A study protocol of a randomised controlled trial to measure the effects of an augmented prescribed exercise programme (APEP) for frail older medical patients in the acute setting

Background: Older adults experience functional decline in hospital leading to increased healthcare burden and morbidity. The benefits of augmented exercise in hospital remain uncertain. The aim of this trial is to measure the short and longer-term effects of augmented exercise for older medical in-patients on their physical performance, quality of life and health care utilisation. Design and Methods: Two hundred and twenty older medical patients will be blindly randomly allocated to the intervention or sham groups. Both groups will receive usual care (including routine physiotherapy care) augmented by two daily exercise sessions. The sham group will receive stretching and relaxation exercises while the intervention group will receive tailored strengthening and balance exercises. Differences between groups will be measured at baseline, discharge, and three months. The primary outcome measure will be length of stay. The secondary outcome measures will be healthcare utilisation, activity (accelerometry), physical performance (Short Physical Performance Battery), falls history in hospital and quality of life (EQ-5D-5 L). Discussion: This simple intervention has the potential to transform the outcomes of the older patient in the acute setting.

Die Gletscher der bolivianischen Anden, Verbreitung von Gletschern und neuzeitlichen Moränen in der Cordillera Apolobamba Cololo Region (Ostkordillere)

The uniform triangulation of the whole glacierized area of the Eastern Cordillera of Bolivia provided the first comparable geometrie basis for an accurate photogrammetric height evaluation of glaciers in the mountain range from the far south up to the Peruvian border. A total of 1775 glaciers, larger than 0.1 ha, were recorded in 16 mountain ranges ofthe East- ern Cordillera. Snow lines in the outer tropics can now be analysed with an accuracy of European standards. In spite of the widemeshed network of meteorological stations this allows a more pre- eise climatic differentiation to be made, particularly at high altitude sites. The methods and results of the analysis are described. Because of these results it becomes necessary to revise and refine previous concepts of the spatial distribution of climatic phenomena. Characteristics of glaciers in the Bolivian Cordillera obviously depend on the NE to SW decline in precipitation. The snow lines which are found at an altitude of 4500 m on the north- eastern slope directed towards the Yungas climb up to 5200 m on the lee slope towards the Alti- plano. The N to S increase in snowline elevation is not as significant as expected. With some res- ervation a 100 m fall in the snowline elevation in the Bolivian Cordillera can be explained by an increase in precipitation of about 50 mm.

Biological impacts of enhanced alkalinity in Carcinus maenas

Further steps are needed to establish feasible alleviation strategies that are able to reduce the impacts of ocean acidification, whilst ensuring minimal biological side-effects in the process. Whilst there is a growing body of literature on the biological impacts of many other carbon dioxide reduction techniques, seemingly little is known about enhanced alkalinity. For this reason, we investigated the potential physiological impacts of using chemical sequestration as an alleviation strategy. In a controlled experiment, Carcinus maenas were acutely exposed to concentrations of Ca(OH)2 that would be required to reverse the decline in ocean surface pH and return it to pre-industrial levels. Acute exposure significantly affected all individuals' acid-base balance resulting in slight respiratory alkalosis and hyperkalemia, which was strongest in mature females. Although the trigger for both of these responses is currently unclear, this study has shown that alkalinity addition does alter acid-base balance in this comparatively robust crustacean species.

Diatom-bound N isotope records over the last two glacial cycles in sediment core PS75/072-4

In a sediment core from the Pacific sector of the Antarctic Zone (AZ) of the Southern Ocean, we report diatom-bound N isotope (d15Ndb) records for total recoverable diatoms and two distinct diatom assemblages (pennate and centric rich). These data indicate tight coupling between the degree of nitrate consumption and Antarctic climate across the last two glacial cycles, with d15Ndb (and thus the degree of nitrate consumption) increasing at each major Antarctic cooling event. Coupled with evidence from opal- and barium-based proxies for reduced export production during ice ages, the d15Ndb increases point to ice age reductions in the supply of deep ocean-sourced nitrate to the AZ surface. The two diatom assemblages and species abundance data indicate that the d15Ndb changes are not the result of changing species composition. The pennate and centric assemblage d15Ndb records indicate similar changes but with a significant decline in their difference during peak ice ages. A tentative seasonality-based interpretation of the centric-to-pennate d15Ndb difference suggests that late summer surface waters became nitrate free during the peak glacials.

