Water, water everywhere: Dehydration in the midst of plenty: An observational study of barriers and enablers to adequate hydration in older hospitalized patients

While dehydration is common in older patients and is associated with poor outcomes, it has been infrequently studied in the hospital setting. Thus, the aim of this study was to identify potential barriers and enablers to the maintenance of adequate hydration in older patients in an acute hospital environment. An observational study, involving patients aged 60 years and older admitted to an acute care hospital in Queensland, Australia, was undertaken. Forty-four patients were observed during mealtimes, and chart and room audits were performed to identify hydration management strategies, weight records and the presence or absence of fluid balance charts. Results revealed a number of system and practice-related barriers including patient difficulties with opening fluid containers and low levels of documentation of hydration management strategies. Addressing these issues is an important first step towards improving the management of hydration in medically ill older hospital patients.

Applying urban morphology theory to design practice

The aim of this paper is to investigate the relationship between research and design through an applied example of how architects can approach the design for a building guided by data derived from morphological research. An Expert Focus Group consisting of nine leading architects and urban designers from Brisbane, Australia was given the task of testing this proposition. Analysis of the workshop outcomes are examined, and the design drawings of each participant are assessed to determine the relative congruence of the design proposals within the morphological commodity of the specific context. In addition, qualitative data, captured through verbal and written feedback is assessed highlighting the participants' observations and experiences of the workshop. This paper makes a contribution to the current debate within the field on the opportunities of integrating research with practice.

How do Australian podiatrists manage patients with diabetes The Australian diabetic foot management survey

Background Diabetic foot complications are the leading cause of lower extremity amputation and diabetes-related hospitalisation in Australia. Studies demonstrate significant reductions in amputations and hospitalisation when health professionals implement best practice management. Whilst other nations have surveyed health professionals on specific diabetic foot management, to the best of the authors’ knowledge this appears not to have occurred in Australia. The primary aim of this study was to examine Australian podiatrists’ diabetic foot management compared with best practice recommendations by the Australian National Health Medical Research Council. Methods A 36-item Australian Diabetic Foot Management survey, employing seven-point Likert scales (0 = Never; 7 = Always) to measure multiple aspects of best practice diabetic foot management was developed. The survey was briefly tested for face and content validity. The survey was electronically distributed to Australian podiatrists via professional associations. Demographics including sex, years treating patients with diabetes, employment-sector and patient numbers were also collected. Chi-squared and Mann Whitney U tests were used to test differences between sub-groups. Results Three hundred and eleven podiatrists responded; 222 (71%) were female, 158 (51%) from the public sector and 11–15 years median experience. Participants reported treating a median of 21–30 diabetes patients each week, including 1–5 with foot ulcers. Overall, participants registered median scores of at least “very often” (>6) in their use of most items covering best practice diabetic foot management. Notable exceptions were: “never” (1 (1 – 3)) using total contact casting, “sometimes” (4 (2 – 5)) performing an ankle brachial index, “sometimes” (4 (1 – 6)) using University of Texas Wound Classification System, and “sometimes” (4 (3 – 6) referring to specialist multi-disciplinary foot teams. Public sector podiatrists reported higher use or access on all those items compared to private sector podiatrists (p < 0.01). Conclusions This study provides the first baseline information on Australian podiatrists’ adherence to best practice diabetic foot guidelines. It appears podiatrists manage large caseloads of people with diabetes and are generally implementing best practice guidelines recommendations with some notable exceptions. Further studies are required to identify barriers to implementing these recommendations to ensure all Australians with diabetes have access to best practice care to prevent amputations.

The application of learning analytics to improve learning: Questions from the academy

Since 2007, close collaboration between the Learning and Teaching Unit’s Academic Quality and Standards team and the Department of Reporting and Analysis’ Business Objects team resulted in a generational approach to reporting where QUT established a place of trust. This place of trust is where data owners are confident in date storage, data integrity, reported and shared. While the role of the Department of Reporting and Analysis focused on the data warehouse, data security and publication of reports, the Academic Quality and Standards team focused on the application of learning analytics to solve academic research questions and improve student learning. Addressing questions such as: • Are all students who leave course ABC academically challenged? • Do the students who leave course XYZ stay within the faculty, university or leave? • When students withdraw from a unit do they stay enrolled on full or part load or leave? • If students enter through a particular pathway, what is their experience in comparison to other pathways? • With five years historic reporting, can a two-year predictive forecast provide any insight? In answering these questions, the Academic Quality and Standards team then developed prototype data visualisation through curriculum conversations with academic staff. Where these enquiries were applicable more broadly this information would be brought into the standardised reporting for the benefit of the whole institution. At QUT an annual report to the executive committees allows all stakeholders to record the performance and outcomes of all courses in a snapshot in time or use this live report at any point during the year. This approach to learning analytics was awarded the Awarded 2014 ATEM/Campus Review Best Practice Awards in Tertiary Education Management for The Unipromo Award for Excellence in Information Technology Management.

