Encouraging, assisting, and time to eat : comparison of mealtime assistance interventions in elderly medical inpatients

BACKGROUND: The prevalence of protein-energy malnutrition in older adults is reported to be as high as 60% and is associated with poor health outcomes. Inadequate feeding assistance and mealtime interruptions may contribute to malnutrition and poor nutritional intake during hospitalisation. Despite being widely implemented in practice in the United Kingdom and increasingly in Australia, there have been few studies examining the impact of strategies such as Protected Mealtimes and dedicated feeding assistant roles on nutritional outcomes of elderly inpatients. AIMS: The aim of this research was to implement and compare three system-level interventions designed to specifically address mealtime barriers and improve energy intakes of medical inpatients aged ≥65 years. This research also aimed to evaluate the sustainability of any changes to mealtime routines six months post-intervention and to gain an understanding of staff perceptions of the post-intervention mealtime experience. METHODS: Three mealtime assistance interventions were implemented in three medical wards at Royal Brisbane and Women's Hospital: AIN-only: Additional assistant-in-nursing (AIN) with dedicated nutrition role. PM-only: Multidisciplinary approach to meals, including Protected Mealtimes. PM+AIN: Combined intervention: AIN + multidisciplinary approach to meals. An action research approach was used to carefully design and implement the three interventions in partnership with ward staff and managers. Significant time was spent in consultation with staff throughout the implementation period to facilitate ownership of the interventions and increase likelihood of successful implementation. A pre-post design was used to compare the implementation and nutritional outcomes of each intervention to a pre-intervention group. Using the same wards, eligible participants (medical inpatients aged ≥65 years) were recruited to the preintervention group between November 2007 and March 2008 and to the intervention groups between January and June 2009. The primary nutritional outcome was daily energy and protein intake, which was determined by visually estimating plate waste at each meal and mid-meal on Day 4 of admission. Energy and protein intakes were compared between the pre and post intervention groups. Data were collected on a range of covariates (demographics, nutritional status and known risk factors for poor food intake), which allowed for multivariate analysis of the impact of the interventions on nutritional intake. The provision of mealtime assistance to participants and activities of ward staff (including mealtime interruptions) were observed in the pre-intervention and intervention groups, with staff observations repeated six months post-intervention. Focus groups were conducted with nursing and allied health staff in June 2009 to explore their attitudes and behaviours in response to the three mealtime interventions. These focus group discussions were analysed using thematic analysis. RESULTS: A total of 254 participants were recruited to the study (pre-intervention: n=115, AIN-only: n=58, PM-only: n=39, PM+AIN: n=42). Participants had a mean age of 80 years (SD 8), and 40% (n=101) were malnourished on hospital admission, 50% (n=108) had anorexia and 38% (n=97) required some assistance at mealtimes. Occasions of mealtime assistance significantly increased in all interventions (p<0.01). However, no change was seen in mealtime interruptions. No significant difference was seen in mean total energy and protein intake between the preintervention and intervention groups. However, when total kilojoule intake was compared with estimated requirements at the individual level, participants in the intervention groups were more likely to achieve adequate energy intake (OR=3.4, p=0.01), with no difference noted between interventions (p=0.29). Despite small improvements in nutritional adequacy, the majority of participants in the intervention groups (76%, n=103) had inadequate energy intakes to meet their estimated energy requirements. Patients with cognitive impairment or feeding dependency appeared to gain substantial benefit from mealtime assistance interventions. The increase in occasions of mealtime assistance by nursing staff during the intervention period was maintained six-months post-intervention. Staff focus groups highlighted the importance of clearly designating and defining mealtime responsibilities in order to provide adequate mealtime care. While the purpose of the dedicated feeding assistant was to increase levels of mealtime assistance, staff indicated that responsibility for mealtime duties may have merely shifted from nursing staff to the assistant. Implementing the multidisciplinary interventions empowered nursing staff to "protect" the mealtime from external interruptions, but further work is required to empower nurses to prioritise mealtime activities within their own work schedules. Staff reported an increase in the profile of nutritional care on all wards, with additional non-nutritional benefits noted including improved mobility and functional independence, and better identification of swallowing difficulties. IMPLICATIONS: The PhD research provides clinicians with practical strategies to immediately introduce change to deliver better mealtime care in the hospital setting, and, as such, has initiated local and state-wide roll-out of mealtime assistance programs. Improved nutritional intakes of elderly inpatients was observed; however given the modest effect size and reducing lengths of hospital stays, better nutritional outcomes may be achieved by targeting the hospital-to-home transition period. Findings from this study suggest that mealtime assistance interventions for elderly inpatients with cognitive impairment and/or functional dependency show promise.

