Inspiratory muscle warm-up does not improve cycling time-trial performance

Purpose: This study examined the effects of an active cycling warm-up, with and without the addition of an inspiratory muscle warm-up (IMW), on 10-km cycling time-trial performance

Dementia Care Mapping™ to reduce agitation in care home residents with dementia: the EPIC cluster RCT

Background The quality of care for people with dementia in care homes is of concern. Interventions that can improve care outcomes are required. Objective To investigate the clinical effectiveness and cost-effectiveness of Dementia Care Mapping™ (DCM) for reducing agitation and improving care outcomes for people living with dementia in care homes, versus usual care. Design A pragmatic, cluster randomised controlled trial with an open-cohort design, follow-up at 6 and 16 months, integrated cost-effectiveness analysis and process evaluation. Clusters were not blinded to allocation. The primary end point was completed by staff proxy and independent assessors. Setting Stratified randomisation of 50 care homes to the intervention and control groups on a 3 : 2 ratio by type, size, staff exposure to dementia training and recruiting hub. Participants Fifty care homes were randomised (intervention, n = 31; control, n = 19), with 726 residents recruited at baseline and a further 261 recruited after 16 months. Care homes were eligible if they recruited a minimum of 10 residents, were not subject to improvement notices, had not used DCM in the previous 18 months and were not participating in conflicting research. Residents were eligible if they lived there permanently, had a formal diagnosis of dementia or a score of 4+ on the Functional Assessment Staging Test of Alzheimer’s Disease, were proficient in English and were not terminally ill or permanently cared for in bed. All homes were audited on the delivery of dementia and person-centred care awareness training. Those not reaching a minimum standard were provided training ahead of randomisation. Eighteen homes took part in the process evaluation. Intervention Two staff members from each intervention home were trained to use DCM and were asked to carry out three DCM cycles; the first was supported by an external expert. Main outcome measures The primary outcome was agitation (Cohen-Mansfield Agitation Inventory), measured at 16 months. Secondary outcomes included resident behaviours and quality of life. Results There were 675 residents in the final analysis (intervention, n = 388; control, n = 287). There was no evidence of a difference in agitation levels between the treatment arms. The adjusted mean difference in Cohen-Mansfield Agitation Inventory score was –2.11 points, being lower in the intervention group than in the control (95% confidence interval –4.66 to 0.44; p = 0.104; adjusted intracluster correlation coefficient: control = 0, intervention = 0.001). The sensitivity analyses results supported the primary analysis. No differences were detected in any of the secondary outcomes. The health economic analyses indicated that DCM was not cost-effective. Intervention adherence was problematic; only 26% of homes completed more than their first DCM cycle. Impacts, barriers to and facilitators of DCM implementation were identified. Limitations The primary completion of resident outcomes was by staff proxy, owing to self-report difficulties for residents with advanced dementia. Clusters were not blinded to allocation, although supportive analyses suggested that any reporting bias was not clinically important. Conclusions There was no benefit of DCM over control for any outcomes. The implementation of DCM by care home staff was suboptimal compared with the protocol in the majority of homes. Future work Alternative models of DCM implementation should be considered that do not rely solely on leadership by care home staff. Trial registration Current Controlled Trials ISRCTN82288852. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 16. See the NIHR Journals Library website for further project information

The Spectral Energy Distribution and Mass-loss Rate of the A-Type Supergiant Deneb

