Establishing an evidenced-based dietetic model of care in haemodialysis using implementation science

To establish an evidence-based dietetics service in an in-centre haemodialysis unit utilising implementation science.The service was developed through the Knowledge-to-Action Framework. The steps of the Action Cycle were addressed through a literature review, identification of evidence-based guidelines, benchmarking and local staff engagement. The theoretical domains framework (TDF) was used to identify barriers/enablers, and behaviour change wheel to determine appropriate interventions. To monitor, evaluate outcomes and assess sustained knowledge use we employed multidisciplinary team engagement and database use. Audit data were collected at baseline, 6 and 12 months on nutrition assessment (Patient-Generated Subjective Global Assessment), intervention timeliness and alignment to dietetic workforce recommendations. Descriptive statistics, McNemar tests and a linear mixed model were applied.Barriers existed in the knowledge, skills, environmental context and resources TDF domains. Suitable interventions were identified with training on nutritional management of haemodialysis patients delivered to 148 nurses, and nutrition management recommendations summarised into local procedural resources. A database to prompt and monitor outcome measures was created and indicated that over 18 months post-service commencement, eligible patients received nutrition assessment at least 6-monthly, aligning with recommendations. Prevalence of malnutrition was 28% (n = 9/32) at baseline, 23% (n = 5/22) at 6 months and 20% (n = 4/20) at 12 months (P = 0.50).We demonstrated benefits to service development and implementation with implementation science providing a structured and methodical approach to translating guidelines into practice. Development of training, resources and prompts for outcome measures has supported the establishment of an evidence-based dietetics service in a haemodialysis unit

Framing an independent, integrated and evidence-based evaluation of the state of Australia's biophysical and human environments

A new approach was developed for Australia's 2011 national State of the Environment (SoE) report to integrate the assessment of biophysical and human elements of the environment. A Common Assessment and Reporting Framework (CARF) guided design and implementation, responding to jurisdictional complexity, outstanding natural diversity and ecosystem values, high levels of cultural and heritage diversity, and a paucity of national-scale data. The CARF provided a transparent response to the need for an independent, robust and evidence-based national SoE report. We conclude that this framework will be effective for subsequent national SoE assessments and other integrated national-scale assessments in data-poor regions.The work reported here was funded and supported by DSEWPaC, and we recognise the high level of professional support provided by the DSEWPaC SoE Team and other staff, the professional support of Biotext information consultancy (biotext. com.au), the vision of the commissioning Minister for Environment Protection, Heritage and the Arts (Peter Garrett) in presenting us with this challenge, and the support of the presenting Minister for Sustainability, Environment, Water, Population and Communities (Tony Burke) in accepting and delivering the final report to Australia

Clostridium difficile Infection and Proton Pump Inhibitor Use in Hospitalized Pediatric Cystic Fibrosis Patients

Children with cystic fibrosis (CF) often take proton pump inhibitors (PPIs), which helps improve efficacy of fat absorption with pancreatic enzyme replacement therapy. However, PPI use is known to be associated with Clostridium difficile-(C. diff-) associated diarrhea (CDAD). We retrospectively evaluated the incidence of C. diff infection from all pediatric hospital admissions over a 5-year period at a single tertiary children's hospital. We found significantly more C. diff-positive stool tests in hospitalized patients with CF compared to patients with no diagnosis of CF. However, use of a PPI was not associated with an increased risk of CDAD in hospitalized CF patients. In summary, C. diff infection is more common in hospitalized pediatric CF patients although PPI use may not be a risk factor for CDAD development in this patient population

Heaviness, health and happiness: a cross-sectional study of 163 066 UK Biobank participants

<b>Background</b><p></p> Obesity is known to increase the risk of many diseases and reduce overall quality of life. This study examines the relationship with self-reported health (SRH) and happiness.<p></p> <b>Methods</b> <p></p>We conducted a cross-sectional study of the 163 066 UK Biobank participants who completed the happiness rating. The association between adiposity and SRH and happiness was examined using logistic regression. SRH was defined as good (excellent, good), or poor (fair, poor). Self-reported happiness was defined as happy (extremely, very, moderately) or unhappy (moderately, very, extremely). <p></p> <b>Results</b> <p></p>Poor health was reported by 44 457 (27.3%) participants. The adjusted ORs for poor health were 3.86, 2.92, 2.60 and 6.41 for the highest, compared with lowest, deciles of Body Mass Index, waist circumference, waist to hip ratio and body fat percent, respectively. The associations were stronger in men (p<0.001). Overall, 7511 (4.6%) participants felt unhappy, and only class III obese participants were more likely to feel unhappy (adjusted OR 1.33, 95% CI 1.15 to 1.53, p<0.001) but the associations differed by sex (p<0.001). Among women, there was a significant association between unhappiness and all levels of obesity. By contrast, only class III obese men had significantly increased risk and overweight and class I obese men were less likely to be unhappy. <p></p> <b>Conclusions</b><p></p>Obesity impacts adversely on happiness as well as health, but the association with unhappiness disappeared after adjustment for self-reported health, indicating this may be mediated by health. Compared with obese men, obese women are less likely to report poor health, but more likely to feel unhappy. <p></p&gt