State-of-the-art of the Australian thin bed concrete structural masonry

With a view to minimising the spiraling labour costs, the concrete masonry industry is developing thin layer mortar technology (known as thin bed technology) collaboratively with Queensland University of Technology. Similar technologies are practiced in Europe mainly for clay brick masonry; in the UK thin layer mortared concrete masonry has been researched under commercial contract with limited information published. This paper presents numerous experimental data generated over the past three years. It is shown that this form of masonry requires special drymixed mortar containing a minimum of 2% polymer for improved workability and blocks with tighter height tolerance, both of which might increase the cost of these constituent materials. However, through semiskilled labour, tools to dispense and control the thickness of mortar and the associated increase in productivity, reduction to the overall costs of this form of construction can be achieved. Further the polymer mortar provides several advantages: (1) improved sustainability due to dry curing and (2) potential to construct mortar layers of 2mm thickness and (3) ability for mechanisation of mortar application and control of thickness without the need for skilled labour.

Age and curing effect on the bond strength of thin bed concrete masonry with polymer cement mortar

Bond characteristics of masonry are partly affected by the type of mortar used, the techniques of dispersion of mortar and the surface texture of the concrete blocks. Additionally it is understood from the studies on conventional masonry, the bond characteristics are influenced by masonry age and curing methods as well as dryness/dampness at the time of testing. However, all these effects on bond for thin bed masonry containing polymer cement mortar are not well researched. Therefore, the effect of ageing and curing method on bond strength of masonry made with polymer cement mortar was experimentally investigated as part of an ongoing bond strength research program on thin bed concrete masonry at Queensland University of technology. This paper presents the experimental investigation of the flexural and shears bond characteristics of thin bed concrete masonry of varying age/ curing methods. Since, the polymer cement mortar is commonly used in thin bed masonry; bond development through two different curing conditions (dry/wet) was investigated in this research work. The results exhibit that the bond strength increases with the age under the wet and dry curing conditions; dry curing produce stronger bond and is considered as an advantage towards making this form of thin bed masonry better sustainable.

Developments in mud filtration technology in the sugarcane industry

Dirt collected with sugarcane is processed and separated from the juice in the sugar factory by filtration equipment for return to the cane fields. New technologies over the past decade have enabled performance improvements to be obtained for this key unit operation. Filter mud product still contains a reasonable amount of sugar and the transportation of high moisture mud product has considerable cost. Australia’s traditional approach has been to use Rotary Vacuum Filters for processing and separating mud and other impurities from juice, but in recent years there has been interest in reducing sugar losses and transportation costs through utilisation of new technologies such as Horizontal Bed Filters, Vacuum Belt Press Filters, Membrane Press Filters and Centrifuges. Increasingly, these alternative equipment are being installed in new factories. This chapter describes the general principles of mud filtration theory and mud conditioning followed by a detailed description and review of the various filtration technologies and analysis of the relative merits associated with the equipment.

Coal desulfurization in a fluidized bed reactor

Fluidized bed reactor technology was investigated as a means of developing a new simple and low cost process for coal desulfurization. Preliminary experimental results obtained in a 2.54 cm batch fluidized bed reactor have shown that over 80% total sulfur reductions can be achieved by sequential chlorination and dechlorination/ hydrodesulfurization of high sulfur pulverized coals. Proximate and ultimate analyses of desulfurized coals have revealed enhanced carbon and fixed carbon levels and substantially reduced volatile, oxygen and hydrogen contents. While there was a minor increase in the ash content and heating value, nitrogen and chlorine contents were essentially unchanged. Compared to an earlier slurry phase process, the fluidized bed reactors process has specific advantages such as shorter reaction times, fewer processing steps and reduced reactant requirements. A fluidized bed reactor process may thus have a potential of being developed into a simple and economic means of converting high sulfur coals to environmentally acceptable fuels.

Design of plane sand-bed channels affected by seepage

The importance of seepage in the design of channels is discussed. Experimental investigations reveal that seepage, either in the downward direction (suction) or in the upward direction (injection), can significantly change the resistance as well as the mobility of the sand-bed particles. A resistance equation relating 'particle Reynolds number' and 'shear Reynolds number' under seepage conditions is developed for plane sediment beds. Finally, a detailed design procedure of the plane sediment beds affected by seepage is presented.