A stellar wind module has been developed for the PHOENIX stellar atmosphere code for the purpose of computing non-LTE, line-blanketed, expanding atmospheric structures and detailed synthetic spectra of hot luminous stars with winds. We apply the code to observations of Deneb, for which we report the first positive detections of mm and cm emission (obtained using the SCUBA and the VLA), as well a strong upper limit on the 850 micron flux (using the HHT). The slope of the radio spectrum shows that the stellar wind is partially ionized. We report a uniform-disk angular diameter measurement, 2.40 +/- 0.06 mas, from the Navy Prototype Optical Interferometer (NPOI). The measured bolometric flux and corrected NPOI angular diameter yield an effective temperature of 8600 +/- 500 K. Least-squares comparisons of synthetic spectral energy distributions from 1220 A to 3.6 cm with the observations provide estimates for the effective temperature and the mass-loss rate of 8400 +/- 100 K and 8 +/- 3 E-7 M_sun/yr, respectively. This range of mass-loss rates is consistent with that derived from high dispersion UV spectra when non-LTE metal-line blanketing is considered. We are unable achieve a reasonable fit to a typical Halpha P-Cygni profile with any model parameters over a reasonable range. This is troubling because the \ha profile is the observational basis for Wind Momentum-Luminosity Relationship.Comment: Accepted by the Astrophysical Journal, 43 pages, 23 figure

Spatial Dynamics Of Vertical And Horizontal Intergovernmental Collaboration

Although researchers have made progress in understanding motivations behind local government collaboration, there is little research that explores the spatial dynamics of such interactions. Does the idea of collaboration travel horizontally, passed from neighbor to neighbor, or is vertical leadership from state, county, or regional actors more important in influencing local governments’ decisions to share resources and functions? What factors influence local governments’ choices to collaborate with their neighbors versus a regional entity, county, or state government? In this article, we investigate the importance of vertical and horizontal influences when local governments decide to collaborate around land use planning. Using data from a survey of Michigan local government officials, we take a spatial statistical approach to answering this question. We find widespread evidence of collaboration at multiple scales, and observe patterns of both horizontal and vertical influence. We also find that contextual factors help to explain these patterns of collaboration.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112248/1/juaf12139.pd

Landholder Typologies Used in the Development of Natural Resource Management Programs in Australia - A Review

This article reviews the literature on the identification of landholder typologies that can be used to assist the design and delivery of natural resource management (NRM) programs. Australian researchers have developed typologies of landholders based on a variety of criteria. The rationale for developing landholder typologies is first discussed before reviewing the various approaches that have been used by Australian researchers and comparing their findings. The methods employed have differed according to the theories used to guide the research and the 'clients' or 'sponsors' of the research. The landholder types they describe, however, have a number of similarities. These similarities suggest that the studies have identified the same fundamental divisions in the rural community, and that it may be possible to integrate landholder typologies for a variety of NRM and non-NRM applications. It is concluded that further research could usefully investigate whether concepts of social class or sub-cultures may be appropriate to define and describe the variations in landholder types

Assessing the transition of municipal solid waste management using combined material flow analysis and life cycle assessment

Faced with the challenges to deal with increasingly growing and ever diversified municipal solid waste (MSW), a series of waste directives have been published by European Commission to divert MSW from landfills to more sustainable management options. The presented study assessed the transition of MSW man-agement in Nottingham, UK, since the enforcement of the EU Landfill Directive using a tool of combined materials flow analysis (MFA) and life cycle assess-ment (LCA). The results show that the MSW management system in Nottingham changed from a relatively simple landfill & energy from waste (EfW) mode to a complex, multi-technology mode. Improvements in waste reduction, material re-cycling, energy recovery, and landfill prevention have been made. As a positive result, the global warming potential (GWP) of the MSW management system re-duced from 1,076.0 kg CO2–eq./t of MSW in 2001/02 to 211.3 kg CO2–eq./t of MSW in 2016/17. Based on the results of MFA and LCA, recommendations on separating food waste and textile at source and updating treatment technologies are made for future improvement

Coastal urban and peri-urban Indigenous people’s adaptive capacity to climate change

