Admiralty Litigation In Perpetuum: The Continuing Saga of Package Litigation and Third World Delivery Problems

Certain admiralty cargo issues are litigated frequently, often in search of a magical test which will preclude all further litigation. Three such issues are package limitations, the burden of proving the condition and quantity of cargo stowed within containers, and the point at which the ocean carrier delivers cargo at discharge and thus completes its duties under the contract of carriage. Despite the frequency with which these issues have been litigated, significant disagreement remains among the circuit courts as to their proper resolution. This article will examine the current state of judicial uncertainty in these areas and the indications given by the courts as the positions most likely to be adopted in the future

Screening for pre-clinical disability in different residential settings

<p>Abstract</p> <p>Background</p> <p>Preventing disability and offering effective interventions to older people during early decline in function is most likely to be effective if those most at risk of progressive disablement are able to be identified. Similarly the ability to easily identify a group with similar functional profile from disparate sectors of the community is of significant benefit to researchers. This study aimed to (1) describe the use of a pre-clinical disability screening tool to select a functionally comparable group of older men and women with early functional limitation from different settings, and (2) explore factors associated with function and disability.</p> <p>Methods</p> <p>Self-reported function and disability measured with the Late-Life Function and Disability Instrument along with a range of physical performance measurements were compared across residential settings and gender in a sample of 471 trial participants identified as pre-clinically disabled after being screened with the Fried pre-clinical disability tool. Factors that might lie on the pathway to progressive disablement were identified using multiple linear regression analysis.</p> <p>Results</p> <p>We found that a sample population, screened for pre-clinical disability, had a functional status and disability profile reflecting early functional limitation, regardless of residential setting or gender. Statistical models identified a range of factors associated with function and disability which explained a greater degree of the variation in function, than disability.</p> <p>Conclusions</p> <p>We selected a group of people with a comparable function and disability profile, consistent with the pre-clinical stage of disability, from a sample of older Australian men and women from different residential settings using the Fried pre-clinical disability screening tool. The results suggest that the screening tool can be used with greater confidence for research, clinical and population health purposes. Further research is required to examine the validity of the tool. These findings offer insight into the type of impairment factors characterising early functional loss that could be addressed through disability prevention initiatives.</p> <p>Trial Registration</p> <p>ACTRN01206000431527</p

The fitness for the Ageing Brain Study II (FABS II): protocol for a randomized controlled clinical trial evaluating the effect of physical activity on cognitive function in patients with Alzheimer's disease

Background: Observational studies have documented a potential protective effect of physical exercise in older adults who are at risk for developing Alzheimer's disease. The Fitness for the Ageing Brain II (FABS II) study is a multicentre randomized controlled clinical trial (RCT) aiming to determine whether physical activity reduces the rate of cognitive decline among individuals with Alzheimer's disease. This paper describes the background, objectives of the study, and an overview of the protocol including design, organization and data collection methods

A mixed methods process evaluation of a person-centred falls prevention program

Background RESPOND is a telephone-based falls prevention program for older people who present to a hospital emergency department (ED) with a fall. A randomised controlled trial (RCT) found RESPOND to be effective at reducing the rate of falls and fractures, compared with usual care, but not fall injuries or hospitalisations. This process evaluation aimed to determine whether RESPOND was implemented as planned, and identify implementation barriers and facilitators. Methods A mixed-methods evaluation was conducted alongside the RCT. Evaluation participants were the RESPOND intervention group (n=263) and the clinicians delivering RESPOND (n=7). Evaluation data were collected from participant recruitment and intervention records, hospital administrative records, audio-recordings of intervention sessions, and participant questionnaires. The Rochester Participatory Decision-Making scale (RPAD) was used to evaluate person-centredness (score range 0 (worst) - 9 (best)). Process factors were compared with pre-specified criteria to determine implementation fidelity. Six focus groups were held with participants (n=41), and interviews were conducted with RESPOND clinicians (n=6). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation – Behaviour’ (COM-B) behaviour change framework. Results RESPOND was implemented at a lower dose than the planned 10 hours over six months, with a median (IQR) of 2.9 hours (2.1, 4). The majority (76%) of participants received their first intervention session within one month of hospital discharge. Clinicians delivered the program in a person-centred manner with a median (IQR) RPAD score of 7 (6.5, 7.5) and 87% of questionnaire respondents were satisfied with the program. The reports from participants and clinicians suggested that implementation was facilitated by the use of positive and personally relevant health messages. Complex health and social issues were the main barriers to implementation. Conclusions RESPOND was person-centred and reduced falls and fractures at a substantially lower dose, using fewer resources, than anticipated. However, the low dose delivered may account for the lack of effect on falls injuries and hospitalisations. The results from this evaluation provide detailed information to guide future implementation of RESPOND of similar programs. Trial registration: This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014)

