Prospects and constraints of nursing home-based integrated adult day care : Viewpoints of experts

Hämel K, Röhnsch G. Möglichkeiten und Grenzen integrierter Tagespflege in Pflegeheimen: Sichtweisen von ExpertInnen. Zeitschrift fur Gerontologie und Geriatrie. 2019;52(2): 148–156.BACKGROUND: Even when they are in need of care, old people prefer to stay in their community. An appropriate design of nonresidential and residential care services close to people's home is crucial for supporting them. In the model project "Pflege stationar-Weiterdenken!" (Nursing home care-think ahead!) nursing homes offer extended services to old people in the community. This includes integrated day care (ITP), which entails day guests spending the day with residents of the facilities. This article examines the opportunities and challenges arising when designing and implementing this type of cross-sectoral care model.; METHOD: Guided interviews were carried out with 20experts who were either professionals working at the model institutions or involved in the project at the planning and cooperation levels. The data collected were evaluated using thematic coding.; RESULTS: The opportunities and challenges lie at two levels. (1)At the institutional level advantages are greater individual and flexible timeframes of usage and better accessibility of day care for care-dependent people through the integration into residential care settings. The challenges involve administrative and management issues as well as apprehensions among the employees concerning the increased workload. (2)At the level of interaction and social integration experts emphasized the importance of making allowances for the interests and needs of day guests and residents. Furthermore, they confirmed that if this is achieved then integrated day care can improve the social participation of both user groups.; CONCLUSION: From the experts' point of view, the ITP holds the potential for cross-sectoral care for old people in need of care close to their homes. Afinal assessment will require further analysis, especially on users' views

Adakite-like volcanism of Ecuador: lower crust magmatic evolution and recycling

In the Northern Andes of Ecuador, a broad Quaternary volcanic arc with significant across-arc geo- chemical changes sits upon continental crust consisting of accreted oceanic and continental terranes. Quaternary volcanic centers occur, from west to east, along the Western Cordillera (frontal arc), in the Inter-Andean Depression and along the Eastern Cordillera (main arc), and in the Sub-Andean Zone (back-arc). The adakite-like signatures of the frontal and main arc volcanoes have been interpreted either as the result of slab melting plus subsequent slab melt–mantle interactions or of lower crustal melting, fractional crystallization, and assimilation processes. In this paper, we present petrographic, geo- chemical, and isotopic (Sr, Nd, Pb) data on dominantly andesitic to dacitic volcanic rocks as well as crustal xenolith and cumulate samples from five volcanic centers (Pululagua, Pichincha, Ilalo, Chacana, Sumaco) forming a NW–SE transect at about 0° latitude and encompassing the frontal (Pululagua, Pichincha), main (Ilalo, Chacana), andback-arc (Sumaco) chains. All rocks display typical sub- duction-related geochemical signatures, such as Nb and Ta negative anomalies and LILE enrichment. They show a relative depletion of fluid-mobile elements and a general increase in incompatible elements from the front to the back-arc suggesting derivation from progressively lower degrees of partial melting of the mantle wedge induced by decreasing amounts of fluids released from the slab. We observe widespread petrographic evidence of interaction of primary melts with mafic xenoliths as well as with clino- pyroxene- and/or amphibole-bearing cumulates and of magma mixing at all frontal and main arc volcanic centers. Within each volcanic center, rocks display correlations between evolution indices and radiogenic isotopes, although absolute variations of radiogenic isotopes are small and their values are overall rather primitive (e.g., eNd = ?1.5 to ?6, 87Sr/86Sr = 0.7040–0.70435). Rare earth element patterns are characterized by variably frac- tionated light to heavy REE (La/YbN = 5.7–34) and by the absence of Eu negative anomalies suggesting evolution of these rocks with limited plagioclase fractionation. We interpret the petrographic, geochemical, and isotopic data as indicating open-system evolution at all volcanic centers characterized by fractional crystallization and magma mixing processes at different lower- to mid-crustal levels as well as by assimilation of mafic lower crust and/or its partial melts. Thus, we propose that the adakite-like sig- natures of Ecuadorian rocks (e.g., high Sr/Y and La/Yb values) are primarily the result of lower- to mid-crustal processing of mantle-derived melts, rather than of slab melts and slab melt–mantle interactions. The isotopic sig- natures of the least evolved adakite-like rocks of the active and recent volcanoes are the same as those of Tertiary ''normal'' calc-alkaline magmatic rocks of Ecuador sug- gesting that the source of the magma did not changethrough time. What changed was the depth of magmatic evolution, probably as a consequence of increased com- pression induced by the stronger coupling between the subducting and overriding plates associated with subduc- tion of the aseismic Carnegie Ridge