In-reach specialist nursing teams for residential care homes : uptake of services, impact on care provision and cost-effectiveness

Background: A joint NHS-Local Authority initiative in England designed to provide a dedicated nursing and physiotherapy in-reach team (IRT) to four residential care homes has been evaluated.The IRT supported 131 residents and maintained 15 'virtual' beds for specialist nursing in these care homes. Methods: Data captured prospectively (July 2005 to June 2007) included: numbers of referrals; reason for referral; outcome (e.g. admission to IRT bed, short-term IRT support); length of stay in IRT; prevented hospital admissions; early hospital discharges; avoided nursing home transfers; and detection of unrecognised illnesses. An economic analysis was undertaken. Results: 733 referrals were made during the 2 years (range 0.5 to 13.0 per resident per annum)resulting in a total of 6,528 visits. Two thirds of referrals aimed at maintaining the resident's independence in the care home. According to expert panel assessment, 197 hospital admissions were averted over the period; 20 early discharges facilitated; and 28 resident transfers to a nursing home prevented. Detection of previously unrecognised illnesses accounted for a high number of visits. Investment in IRT equalled £44.38 per resident per week. Savings through reduced hospital admissions, early discharges, delayed transfers to nursing homes, and identification of previously unrecognised illnesses are conservatively estimated to produce a final reduction in care cost of £6.33 per resident per week. A sensitivity analysis indicates this figure might range from a weekly overall saving of £36.90 per resident to a 'worst case' estimate of £2.70 extra expenditure per resident per week. Evaluation early in implementation may underestimate some cost-saving activities and greater savings may emerge over a longer time period. Similarly, IRT costs may reduce over time due to the potential for refinement of team without major loss in effectiveness. Conclusion: Introduction of a specialist nursing in-reach team for residential homes is at least cost neutral and, in all probability, cost saving. Further benefits include development of new skills in the care home workforce and enhanced quality of care. Residents are enabled to stay in familiar surroundings rather than unnecessarily spending time in hospital or being transferred to a higher dependency nursing home setting

A Comparison of Levels of Select Minerals in Scalp Hair Samples with Estimated Dietary Intakes of These Minerals in Women of Reproductive Age

The objective of this study was to evaluate daily intake of minerals and concentrations of minerals in hair in women of reproductive age. The study included 77 menstruating women, aged 35.9 ± 9.7 years. Subjects were divided into three groups according to age. All women were healthy. Hair samples were taken from several points of the occipital scalp. The content of minerals in hair samples was determined by flame atomic absorption spectrometry. Dietary intake of the analysed minerals was assayed on the basis of dietary intake interviews from three preceding days and evaluated using the dietetic computer programme. It was shown that calcium and iron daily intake by the women was below the recommended value. Only few women had low concentrations (below reference values) of magnesium, copper and zinc in hair. Statistically significant differences were shown between age groups. Generally, the concentrations of minerals in hair in the younger (19–30 years) and the older women (41–50 years) were higher than in hair of middle-aged women (31–40 years). The content of calcium, magnesium, iron and zinc in daily diets of women correlated inversely with copper level in their hair. Food products with good bioavailability of iron and calcium should be recommended for women of childbearing age in all age groups

Birds use structural properties when selecting materials for different parts of their nests

Bird nests can have various roles but all act as the location for incubation, so at least have to serve to hold and support the incubating bird and its clutch of eggs. Nest construction is species specific and the use of materials varies between different parts of the nest. At present we know very little about the role that these materials play in the structural characteristics of the nest. This study examined materials from deconstructed nests from four species of thrush (Turdidae) and two species of finch (Fringillidae) that all constructed nests made of woody stems. It was hypothesised that structural properties would vary within the different regions of a nest, with thicker and stronger materials being found in parts of the nest needing the most support. Secondly, it was predicted that structural properties would vary little between nests of members of the same family, but would be quite different between nests of different families. Nests were deconstructed to quantify the materials used in the cup lining, and the upper and lower parts of the outer nest. The 20 thickest pieces of material were selected from each nest part and for each piece, and their diameter and mass quantified. Each piece was then subjected to a three-point bending test using an Instron universal testing machine to determine its rigidity and bending strength. Placement of materials in the nest was non-random in all species. The materials used in the outer part of the nest were thicker, stronger and stiffer than those materials found in the cup lining. The extent to which these structural properties varied between families depended on where the material was taken from the nest. Both strength and rigidity strongly positively correlated with the diameter of the piece of material. We hypothesise that birds are not directly aware of the structural properties of the material per se but rather assess diameter and mass of the material when they pick it up by the bill. Using this information they decide on whether the piece is suitable for that appropriate stage of nest construction

