A cluster randomised controlled trial to evaluate a policy of making hip protectors available to residents of nursing homes

Objectives: to evaluate the effectiveness of a policy of making hip protectors available to residents of nursing homes. Design: a cluster randomised controlled trial of the policy in nursing and residential homes, with the home as the unit of randomisation. Setting: 127 nursing and residential homes in the greater Belfast area of Northern Ireland. Participants: 40 homes in the intervention group (representing 1,366 occupied beds) and 87 homes in the control group (representing 2,751 occupied beds). Interventions: a policy of making hip protectors available free of charge to residents of nursing homes and supporting the implementation process by employing a nurse facilitator to encourage staff in the homes to promote their use, over a 72-week period. Main outcome measures: the rate of hip fractures in intervention and control homes, and the level of adherence to use of hip protectors. Results: there were 85 hip fractures in the intervention homes and 163 in the control homes. The mean fracture rate per 100 residents was 6.22 in the intervention homes and 5.92 in the control homes, giving an adjusted rate ratio for the intervention group compared to the control group of 1.05 (95% CI 0.77, 1.43, P = 0.76). Initial acceptance of the hip protectors was 37.2% (508/1,366) with adherence falling to 19.9% (272/1,366) at 72 weeks. Conclusions: making hip protectors available to residents of nursing and residential homes did not reduce the rate of hip fracture.

Anti-sized reed bed system for animal wastewater treatment: a comparative study

This paper presents a comparative study on the treatment of high-strength animal wastewater in two parallel lab-scale constructed reed bed systems, progressively-sized system and anti-sized system, which have same configuration but different arrangement of bed media. The reed bed systems were operated in a tidal flow pattern to treat diluted pig slurry. Detailed analyses were carried out for the removal of some key pollutants including COD, BOD5, NH4-N, P and suspended solids. The results showed that both systems have considerable capacity for the removal of solids, organic matter and inorganic nutrients. The formation of biofilms on the surfaces of gravel media in both reed bed systems was monitored by scanning selected gravel samples using scanning electron microscopy. In general, no significant difference was detected with regard to the percentage pollutant removal in the systems. However, the anti-sized system demonstrated a clear advantage in its ability to slow down the clogging of bed media and avoid the impairment of long-term functioning and sustainability of the beds. A conceptual model was developed to predict the occurrence of the clogging. The validity of the model was tested using data from this study and from the literatures.

Can traditional harvesting methods for cockles be accommodated in a Special Area of Conservation?

The European Natura 2000 project attempts to balance conservation and exploitation by permitting activities that do not affect the conservation status of designated sites. Given the scale of Natura 2000, guidelines are needed to facilitate the drafting of simple site management plans. This need is particularly acute for traditional harvesting methods for which there is usually strong local opposition to the imposition of controls. These issues were examined in Strangford Lough, a special area of conservation where cockles have traditionally been harvested by hand-raking. Raking was found not to affect the ability of cockles to rebury. There were significant reductions in Zostera biomass when raking was carried out within eelgrass beds (a 90% reduction in biomass available to winter migrant birds from summer raking). Traditional harvesting methods could therefore be accepted in Strangford as long as Zostera beds are avoided. A relatively low intensity of harvesting activity in Strangford Lough probably reflects low cockle densities (average 91.8 m(-2)), with the most economically valuable individuals at some distance from points of access to the shore. An economically feasible management plan could sanction traditional harvesting and result in the implementation of more resource-intensive management only if increases in cockle stocks and market prices stimulate large increases in harvesting activity.

The importance of reproductive strategies in population genetic approaches to conservation: an example from the marine angiosperm genus Zostera

Knowledge of the levels of genetic diversity maintained in natural populations can play a central role in conservation programmes, particularly in threatened habitats or species. Fluctuations in population size can lead to loss of variation and, consequently, increase the risk of extinction. We have examined whether such a genetic bottleneck has occurred in populations of two species in the seagrass genus Zostera, which are believed to have been affected by an outbreak of wasting disease at the start of the last century. A test for heterozygote excess at five nuclear microsatellite loci did not suggest the occurrence of a genetic bottleneck, but analysis of seven chloroplast microsatellite loci and sequence data from two regions did suggest a bottleneck in the chloroplast genome. Extremely low levels of between-population diversity suggest that all subpopulations can be treated as a single management unit for each species. Comparable levels of nuclear genetic diversity were found in the three populations of the primarily sexual Zostera marina var. angustifolia studied but a wider range of within-population diversity was found in Zostera noltii, which displays both. sexual and vegetative reproductive strategies. This may be due to an increase in sexual recruitment due to localised fresh water inflow into the study site near to the most diverse population. Such populations should be prioritised as source material for any replanting or remediation due to natural or anthropogenic loss of Zostera beds in the area.