The role of sustainable agriculture and renewable-resource management in reducing greenhouse-gas emissions and increasing sinks in China and India

This paper contains an analysis of the technical options in agriculture for reducing greenhouse-gas emissions and increasing sinks, arising from three distinct mechanisms: (i) increasing carbon sinks in soil organic matter and above-ground biomass; (ii) avoiding carbon emissions from farms by reducing direct and indirect energy use; and (iii) increasing renewable-energy production from biomass that either substitutes for consumption of fossil fuels or replaces inefficient burning of fuelwood or crop residues, and so avoids carbon emissions, together with use of biogas digesters and improved cookstoves. We then review best-practice sustainable agriculture and renewable-resource-management projects and initiatives in China and India, and analyse the annual net sinks being created by these projects, and the potential market value of the carbon sequestered. We conclude with a summary of the policy and institutional conditions and reforms required for adoption of best sustainability practice in the agricultural sector to achieve the desired reductions in emissions and increases in sinks. A review of 40 sustainable agriculture and renewable-resource-management projects in China and India under the three mechanisms estimated a carbon mitigation potential of 64.8 MtC yr(-1) from 5.5 Mha. The potential income for carbon mitigation is $324 million at $5 per tonne of carbon. The potential exists to increase this by orders of magnitude, and so contribute significantly to greenhouse-gas abatement. Most agricultural mitigation options also provide several ancillary benefits. However, there are many technical, financial, policy, legal and institutional barriers to overcome.

Marine protected areas and small-scale fisheries in South Africa: promoting governance, participation, equity and benefit sharing

This monograph studies the progress achieved by conservation partners in South Africa on the implementation of the Convention on Biological Diversity (CBD) Programme Element Two components of governance, participation, equity and benefit sharing, from the perspective of small-scale fishing communities. It explores the strategies and mechanisms used by different authorities to create the conditions whereby local communities can benefit from marine protected areas (MPAs), of which South Africa has gazetted 24, highlighting examples of best practice. The monograph will be useful for researchers, scientists, fishworker organizations, environmentalists and anyone interested in the protection of marine biodiversity and the promotion of sustainable fisheries management.

Risk management and the potential of cattle insurance in Tigray, Northern Ethiopia

This study explores the role of livestock insurance to complement existing risk management strategies adopted by smallholder farmers. Using survey data, first, it provides insights into farmers’ risk perception of livestock farming, in terms of likelihood and severity of risk, attitude to risk and their determinants. Second, it examines farmers’ risk management strategies and their determinants. Third, it investigates farmers’ potential engagement with a hypothetical cattle insurance decision and their intensity of participation. Factor analysis is used to analyse risk sources and risk management, multiple regressions are used to identify the determinants; a Heckman model was used to investigate cattle insurance participation and intensity of participation. The findings show different groups of farmers display different risk attitude in their decision-making related to livestock farming. Production risk (especially livestock diseases) was perceived as the most likely and severe source of risk. Disease control was perceived as the best strategy to manage risk overall. Disease control and feed management were important strategies to mitigate the production risks. Disease control and participation on safety net program were found to be important to counter households’ financial risks. With regard to the hypothetical cattle insurance scheme, 94.38% of households were interested to participate in cattle insurance. Of those households that accepted cattle insurance, 77.38% of the households were willing to pay the benchmark annual premium of 4% of the animal value while for the remaining households this was not affordable. The average number of cattle that farmers were willing to insure was 2.71 at this benchmark. Results revealed that income (log income) and education levels influenced positively and significantly farmers’ participation in cattle insurance and the number of cattle to insure. The findings prompt policy makers to consider livestock insurance as a complement to existing risk management strategies to reduce poverty in the long-run.

