Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review

Objective: To assess the efficacy of interventions and environmental factors on increasing fluid intake or reducing dehydration risk in older people living in long-term care facilities. Design: Systematic review of intervention and observational studies. Data Sources: Thirteen electronic databases were searched from inception until September 2013 in all languages. References of included papers and reviews were checked. Eligibility criteria: Intervention and observational studies investigating modifiable factors to increase fluid intake and/or reduce dehydration risk in older people (≥65 years) living in long-term care facilities who could drink orally. Review methods: Two reviewers independently screened, selected, abstracted data and assessed risk of bias from included studies, narrative synthesis was performed. Results: 4328 titles and abstracts were identified, 325 full-text papers obtained and 23 included in the review. Nineteen intervention and 4 observational studies from 7 countries investigated factors at resident, institutional or policy level. Overall the studies were at high risk of bias due to selection and attrition bias and lack of valid outcome measures of fluid intake and dehydration assessment. Reported findings from six of the nine intervention studies investigating the effect of multi-component strategies on fluid intake or dehydration described a positive effect. Components included greater choice and availability of beverages, increased staff awareness, increased staff assistance with drinking and toileting. Implementation of the US Resident Assessment Instrument reduced dehydration prevalence from 3% to 1%, p=0.01. Two smaller studies reported positive effects, one on fluid intake in 9 men with Alzheimer's Disease using high-contrast red cups, the other involved supplementing 13 mildly dehydrated residents with oral hydration solution over 5 days to reduce dehydration. Modifications to the dining environment, advice to residents, presentation of beverages and mode of delivery (straw vs beaker; pre-thickened drinks vs those thickened at the bedside) were inconclusive. Two large observational studies with good internal validity investigated effects of ownership; in Canada, for-profit ownership was associated with increased hospital admissions for dehydration; no difference was seen in dehydration prevalence between US for-profit and not-for-profit homes, although chain facilities were associated with lower odds of dehydration. This US study did not suggest any effect of staffing levels on dehydration prevalence. Conclusions: A wide range of interventions and exposures were identified, but the efficacy of many strategies remains unproven due to the high risk of bias present in many studies. Reducing dehydration prevalence in long-term care facilities is likely to require multiple strategies involving policymakers, management and care staff, but these require further investigation using more robust study methodologies. Systematic review registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO/display_record.asp? ID=CRD42012003100)

Effects of replacing soybean meal with xylose-treated soybean meal on performance of nursing Awassi ewes and fattening lambs

Two experiments were conducted to evaluate the effect of replacing soybean meal with xylose-treated soybean meal (soypass meal; SPM) on performance of nursing Awassi ewes and fattening lambs. In Experiment 1, lasting for eight weeks, 39 Awassi ewes and their lambs were randomly assigned to three diets. Diets were formulated by replacing soybean meal from the basal diet (CON-SBM; n=13) with 50% (50% SPM; n=13) and 100% (100% SPM; n=13) SPM. Initial and final weights of the ewes were not different (P>0.55) among diets. Total gain and average daily gain (ADG) of lambs were similar (P=0.44) among diets. Ewes fed the CON-SBM diet tended (P<0.09) to have lower milk yields than those fed the 50% SPM and 100% SPM diets. No differences (P>0.38) in milk component percentages among diets were observed. In Experiment 2, lasting for 63 days, twenty weaned lambs were used to determine the effects of replacing soybean meal with SPM on growth performance. Diets were either soybean meal (SBM; n=10) or SPM (SPM; n=10). Nutrient intake and digestibility were not different between diets. However, rumen undegradable protein intake was greater (P<0.05) for the SPM diet than for the SBM diet. Final body weight, ADG and the feed conversion ratio were similar (P>0.05) between the diets. Results suggest that replacement of soybean meal with soypass meal is not likely to produce any production benefits in nursing Awassi ewes and fattening lambs except for the slight improvement of milk yield

Globalization, educational targeting and stable inequalities : a comparative analysis of Argentina, Brazil and Chile

This article analyzes educational targeting in Argentina, Brazil and Chile from a sociological point of view. In essence, it presents the 'logic of induction' as an ideal type. This pedagogic discourse is the vehicle of an educational anti-poverty strategy that expects to induce clearly targeted groups to improve on their own. The analysis explores the influence of the global educational agenda, the empirical connection between this discourse and the mechanism of emulation as well as the territorialization of educational inequality. Emulation plays the main role inasmuch as the logic of induction eventually leads the target groups to compare their adverse situation with more privileged groups, what legitimizes the current structures of categorical inequality (Tilly 1998). Finally, a brief statistical summary reports that the trends of educational inequality have remained stable as far as urban- rural ratios (in Brazil and Chile) and regional disparities (in the three countries) are concerned

Plant Responses to Extreme Climatic Events: A Field Test of Resilience Capacity at the Southern Range Edge

The expected and already observed increment in frequency of extreme climatic events may result in severe vegetation shifts. However, stabilizing mechanisms promoting community resilience can buffer the lasting impact of extreme events. The present work analyzes the resilience of a Mediterranean mountain ecosystem after an extreme drought in 2005, examining shoot-growth and needle-length resistance and resilience of dominant tree and shrub species (Pinus sylvestris vs Juniperus communis, and P. nigra vs J. oxycedrus) in two contrasting altitudinal ranges. Recorded high vegetative-resilience values indicate great tolerance to extreme droughts for the dominant species of pine-juniper woodlands. Observed tolerance could act as a stabilizing mechanism in rear range edges, such as the Mediterranean basin, where extreme events are predicted to be more detrimental and recurrent. However, resistance and resilience components vary across species, sites, and ontogenetic states: adult Pinus showed higher growth resistance than did adult Juniperus; saplings displayed higher recovery rates than did conspecific adults; and P. nigra saplings displayed higher resilience than did P. sylvestris saplings where the two species coexist. P. nigra and J. oxycedrus saplings at high and low elevations, respectively, were the most resilient at all the locations studied. Under recurrent extreme droughts, these species-specific differences in resistance and resilience could promote changes in vegetation structure and composition, even in areas with high tolerance to dry conditions.This study was supported by Ministerio de Ciencia e Innovación (Spanish Government) Projects CGL2008-04794 and CGL2011-29910 to R.Z., and by grant FPU-MEC (AP2005-1561) to A. H

The evolution of plasmid-carried antibiotic resistance

BACKGROUND: Antibiotic resistance represents a significant public health problem. When resistance genes are mobile, being carried on plasmids or phages, their spread can be greatly accelerated. Plasmids in particular have been implicated in the spread of antibiotic resistance genes. However, the selective pressures which favour plasmid-carried resistance genes have not been fully established. Here we address this issue with mathematical models of plasmid dynamics in response to different antibiotic treatment regimes. RESULTS: We show that transmission of plasmids is a key factor influencing plasmid-borne antibiotic resistance, but the dosage and interval between treatments is also important. Our results also hold when plasmids carrying the resistance gene are in competition with other plasmids that do not carry the resistance gene. By altering the interval between antibiotic treatments, and the dosage of antibiotic, we show that different treatment regimes can select for either plasmid-carried, or chromosome-carried, resistance. CONCLUSIONS: Our research addresses the effect of environmental variation on the evolution of plasmid-carried antibiotic resistance

Language endangerment and language documentation in Africa

Non peer reviewe