Oral liquid nutritional supplements for people with dementia in residential aged care facilities

AIM: This systematic review investigated the prescription, administration and effectiveness of oral liquid nutritional supplements (OLNS) for people with dementia in residential aged care facilities (RACF). METHODS: A comprehensive search of relevant databases, hand searching and cross-referencing found 15 relevant articles from a total of 2910 possible results. Articles which met the inclusion criteria were critically appraised by two independent reviewers using the relevant Joanna Briggs Institute (JBI) appraisal checklist. Data were extracted using the relevant JBI extraction instruments. No data synthesis was possible due to clinical and methodological heterogeneity. RESULTS: Included studies examined a range of strategies, issues and results related to OLNS for persons with dementia in RACFs; however there appear to be significant gaps in the current body of research, particularly in relation to examinations of effectiveness. CONCLUSIONS: This review was unable to produce a definitive finding regarding effectiveness. OLNS may improve the nutritional state of residents with dementia and help prevent weight loss, and there is some suggestion that it may slow the rate of cognitive decline. However, in order for OLNS to be effective, nursing and care staff need to ensure that sufficient attention is paid to the issues of prescription and administration.

Engaging decision makers in the business case for biophilic urbanism

The cognitive benefits of biophilia have been studied quite extensively, dating as far back as the 1980s, while studies into economic benefits are still in their infancy. Recent research has attempted to quantify a number of economic returns on biophilic elements; however knowledge in this field is still ad hoc and highly variable. Many studies acknowledge difficulties in discerning information such as certain social and aesthetic benefits. While conceptual understanding of the physiological and psychological effects of exposure to nature is widely recognised and understood, this has not yet been systematically translated into monetary terms. It is clear from the literature that further research is needed to both obtain data on the economics of biophilic urbanism, and to create the business case for biophilic urbanism. With this in mind, this paper will briefly highlight biophilic urbanism referencing previous work in the field. It will then explore a number of emergent gaps in the measurable economic understanding of these elements and suggest opportunities for engaging decision makers in the business case for biophilic urbanism. The paper concludes with recommendations for moving forward through targeted research and economic analysis.

Robust Web content extraction

We present an empirical evaluation and comparison of two content extraction methods in HTML: absolute XPath expressions and relative XPath expressions. We argue that the relative XPath expressions, although not widely used, should be used in preference to absolute XPath expressions in extracting content from human-created Web documents. Evaluation of robustness covers four thousand queries executed on several hundred webpages. We show that in referencing parts of real world dynamic HTML documents, relative XPath expressions are on average significantly more robust than absolute XPath ones.

A Novel Approach for Designing Generator Excitation controllers Using the IDA-PBC Technique

This paper presents a novel approach for designing of generator excitation controllers using Interconnection and Damping Assignment Passivity Based Control (IDA-PBC) technique for a Single Machine Infinite Bus (SMIB) system that can also be directly used in a multi-machine environment. The generator system equations are modified by referencing the rotor angle with respect to the secondary of the transformer bus instead of the infinite bus. For the modified system equations, IDA-PBC is applied to stabilize the system around an operating condition. The IDA-PBC design results in a Lyapunov function for the modified system. The new control law is practically feasible and can be applied directly to multi-machine system without referring to external system parameters. The effectiveness of the proposed controller is tested on a SMIB and a 10 generator 39 bus test system for a range of operating conditions. The Proposed excitation controller has shown good performance for both small and large disturbances when compared to the performance of a conventional static exciter with power system stabilizer.

Opettajan uskomukset opetustyön lähtökohtana : näkökulmia pedagogiseen ajatteluun