Widening the Circle of Engagement Around Environmental Issues using Cloud-based Tools

Environmental data are being generated and collected at unprecedented rates. However, the diversity in form and format of these environmental assets poses challenges for collaborative and reproducible science. Moreover, access constraints that surround environmental data lead to difficulty in use and interpretation of results. Cloud computing offers high potential to break down such barriers and engender collaboration, attribution, reuse, and reproducibility. In this article we review the design of the Environmental Virtual Observatory pilot (EVOp) that was conceived as a cloud-enabled virtual research space for different users interested in environmental science, ranging from domain specialists to the general public. We discuss the key technologies and processes used: a hybrid cloud infrastructure; standard service interfaces; a unified service delivery platform; and a test-driven development cycle. We also discuss the methodology by showcasing one of the exemplars developed in EVOp, stressing the importance of weaving stakeholder engagement from the beginning and throughout the process. We also briefly highlight some of the lessons learnt of working in an interdisciplinary team

Multiproxy analysis of permafrost preserved faeces provides an unprecedented insight into the diets and habitats of extinct and extant megafauna

The study of faecal samples to reconstruct the diets and habitats of extinct megafauna has traditionally relied on pollen and macrofossil analysis. DNA metabarcoding has emerged as a valuable tool to complement and refine these proxies. While published studies have compared the results of these three proxies for sediments, this comparison is currently lacking for permafrost preserved mammal faeces. Moreover, most metabarcoding studies have focused on a single plant-specific DNA marker region. In this study, we target both the commonly used chloroplast trnL P6 loop as well as nuclear ribosomal ITS (nrITS). The latter can increase taxonomic resolution of plant identifications but requires DNA to be relatively well preserved because of the target length (∼300–500 bp). We compare DNA results to pollen and macrofossil analyses from permafrost and ice-preserved faeces of Pleistocene and Holocene megafauna. Samples include woolly mammoth, horse, steppe bison as well as Holocene and extant caribou. Most plant identifications were found using DNA, likely because the studied faeces contained many vegetative remains that could not be identified using macrofossils or pollen. Several taxa were, however, identified to lower taxonomic levels uniquely with macrofossil and pollen analysis. The nrITS marker provides species level taxonomic resolution for commonly encountered plant families that are hard to distinguish using the other proxies (e.g. Asteraceae, Cyperaceae and Poaceae). Integrating the results from all proxies, we are able to accurately reconstruct known diets and habitats of the extant caribou. Applying this approach to the extinct mammals, we find that the Holocene horse and steppe bison were not strict grazers but mixed feeders living in a marshy wetland environment. The mammoths showed highly varying diets from different non-analogous habitats. This confirms the presence of a mosaic of habitats in the Pleistocene ‘mammoth steppe’ that mammoths could fully exploit due to their flexibility in food choice

Late Pleistocene–Holocene Palaeoenvironmental Evolution of the Makgadikgadi Basin, Central Kalahari, Botswana: New Evidence From Shallow Sediments and Ostracod Fauna

