A pilot RCT of a multi-component nutrition intervention for nursing home residents with dementia

Background Malnutrition and unintentional weight loss are major clinical issues in people with dementia living in residential aged care facilities (RACFs) and are associated with serious adverse outcomes. However, evidence regarding effective interventions is limited and strategies to improve the nutritional status of this population are required. This presentation describes the implementation and results of a pilot randomised controlled trial of a multi-component intervention for improving the nutritional status of RACF residents with dementia. Method Fifteen residents with moderate-severe dementia living in a secure long-term RACF participated in a five week pilot study. Participants were randomly allocated to either an Intervention (n=8) or Control group (n=7). The intervention comprised four elements delivered in a separate dining room at lunch and dinner: the systematic reinforcement of residents’ eating behaviors using a specific communication protocol; family-style dining; high ambiance table presentation; and routine Dietary-Nutrition Champion supervision. Control group participants ate their meals according to the facility’s standard practice. Baseline and follow-up assessments of nutritional status, food consumption, and body mass index were obtained by qualified nutritionists. Additional assessments included measures of cognitive functioning, mealtime agitation, depression, wandering status and multiple measures of intervention fidelity. Results No participant was malnourished at study commencement and participants in both groups gained weight from follow-up to baseline which was not significantly different between groups (t=0.43; p=0.67). A high degree of treatment fidelity was evident throughout the intervention. Qualitative data from staff indicate the intervention was perceived to be beneficial for residents. Conclusions This multi-component nutritional intervention was well received and was feasible in the RACF setting. Participants’ sound nutritional status at baseline likely accounts for the lack of an intervention effect. Further research using this protocol in malnourished residents is recommended. For success, a collaborative approach between researchers and facility staff, particularly dietary staff, is essential.

Advancing initiatives in care of cognitively impaired patients in acute care settings

In November 2014, the Australian Commission on Safety and Quality in Health Care (ACSQHC) released “A better way to care: Safe and high quality care for patients with cognitive impairment (dementia and delirium) in hospital”. http://www.safetyandquality.gov.au/our-work/cognitive-impairment. The handbook is available as three separate resources for the three audiences: clinicians, service managers and consumers. These resources are designed to inform and guide improved care for older patients with cognitive impairment (CI) (dementia, delirium) in acute care settings. In particular, the service managers resource recommends that organisations comprehensively prepare themselves so that they are alert to delirium and the risk it poses for patients, that they can recognise and respond to patients with CI, and that they are able to provide safe and high quality care tailored to individual patient’s needs. Service managers and clinicians should carefully consider the information provided in the resources and judiciously explore how best to modify and adapt everyday care practices where appropriate. It is important that clinical teams respond to the available information as the ACSQHC identifies that dementia and/or delirium is associated with adverse outcomes, including functional decline, increased risk of falls, and increased morbidity and mortality...

Post-traumatic stress and dementia: Staff perspectives

Some evidence suggests that behavioural and psychological symptoms of dementia (BPSD) are more pronounced in veterans with a history of post-traumatic stress disorder (PTSD) than in others with dementia. Catherine Travers, Elizabeth Beattie and Elaine Fielding surveyed Australian healthcare professionals to better understand whether PTSD influences the expression of these symptoms in veterans with dementia.

Averting biodiversity collapse in tropical forest protected areas

The rapid disruption of tropical forests probably imperils global biodiversity more than any other contemporary phenomenon(1-3). With deforestation advancing quickly, protected areas are increasingly becoming final refuges for threatened species and natural ecosystem processes. However, many protected areas in the tropics are themselves vulnerable to human encroachment and other environmental stresses(4-9). As pressures mount, it is vital to know whether existing reserves can sustain their biodiversity. A critical constraint in addressing this question has been that data describing a broad array of biodiversity groups have been unavailable for a sufficiently large and representative sample of reserves. Here we present a uniquely comprehensive data set on changes over the past 20 to 30 years in 31 functional groups of species and 21 potential drivers of environmental change, for 60 protected areas stratified across the world's major tropical regions. Our analysis reveals great variation in reserve `health': about half of all reserves have been effective or performed passably, but the rest are experiencing an erosion of biodiversity that is often alarmingly widespread taxonomically and functionally. Habitat disruption, hunting and forest-product exploitation were the strongest predictors of declining reserve health. Crucially, environmental changes immediately outside reserves seemed nearly as important as those inside in determining their ecological fate, with changes inside reserves strongly mirroring those occurring around them. These findings suggest that tropical protected areas are often intimately linked ecologically to their surrounding habitats, and that a failure to stem broad-scale loss and degradation of such habitats could sharply increase the likelihood of serious biodiversity declines.

Let sleeping doggerel lie?: James Joyce's "The Death of Parnell" and the challenges of addressing 'bad' verse in translation

Eterio Pajares, Raquel Merino y José Miguel Santamaría (eds.)