Phosphorus export from a restored wetland ecosystem in response to natural and experimental hydrologic fluctuations

Wetland restoration is a commonly used approach to reduce nutrient loading to freshwater and coastal ecosystems, with many wetland restoration efforts occurring in former agricultural fields. Restored wetlands are expected to be effective at retaining or removing both nitrogen and phosphorus (P), yet restoring wetland hydrology to former agricultural fields can lead to the release of legacy fertilizer P. Here, we examined P cycling and export following rewetting of the Timberlake Restoration Project, a 440 ha restored riverine wetland complex in the coastal plain of North Carolina. We also compared P cycling within the restored wetland to two minimally disturbed nearby wetlands and an adjacent active agricultural field. In the restored wetland we observed increased soluble reactive phosphorus (SRP) concentrations following initial flooding, consistent with our expectations that P bound to iron would be released under reducing conditions. SRP concentrations in spring were 2.5 times higher leaving the restored wetland than a forested wetland and an agricultural field. During two large-scale drawdown and rewetting experiments we decreased the water depth by 1 m in ∼10 ha of inundated wetland for 2 weeks, followed by reflooding. Rewetting following experimental drainage had no effect on SRP concentrations in winter, but SRP concentrations did increase when the experiment was repeated during summer. Our best estimates suggest that this restored wetland could release legacy fertilizer P for up to a decade following hydrologic restoration. The time lag between restoration and biogeochemical recovery should be incorporated into management strategies of restored wetlands. Copyright 2010 by the American Geophysical Union.

Compression therapy in leg ulcer management

Led ulcer management is an important consideration for all nurses involved in the care of older people. Non-specialists in tissue viability might not always be aware of the evidence base for best practice. The authors examine the effectiveness of multi-layer and single-layer long or short stretch bandage systems in leg ulcer management.

Developing NGO competencies in post-disaster reconstruction: a theoretical framework

In the aftermath of recent natural disasters, NGOs have become increasingly involved in the permanent reconstruction of affected communities. These organizations, often operating well outside their expertise, encounter significant barriers as they implement reconstruction programmes. This paper presents the theoretical bedrock of a current research project, the overall goal of which is to design a competency-based framework model that can be used by NGOs in post-disaster reconstruction projects. Drawing on established theories of management, a unique perspective has been developed from which a competency-based reconstruction theory emerges. This theoretical framework brings together three distinct fields; Disaster Management, Strategic Management and Project Management, each vital to the success of the model. This theoretical study will incorporate a critical review of literature within each field. It is imperative that NGOs involved in post-disaster reconstruction familiarize themselves with concepts and strategies. It is hoped that the competence-based frame-work model that is produced on the basis of this theory will help define the standard of best practice to which future NGO projects might align themselves.

An evaluation of the effect of altering nutrition and nutritional strategies in early lactation on reproductive performance and estrous behavior of high-yielding Holstein-Friesian dairy cows

Reproductive performance in the high-yielding dairy cow has severely decreased in the last 40 yr. The aim of this study was to compare the effectiveness of 4 nutritional strategies in improving the reproductive performance of high-yielding dairy cows. It was hypothesized that offering cows a high-starch ration in early lactation would enhance the onset of luteal activity, and that decreasing the severity of negative energy balance in the early postcalving period would improve reproductive parameters. Nutritional regimens aimed at improving fertility were applied to 96 Holstein-Friesian dairy animals. Upon calving, animals were allocated in a balanced manner to one of 4 dietary treatments. Primiparous animals were balanced according to live weight, body condition score and calving date. Multiparous animals were balanced according to parity, previous lactation milk yield, liveweight, body condition score and calving date. Treatment 1 was based on an industry best practice diet (control) to contain 170 g of crude protein/kg of dry matter. Treatment 2 was an individual cow feeding strategy, whereby the energy balance (EB) of individual animals was managed so as to achieve a predetermined target daily EB profile (+/- 10 MJ/d). Treatment 3 was a high-starch/high-fat combination treatment, whereby an insulinogenic (high-starch) diet was offered in early lactation to encourage cyclicity and followed by a lipogenic (low-starch, high-fat) diet to promote embryo development. Treatment 4 was a low-protein diet, containing 140 g of crude protein/kg of dry matter, supplemented with protected methionine at an inclusion level of 40 g per animal per day. The nutritional strategies implemented in this study had no statistically significant effects on cow fertility measures, which included the onset of luteal activity, conception rate, in-calf rate, and the incidence of atypical cycles. The individual cow feeding strategy improved EB in early lactation but had no benefit on conception rate to first insemination. However, conception rate to second insemination, 100-d pregnancy rate (from the commencement of breeding), and overall pregnancy rate tended to be higher in this group. The high-starch/high-fat treatment tended to decrease the proportion of delayed ovulations and increase the proportion of animals cycling by d 50 postcalving. Animals that failed to conceive to first insemination had a significantly longer luteal phase in the first cycle postpartum and a longer inter-ovulatory interval in the second cycle postpartum. With regards to estrous behavior, results indicate that as the size of the sexually active group increased, the intensity of estrus and the expression of mounting or attempting to mount another cow also increased. Furthermore, cows that became pregnant displayed more intense estrous behavior than cows that failed to become pregnant.