Research bed for unit selection based text to speech synthesis

The paper describes a modular, unit selection based TTS framework, which can be used as a research bed for developing TTS in any new language, as well as studying the effect of changing any parameter during synthesis. Using this framework, TTS has been developed for Tamil. Synthesis database consists of 1027 phonetically rich prerecorded sentences. This framework has already been tested for Kannada. Our TTS synthesizes intelligible and acceptably natural speech, as supported by high mean opinion scores. The framework is further optimized to suit embedded applications like mobiles and PDAs. We compressed the synthesis speech database with standard speech compression algorithms used in commercial GSM phones and evaluated the quality of the resultant synthesized sentences. Even with a highly compressed database, the synthesized output is perceptually close to that with uncompressed database. Through experiments, we explored the ambiguities in human perception when listening to Tamil phones and syllables uttered in isolation,thus proposing to exploit the misperception to substitute for missing phone contexts in the database. Listening experiments have been conducted on sentences synthesized by deliberately replacing phones with their confused ones.

Single Particle and Packed Bed Combustion in Modern Gasifier Stoves—Density Effects

This article is concerned with a study of an unusual effect due to density of biomass pellets in modern stoves based on close-coupled gasification-combustion process. The two processes, namely, flaming with volatiles and glowing of the char show different effects. The mass flux of the fuel bears a constant ratio with the air flow rate of gasification during the flaming process and is independent of particle density; char glowing process shows a distinct effect of density. The bed temperatures also have similar features: during flaming, they are identical, but distinct in the char burn (gasification) regime. For the cases, wood char and pellet char, the densities are 350, 990 kg/m(3), and the burn rates are 2.5 and 3.5 g/min with the bed temperatures being 1380 and 1502 K, respectively. A number of experiments on practical stoves showed wood char combustion rates of 2.5 +/- 0.5 g/min and pellet char burn rates of 3.5 +/- 0.5 g/min. In pursuit of the resolution of the differences, experimental data on single particle combustion for forced convection and ambient temperatures effects have been obtained. Single particle char combustion rate with air show a near-d(2) law and surface and core temperatures are identical for both wood and pellet char. A model based on diffusion controlled heat release-radiation-convection balance is set up. Explanation of the observed results needs to include the ash build-up over the char. This model is then used to explain observed behavior in the packed bed; the different packing densities of the biomass chars leading to different heat release rates per unit bed volume are deduced as the cause of the differences in burn rate and bed temperatures.

Universal flame propagation behavior in packed bed of biomass

This article aims at seeking the universal behavior of propagation rate variation with air superficial velocity (V-s) in a packed bed of a range of biomass particles in reverse downdraft mode while also resolving the differing and conflicting explanations in the literature. Toward this, measurements are made of exit gas composition, gas phase and condensed phase surface temperature (T-g and T-s), and reaction zone thickness for a number of biomass with a range of properties. Based on these data, two regimes are identified: gasificationvolatile oxidation accompanied by char reduction reactions up to 16 +/- 1cm/s of V-s and above this, and char oxidationsimultaneous char oxidation and gas phase combustion. In the gasification regime, the measured T-s is less than T-g; a surface heat balance incorporating a diffusion controlled model for flaming combustion gives and matches with the experimental results to within 5%. In the char oxidation regime, T-g and T-s are nearly equal and match with the equilibrium temperature at that equivalence ratio. Drawing from a recent study of the authors, the ash layer over the oxidizing char particle is shown to play a critical role in regulating the radiation heat transfer to fresh biomass in this regime and is shown to be crucial in explaining the observed propagation behavior. A simple model based on radiation-convection balance that tracks the temperature-time evolution of a fresh biomass particle is shown to support the universal behavior of the experimental data on reaction front propagation rate from earlier literature and the present work for biomass with ash content up to 10% and moisture fraction up to 10%. Upstream radiant heat transfer from the ash-laden hot char modulated by the air flow is shown to be the dominant feature of this model.

Scientific and technological aspects of fixed bed biomass gasification

In recent years new emphasis has been placed on problems of the environmental aspects of waste disposal, especially investigating alternatives to landfill, sea dumping and incineration. There is also a strong emphasis on clean, economic and efficient processes for electric power generation. These two topics may at first appear unrelated. Nevertheless, the technological advances are now such that a solution to both can be combined in a novel approach to power generation based on waste-derived fuels, including refuse-derived fuel (RDF) and sludge power (SP) by utilising a slagging gasifier and advance fuel technology (AFT). The most appropriate gasification technique for such waste utilisation is the British Gas/Lurgi (BGL) high pressure, fixed bed slagging gasifier where operation on a range of feedstocks has been well-documented. This gasifier is particularly amenable to briquette fuel feeding and, operating in an integrated gasification combined cycle mode (IGCC), is particularly advantageous. Here, the author details how this technology has been applied to Britain's first AFT-IGCC Power Station which is now under development at Fife Energy Ltd., in Scotland, the former British Gas Westfield Development Centre.

