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Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. The overall aim of the review is to determine the effectiveness of interventions to prevent obesity in 5 to 11-year-old children. The four objectives are:. to evaluate the effects of interventions that aim to modify dietary intake on changes in zBMI score, BMI and serious adverse events among children; to evaluate the effects of interventions that aim to modify physical activity, sedentary behaviour, sleep, play and/or structured exercise on changes in zBMI score, BMI and serious adverse events among children; to evaluate the combined effects of interventions that aim to modify both dietary intake and physical activity/movement behaviours on changes in zBMI score, BMI and serious adverse events among children; to compare the effects of interventions that aim to modify dietary interventions with those that aim to modify physical activity/movement behaviours on changes in zBMI score, BMI and serious adverse events among children. The secondary objectives are designed to explore if, how, and why the effectiveness of interventions on zBMI/BMI varies depending on the following PROGRESS factors. Place of residence Race/ethnicity/culture/language Occupation Gender/sex Religion Education Socioeconomic status Social capital. The PROGRESS acronym is intended to ensure that there is explicit consideration of health inequity, the unfair difference in disease burden, when conducting research and adapting research evidence to inform the design of new interventions (O'Neill 2014). The PROGRESS acronym describes factors that contribute to health inequity. Recent work on race and religion in the UK suggests that consideration of these factors is critical to the design of new interventions (Rai 2019). We will also collect, from RCTs, information about the costs of interventions so that policymakers can use the review as a source of information from which they may prepare cost-effectiv

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. The overall aim of the review is to determine the effectiveness of interventions to prevent obesity in 12 to 18-year-old children and adolescents. The four objectives are:. to evaluate the effects of interventions that aim to modify dietary intake on changes in zBMI score, BMI and serious adverse events among children and adolescents; to evaluate the effects of interventions that aim to modify physical activity, sedentary behaviour, sleep, play and/or structured exercise on changes in zBMI score, BMI and serious adverse events among children and adolescents; to evaluate the combined effects of interventions that aim to modify both dietary intake and physical activity/movement behaviours on changes in zBMI score, BMI and serious adverse events among children and adolescents; to compare the effects of interventions that aim to modify dietary interventions with those that aim to modify physical activity/movement behaviours on changes in zBMI score, BMI and serious adverse events among children. The secondary objectives are designed to explore if, how, and why the effectiveness of interventions on zBMI/BMI varies depending on the following PROGRESS factors. Place of residence Race/ethnicity/culture/language Occupation Gender/sex Religion Education Socioeconomic status Social capital. The PROGRESS acronym is intended to ensure that there is explicit consideration of health inequity, the unfair difference in disease burden, when conducting research and adapting research evidence to inform the design of new interventions (O'Neill 2014). The PROGRESS acronym describes factors that contribute to health inequity. Recent work on race and religion in the UK suggested that consideration of these factors is critical to the design of new interventions (Rai 2019). We will also collect, from RCTs, information about the costs of interventions so that policymakers can use the review as

Background: Medication-related problems (MRPs) occur across the continuum of emergency department (ED) care: they may contribute to ED presentation, occur in the ED/short-stay unit (SSU), at hospital admission, or shortly after discharge to the community. This project aimed to determine predictors for MRPs across the continuum of ED care and incorporate these into screening tools (one for use at ED presentation and one at ED/SSU discharge), to identify patients at greatest risk, who could be targeted by ED pharmacists. Methods: A prospective, observational, multicenter study was undertaken in nine EDs, between July 2016 and August 2017. Blocks of ten consecutive adult patients presenting at pre-specified times were identified. Within 1 week of ED discharge, a pharmacist interviewed patients and undertook a medical record review to determine a medication history, patient understanding of treatment, risk factors for MRPs and to manage the MRPs. Logistic regression was undertaken to determine predictor variables. Multivariable regression beta coefficients were used to develop a scoring system for the two screening tools. Results: Of 1,238 patients meeting all inclusion criteria, 904 were recruited. Characteristics predicting MRPs related to ED presentation were: patient self-administers regular medications (OR = 7.95, 95%CI = 3.79-16.65), carer assists with medication administration (OR = 15.46, 95%CI = 6.52-36.67), or health-professional administers (OR = 5.01, 95%CI = 1.77-14.19); medication-related ED presentation (OR = 9.95, 95%CI = 4.92-20.10); age ≥80 years (OR = 3.63, 95%CI = 1.96-6.71), or age 65-79 years (OR = 2.01, 95%CI = 1.17-3.46); potential medication adherence issue (OR = 2.27, 95%CI = 1.38-3.73); medical specialist seen in past 6-months (OR = 2.02, 95%CI = 1.42-2.85); pharmaceutical benefit/pension/concession cardholder (OR = 1.89, 95%CI = 1.28-2.78); inpatient in previous 4-weeks (OR = 1.60, 95%CI = 1.02-2.52); being male (OR = 1.48, 95%CI = 1.05-2.10)

