were completed online or via postal mail. Participants were 99 consumers, carers and clinicians with experience or expertise in problem drinking from Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States. Items that reached consensus on importance were retained and written into guidelines. RESULTS: The overall response rate across all three rounds was 68.7% (67.6% consumers/carers, 69.2% clinicians), with 184 first aid strategies rated as essential or important by > or =80% of panel members. The endorsed guidelines provide guidance on how to: recognize problem drinking; approach someone if there is concern about their drinking; support the person to change their drinking; respond if they are unwilling to change their drinking; facilitate professional help seeking and respond if professional help is refused; and manage an alcohol-related medical emergency. CONCLUSION: The guidelines provide a consensus-based resource for community members seeking to help someone with a drinking problem. Improving community awareness and understanding of how to identify and support someone with a drinking problem may lead to earlier recognition of problem drinking and greater facilitation of professional help seeking.

Profiling nursing resources in Australian emergency departments

BACKGROUND: Emergency nurses have a key role in managing the large numbers of patients that attend Australian emergency departments (EDs) annually, and require adequate educational preparation to deliver safe and quality patient care. This paper provides a detailed profile of nursing resources in Australian EDs, including ED locations, annual patient attendances, nurse staffing including level of education, and educational resources. METHODS: Data were collected via online surveys of emergency Nurse Unit Managers and Nurse Educators and the MyHospitals website. Data were analysed by hospital peer group and state or territory. Comparisons were made using the Kruskal-Wallis Test and Spearman Rank Order Correlation. RESULTS: In 2011-2012, there were a median of 36,274 patient attendances to each of the 118 EDs sampled (IQR 28,279-46,288). Most of the nurses working in EDs were Registered Nurses (95.2%). Organisations provided educational resources including Clinical Nurse Educators (80.6%), learning packages (86%) and facilitation of postgraduate study (98%), but resources, both human and educational varied substantially between states and territories. One-third of emergency nurses held a relevant postgraduate qualification (30%). CONCLUSION: There are important variations in the emergency nursing resources available between Australian states and territories. The high percentage of RNs in Australian EDs is a positive finding, however strategies to increase the percentage of nurses with relevant postgraduate qualifications are required.

A succession of theories : purging redundancy from disturbance theory

The topics of succession and post-disturbance ecosystem recovery have a long and convoluted history. There is extensive redundancy within this body of theory, which has resulted in confusion, and the links among theories have not been adequately drawn. This review aims to distil the unique ideas from the array of theory related to ecosystem change in response to disturbance. This will help to reduce redundancy, and improve communication and understanding between researchers. We first outline the broad range of concepts that have developed over the past century to describe community change in response to disturbance. The body of work spans overlapping succession concepts presented by Clements in 1916, Egler in 1954, and Connell and Slatyer in 1977. Other theories describing community change include state and transition models, biological legacy theory, and the application of functional traits to predict responses to disturbance. Second, we identify areas of overlap of these theories, in addition to highlighting the conceptual and taxonomic limitations of each. In aligning each of these theories with one another, the limited scope and relative inflexibility of some theories becomes apparent, and redundancy becomes explicit. We identify a set of unique concepts to describe the range of mechanisms driving ecosystem responses to disturbance. We present a schematic model of our proposed synthesis which brings together the range of unique mechanisms that were identified in our review. The model describes five main mechanisms of transition away from a post-disturbance community: (i) pulse events with rapid state shifts; (ii) stochastic community drift; (iii) facilitation; (iv) competition; and (v) the influence of the initial composition of a post-disturbance community. In addition, stabilising processes such as biological legacies, inhibition or continuing disturbance may prevent a transition between community types. Integrating these six mechanisms with the functional trait approach is likely to improve the predictive capacity of disturbance theory. Finally, we complement our discussion of theory with a case study which emphasises that many post-disturbance theories apply simultaneously to the same ecosystem. Using the well-studied mountain ash (Eucalyptus regnans) forests of south-eastern Australia, we illustrate phenomena that align with six of the theories described in our model of rationalised disturbance theory. We encourage further work to improve our schematic model, increase coverage of disturbance-related theory, and to show how the model may link to, or integrate with, other domains of ecological theory.

Central proopiomelanocortin but not neuropeptide Y mediates sympathoexcitation and hypertension in fat fed conscious rabbits

OBJECTIVE: High-fat diet (HFD)-induced hypertension in rabbits is neurogenic because of the central sympathoexcitatory actions of leptin. Hypothalamic melanocortin and neuropeptide Y (NPY) neurons are recognized as the major signalling pathways through which leptin exerts its central effects. In this study, we assessed the effects of specific antagonists and agonists to melanocortin and NPY receptors on HFD-induced sympathoexcitation and hypertension. METHODS: Rabbits were instrumented with intracerebroventricular cannula, renal sympathetic nerve activity (RSNA) electrode, and blood pressure telemetry transmitter. RESULTS: After 3 weeks HFD (13.5% fat, n = 12) conscious rabbits had higher RSNA (+3.8  nu, P = 0.02), blood pressure (+8.6  mmHg, P < 0.001) and heart rate (+15  b/min, P = 0.01), and brain-derived neurotrophic factor levels in the hypothalamus compared with rabbits fed a control diet (4.2% fat, n = 11). Intracerebroventricular administration of the melanocortin receptor antagonist SHU9119 reduced RSNA (-2.7  nu) and blood pressure (-8.5  mmHg) in HFD but not control rabbits, thus reversing 100% of the hypertension and 70% of the sympathoexcitation induced by a HFD. By contrast, blocking central NPY Y1 receptors with BVD10 increased RSNA only in HFD rabbits. Intracerebroventricular α-melanocortin stimulating hormone increased RSNA and heart rate (P < 0.001) in HFD rabbits but had no effect in control rabbits. CONCLUSION: These findings suggest that obesity-induced hypertension and increased RSNA are dependent on the balance between greater activation of melanocortin signalling through melanocortin receptors and lesser activation of NPY sympathoinhibitory signalling. The amplification of the sympathoexcitatory effects of α-melanocortin stimulating hormone also indicates that the underlying mechanism is related to facilitation of leptin-melanocortin signalling, possibly involving chronic activation of brain-derived neurotrophic factor.

Owner-driven reconstruction in India: a case-study of Kosi River floods in Bihar

An Owner-Driven Reconstruction (ODR) approach was adopted in the Indian state of Bihar, post 2008 Kosi River floods. This ODR was unique as it was piloted prior to policy formation. The paper discusses preliminary observations from empirical investigations conducted in two settlements of Bihar - Orlaha and Puraini, during 2012 and 2014. The aim was to identify ‘key processes’ or effectiveness of ODR approaches that enhance long-term disaster-resilience of housing and community autonomy. From the case-study investigations, one of the themes – community facilitation is discussed, with its positives and negatives for future replication.