Management of long-term sickness absence: a systematic realist review

Purpose
The increasing impact and costs of long term sickness absence have been well documented. However, the diversity and complexity of interventions and of the contexts in which these take place makes a traditional review problematic. Therefore, we undertook a systematic realist review to identify the dominant programme theories underlying best practice, to assess the evidence for these theories, and to throw light on important enabling or disabling contextual factors.

Method
A search of the scholarly literature from 1950 to 2011 identified 5,576 articles, of which 269 formed the basis of the review.

Results
We found that the dominant programme theories in relation to effective management related to: early intervention or referral by employers; having proactive organisational procedures; good communication and cooperation between stakeholders; and workplace-based occupational rehabilitation. Significant contextual factors were identified as the level of support for interventions from top management, the size and structure of the organisation, the level of financial and organisational investment in the management of long-term sickness absence, and the quality of relationships between managers and staff.

Conclusions
Consequently, those with responsibility for managing absence should bear in mind the contextual factors that are likely to have an impact on interventions, and do what they can to ensure stakeholders have at least a mutual understanding (if not a common purpose) in relation to their perceptions of interventions, goals, culture and practice in the management of long term sickness absence.

Waste Management and Sustainability during the Design Phase of a Construction Project: A Qualitative Review

Waste management and sustainability are two core underlying philosophies that the construction sector must acknowledge and implement; however, this can prove difficult and time consuming. To this end, the aim of this paper is to examine waste management strategies and the possible benefits, advantages and disadvantages to their introduction and use, while also to examine any inter-relationship with sustainability, particularly at the design stage. The purpose of this paper is to gather, examine and review published works and investigate factors which influence economic decisions at the design phase of a construction project. In addressing this aim, a three tiered sequential research approach is adopted; in-depth literature review, interviews/focus groups and qualitative analysis. The resulting data is analyzed, discussed, with potential conclusions identified; paying particular attention to implications for practice within architectural firms. This research is of importance, particularly to the architectural sector, as it can add to the industry’s understanding of the design process, while also considering the application and integration of waste management into the design procedure. Results indicate that the researched topic had many advantages but also had inherent disadvantages. It was found that the potential advantages outweighed disadvantages, but uptake within industry was still slow and that better promotion and their benefits to; sustainability, the environment, society and the industry were required.

Factors Influencing the Implementation of Site Waste Management Plans on UK Projects of all sizes

The purpose of this research is to identify and assess the opportunities and challenges of implementing a Site Waste Management Plan (SWMP) on projects irrespective of size. In the UK, construction and demolition waste accounts for a third of all UK waste. There are a number of factors that influence the implementation of SWMPs. In order to identify and analyse these factors, 4 unstructured interviews were carried out and a sample of 56 participants completed a questionnaire survey. The scope of the study was limited to UK
construction industry professionals. The analysis revealed that more needs to be done if the industry is to meet government targets of reduction in construction related waste going to landfill. In addition, although SWMP may not yet be legally required on all construction projects, clients and contractors need to realise
the benefits to cut costs and implement best practice by adopting a SWMP. The benefits of implementing a SWMP will not only help to achieve this but also gain significant cost savings on projects and is also extremely beneficial to the environment. This study presents evidence that contractors need to do more to reduce waste and draws a clear link between waste reduction and the implementation of SWMPs. The findings are useful in the ongoing efforts to encourage the industry to find smarter, more efficient and less
damaging ways to operate

Material Logistics in Urban Construction Sites: A Structural Equation Model

Aim: The aim of this paper is to identify best practice relating to the effective management of materials in an urban, confined construction site, using structural equation modelling.

Methodology: A literature review, case study analysis and questionnaire survey are employed, with the results scrutinised using confirmatory factor analysis in the form of structural equation modelling.

Results: The following are the leading strategies in the management of materials in a confined urban site environment; (1) Consult and review the project programme, (2) Effective communication and delivery, (3) Implement site safety management plans, and (4) Proactive spatial monitoring and control.

Implication for Practice: With the relentless expansion of urban centres and the increasing high cost of materials, any potential savings made on-site would translate into significant monetary concessions on completion of a development.

Originality/Value: As on-site project management professionals successfully identify and implement the various strategies in the management of plant and materials on a confined urban site, successful resource management in this restrictive environment is attainable.

Innovative Aspect of Paper: An empirical study of three different construction sites in three different countries (Ireland, England and USA) together with a questionnaire survey from the industry, investigating the managerial strategies in the management of plant and material in confined urban site environments