(1) Background: Delirium is a common complication among surgical patients after major surgery, but it is often underdiagnosed in the post-anaesthetic care unit (PACU). Valid and reliable tools are required for improving diagnoses of delirium. The objective of this study was to evaluate the diagnostic test accuracy of the Three-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) and the 4A's Test (4AT) as screening tools for detection of delirium in older people in the PACU. (2) Methods: A prospective diagnostic test accuracy study was conducted in the PACU and surgical wards of a university-affiliated tertiary care hospital in Victoria, Australia. A consecutive prospective cohort of elective and emergency patients (aged 65 years or older) admitted to the PACU were recruited between July 2021 and December 2021 following a surgical procedure performed under general anaesthesia and expected to stay in the hospital for at least 24 h following surgery. The outcome measures were sensitivity, specificity positive predictive value and negative predictive value for 3D-CAM and 4AT. (3) Results: A total of 271 patients were recruited: 16.2% (44/271) had definite delirium. For a diagnosis of definite delirium, the 3D-CAM (area under curve (AUC) = 0.96) had a sensitivity of 100% (95% CI 92.0 to 100.0) in the PACU and during the first 5 days post-operatively. Specificity ranged from 93% (95% CI 87.8 to 95.2) to 91% (95% CI 85.9 to 95.2) in the PACU and during the first 5 days post-operatively. The 4AT (AUC = 0.92) had a sensitivity of 93% (95% CI 81.7 to 98.6) in the PACU and during the first 5 days post-operatively, and specificity ranged from 89% (95% CI 84.6 to 93.1) to 87% (95%CI 80.9 to 91.8) in the PACU and during the first 5 days post-operatively. (4) Conclusions: The 3D-CAM and the 4AT are sensitive and specific screening tools that can be used to detect delirium in older people in the PACU. Screening with either tool could have an important clinical impa

Objective: Patients present to EDs with various medication-related problems (MRPs). MRPs are also associated with ED care, occurring during ED presentation or shortly afterwards. The aim of the present study is to describe the prevalence and nature of MRPs that occur prior to, during or shortly after leaving ED. Method(s): We undertook a prospective, observational study in nine Australian EDs. Blocks of 10 consecutive adult patients who were not seen by a pharmacist in ED and who presented at pre-specified times were identified. Within 1 week of ED discharge, a pharmacist interviewed patients and undertook a medical record review to determine their medication history, patients' understanding of treatment, potential MRP risk factors and manage any identified MRPs. Result(s): A total of 904 patients were recruited: 14.8% aged >=80 years, 18.9% taking more than eight regular medications; 581 MRPs were identified; 287 (49.4%, 95% confidence interval [CI] 45.3-53.5%) of moderate-high significance. Most highly significant MRPs involved high-risk medications, particularly strong opioids, insulin and anti-coagulants. The most common types of MRPs were prescribing errors (46.8%), patient adherence/knowledge issues (31.2%) and adverse drug reactions (7.4%). Of all patients, 381 (42.1%, 95% CI 38.9-45.5%) had at least one MRP; 31.4% (95% CI 28.4-34.6%) had MRPs that could be identified or managed by screening at ED presentation and 12.4% (95% CI 10.4-14.8%) had MRPs that could be identified or managed by screening at ED discharge. Conclusion(s): Patients experienced a range of MRPs throughout the ED continuum of care. From these data, screening tools will be developed so that ED clinicians may identify patients at greatest risk of MRPs.Copyright © 2020 Australasian College for Emergency Medicine