The purpose of this research was to examine teacher’s pedagogical thinking based on beliefs. It aimed to investigate and identify beliefs from teachers’ speech when they were reflecting their own teaching. Placement of beliefs in levels of pedagogical thinking was also examined. The second starting point for a study was the Instrumental Enrichment -intervention, which aims to enhance learning potential and cognitive functioning of students. The goal of this research was to investigate how five main principles of the intervention come forward in teachers’ thinking. Specifying research question was: how similar teachers’ beliefs are to the main principles of intervention. The teacher-thinking paradigm provided the framework for this study. The essential concepts of this study are determined exactly in the theoretical framework. Model of pedagogical thinking was important in the examination of teachers’ thinking. Beliefs were approached through the referencing of varied different theories. Feuerstein theory of Structural cognitive modifiability and Mediated learning experience completed the theory of teacher thinking. The research material was gathered in two parts. In the first part two mathematics lessons of three class teachers were videotaped. In second part the teachers were interviewed by using a stimulated recall method. Interviews were recorded and analysed by qualitative content analysis. Teachers’ beliefs were divided in themes and contents of these themes were described. This part of analysis was inductive. Second part was deductive and it was based on theories of pedagogical thinking levels and Instrumental Enrichment -intervention. According to the research results, three subcategories of teachers’ beliefs were found: beliefs about learning, beliefs about teaching and beliefs about students. When the teachers discussed learning, they emphasized the importance of understanding. In teaching related beliefs student-centrality was highlighted. The teachers also brought out some demands for good education. They were: clarity, diversity and planning. Beliefs about students were divided into two groups. The teachers believed that there are learning differences between students and that students have improved over the years. Because most of the beliefs were close to practice and related to concrete classroom situation, they were situated in Action level of pedagogical thinking. Some teaching and learning related beliefs of individual teachers were situated in Object theory level. Metatheory level beliefs were not found. Occurrence of main principles of intervention differed between teachers. They were much more consistent and transparent in the beliefs of one teacher than of the other two teachers. Differences also occurred between principles. For example reciprocity came up in every teacher’s beliefs, but modifiability was only found in the beliefs of one teacher. Results of this research were consistent with other research made in the field. Teachers’ beliefs about teaching were individual. Even though shared themes were found, the teachers emphasized different aspects of their work. Occurrence of beliefs that were in accordance with the intervention were teacher-specific. Inconsistencies were also found within teachers and their individual beliefs.

Perspectives on prescribing in nursing homes in Helsinki

Prescribing for older patients is challenging. The prevalence of diseases increases with advancing age and causes extensive drug use. Impairments in cognitive, sensory, social and physical functioning, multimorbidity and comorbidities, as well as age-related changes in pharmacokinetics and pharmacodynamics all add to the complexity of prescribing. This study is a cross-sectional assessment of all long-term residents aged ≥ 65 years in all nursing homes in Helsinki, Finland. The residents’ health status was assessed and data on their demographic factors, health and medications were collected from their medical records in February 2003. This study assesses some essential issues in prescribing for older people: psychotropic drugs (Paper I), laxatives (Paper II), vitamin D and calcium supplements (Paper III), potentially inappropriate drugs for older adults (PIDs) and drug-drug interactions (DDIs)(Paper IV), as well as prescribing in public and private nursing homes. A resident was classified as a medication user if his or her medication record indicated a regular sequence for its dosage. Others were classified as non-users. Mini Nutritional Assessment (MNA) was used to assess residents’ nutritional status, Beers 2003 criteria to assess the use of PIDs, and the Swedish, Finnish, INteraction X-referencing database (SFINX) to evaluate their exposure to DDIs. Of all nursing home residents in Helsinki, 82% (n=1987) participated in studies I, II, and IV and 87% (n=2114) participated in the study III. The residents’ mean age was 84 years, 81% were female, and 70% were diagnosed with dementia. The mean number of drugs was 7.9 per resident; 40% of the residents used ≥ 9 drugs per day, and were thus exposed to polypharmacy. Eighty percent of the residents received psychotropics; 43% received antipsychotics, and 45% used antidepressants. Anxiolytics were prescribed to 26%, and hypnotics to 28% of the residents. Of those residents diagnosed with dementia, 11% received antidementia drugs. Fifty five percent of the residents used laxatives regularly. In multivariate analysis, those factors associated with regular laxative use were advanced age, immobility, poor nutritional status, chewing problems, Parkinson’s disease, and a high number of drugs. Eating snacks between meals was associated with lower risk for laxative use. Of all participants, 33% received vitamin D supplementation, 28% received calcium supplementation, and 20% received both vitamin D and calcium. The dosage of vitamin D was rather low: 21% received vitamin D 400 IU (10 µg) or more, and only 4% received 800 IU (20 µg) or more. In multivariate analysis, residents who received vitamin D supplementation enjoyed better nutritional status, ate snacks between meals, suffered no constipation, and received regular weight monitoring. Those residents receiving PIDs (34% of all residents) more often used psychotropic medication and were more often exposed to polypharmacy than residents receiving no PIDs. Residents receiving PIDs were less often diagnosed with dementia than were residents receiving no PIDs. The three most prevalent PIDs were short-acting benzodiazepine in greater dosages than recommended, hydroxyzine, and nitrofurantoin. These three drugs accounted for nearly 77% of all PID use. Of all residents, less than 5% were susceptible to a clinically significant DDI. The most common DDIs were related to the use of potassium-sparing diuretics, carbamazepine, and codeine. Residents exposed to potential DDIs were younger, had more often suffered a previous stroke, more often used psychotropics, and were more often exposed to PIDs and polypharmacy than were residents not exposed to DDIs. Residents in private nursing homes were less often exposed to polypharmacy than were residents in public nursing homes. Long-term residents in nursing homes in Helsinki use, on average, nearly eight drugs daily. The use of psychotropic drugs in our study was notably more common than in international studies. The prevalence of laxatives equaled other prior international studies. Regardless of the known benefit and recommendation of vitamin D supplementation for elderly residing mostly indoors, the proportion of nursing home residents receiving vitamin D and calcium was surprisingly low. The use of PIDs was common among nursing home residents. PIDs increased the likelihood of DDIs. However, DDIs did not seem a major concern among the nursing home population. Monitoring PIDs and potential drug interactions could improve the quality of prescribing.

