Evaluation of exercise on individuals with dementia and their carers: a randomised controlled trial

Background Almost all of the 820,000 people in the UK with dementia will experience Behavioural and Psychological Symptoms of Dementia (BPSD). However, research has traditionally focused on treating cognitive symptoms, thus neglecting core clinical symptoms that often have a more profound impact on living with dementia. Recent evidence (Kales et al, 2007; Ballard et al, 2009) indicates that the popular approach to managing BPSD - prescription of anti-psychotic medication - can increase mortality and the risk of stroke in people with dementia as well as impair quality of life and accelerate cognitive decline. Consequently, there is a need to evaluate the impact that non-pharmacological interventions have on BPSD; we believe physical exercise is a particularly promising approach. Methods/Design We will carry out a pragmatic, randomised, single-blind controlled trial to evaluate the effectiveness of exercise (planned walking) on the behavioural and psychological symptoms of individuals with dementia. We aim to recruit 146 people with dementia and their carers to be randomized into two groups; one will be trained in a structured, tailored walking programme, while the other will continue with treatment as usual. The primary outcome (BPSD) will be assessed with the Neuropsychiatric Inventory (NPI) along with relevant secondary outcomes at baseline, 6 and 12 weeks. Discussion Designing this study has been challenging both ethically and methodologically. In particular to design an intervention that is simple, measurable, safe, non-invasive and enjoyable has been testing and has required a lot of thought. Throughout the design, we have attempted to balance methodological rigour with study feasibility. We will discuss the challenges that were faced and overcome in this paper

The changing culture of silviculture

Changing climates are altering the structural and functional components of forest ecosystems at an unprecedented rate. Simultaneously, we are seeing a diversification of public expectations on the broader sustainable use of forest resources beyond timber production. As a result, the science and art of silviculture needs to adapt to these changing realities. In this piece, we argue that silviculturists are gradually shifting from the application of empirically derived silvicultural scenarios to new sets of approaches, methods and practices, a process that calls for broadening our conception of silviculture as a scientific discipline. We propose a holistic view of silviculture revolving around three key themes: observe, anticipate and adapt. In observe, we present how recent advances in remote sensing now enable silviculturists to observe forest structural, compositional and functional attributes in near-real-time, which in turn facilitates the deployment of efficient, targeted silvicultural measures in practice that are adapted to rapidly changing constraints. In anticipate, we highlight the importance of developing state-of-the-art models designed to take into account the effects of changing environmental conditions on forest growth and dynamics. In adapt, we discuss the need to provide spatially explicit guidance for the implementation of adaptive silvicultural actions that are efficient, cost-effective and socially acceptable. We conclude by presenting key steps towards the development of new tools and practical knowledge that will ensure meeting societal demands in rapidly changing environmental conditions. We classify these actions into three main categories: reexamining existing silvicultural trials to identify key stand attributes associated with the resistance and resilience of forests to multiple stressors, developing technological workflows and infrastructures to allow for continuous forest inventory updating frameworks, and implementing bold, innovative silvicultural trials in consultation with the relevant communities where a range of adaptive silvicultural strategies are tested. In this holistic perspective, silviculture can be defined as the science of observing forest condition and anticipating its development to apply tending and regeneration treatments adapted to a multiplicity of desired outcomes in rapidly changing realities

The changing culture of silviculture

Changing climates are altering the structural and functional components of forest ecosystems at an unprecedented rate. Simultaneously, we are seeing a diversification of public expectations on the broader sustainable use of forest resources beyond timber production. As a result, the science and art of silviculture needs to adapt to these changing realities. In this piece, we argue that silviculturists are gradually shifting from the application of empirically derived silvicultural scenarios to new sets of approaches, methods and practices, a process that calls for broadening our conception of silviculture as a scientific discipline. We propose a holistic view of silviculture revolving around three key themes: observe, anticipate and adapt. In observe, we present how recent advances in remote sensing now enable silviculturists to observe forest structural, compositional and functional attributes in near-real-time, which in turn facilitates the deployment of efficient, targeted silvicultural measures in practice that are adapted to rapidly changing constraints. In anticipate, we highlight the importance of developing state-of-the-art models designed to take into account the effects of changing environmental conditions on forest growth and dynamics. In adapt, we discuss the need to provide spatially explicit guidance for the implementation of adaptive silvicultural actions that are efficient, cost-effective and socially acceptable. We conclude by presenting key steps towards the development of new tools and practical knowledge that will ensure meeting societal demands in rapidly changing environmental conditions. We classify these actions into three main categories: re-examining existing silvicultural trials to identify key stand attributes associated with the resistance and resilience of forests to multiple stressors, developing technological workflows and infrastructures to allow for continuous forest inventory updating frameworks, and implementing bold, innovative silvicultural trials in consultation with the relevant communities where a range of adaptive silvicultural strategies are tested. In this holistic perspective, silviculture can be defined as the science of observing forest condition and anticipating its development to apply tending and regeneration treatments adapted to a multiplicity of desired outcomes in rapidly changing realities