Admiralty Litigation In Perpetuum: The Continuing Saga of Package Litigation and Third World Delivery Problems

Certain admiralty cargo issues are litigated frequently, often in search of a magical test which will preclude all further litigation. Three such issues are package limitations, the burden of proving the condition and quantity of cargo stowed within containers, and the point at which the ocean carrier delivers cargo at discharge and thus completes its duties under the contract of carriage. Despite the frequency with which these issues have been litigated, significant disagreement remains among the circuit courts as to their proper resolution. This article will examine the current state of judicial uncertainty in these areas and the indications given by the courts as the positions most likely to be adopted in the future

Impact of Tai-Chi on falls among preclinically disabled older people: A randomized controlled trial

Objective: To investigate the effectiveness of tai-chi in preventing falls among community-dwelling older people. Design: Multisite parallel group individually randomized controlled trial. Setting: Melbourne, Australia. Participants: Preclinically disabled community-dwelling people 70+years (n=503), without major medical conditions or moderate to severe cognitive impairment. Intervention: Sixty-minute modified Sun style tai-chi group-based exercise program twice weekly for 48weeks; control intervention was a seated group-based flexibility exercise program of the same dose. Measurements: All falls, self-reported using a monthly calendar, analyzed at 24weeks and 48weeks. Injurious falls reported in follow-up telephone interviews for each reported fall. Results: The adjusted fall incidence rate ratios at 24 and 48weeks were 1.08 [(95% confidence interval (CI) 0.64-1.81)], and 1.12 (95% CI 0.75-1.67), respectively. A higher proportion of intervention participants ceased attendance in the first 24weeks (difference 17.9%, 95% CI 9.6-25.8), and the second 24weeks (2.7%, 95% CI-5.0 to 10.4). Intervention participants who ceased attendance had lower left quadriceps strength (difference 3.3kg 95% CI 0.15-6.36) and required longer to complete the timed up and go test (difference 1.7seconds 95% CI 0.22-3.17) at baseline. Conclusions: This study does not support modified Sun style tai-chi as a falls prevention measure among relatively well community-dwelling older people with modified mobility and at increased risk of disability. Insufficient intervention intensity, or low exercise class attendance may have contributed to the lack of effect, as may have attrition bias among the intervention group

Depression Among Nonfrail Old Men Is Associated With Reduced Physical Function and Functional Capacity After 9 Years Follow-up: The Health in Men Cohort Study.

BACKGROUND: Older adults with depression have increased risk of frailty and death. OBJECTIVE: To determine if history of depression hinders future physical and functional capacity. DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal cohort study of 1148 men aged 70-87 years who were living in the Perth metropolitan community in 2001-2004 and completed a follow-up assessment of physical and functional capacity in 2011-2012. MAIN OUTCOME AND MEASURES: Outcomes were collected in 2011-2012 and included 4 measures of physical function (timed up-and-go, timed sit-to-stand, functional reach, and step test) and the assessment of basic (activities of daily living) and instrumental activities of daily living. We also collected information on depression and frailty [using the FRAIL (fatigue resistance ambulation illness, and loss of weight) scale] in 2001-2004 and 2011-2012. Frail men at the 2001-2004 were excluded from the analyses. RESULTS: Men with history of depression at the 2001-2004 assessment showed significantly worse performance than their counterparts in the timed sit-to-stand and step tests 9 years later. They also had approximately twice the risk of attaining the lowest decile of performance in both tests (analyses adjusted for age, education, and prevalent depressive symptoms). In addition, the adjusted risk ratio of impaired instrumental activities of daily living was 58% (95% confidence interval 15%, 116%) greater for men with than without history of past depression. These associations were particularly robust for men with current depression at the 2001-2004 assessment. CONCLUSIONS: Nonfrail older men with history of current or past depression showed greater impairment of physical and functional capacity 9 years later. Older men with history of depression may benefit from regular monitoring of physical and occupational function and should be targeted by preventive trials designed to improve function and decrease frailty