The PRIME 1996 cruise: an overview

The UK PRIME cruise, June-July 1996 in the NE Atlantic, consisted of two legs. During the first, detailed chemical and biological observations were made in time-series mode adjacent to the centre of a cold-core eddy in the vicinity of 59 degreesN 20 degreesW using SF6 tracer techniques as the basis for the Lagrangian study. The eddy, which appeared to have been formed the previous winter, remained coherent over the 9 days of the survey and advected only slowly. The phytoplankton community in the eddy was dominated by the coccolithophorid Coccolithus huxleyi. High microzooplankton grazing rates indicated minimal export losses from the surface layer. Significant shifts in many, but not all, of the chemical and biological properties measured were observed over the course of the experiment, especially after the passage of a storm event, which resulted in considerable deepening of the mixed layer followed by a return to fully stratified conditions. The second leg consisted of a transect from 59 degreesN 20 degreesW to 37 degreesN 19 degreesW, with a further Lagrangian time-series study based on a drogue marker initiated at the southern end of the transect. Maximal biological activity was generally encountered in the region between two fronts located at 52.5 degreesN and 48 degreesN, while to the south of 48 degreesN oligotrophic conditions prevailed. At the southern Lagrangian site, a deep chlorophyll maximum was present and high column new production was recorded as a result of the euphotic zone extending below the depth of the nutricline. Microzooplankton grazing rates were lower at this location than at the northern eddy site. The influx of a warm, saline water body into the upper layers during the southern survey led to a major shift in many of the biological and chemical properties being measured. At both the northern and southern Lagrangian sites, the biomass of the mesozooplankton exceeded that of the microzooplankton. (C) 2001 Elsevier Science Ltd. All rights reserved.

Algal epiphytes of Zostera marina: Variation in assemblage structure from individual leaves to regional scale

Data from a hierarchical study of four Zostera marina beds in Wales were used to identify the spatial scales of variation in epiphyte assemblages. There were significant within and among bed differences in assemblage structure. The differences in assemblage structure with spatial scale generally persisted when species identifications were aggregated into functional groups. There was also significant within and among bed variability in Zostera density and average length. Local variations in Zostera canopy variables at the quadrat scale (total leaf length, average leaf length and leaf density per quadrat) were not related to epiphyte species richness nor to the structure of the assemblage. In contrast, individual leaf length was significantly related to species richness in two of the beds and the structure of epiphyte assemblages was always related to individual leaf lengths. The absence of links between quadrat scale measurements of canopy variables and assemblage structure may reflect the high turnover of individual Zostera leaves. Experimental work is required to discriminate further between the potential causes of epiphyte assemblage variation within and between beds. No bed represented a refuge where a rare species was abundant. If a species was uncommon at the bed scale, it was also uncommon in beds where it occurred. The heterogeneous assemblages found in this study suggest that a precautionary approach to conservation is advisable.

Environmental tolerances of free-living coralline algae (maerl): implications for European marine conservation

Maerl is a general term used for loose-lying subtidal beds of nodular coralline red algae. Maerl beds support high associated invertebrate and algal biodiversity, and are subject to European and UK conservation legislation. Previous investigations have shown European maerl to be ecologically fragile due to growth rates of approximately I mm per year. However, these very slow growth rates have hampered attempts to determine the key ecological requirements and sensitivity characteristics of living maerl. In this study, photosynthetic capacity determined by pulse amplitude modulated (PAM) fluorometry was used as a diagnostic of stress caused by various environmental conditions. Maerl species were exposed to a range of temperatures, salinities and light levels and to burial, fragmentation, desiccation and heavy metal treatment. Maerl was not as susceptible as previously assumed to extremes of salinity, temperature and heavy metal pollution, but burial, especially in fine or anoxic sediments, was lethal or caused significant stress. These data indicate that the main anthropogenic hazard for live maerl and the rich communities that depend on them is smothering by fine sediment, such as that produced by trawling or maerl extraction, from sewage discharges or shellfish and fish farm waste, and sedimentation resulting from disruption to tidal flow. (C) 2004 Elsevier Ltd. All rights reserved.