A randomised controlled trial comparing the effectiveness of Tai Chi alongside usual care with usual care alone on the postural balance of community-dwelling people with dementia: Protocol for The TACIT Trial (TAi ChI for people with dementia).

Background: Falls are a public health issue for the older adult population and more so for people with dementia (PWD). Compared with their cognitively intact peers, PWD are at higher risk of falls and injurious falls. This randomised controlled trial aims to test the clinical and cost effectiveness of Tai Chi to improve postural balance among community-dwelling PWD and to assess the feasibility of conducting a larger definitive trial to reduce the incidence of falls among PWD. Methods: A 3-centre parallel group randomised controlled trial with embedded process evaluation. One hundred and fifty community-dwelling dyads of a person with dementia and their informal carer will be recruited and assessed at baseline and at six-month follow-up. Dyads will be randomised in a 1:1 ratio to either usual care or usual care plus a Tai Chi intervention for 20 weeks. The Tai Chi intervention will consist of weekly classes (45 minutes’ Tai Chi plus up to 45 minutes for informal discussion, with up to 10 dyads per class) and home-based exercises (20 minutes per day to be facilitated by the carer). Home practice of Tai Chi will be supported by the use of behaviour change techniques with the Tai Chi instructor at a home visit in week 3-4 of the intervention (action planning, coping planning, self-monitoring, and alarm clock reminder) and at the end of each class (feedback on home practice). The primary outcome is dynamic balance measured using the Timed Up and Go test, coinciding with the end of the 20-week intervention phase for participants in the Tai Chi arm. Secondary outcomes for PWD include functional balance, static balance, fear of falling, global cognitive functioning, visual-spatial cognitive functioning, quality of life, and falls. Secondary outcomes for carers include dynamic balance, static balance, quality of life, costs, and carer burden. Discussion: This trial is the first in the UK to test the effectiveness of Tai Chi to improve balance among PWD. The trial will inform a future study that will be the first in the world to use Tai Chi in a trial to prevent falls among PWD. Trial registration: NCT02864056

ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed

Predicting individual tree mortality in northern hardwood stands under uneven-aged management in southern Québec, Canada

This study proposes a generalized linear mixed model to predict individual tree mortality in northern hardwood stands under uneven-aged management. The model is based on a complementary log-log (CLL) link function, and was calibrated using permanent-plot data. Tree vigor, stem product, diameter at breast height and stand basal area were tested as explanatory variables. A plot and an interval random effect were specified to account for spatial correlations. When compared with the traditional logit link function, the CLL facilitates the inclusion of the time factor. In this case study, there was an important variability of mortality predictions between the plots and the intervals for a given plot. The interval random effect is thought to be associated with catastrophic mortality. Since both tree vigor and stem product proved to be significant mortality predictors, we recommend that these variables be evaluated to increase the accuracy of mortality models.Prévision de la mortalité des tiges individuelles dans les peuplements de feuillus nobles sous aménagement inéquienne dans le sud du Québec, Canada. Cette étude présente un modèle linéaire mixte généralisé pour la prévision de la mortalité dans les peuplements de feuillus nobles sous aménagement. Le modèle utilise une fonction de lien log-log complémentaire (LLC) et a été étalonné à l'aide de données de placettes permanentes. La vigueur de l'arbre, le produit, le diamètre à hauteur de poitrine et la surface terrière ont été testés comme variables explicatives. Des effets aléatoires de placette et d'intervalle ont été spécifiés dans le modèle afin de tenir compte des corrélations spatiales. Comparée au traditionnel logit, la fonction de lien LLC facilite l'inclusion du facteur temps. Dans ce cas d'étude, il existait une importante variabilité des prévisions entre les placettes et les intervalles de temps d'une même placette. On présume que l'effet aléatoire d'intervalle représente la mortalité catastrophique. Puisque la vigueur et le produit des tiges se sont avérés être des variables significatives, il est recommandé de les évaluer afin d'améliorer la précision des modèles de mortalité