Mortality and climatic/environmental correlates of Widdringtonia cedargensis trees in the Cederberg, South Africa

Background: Conifer populations appear disproportionately threatened by global change. Most examples are, however, drawn from the northern hemisphere and long-term rates of population decline are not well documented as historical data are often lacking. We use a large and long-term (1931-2013) repeat photography dataset together with environmental data and fire records to account for the decline of the critically endangered Widdringtonia cedarbergensis. Eighty-seven historical and repeat photo-pairs were analysed to establish 20th century changes in W. cedarbergensis demography. A generalized linear mixed-effects model was fitted to determine the relative importance of environmental factors and fire-return interval on mortality for the species. Results: From an initial total of 1313 live trees in historical photographs, 74% had died and only 44 (3.4%) had recruited in the repeat photographs, leaving 387 live individuals. Juveniles (mature adults) had decreased (increased) from 27% (73%) to 8% (92%) over the intervening period. Our model demonstrates that mortality is related to greater fire frequency, higher temperatures, lower elevations, less rocky habitats and aspect (i.e. east-facing slopes had the least mortality). Conclusions: Our results show that W. cedarbergensis populations have declined significantly over the recorded period, with a pronounced decline in the last 30 years. Individuals that established in open habitats at lower, hotter elevations and experienced a greater fire frequency appear to be more vulnerable to mortality than individuals growing within protected, rocky environments at higher, cooler locations with less frequent fires. Climate models predict increasing temperatures for our study area (and likely increases in wildfires). If these predictions are realised, further declines in the species can be expected. Urgent management interventions, including seedling out-planting in fire-protected high elevation sites, reducing fire frequency in higher elevation populations, and assisted migration, should be considered.

Biogenic barium in Cretaceous-Paleogene sediments

One of the best-studied aspects of the K-Pg mass extinction is the decline and subsequent recovery of open ocean export productivity (e.g., the flux of organic matter from the surface to deep ocean). Some export proxies, including surface-to-deep water d13C gradients and carbonate sedimentation rates, indicate a global decline in export productivity triggered by the extinction. In contrast, benthic foraminiferal and other geochemical productivity proxies suggest spatially and temporally heterogeneous K-Pg boundary effects. Here we address these conflicting export productivity patterns using new and compiled measurements of biogenic barium. Unlike a previous synthesis, we find that the boundary effect on export productivity and the timing of recovery varied considerably between different oceanic sites. The northeast and southwest Atlantic, Southern Ocean, and Indian Ocean records saw export production plummet and remain depressed for 350 thousand to 2 million years. Biogenic barium and other proxies in the central Pacific and some upwelling or neritic Atlantic sites indicate the opposite, with proxies recording either no change or increased export production in the early Paleocene. Our results suggest that widespread declines in surface-to-deep ocean d13C do not record a global decrease in export productivity. Rather, independent proxies, including barium and other geochemical proxies, and benthic community structure, indicate that some regions were characterized by maintained or rapidly recovered organic flux from the surface ocean to the deep seafloor, while other regions had profound reductions in export productivity that persisted long into the Paleocene.

Under-ice export flux measurements by short-term drifting sediment traps at 27 stations in the Arctic Ocean during summer 1995, 1997, and 2012

A critical question regarding the organic carbon cycle in the Arctic Ocean is whether the decline in ice extent and thickness and the associated increase in solar irradiance in the upper ocean will result in increased primary production and particulate organic carbon (POC) export. To assess spatial and temporal variability in POC export, under-ice export fluxes were measured with short-term sediment traps in the northern Laptev Sea in July-August-September 1995, north of the Fram Strait in July 1997, and in the Central Arctic in August-September 2012. Sediment traps were deployed at 2-5 m and 20-25 m under ice for periods ranging from 8.5 to 71 h. In addition to POC fluxes, total particulate matter, chlorophyll a, biogenic particulate silica, phytoplankton, and zooplankton fecal pellet fluxes were measured to evaluate the amount and composition of the material exported in the upper Arctic Ocean. Whereas elevated export fluxes observed on and near the Laptev Sea shelf were likely the combined result of high primary production, resuspension, and release of particulate matter from melting ice, low export fluxes above the central basins despite increased light availability during the record minimum ice extent of 2012 suggest that POC export was limited by nutrient supply during summer. These results suggest that the ongoing decline in ice cover affects export fluxes differently on Arctic shelves and over the deep Arctic Ocean and that POC export is likely to remain low above the central basins unless additional nutrients are supplied to surface waters.