Shore exposure affects mussel population structure and mediates the effect of epibiotic algae on mussel survival in SW Ireland

On rocky shores, the relative importance of abiotic and biotic processes that regulate community structure are thought to vary with levels of shore exposure. This can lead to characteristic features found on sheltered and exposed shores. This study identified differences in the population structure of mussels on exposed and sheltered rocky shores on Atlantic coasts of south-west Ireland. Direct interactions between epibiotic algae and their host mussels were also examined to test if potential effects varied with shore exposure. Mussel beds on sheltered shores were less dense and comprised larger mussels with greater rates of individual survival and growth than those on exposed shores. The results of a field experiment showed that algal epibionts had a negative effect on mussel survival on sheltered shores but not on exposed shores. Surprisingly, the presence of algal epibionts had no effect on mussel growth on either shore type. These findings contrast with those of previous studies. The effects of shore exposure and algal epibionts on Mussels may be species-specific and may interact with other factors across different regions. This study shows that predictions of effects of exposure on mussel populations and their epibionts should only be based on specific experimental evidence and cannot be generalised across regions. (C) 2009 Elsevier Ltd. All rights reserved.

Biodiversity among mussels: separating the influence of sizes of mussels from the ages of patches

The role of habitat structure in controlling the composition of assemblages has often been studied, but is rarely manipulated so that it is distinguishable from other factors. Differences in habitat structure as determined by differences in mussel size structure may affect the diversity of assemblages associated with mussel beds. Previous studies examining the effect of the size of individual mussels in a patch on the diversity of associated macro-faunal assemblages confounded the age of the patch with the size of the mussels. We manipulated the age of mussel patches and the size of the mussels within them to test experimentally whether the size of mussels influenced the structure of associated assemblages. At one of the two locations considered, the structure of macro-faunal assemblages in patches of larger mussels differed significantly from those in patches of the same age composed of smaller mussels. At this location, the size of mussels did not affect species richness but the abundance and proportion of organisms present differed depending on the size of the mussels. Here patches of larger mussels contained greater numbers of Nematodes and Oligochaetes and a lower abundance of taxa, such as faera forsmani and Lepidonotus clava. We also found that invertebrate assemblages in general differed between the two locations. The effect of the size structure of mussels, however, varied spatially demonstrating that the effect of habitat structure on the diversity of associated assemblages is context dependent.

Do mussel patches provide a refuge for algae from grazing gastropods?

On rocky shores, cover of macroalgae is often greater growing epibiotically on mussels compared to algae growing directly attached to rock. A survey of two shores on the east coast of Ireland confirmed that mussel beds contained greater percentage algal cover and more diverse algal assemblages compared to those on rock. The reasons for this difference are not clear. It has been suggested that mussel beds provide a refuge for algae from grazing gastropods. Surprisingly, we found no evidence to support this. Using wax discs, gastropod grazing patterns were found to be similar within the mussel beds as on rock. The mussel beds do not appear to provide a refuge for algae from grazing activity at this scale and we suggest other possible mechanisms for the prevalence of epibiotic algal cover on mussels. Intertidal grazers may in fact affect the epibiotic algae on mussels and thereby affect indirectly the persistence of mussel beds.

Screening wall effects of a thin fluidized bed by near-infrared imaging

Near-infrared (NIR) imaging was used to observe water vapour flow in a gas-solid fluidized bed reactor. The technique consisted of a broadband light, an optical filter with a bandwidth centred on strong water vapour absorptions, a Vidicon NIR camera, a nozzle from which an optically active mixture of gas and water vapour was trans-illuminated by an NIR beam and collected data of transmittance were normalized to actual optical path. The procedure was applied to a thin fluidized bed reactor with a low aspect ratio of tube to particle diameters (D-1/d(p)) in order to validate the wall effect on flow dynamics and mass transfer during the reduction of ceria-silica by hydrogen. High concentrations of water vapour emerged in the vicinity of the wall when the bed was operated at pseudo-static conditions but disappeared when the bed was run at minimum bubbling conditions. This result shows the capability of optical methods with affordable costs to 2D imaging opaque packed bed by using a spatially resolved probe located at the exit, which is of great benefit for in situ visualization of anisotropic concentrations in packed beds under industrially relevant conditions and thus for elucidation of the underlying reaction mechanism and diffusion interactions. Crown Copyright (c) 2011 Published by Elsevier B.V. All rights reserved.