Experiments and analysis of propagation front under gasification regimes in a packed bed

The paper analyses the results of experiments on the propagation rate in a fuel bed under gasification conditions in a co-current reactor configuration. Experiments using wood chips with different values of moisture content have been conducted under gasification conditions. The influence of air mass flux on the propagation rate, peak temperature and gas quality is investigated. It is observed from the experiments that the flame front propagation rate initially increases as the air mass flux increased, reaching a peak propagation rate, and further increase in the air mass flux results in a decrease in the propagation rate. However, the bed movement increases with the increase in air mass flux. The experimental results provide an understanding on influence of the fuel properties on propagation front. The surface area per unit volume of the particles in the packed bed plays an important role in the propagation rate. It has been argued that the flaming pyrolysis contributes towards the flame propagation as opposed to the overall combustion process in a packed bed. The calorific value of the producer gas generated is nearly the same over the entire range of air mass flux for bone-dry and 10% moist wood. (C) 2014 Elsevier B.V. All rights reserved.

ANRC Hybrid Test Bed Implementation and an End-to-End Performance Characterization of Dynamic Spectrum Access

An abundance of spectrum access and sensing algorithms are available in the dynamic spectrum access (DSA) and cognitive radio (CR) literature. Often, however, the functionality and performance of such algorithms are validated against theoretical calculations using only simulations. Both the theoretical calculations and simulations come with their attendant sets of assumptions. For instance, designers of dynamic spectrum access algorithms often take spectrum sensing and rendezvous mechanisms between transmitter-receiver pairs for granted. Test bed designers, on the other hand, either customize so much of their design that it becomes difficult to replicate using commercial off the shelf (COTS) components or restrict themselves to simulation, emulation /hardware-in-Ioop (HIL), or pure hardware but not all three. Implementation studies on test beds sophisticated enough to combine the three aforementioned aspects, but at the same time can also be put together using COTS hardware and software packages are rare. In this paper we describe i) the implementation of a hybrid test bed using a previously proposed hardware agnostic system architecture ii) the implementation of DSA on this test bed, and iii) the realistic hardware and software-constrained performance of DSA. Snapshot energy detector (ED) and Cumulative Summation (CUSUM), a sequential change detection algorithm, are available for spectrum sensing and a two-way handshake mechanism in a dedicated control channel facilitates transmitter-receiver rendezvous.

Gasification of wood particles in a co-current packed bed: Experiments and model analysis

This study focuses on addressing the propagation front movement in a co-current downdraft gasification system. A detailed single particle modeling analysis extended to the packed bed reactor is used to compare with the experimental measurement as well those available in the literature. This model for biomass gasification systems considered pyrolysis process, gas phase volatile combustion, and heterogeneous char reactions along with gas phase reactions in the packed bed. The pyrolysis kinetics has a critical influence on the gasification process. The propagation front has been shown to increase with air mass flux, attains a peak and then decreases with further increase in air mass flux and finally approaches negative propagation rate. This indicates that front is receding, or no upward movement() bra her it is moving downward towards the char bed. The propagation rate correlates with mass flux as (m) over dot `'(0.883) during the increasing regimes of the front movement The study clearly identifies that bed movement is an important parameter for consideration in a co-current configuration towards establishing the effective bed movement. The study also highlights the importance of surface area to volume ratio of the particles in the packed bed and its influence on the volatile generation. Finally, the gas composition for air gasification under various air mass fluxes is compared with the experimental results. (C) 2016 Elsevier B.V. All rights reserved.

Seabed Sensor Technology, Savannah, Georgia, February 1-3, 2006: workshop proceedings

Future coastal management practices require that a holistic, ecosystem management approach be adopted. Coastal ecosystems, however, present a variety of specific and unique challenges relative to open ocean systems. In particular, interactions with the seabed significantly influence the coastal ecosystem. Observing technologies must be developed and employed to incorporate seafloor interactions, processes and habitat diversity into research and management activities. An ACT Workshop on Seabed Sensor Technology was held February 1-3, 2006 in Savannah, Georgia, to summarize the current state of sensor technologies applicable to examining and monitoring the coastal seabed, including the near-bed benthic boundary layer and surface sediment layer. Workshop participants were specifically charged to identify current sensors in use, recommend improvements to these systems and to identify areas for future development and activities that would advance the use of sensor technology in the observation, monitoring and management of the coastal benthic environment. (pdf contains 23 pages)