The Makgadikgadi Basin in Botswana hosts a system of salt lakes, which developed from the Upper Pleistocene onward due to the gradual shrinking of the giant Lake Palaeo-Makgadikgadi. Stratigraphic and palaeoclimatic studies of this area are difficult due to the influence of several factors, such as a complex history of regional tectonic activities, as well as climatic changes coupled with dryland diagenetic processes. This lake, in the central Kalahari, is the key to understanding the climatic variability in the southern part of Africa in the Quaternary and has played an important role in the evolution of numerous taxa, including our own. In this study, detailed sedimentological analyses (grain size and major elements distribution) of shallow sediments from the Makgadikgadi Pans were combined with the first comprehensive study of the encountered ostracod fauna to establish trends in the environmental changes in the area from the late Quaternary. Ostracod fossil assemblages from the cores of the Makgadikgadi Pans are dominated by the Limnocythere ssp., an opportunistic taxa commonly colonizing the littoral areas of shallow evaporative, ephemeral lakes, together with the subordinate occurrences of Sarcypridopsis ochracea, Sclerocypris cf. bicornis, Candonopsis spp., and Ilyocypris spp. The sediments from the pans show fluctuations in the Cl/K and Ca/Cl ratios, often in phase with the relative abundance of Limnocythere suggesting a cyclicity induced by changes of salinity and alkalinity in the water. This multi-proxy study of the cores collected from the pans suggests a Late Pleistocene shallow, playa lake environment with strongly alkaline water, interrupted by a prolonged drought with sustained aeolian conditions between ∼16 and 2 ka BP. Increasing diversity of ostracod fauna in the top 20–30 cm of the cores indicates that a temporary shift toward higher humidity occurred around 2–1.5 ka BP and lasted through the Medieval Warm Period. This humid period was followed by an overall desiccation trend that started with the Little Ice Age and continues until the present day

Gender differences in the association between adiposity and probable major depression: a cross-sectional study of 140,564 UK Biobank participants

<b>Background</b><p></p> Previous studies on the association between adiposity and mood disorder have produced contradictory results, and few have used measurements other than body mass index (BMI). We examined the association between probable major depression and several measurements of adiposity: BMI, waist circumference (WC), waist-hip-ratio (WHR), and body fat percentage (BF%).<p></p> <b>Methods</b><p></p> We conducted a cross-sectional study using baseline data on the sub-group of UK Biobank participants who were assessed for mood disorder. Multivariate logistic regression models were used, adjusting for potential confounders including: demographic and life-style factors, comorbidity and psychotropic medication.<p></p> <b>Results</b><p></p> Of the 140,564 eligible participants, evidence of probable major depression was reported by 30,145 (21.5%). The fully adjusted odds ratios (OR) for obese participants were 1.16 (95% confidence interval (CI) 1.12, 1.20) using BMI, 1.15 (95% CI 1.11, 1.19) using WC, 1.09 (95% CI 1.05, 1.13) using WHR and 1.18 (95% CI 1.12, 1.25) using BF% (all p <0.001). There was a significant interaction between adiposity and gender (p = 0.001). Overweight women were at increased risk of depression with a dose response relationship across the overweight (25.0-29.9 kg/m2), obese I (30.0-34.9 kg/m2), II (35.0-39.9 kg/m2) and III (≥40.0 kg/m2) categories; fully adjusted ORs 1.14, 1.20, 1.29 and 1.48, respectively (all p < 0.001). In contrast, only obese III men had significantly increased risk of depression (OR 1.29, 95% CI 1.08, 1.54, p = 0.006).<p></p> <b>Conclusion</b><p></p> Adiposity was associated with probable major depression, irrespective of the measurement used. The association was stronger in women than men. Physicians managing overweight and obese women should be alert to this increased risk

SCIRIA Openmind seminar series, autonomatic

SCIRIA ‘OpenMind’ was a regular seminar series for University of the Arts London staff, MA and PhD students and the public. The seminars were hosted at Camberwell College of Arts and Chelsea College of Art and Design. The footage, audio and flyers offer an insight into the research processes and activities of SCIRIA members, associates and external speakers

Influence of the initial cooling rate from γ′ supersolvus temperatures on microstructure and phase compositions in a nickel superalloy

Different cooling paths from a supersolvus temperature have been applied to FGH96, a polycrystalline nickel base superalloy for turbine disc applications, in order to simulate the different microstructures that exist through the thickness of a disc following an industrial heat treatment. Secondary and tertiary γ′ precipitate size distributions and morphology have been analysed and compared for the different heat treatments using SEM and atom probe tomography (APT). Detailed compositional data for both γ′ precipitate and γ matrix are presented, and compared to equilibrium compositions calculated by Thermo-Calc. For the heat-treatments studied, the secondary γ′ composition indicates a shell of differing composition to that towards the precipitate core. From sequential equilibria compositional calculations, it is suggested that the ‘shell’ forms at a lower temperature than the precipitate core. The fine tertiary precipitates do not show the core-shell compositional differences on continuous cooling. W peaks are noted at the γ/γ′ interfacial region, which is of significance for retarding coarsening. A γ′ depletion zone surrounds the secondary precipitates, within which the γ matrix composition differs significantly to the γ far-field values, Finally, a precipitate nucleation and growth mechanistic model is suggested based on the experimental data and Thermo-Calc calculations