This chapter discusses the adaptive capacity of coastal urban and peri-urban Indigenous People’s to climate change. It is based on the findings of a National Climate Change Adaptation Research Facility (NCCARF) funded project that utilised a series of case studies that engaged key representatives from Indigenous organisations in five coastal locations in three states of south-eastern Australia (Low Choy D, Clarke P, Jones D, Serrao-Neumann S, Hales R, Koschade O et al., Aboriginal reconnections: understanding coastal urban and peri-urban Indigenous people’s vulnerability and adaptive capacity to climate change, National Climate Change Adaptation Research Facility, Gold Coast, 139 pp, 2013). The study has highlighted the social, economic and environmental impacts on urban and peri-urban Indigenous communities inhabiting coastal areas throughout south-eastern Australia. These impacts include a loss of community and environmental assets, such as cultural heritage sites, with significant impacts on their quality of life and the establishment of potential favourable conditions for the spread of plant diseases, weeds and pests. The study also found that opportunities did not readily exist for engagement with climate change adaptation policy and initiatives and this was further exacerbated by acute shortages of qualified/experienced Indigenous members that could represent their communities’ interests in climate change adaptation forums. The evidence emerging from this research clearly demonstrates that Aboriginal people’s consideration of the future, even with the overlay of climate change and the requirements for serious considerations of adaptation, are significantly influenced and dominated by economic aspirations which are seen as fundamental survival strategies for their communities

Dementia Care Mapping™ to reduce agitation in care home residents with dementia: The DCM™ EPIC cluster randomised controlled trial

Background: Quality of care for people with dementia in care homes is of concern. Interventions that can improve care outcomes are required. Objective: To investigate the clinical and cost-effectiveness of Dementia Care MappingTM (DCM™) for reducing agitation, and improving care outcomes for people living with dementia in care homes, versus usual care. Design: A pragmatic, cluster randomised controlled trial with open-cohort design, follow-up at 6- and 16-months, integrated cost-effectiveness analysis and process evaluation. Clusters were not blinded to allocation. Primary endpoint was completed by staff-proxy and independent assessors. Setting: Stratified randomisation of 50 care homes to intervention/control on a 3:2 ratio by type, size, staff exposure to dementia training and recruiting hub. Participants: Fifty care homes were randomised (31 intervention, 19 control), with 726 residents recruited at baseline and a further 261 at 16-months. Care homes were eligible if they recruited a minimum of 10 residents, were not subject to improvement notices, had not used DCM™ in the previous 18-months and were not participating in conflicting research. Residents were eligible if they lived there permanently, had a formal diagnosis of dementia/score of 4+ on the Functional Assessment Staging of Alzheimer’s Disease, were proficient in English, not at end-of-life/permanently cared for in bed. All homes were audited on delivery of dementia and person-centred care awareness training. Those not reaching a minimum standard were provided training ahead of randomisation. Eighteen homes took part in the process evaluation. Intervention: Two staff from each intervention home were trained to use DCM™ and requested to carry out three DCM™ cycles; the first supported by an external expert. Main outcome measures: The primary outcome was agitation (Cohen-Mansfield Agitation Inventory) at 16-months. Secondary outcomes included resident behaviours and quality of life. Results: There were 675 residents in the final analysis (287 control, 388 intervention). There was no evidence of difference in agitation levels between arms. The adjusted mean difference in CMAI score was -2.11 points, lower in the intervention group than control (95% CI -4.66 to 0.44, p=0.104, adjusted ICC control=0, intervention 0.001). The sensitivity analyses results supported the primary analysis. No differences were detected in any of the secondary outcomes. The health economic analyses indicated DCM™ was not cost-effective. Intervention adherence was problematic; only 26% of homes completed more than their first DCM™ cycle. Impacts of and barriers and facilitators to DCM™ implementation were identified. Limitations: Primary completion of resident outcomes was by staff proxy due to self-report difficulties for residents with advanced dementia. Clusters were not blinded to allocation although supportive analyses suggested any reporting bias was not clinically important. Conclusions: There was no benefit of DCM™ over control on any outcomes. Implementation of DCM™ by care home staff was sub-optimal compared to protocol in the majority of homes. Future work: Alternative models of DCM™ implementation should be considered, which do not rely solely on leadership by care home staff. Trial registration: Current Controlled Trials ISRCTN82288852 Funding: This project was funded by the National Institute for Health Research Health Technology Assessment programme (project number 11/15/13)