Panel discussion: U.S. EPA using modeling and ecosystem services to enhance coastal decision making

This panel will discuss the research being conducted, and the models being used in three current coastal EPA studies being conducted on ecosystem services in Tampa Bay, the Chesapeake Bay and the Coastal Carolinas. These studies are intended to provide a broader and more comprehensive approach to policy and decision-making affecting coastal ecosystems as well as provide an account of valued services that have heretofore been largely unrecognized. Interim research products, including updated and integrated spatial data, models and model frameworks, and interactive decision support systems will be demonstrated to engage potential users and to elicit feedback. It is anticipated that the near-term impact of the projects will be to increase the awareness by coastal communities and coastal managers of the implications of their actions and to foster partnerships for ecosystem services research and applications. (PDF contains 4 pages)

Five concepts in planning theory useful to coastal management

In recent years coastal resource management has begun to stand as its own discipline. Its multidisciplinary nature gives it access to theory situated in each of the diverse fields which it may encompass, yet management practices often revert to the primary field of the manager. There is a lack of a common set of “coastal” theory from which managers can draw. Seven resource-related issues with which coastal area managers must contend include: coastal habitat conservation, traditional maritime communities and economies, strong development and use pressures, adaptation to sea level rise and climate change, landscape sustainability and resilience, coastal hazards, and emerging energy technologies. The complexity and range of human and environmental interactions at the coast suggest a strong need for a common body of coastal management theory which managers would do well to understand generally. Planning theory, which itself is a synthesis of concepts from multiple fields, contains ideas generally valuable to coastal management. Planning theory can not only provide an example of how to develop a multi- or transdisciplinary set of theory, but may also provide actual theoretical foundation for a coastal theory. In particular we discuss five concepts in the planning theory discourse and present their utility for coastal resource managers. These include “wicked” problems, ecological planning, the epistemology of knowledge communities, the role of the planner/ manager, and collaborative planning. While these theories are known and familiar to some professionals working at the coast, we argue that there is a need for broader understanding amongst the various specialists working in the increasingly identifiable field of coastal resource management. (PDF contains 4 pages)

A re-examination of tigerfish growth rates in Lake Kariba

Growth rates of male and female tigerfish Hydrocynus vittatus were determined from length/frequencies of fish from the Sanyati Basin and Sinamwenda estuary, Lake Kariba. Growth rates were similar in both sexes for the first two years, after which females grew faster and reached a greater length. Fish from the Sanyati Basin appeared to grow slightly faster than those from the Sinamwenda Estuary.

A comparison of phytoplankton and total particle counts

Phytoplankton counts made under the light microscope were compared to counts using an electronic dimensional particle counter. Counts were made on a monthly basis, on water samples taken from one station in the Sanyati Basin. Neither total particle numbers nor total particle volume compare closely with phytoplankton numbers. Total particle numbers were of the order of one and a half to two times greater than the phytoplankton numbers.

Preliminary phytoplankton counts in the Sanyati Basin, Lake Kariba

Phytoplankton counts were made on a monthly basis on water samples, taken from one station in the Sanyati Basin. The results show seasonal fluctuations which are probably nutrient dependant. High phytoplankton numbers occur at times of high nutrient levels as was found with the crustacean zooplankton populations (Marshall 1980). Numbers also decreased with depth down to the thermocline. Below the thermocline there was little or no change in numbers.

Bibliography of synthesis documents on selected coastal ocean topics

This compilation of references to works which synthesize information on coastal topics is intended to be useful to resource managers in decision making processes. However, the utility must be understand in terms of its limited coverage. The bibliography is not inclusive of all the published materials on the topics selected. Coverage is clearly defined in the following paragraph. The time span of the bibliography is limited to references that were published from I983 to 1993, except for a last-minute addition of a few 1994 publications. All searches were done in mid- to late-1993. The bibliography was compiled from searches done on the following DIALOG electronic databases: Aquatic Sciences and Fisheries Abstracts, BlOSlS Previews, Dissertation Abstracts Online, Life Sciences Collection, NTlS (National Technical lnformation Service), Oceanic Abstracts, Pollution Abstracts, SciSearch, and Water Resources Abstracts. In addition, two NOAA electronic datases were searched: the NOAA Library and lnformation Catalog and the NOAA Sea Grant Depository Database. Synthesis of information is not an ubiquitous term used in database development. In order to locate syntheses of required coastal topics, 89 search terms were used in combinations which required 10 searches from each file. From the nearly 6,000 citations which resulted from the electronic searches, the most appropriate were selected to produce this bibliography. The document was edited and indexed using Wordperfect software. When available, an abstract has been included. Every abstract was edited. The bibliography is subdivided into four main topics or sections: ecosystems, coastal water body conditions, natural disasters, and resource management. In the ecosystems section, emphasis is placed on organisms in their environment on the major coastlines of the U.S. In the second section, coastal water body conditions, the environment itself is emphasized. References were found for the Alaskan coast, but none were found for Hawaii. The third section, on natural disasters, emphasizes environmental impacts resulting from natural phenomena. Guidelines, planning and management reports, modelling documents, strategic and restoration plans, and environmental economics related to sustainability are included in the fourth section, resource management. Author, geographic, and subject indices indices are provided. The authors would like to thank Victor Omelczenko and Terry Seldon of the NOAA Sea Grant Office for access to and training on the NOAA Sea Grant Depository Database. We are grateful also to Dorothy Anderson, Philip Keavey, and Elizabeth Petersen who reviewed the draft document.

The Islay wave power project: an engineering prospective

The design, construction and subsequent operation of the 75 kW oscillating water column wave power plant on the Isle of Islay has provided a significant insight into the practicality of wave power conversion. The development of wave power plant poses a significant design and construction challenge for not only civil but also mechanical and electrical engineers. The plant must withstand the immense forces imposed during storms, yet efficiently convert the slow cyclic motion of waves into a useful energy source such as electricity and do so at a price competitive with other forms of generation. In addition, the hostile marine environment hampers the construction process and the variability of the wave resource poses problems for electrical control and grid integration. Many sceptics consider wave power conversion to be too difficult, too expensive and too variable to justify the effort and expense necessary to develop this technology. However, the authors contend that with modular wave power systems developed from the practical experience gained with the Islay plant, wave power is a viable technology with a considerable world market potential. However, this technology is still at the early stages of development and will require the construction of a number of different prototypes before there is extensive commercial exploitation.