The context of enterprise education: Insights into current practices

This paper presents the results of an investigation into contextual differences in the development and delivery of enterprise education in higher education globally. Using information gathered from an online survey distributed to enterprise educators, distinct differences in the provision of enterprise education are identified, as are differences of opinion among enterprise educators. The findings demonstrate that although enterprise education is highly diversified in terms of presentation, content and style, there are clear commonalities with regard to expected student outcomes. The respondents reported low levels of business start-up activity among students during enterprise education and/or within one year of graduation. Over 75% of the educators surveyed had personal start-up experience, and there was limited reliance on academic literature, with a preference for referencing broader stakeholder perspectives. With regard to the practical implications of this research, the international metric of enterprise education appears to be a broad set of enterprising skills that equip and enable students to recognize and exploit opportunities in order to navigate future unknowns. The commonly employed metric of business start-up appears less valid in light of this investigation.

Bioabsorbable materials for osteosynthesis and small joint arthroplasty in the hand

Fractures and arthritic joint destruction are common in the hand. A reliable and stable fracture fixation can be achieved by metal implants, which however, become unnecessary or even harmful after consolidation. The silicone implant arthroplasty is the current method of choice for reconstruction of metacarpophalangeal joints in rheumatoid patients. However, the outcome tends to worsen with long-term follow-up and implant-related complications become frequent. To address these problems, bioabsorbable implants were designed for the hand area. Aims of the studies were: 1) to evaluate the biomechanical stabilities provided by self- reinforced (SR) bioabsorbable implants in a transverse and an oblique osteotomy of small tubular bones and to compare them with those provided by metal implants; 2) to evaluate the SR poly-L/DL-lactide 70/30 plate for osteosynthesis in a proof-of-principle type of experiment in three cases of hand injuries; and 3) to evaluate the poly-L/D-lactide (PLA) 96/4 joint scaffold, a composite joint implant with a supplementary intramedullary Polyactive® stem and Swanson silicone implant in an experimental small joint arthroplasty model. Methods used were: 1) 112 fresh frozen human cadaver and 160 pig metacarpal bones osteotomised transversally or obliquely, respectively, and tested ex vivo in three point bending and in torsion; 2) three patient cases of complex hand injuries; and 3) the fifth metacarpophalangeal joints reconstructed in 18 skeletally-mature minipigs and studied radiologically and histologically. The initial fixation stabilities provided by bioabsorbable implants in the tubular bones of the hand were comparable with currently-employed metal fixation techniques, and were sufficient for fracture stabilisation in three preliminary cases in the hand. However, in torsion the stabilities provided by bioabsorbable implants were lower than that provided by metal counterparts. The bioabsorbable plate enhanced the bending stability for the bioabsorbable fixation construct. PLA 96/4 joint scaffolds demonstrated good biocompatibility and enabled fibrous tissue in-growth in situ. After scaffold degradation, a functional, stable pseudarthrosis with dense fibrous connective tissue was formed. However, the supplementary Polyactive® stem caused a deleterious tissue reaction and therefore the stem can not be applied to the composite joint implant. The bioabsorbable implants have potential for use in clinical hand surgery, but have to await validation in clinical patient series and controlled trials.