OBJECTIVE: Patients present to EDs with various medication-related problems (MRPs). MRPs are also associated with ED care, occurring during ED presentation or shortly afterwards. The aim of the present study is to describe the prevalence and nature of MRPs that occur prior to, during or shortly after leaving ED. METHODS: We undertook a prospective, observational study in nine Australian EDs. Blocks of 10 consecutive adult patients who were not seen by a pharmacist in ED and who presented at pre-specified times were identified. Within 1 week of ED discharge, a pharmacist interviewed patients and undertook a medical record review to determine their medication history, patients' understanding of treatment, potential MRP risk factors and manage any identified MRPs. RESULTS: A total of 904 patients were recruited: 14.8% aged ≥80 years, 18.9% taking more than eight regular medications; 581 MRPs were identified; 287 (49.4%, 95% confidence interval [CI] 45.3-53.5%) of moderate-high significance. Most highly significant MRPs involved high-risk medications, particularly strong opioids, insulin and anti-coagulants. The most common types of MRPs were prescribing errors (46.8%), patient adherence/knowledge issues (31.2%) and adverse drug reactions (7.4%). Of all patients, 381 (42.1%, 95% CI 38.9-45.5%) had at least one MRP; 31.4% (95% CI 28.4-34.6%) had MRPs that could be identified or managed by screening at ED presentation and 12.4% (95% CI 10.4-14.8%) had MRPs that could be identified or managed by screening at ED discharge. CONCLUSIONS: Patients experienced a range of MRPs throughout the ED continuum of care. From these data, screening tools will be developed so that ED clinicians may identify patients at greatest risk of MRPs.

Reconstructions of the timing and frequency of past eruptions are important to assess the propensity for future volcanic activity, yet in volcanic areas such as the East African Rift only piecemeal eruption histories exist. Understanding the volcanic history of scoria-cone fields, where eruptions are often infrequent and deposits strongly weathered, is particularly challenging. Here we reconstruct a history of volcanism from scoria cones situated along the eastern shoulders of the Kenya-Tanzania Rift, using a sequence of tephra (volcanic ash) layers preserved in the similar to 250-ka sediment record of Lake Chala near Mount Kilimanjaro. Seven visible and two non-visible (crypto-) tephra layers in the Lake Chala sequence are attributed to activity from the Mt Kilimanjaro (northern Tanzania) and the Chyulu Hills (southern Kenya) volcanic fields, on the basis of their glass chemistry, textural characteristics and known eruption chronology. The Lake Chala record of eruptions from scoria cones in the Chyulu Hills volcanic field confirms geological and historical evidence of its recent activity, and provides first-order age estimates for seven previously unknown eruptions. Long and well-resolved sedimentary records such as that of Lake Chala have significant potential for resolving regional eruption chronologies spanning hundreds of thousands of years.

AIMS AND OBJECTIVES: (a) Describe the co-development of a point-of-care App to promote uptake of best practice recommendations and consolidate nurses' knowledge for managing symptoms of neurocognitive disorders. (b) Report acceptability, usability and feasibility of the App to nurses for patient care in hospital. BACKGROUND: Strategies used in hospitals to reduce symptoms, risk of harm, or complications of behavioural and psychological symptoms associated with neurocognitive disorders are frequently inconsistent with best practice recommendations. DESIGN: Three-stage, mixed-methods, process and outcome evaluation. METHOD(S): The App was co-developed with experts, nurse end-users and a consumer. Evaluation data were collected from a convenience sample of nurses observed during delivery of 80.5 hr of care to 38 patients; the App (n = 32 patients); and individual and focus group interviews with nurses (n = 25). Reporting adhered to an adapted STROBE checklist. RESULT(S): The App included three components: cognition and risk assessment; tailored evidence-based strategies; and monitoring and evaluation of effectiveness. Observation data captured nurses using the App with 44.7% (n = 17) of eligible inpatients. Cognitive screening was completed at least once for each patient, with 146 risk assessments recorded. Interview data indicated the App's acceptability was enhanced by familiarity and perceived benefits, but hindered by perceived increases in workload, inconsistent use, pressure to use the App and resistance to change. Feasibility and usability were enhanced by easy navigation, and clear and useful content, but hindered by unclear expectations, unfamiliarity and device-related factors. CONCLUSION(S): The App provided an evidence-based tool that was, overall, considered feasible and acceptable to support best practice. Findings provide guidance to enhance usability for future implementation. RELEVANCE TO CLINICAL PRACTICE: Co-development using best evidence and key st