Questioning the merits and demerits of electronic communication in Social Work

This paper examines the social dynamics of electronic exchanges in the human services, particularly in social work. It focuses on the observable effects that email and texting have on the linguistic, relational and clinical rather than managerial aspects of the profession. It highlights how electronic communication is affecting professionals in their practice and learners as they become acculturated to social work. What are the gains and losses of the broad use of electronic devices in daily lay and professional, verbal and non-verbal communication? Will our current situation be seriously detrimental to the demeanor of future practitioners, their use of language, and their ability to establish close personal relationships? The paper analyzes social work linguistic and behavioral changes in light of the growth of electronic communication and offers a summary of merits and demerits viewed through a prism emerging from Baron’s (2000) analysis of human communication.

Progress and the Lack of Progress in Addressing Infant Health and Infant Health Inequalities in Ireland during the 20th Century

There is a growing literature which documents the importance of early life environment for outcomes across the life cycle. Research, including studies based on Irish data, demonstrates that those who experience better childhood conditions go on to be wealthier and healthier adults. Therefore, inequalities at birth and in childhood shape inequality in wellbeing in later life, and the historical evolution of the mortality and morbidity of children born in Ireland is important for understanding the current status of the Irish population. In this paper, I describe these patterns by reviewing the existing literature on infant health in Ireland over the course of the 20th century. Up to the 1950s, infant mortality in Ireland (both North and South) was substantially higher than in other developed countries, with a large penalty for those born in urban areas. The subsequent reduction in this penalty, and the sustained decline in infant death rates, occurred later than would be expected from the experience in other contexts. Using records from the Rotunda Lying-in Hospital in Dublin, I discuss sources of disparities in stillbirth in the early 1900s. Despite impressive improvements in death rates since that time, a comparison with those born at the end of the century reveals that Irish children continue to be born unequal. Evidence from studies which track people across the life course, for example research on the returns to birthweight, suggests that the economic cost of this early life inequality is substantial.

Chinese export competition, declining exports and adjustments at the industry and regional level in Europe

We analyze how a set of 22 European countries was affected by increased Chinese export competition between 1995 and 2008. Employing product-group level data, we observe a reduction in the export volumes of European countries due to increased Chinese export competition. This deceleration in the export sector induces changes within the manufacturing industries, especially a decline in employment. When using more aggregated, regional-level data, our analysis shows that the industry sector as a whole declines, resulting in an increased unemployment rate. The importance of Chinese export competition for Europe is attributable to its high export intensity.

Spatial Variations of the Methanogenic Communities in the Sediments of Tropical Mangroves

Methane production by methanogens in mangrove sediments is known to contribute significantly to global warming, but studies on the shift of methanogenic community in response to anthropogenic contaminations were still limited. In this study, the effect of anthropogenic activities in the mangrove sediments along the north and south coastlines of Singapore were investigated by pyrosequencing of the mcrA gene. Our results showed that hydrogenotrophic, acetoclastic and methylotrophic methanogens coexist in the sediments. The predominance of the methylotrophic Methanosarcinales reflects the potential for high methane production as well as the possible availability of low acetate and high methylated C-1 compounds as substrates. A decline in the number of acetoclastic/methylotrophic methanogens in favor of hydrogenotrophic methanogens was observed along a vertical profile in Sungei Changi, which was contaminated by heavy metals. The diversity of methanogens in the various contaminated stations was significantly different from that in a pristine St. John’s Island. The spatial variation in the methanogenic communities among the different stations was more distinct than those along the vertical profiles at each station. We suggest that the overall heterogeneity of the methanogenic communities residing in the tropical mangrove sediments might be due to the accumulated effects of temperature and concentrations of nitrate, cobalt, and nickel.