Visualization of water vapour flow in a packed bed adsorber by near-infrared diffused transmittance tomography

This work presents a procedure based on spatially-resolved near-infrared imaging, in order to observe temperature and composition maps in gas-solid packed beds subjected to effects of aspect ratio and non-isothermal conditions. The technique was applied to the water vapour flow in a packed bed adsorber of low aspect ratio, filled with silica gel, using a tuneable diode laser, focal planar array detector and tomographic reconstruction. The 2D projected images from parallel scanning permitted data to be retrieved from the packing and above the packing sections of 12.0×12.0×18.2mm at a volume-resolution of 0.15×0.15×0.026mm and a time-resolution of less than 3min. The technique revealed uneven temperature and composition maps in the core packed bed and in the vicinity of the wall due to flow maldistribution. In addition, the heat uptake from the packed bed and local cross-mixing were experimentally ascertained by local profiles of the water vapour composition and temperature under various aspect ratios and feed flow rates. The relative deviations in temperature and compositions were 11.1% and 9.3%, respectively. The deviation in composition, which covers the packing and above the packing sections, was slightly higher than the deviation of 8% obtained up-to-date but was limited to the exit of a packed bed adsorber. © 2011.

Like a rolling stone: the mobility of maerl (Corallinaceae) and the neutrality of the associated assemblages

Beds of nonattached coralline algae (maerl or rhodoliths) are widespread and considered relatively species rich. This habitat is generally found in areas where there is chronic physical disturbance such that maerl thalli are frequently moved. Little is known, however, about how natural disturbance regimes affect the species associated with maerl. This study compared the richness, animal abundance, and algal biomass of maerl-associated species over a two-year period in a wave-disturbed bed and a sheltered maerl bed. Changes in associated species over time were assessed for departures from a neutral model in which the dissimilarity between samples reflects random sampling from a common species pool. Algal biomass and species richness at the wave-exposed site and on stabilized maerl at the sheltered site were reduced at times of higher wind speeds. The changes in species richness were not distinguishable from a neutral model, implying that algal species were added at random to the assemblage as the level of disturbance lessened. Results for animal species were more mixed. Although mobile species were less abundant during windy periods at the exposed site, both neutral and non-neutral patterns were evident in the assemblages. Artificial stabilization of maerl had inconsistent effects on the richness of animals but always resulted in more attached algal species. While the results show that the response of a community to disturbance can be neutral, the domain of neutral changes in communities may be relatively small. Alongside non-neutral responses to natural disturbance, artificial stabilization always resulted in an assemblage that was more distinct than would be expected under random sampling from a common pool. Community responses to stabilization treatments did not consistently follow the predictions of the dynamic equilibrium model, the intermediate disturbance model, or a facilitation model. These inconsistencies may reflect site-specific variation in both the disturbance regime and the adjacent habitats that provide source populations for many of the species found associated with maerl.

International perspectives on the influence of structure and process of weaning from mechanical ventilation.

Background 
Recently, clinical and research attention has been focused on refining weaning processes to improve outcomes for critically ill patients who require mechanical ventilation. One such process, use of a weaning protocol, has yielded conflicting results, arguably because of the influence of existing context and processes.

Objective 
To compare international data to assess differences in context and processes in intensive care units that could influence weaning.  

Methods 
Review of existing national data on provision of care for critically ill patients, including structure, staffing, skill mix, education, roles, and responsibilities for weaning in intensive care units of selected countries.

Results 
Australia, New Zealand, Denmark, Norway, Sweden, and the United Kingdom showed similarities in critical care provision, structure, skill mix, and staffing ratios in intensive care units. Weaning in these countries is generally a collaborative process between nurses and physicians. Notable differences in intensive care units in the United States were the frequent use of an open structure and inclusion of respiratory therapists on the intensive care unit’s health care team. Nurses may be excluded from direct management of ventilator weaning in some institutions, as this role is primarily assumed by respiratory therapists guided by medical directives. Availability of critical care beds was highest in the United States and lowest in the United Kingdom.

Conclusion 
Context and processes of care that could influence ventilator weaning outcomes varied considerably across countries. Further quantification of these contextual influences should be considered when translating research findings into local clinical practice and when designing randomized, controlled trials.