Describing Hand Postures: Inspirations from Classical Mudras

The objective of this work is to develop a systematic methodology for describing hand postures and grasps which is independent of the kinematics and geometry of the hand model which in turn can be used for developing a universal referencing scheme. It is therefore necessary that the scheme be general enough to describe the continuum of hand poses. Indian traditional classical dance form, “Bharathanatyam”, uses 28 single handed gestures, called “mudras”. A Mudra can be perceived as a hand posture with a specific pattern of finger configurations. Using modifiers, complex mudras could be constructed from relatively simple mudras. An adjacency matrix is constructed to describe the relationship among mudras. Various mudra transitions can be obtained from the graph associated with this matrix. Using this matrix, a hierarchy of the mudras is formed. A set of base mudras and modifiers are used for describing how one simple posture of hand can be transformed into another relatively complex one. A canonical set of predefined hand postures and modifiers can be used in digital human modeling to develop standard hand posture libraries.

Interference in Multiprocessor Systems with Localized Memory Access Probabilities

Past studies of memory interference in multiprocessor systems have generally assumed that the references of each processor are uniformly distributed among the memory modules. In this paper we develop a model with local referencing, which reflects more closely the behavior of real-life programs. This model is analyzed using Markov chain techniques and expressions are derived for the multiprocessor performance. New expressions are also obtained for the performance in the traditional uniform reference model and are compared with other expressions-available in the literature. Results of a simulation study are given to show the accuracy of the expressions for both models.

Monitoring hydrilla using two RAPD procedures and the Nonindigenous Aquatic Species database

Hydrilla ( Hydrilla verticillata (L.f.) Royle), an invasive aquatic weed, continues to spread to new regions in the United States. Two biotypes, one a female dioecious and the other monoecious have been identified. Management of the spread of hydrilla requires understanding the mechanisms of introduction and transport, an ability to map and make available information on distribution, and tools to distinguish the known U.S. biotypes as well as potential new introductions. Review of the literature and discussions with aquatic scientists and resource managers point to the aquarium and water garden plant trades as the primary past mechanism for the regional dispersal of hydrilla while local dispersal is primarily carried out by other mechanisms such as boat traffic, intentional introductions, and waterfowl. The Nonindigenous Aquatic Species (NAS) database is presented as a tool for assembling, geo-referencing, and making available information on the distribution of hydrilla. A map of the current range of dioecious and monoecious hydrilla by drainage is presented. Four hydrilla samples, taken from three discrete, non-contiguous regions (Pennsylvania, Connecticut, and Washington State) were examined using two RAPD assays. The first, generated using primer Operon G17, and capable of distinguishing the dioecious and monoecious U.S. biotypes, indicated all four samples were of the monoecious biotype. Results of the second assay using the Stoffel fragment and 5 primers, produced 111 markers, indicated that these samples do not represent new foreign introductions. The differences in the monoecious and dioecious growth habits and management are discussed.

Spatial filtering in tone reproduction and vision

This thesis is concerned with spatial filtering. What is its utility in tone reproduction? Does it exist in vision, and if so, what constraints does it impose on the nervous system?

Tone reproduction is just the art and science of taking a picture and then displaying it. The sensors available to capture an image have a greater dynamic range than the media that may be used to display it. Conventionally, spatial filtering is used to boost contrast; it ameliorates the loss of contrast that results when the sensor signal range is scaled down to fit the display range. In this thesis, a type of nonlinear spatial filtering is discussed that results in direct range reduction without range scaling. This filtering process is instantiated in a real-time image processor built using analog CMOS VLSI.

Spatial filtering must be applied with care in both artificial and natural vision systems. It is argued that the nervous system does not simply filter linearly across an image. Rather, the way that we see things implies that the nervous system filters nonlinearly. Further, many models for color vision include a high-pass filtering step in which the DC information is lost. A real-time study of filtering in color space leads to the conclusion that the nervous system is not that simple, and that it maintains DC information by referencing to white.