Assessment of habitat and survey criteria for the great crested newt (Triturus cristatus) in Scotland: a case study on a translocated population

The great crested newt Triturus cristatus has declined across its range due to habitat loss, motivating research into biotic and abiotic species determinants. However, research has focused on populations in England and mainland Europe. We examined habitat and survey criteria for great crested newts in Scotland, with focus on a large, translocated population. Adult counts throughout the breeding season were obtained annually using torchlight surveys, and Habitat Suitability Index (HSI) assessed at created ponds (N = 24) in 2006 (immediately post-translocation) and 2015 (9 years post-translocation). In 2006, ‘best case’ HSI scores were calculated to predict habitat suitability should great crested newts have unrestricted access to terrestrial habitat. Abiotic criteria included in and omitted from current great crested newt survey guidelines were assessed using data recorded in 2015. Some ponds had improved HSI scores in 2015, but overall failure to meet predicted scores suggests management is needed to improve habitat suitability. Great crested newt activity was positively associated with moon visibility and phase, air temperature, and pH, but negatively correlated with water clarity. Importantly, our results indicate there are abiotic determinants specific to Scottish great crested newts. Principally, survey temperature thresholds should be lowered to enable accurate census of Scottish populations

Analysis on the situation of subjective well-being and its influencing factors in patients with ankylosing spondylitis

BACKGROUND: To examine the subjective well-being (SWB) in patients with ankylosing spondylitis (AS) compared with the healthy controls, and to explore the associations between SWB and demographic characteristics, disease-specific variables in AS patients. METHODS: SWB was assessed with General Well-Being Schedule (GWBS) in 200 AS patients and 210 healthy controls. Comparisons among subgroups were performed to investigate how certain aspects operate as favorable or adverse factors in influencing SWB in the patients with AS. RESULTS: Both men and women with AS reported significantly impaired SWB on all scales of the GWBS except for the Control (O) scale. The results revealed that better sleep, lower disease activity and more family care predicted higher SWB. In AS patients, positive attitude towards therapy prospect was significantly associated with higher SWB. Therapy prospect refers to the hope of patients about the disease treatment. CONCLUSIONS: Compared with general population, SWB might be affected by the onset of AS. There are significant associations between SWB and sleep quality, BASDAI, APGAR, therapy prospect

Evidence of Egg Diversity in Squamate Evolution from Cretaceous Anguimorph Embryos

Lizards are remarkable amongst amniotes, for they display a unique mosaic of reproduction modes ranging from egg-laying to live-bearing. Within this patchwork, geckoes are believed to represent the only group to ever have produced fully calcified rigid-shelled eggs, contrasting with the ubiquitous parchment shelled-eggs observed in other lineages. However, this hypothesis relies only on observations of modern taxa and fossilised gecko-like eggshells which have never been found in association with any embryonic or parental remains. We report here the first attested fossil eggs of lizards from the Early Cretaceous of Thailand, combining hard eggshells with exquisitely preserved embryos of anguimoph (e.g. Komodo dragons, mosasaurs). These fossils shed light on an apparently rare reproduction strategy of squamates, demonstrate that the evolution of rigid-shelled eggs are not an exclusive specialization of geckoes, and suggest a high plasticity in the reproductive organs mineralizing eggshells