Relationships between Tree Vigor Indices and a Tree Classification System Based upon Apparent Stem Defects in Northern Hardwood Stands

Many northern hardwood stands include several low-vigor trees as a result of past management. To restore these degraded stands, partial cuts are applied with partly validated tree classification systems that are based upon apparent stem defects. We sampled 214 sugar maple (Acer saccharum Marsh.) and 84 yellow birch (Betula alleghaniensis Britt.) trees from six sites covering the northern hardwood forest zone of the Province of Quebec, Canada. We evaluated their vigor with a four-class system, and quantified the growth efficiency index and several indices that were based solely upon radial growth. The growth efficiency index increased non-significantly with increasing tree vigor class. The five-year basal area increment (BAI-1-5) was significantly different between the lowest and highest tree vigor classes. Yet, temporal changes in BAI-1-5 helped classify correctly only 16% of high-vigor trees that became poorly vigorous 8–10 years later. Overall, these results suggest that the tree classification system is weakly related to actual tree vigor and its application likely generates few significant gains in future stand vigor. Modifying and simplifying the tree vigor system must be considered to facilitate the tree marking process that is required to improve the vigor of degraded stands

Quantifying the Probability of Decline in Quality: Implications for Selection Management in Northern Hardwood Forests

Northern hardwoods are susceptible to a wide range of defects that can reduce the amount of sound wood with desirable qualities, such as the clear sapwood of sugar maple trees. Yet, the rate at which trees decline in quality due to the development of such defects has never been quantified in northern hardwood forests due to a dearth of repeat inventories that record the appearance of defects over time. As a result, it remains uncertain whether, and how, selection management reduces the probability of decline in quality. In this study, we quantify the rate at which trees decline in quality due to the development of defects, and we test several hypotheses regarding the influence of selection management on quality. Our results show that (1) the probability of decline in quality increases as trees grow larger; (2) crown dieback also increases the probability of decline in quality; (3) the probability of decline in quality is slightly lower in managed stands than in unmanaged stands, and (4) the probability of decline in quality increases with the mean annual temperature of the site. Finally, we combined our estimates of the probability of decline in quality with previous estimates of the probability of mortality to assess the overall risk associated with retaining trees of different species, sizes, and vigour profiles. The resulting metric can inform efforts to improve the management of northern hardwood forests by providing an integrated estimate of the risk that the value of a tree will be reduced, or eliminated, due to mortality or decline in quality

Quantifying the probability of decline in quality : implications for selection management in northern hardwood forests

Northern hardwoods are susceptible to a wide range of defects that can reduce the amount of sound wood with desirable qualities, such as the clear sapwood of sugar maple trees. Yet, the rate at which trees decline in quality due to the development of such defects has never been quantified in northern hardwood forests due to a dearth of repeat inventories that record the appearance of defects over time. As a result, it remains uncertain whether, and how, selection management reduces the probability of decline in quality. In this study, we quantify the rate at which trees decline in quality due to the development of defects, and we test several hypotheses regarding the influence of selection management on quality. Our results show that (1) the probability of decline in quality increases as trees grow larger; (2) crown dieback also increases the probability of decline in quality; (3) the probability of decline in quality is slightly lower in managed stands than in unmanaged stands, and (4) the probability of decline in quality increases with the mean annual temperature of the site. Finally, we combined our estimates of the probability of decline in quality with previous estimates of the probability of mortality to assess the overall risk associated with retaining trees of different species, sizes, and vigour profiles. The resulting metric can inform efforts to improve the management of northern hardwood forests by providing an integrated estimate of the risk that the value of a tree will be reduced, or eliminated, due to mortality or decline in quality