Feira de São Cristóvão: uma incursão sobre os estudos na área e a tentativa de aproximação à relação global-local

O presente trabalho se propõe fazer uma aproximação aos estudos sobre a tradicionalmente chamada Feira de São Cristóvão, levando em consideração a relação entre os agentes partícipes e a dinâmica no espaço. O objetivo é compreender melhor a força que move os atores no sentido da mudança da forma da feira para a forma do Centro Luiz Gonzaga de Tradições Nordestinas (CLGTN), e assim me aproximar da seguinte questão: Por que uma forma de comércio como a modelada na Feira de São Cristóvão, popularmente conhecida como feira dos paraíbas, sobrevive à força das mudanças operadas no ramo, dando lugar aos sofistificados shopping-centers? Para isso, faço uma aproximação ao estado de arte da pesquisa na área com base nas seguintes categorias de análise: a Feira como forma de produção do espaço e a relação Forma-Conteúdo, a relação espaço-identidade na feira e a relação entre agentes internos e externos no Espaço. Vendo a migração como movimento responsável pela constituição de um espaço social e territorialmente diferenciado do nordestino na cidade do Rio de Janeiro, é por ela que inicio a exposição. Esta se continua com a análise dos trabalhos escolhidos para estudo, via as categorias indicadas e, com um capítulo no qual procuro repensar a feira a partir da relação global-local que vem referenciando as reflexões acumuladas na área do urbano a partir da segunda metade do século XX. Por fim, concluo observando que a permanência da feira se deve a um duplo movimento de resistência-absorção que, se redefinindo no tempo e no espaço, não consegue, entretanto, apagar os traços da tradição que lhe deu origem.

Estruturas Discursivas: o Encapsulamento Anafórico em redações de pré-vestibulandos

O presente trabalho conta com cinquenta redações de alunos do curso Pré - vestibular do Sintuperj, que já concluíram o Ensino Médio e, agora, se preparam para fazer o exame de acesso ao ensino superior - vestibular. A abordagem proposta se baseia na análise da referenciação, forma de organização coesiva do texto, especificamente, o encapsulamento anafórico. Para verificar a função discursiva desse fenômeno argumentativo nas redações, a análise foi dividida em duas perspectivas: por um lado, foram investigados os tipos de cadeias de referenciação, designadas como específica, rotulando e contribuindo para a progressão referencial no texto; ou como não específica, simplesmente, retomando e resumindo o conteúdo antecedente, evitando repetições. De outro lado, ampliou-se a análise para os elementos que constituem essas cadeias, verificando como foi realizada a menção ao referente através da manutenção temática. Além disso, foi possível notar como essa manutenção dos dados no texto possibilita a coesão textual e enriquece a argumentação que o aluno faz para defender a sua tese. Portanto, pode-se afirmar que a principal contribuição que esse trabalho oferece para o ensino de língua materna concerne na abordagem do texto a partir de uma perspectiva dos processamentos cognitivos, revelando como os elementos vão sendo construídos nas redações, a partir de componentes culturais e conhecimentos diversos dos alunos, que proporcionam a progressão referencial

O encapsulamento anafórico em redações de vestibular da UEMA

Tomando como base redações produzidas por candidatos que participaram do processo seletivo realizado em 2012 para o preenchimento a vagas de diferentes cursos de graduação oferecidos na Universidade Estadual do Maranhão - UEMA, corpus desta pesquisa, tem-se o objetivo de analisar as ocorrências das retomadas de porções textuais produzidas por pronomes demonstrativos e expressões nominais definidas, constituídas por esses pronomes, denominadas encapsulamentos anafóricos, que contribuem para a progressão referencial dos textos. A abordagem proposta fundamenta-se nos estudos de Referenciação, postulados por Koch (2002, 2006,2009, 2010, 2011), Marcuschi (1998, 2008), Cavalcante (2003, 2011, 2012) e Tedesco (2002). Foram levantadas categorias de análise para a observação do fenômeno em estudo, sob três perspectivas: as formas morfossemânticas que podem assumir as expressões de retomadas no texto; as funções semântico-discursivas exercidas por essas expressões e a localização das expressões de retomada na estrutura textual das redações. O corpus desta pesquisa 45 (quarenta e cinco) redações de vestibular UEMA/2012, que corresponde a 10% da amostra de 450 (quatrocentos e cinquenta) redações analisadas constitui-se em textos dissertativo-argumentativos, o que propiciou a discussão teórica dos conceitos de gêneros discursivos e tipos textuais, no que tange à natureza estrutural dos textos analisados, fundamentando-se em Marcuschi (2008), Koch (2002, 2011), Rojo (2012). O estudo nos leva a afirmar que o pronome demonstrativo e as denominadas expressões nominais definidas constituem-se em um recurso discursivo bastante utilizado nas referidas produções de texto, promovendo não só a ligação entre as diferentes partes do texto, mas também contribuindo para a progressão textual por meio da referenciação