AIMS AND OBJECTIVES: To explore nursing home staff members' beliefs and expectations about what constitutes "quality continence care" for people living in nursing homes. BACKGROUND: Most nursing home residents require assistance to maintain continence or manage incontinence. Best practice guidelines promote active investigation of incontinence, treatment of underlying potentially reversible causes, and initial conservative interventions to prevent, minimise and/or treat incontinence. Despite research showing the positive benefits of implementing active interventions, translating the findings of research into practice in nursing homes has been modest. Understanding the perspectives of individuals who provide continence care may help bridge the gap between evidence and practice. DESIGN: A qualitative exploratory descriptive design. METHODS: Qualitative interviews were conducted with 19 nursing home staff: eight registered nurses, four enrolled nurses and seven personal care workers working in a nursing home in Australia between 2014-2015. Data were analysed inductively to identify themes and subthemes that described and explained staff beliefs about quality continence care in nursing homes. FINDINGS: Participants' understanding and expectations about quality continence care were linked to beliefs about incontinence being an intractable and undignified condition in nursing homes. The key theme to emerge was "protecting residents' dignity" which was supported by the following six subthemes: (i) using pads, ii) providing privacy, (iii) knowing how to "manage" incontinence, (iv) providing timely continence care, (v) considering residents' continence care preferences and (vi) communicating sensitively. CONCLUSION: The findings provide new insight into the basis for continence care practices in nursing homes. Education about continence care should challenge beliefs that limit continence care practice to cleaning, containing and concealing incontinence. There is a need for a

Tephra layers preserved in marine sediments can contribute to the reconstruction of volcanic histories and potentially act as stratigraphic isochrons to link together environmental records. Recent developments in the detection of volcanic ash (tephra) at levels where none is macroscopically visible (so-called ‘crypto-tephra’) have greatly enhanced the potential of tephrostratigraphy for synchronising environmental and archaeological records by expanding the areas over which tephras are found. In this paper, crypto-tephra extraction techniques allow the recovery of 8 non-visible tephra layers to add to the 9 visible layers in a marine sediment core (LC21) from the SE Aegean Sea to form the longest, single core record of volcanic activity in the Aegean Sea. Using a novel, shard-specific methodology, sources of the tephra shards are identified on the basis of their major and trace element single-shard geochemistry, by comparison with geochemical data from proximal Mediterranean volcanic stratigraphies. The results indicate that the tephra layers are derived from 14 or 15 separate eruptions in the last ca 161 ka BP: 9 from Santorini; 2 or 3 from Kos, Yali, or Nisyros; 2 from the Campanian province; and one from Pantelleria. The attributions of these tephra layers indicate that 1) inter-Plinian eruptions from Santorini may have produced regionally significant tephra deposits, 2) marine tephrostratigraphies can provide unique and invaluable data to eruptive histories for island volcanoes, and 3) tephra from both Pantelleria and Campania may be used to correlate marine records from the Aegean Sea to those from the Tyrrhenian, Adriatic and Ionian Seas.

This paper presents the results of cardiovascular changes that occur during a novel rehabilitation strategy called activity based therapy (ABT). Blood volume pulse (BVP) signals were measured during functional electrical stimulation (FES)-induced cycling in adults with spinal cord injury (SCI) persons and results were compared to a passive cycling task and able-bodied controls performing normal cycling. BVP signals were compared during three conditions, a baseline pre-exercise condition, 5 minutes after exercise and after 30-minutes rest following exercise. Exercise recovery was evaluated using normalized inner products values in BVP signals. The results showed that FES-induced cycling in SCI participants resulted in a significantly greater peripheral resistance level and longer time to recover from exercise compared with passive cycling and normal cycling in able-bodied controls. © 2011 IEEE.