Analysis of heat transfer coefficient in silica nanofluids with water as base fluid under transitional flow

The effect of Reynolds number variation in a vertical double pipe counterflow heat exchanger due to the changes in viscosity can cause the change in flow regime, for instance, when heats up and cools down, it can convert from turbulent to laminar or inversely, that can have significant effect on heat transfer coefficient and pressure drop. Mainly, the range of transition phase has been studied in this study with the investigation of silica nanofluid dispersed in water in three different concentrations. The results have been compared with distilled water sample and showed a remarkable raise in heat transfer coefficient while pressure drop has been increased respectively, as well. Although pumping power has to go up at the same time and it is a drawback, heat transfer efficiency grows for diluted samples. On the other hand, for the most concentrated sample, effect of pressure drop dominates which leads to decline in the overall efficiency.

Boosting the CD4 Count in HIV Infection: Comparative Effects of Highly Active Anti-retroviral therapy (HAART) and Different Modalities of Physical Exercise on Biomarkers of Immunity

A decline in the CD4 count is a common feature in HIV/AIDS, suggesting a compromise in immunity of patients. In response, highly active antiretroviral therapy (HAART) is prescribed to slow-down a diminution in the CD4 count and risk of AIDS-related malignancies. However, exercise may improve both the utility and population of innate immune cell components, and may be beneficial for patients with HIV infection. Comparing the effects of different exercises against HAART, on CD4 count, helps in understanding the role and evidence-based application of exercises to ameliorate immune deficiency.

Influence of Socioeconomic Factors on Nutrition During Childhood in Germany and India

Malnutrition, nutritional deficiency, or undernutrition is an imbalanced nutritional status resulting from insufficient intake of nutrients to meet normal physiologic requirements. Malnutrition in childhood has both short-term consequences and long-term consequences on mental and physical health as well as the overall health development of children. Of all regions in the world, the Asia and the Pacific region has achieved the fastest rate of economic growth. There is no evidence that this rapid economic growth translates into a decline in malnutrition of children in Asian countries such as India.

Mothers’ perception of recovery and satisfaction with patent medicine dealers’ treatment of childhood febrile conditions in rural communities

Background Infant mortality in rural areas of Nigeria can be minimized if childhood febrile conditions are treated by trained health personnel, deployed to primary healthcare centres (PHCs) rather than the observed preference of mothers for patent medicine dealers (PMDs). However, health service utilization/patronage is driven by consumer satisfaction and perception of services/product value. The objective of this study was to determine ‘mothers’ perception of recovery’ and ‘mothers’ satisfaction’ after PMD treatment of childhood febrile conditions, as likely drivers of mothers’ health-seeking behaviour, which must be targeted to reverse the trend. Methods Ugwuogo-Nike, in Enugu, Nigeria, has many PMDs/PHCs, and was selected based on high prevalence of childhood febrile conditions. In total, 385 consenting mothers (aged 15–45 years) were consecutively recruited at PMD shops, after purchasing drugs for childhood febrile conditions, in a cross-sectional observational study using a pre-tested instrument; 33 of them (aged 21–47 years) participated in focus group discussions (FGDs). Qualitative data were thematically analysed while a quantitative study was analysed with Z score and Chi square statistics, at p < 0.05. Results Most participants in FGDs perceived that their child had delayed recovery, but were satisfied with PMDs’ treatment of childhood febrile conditions, for reasons that included politeness, caring attitude, drug availability, easy accessibility, flexibility in pricing, shorter waiting time, their God-fearing nature, and disposition as good listeners. Mothers’ satisfaction with PMDs’ treatment is significantly (p < 0.05) associated with mothers’ perception of recovery of their child (χ2 = 192.94, df = 4; p < 0.0001; Cramer’s V = 0.7079). However, predicting mothers’ satisfaction with PMDs’ treatment from a knowledge of mothers’ perception of recovery shows a high accord (lambda[A from B] = 0.8727), unlike when predicting mothers’ perception of recovery based on knowledge of mothers’ satisfaction with PMDs’ treatment (lambda[A from B] = 0.4727). Conclusions Mothers’ satisfaction could be the key ‘driver’ of mothers’ health-seeking behaviour and is less likely to be influenced by mothers’ perception of recovery of their child. Therefore, mothers’ negative perception of their child’s recovery may not induce proportionate decline in mothers’ health-seeking behaviour (patronage of PMDs), which might be influenced mainly by mothers’ satisfaction with the positive attributes of PMDs’ personality/practice and sets an important agenda for PHC reforms.