Long-term Management Solutions Research Articles

Paying a Heavy Price: Costs of Care for People With Severe Obesity in Nursing Homes.

The prevalence of resident obesity in nursing homes has increased dramatically from 22% to 28% between 2005 and 2015. To provide care for people with obesity, nursing homes have changed their admissions, staffing, and equipment, but underlying these changes are increased resources and financial costs of care. The purpose of this study is to describe nursing home organizational aspects of caring for older adults with obesity, with a focus on economic factors, from the perspective of nursing home staff and leadership. This qualitative study used descriptive approaches; data were collected through semistructured telephone interviews. Of 77 nursing home staff and leaders identified as potential study participants, 6 were ineligible, and 71 participated in the study through interviews conducted from 2019 to 2022. A total of 4 primary themes described the issues surrounding the cost of care for obesity in nursing homes: inefficient and risky use of staff time in a setting of persistent staff shortage, expensive and unique equipment needs, inadequate general reimbursement with an absence of obesity-specific reimbursement supplements, and competing short- and long-term management solutions. This qualitative study of nursing home staff and leadership underscores a need for improved approaches to funding obesity care within existing nursing payment models. The increasing prevalence of obesity and the burden of the costs of obesity care for nursing homes will escalate this need over the coming decade.

Evaluation of the human-otter conflict in central Veracruz, Mexico: recommendations for mitigation

ABSTRACT Evaluating human–wildlife conflict is necessary to reach positive long-term management solutions and aid the conservation of biodiversity. We used indirect approaches to evaluate the Human–Neotropical otter conflict in three river basins with high fishing activity in western Mexico and provided recommendations to mitigate the conflict by identifying the variables that increase the risk of predation of ponds by otters. Human–Otter conflict was moderate, and the opinions of community members toward otters were mostly negative, particularly those of the fishing sector. However, after offering environmental education workshops, the number of people recognizing the importance of protecting the species increased, which could result in the acceptance and tolerance toward otters. Avoiding building ponds at ground level and covering ponds with metal mesh, especially in fish-farms located in the middle and upper areas of rivers, as explored with fish-farmers, merits more experimentation, since it could be a good means for reducing the conflict.

Redesigning care for back pain in an Australian hospital setting: A service evaluation to identify need for change.

This needs assessment study examined current processes of physiotherapy care for adults with back pain in a large teaching hospital serving a multicultural community in Sydney, Australia. Evaluation of current practices is a necessary first step in the design of a patient-centred, multidisciplinary service that promotes best practice in back pain management. We conducted a retrospective service evaluation in the physiotherapy outpatient department by reviewing clinical data on episode of care and processes of care for adults managed for back pain over a 6-month period using a defined protocol (n=252). Patients (median age=56years; 72.2% born outside of Australia) were referred from various internal and external sources, with 79.8% having chronic back pain. The median length of episode of care was 8weeks. Active interventions were almost universally used (98.4% of records). Key aspects of assessment were frequently recorded (84.5%-98%of records), but psychosocial risk assessment was not routinely recorded. Aspects of longitudinal management planning, including goal setting, outcome measurement, and routine follow-up, were also not routinely recorded. This study demonstrated that physiotherapy processes of care in this setting followed key messages of best practice particularly with regard to interventions, in contrast to other settings and jurisdictions. However, the brief episodes of care and less evident focus on psychosocial aspects might not align with the needs of the majority with chronic back pain. These findings suggest the need to reframe processes of care with a biopsychosocial approach and structure episodes of care towards long-term management solutions.

Behavioral Ecology of the Coffee White Stem Borer: Toward Ecology-Based Pest Management of India's Coffee Plantations

India is the seventh largest producer of coffee with 395,000 tons of coffee exports that earn 10 billion US dollars annually. Two varieties of coffee are grown in India, Coffea arabica (arabica) and Coffea canephora (robusta). Xylotrechus quadripes, commonly known as Coffee White Stem Borer (CWSB), is a major pest of arabica, causing yearly crop damage of 17–40 million dollars. Management strategies, over 100 years in development, have provided successful, yet inconsistent solutions due to differences in local climate, elevation, natural enemies, grower diligence, and other factors. In addition, increased pesticide use affects both pests as well as their natural enemies, which has severe negative impacts on the biodiverse regions where coffee is grown. As a result, our goal is to develop an ecology-based solution for long term management of CWSB that reduces the use of pesticides and focuses on the importance of natural enemies and native hosts. In situ behavioral experiments were performed to examine the preferences of CWSB for various local species under field conditions. We found that CWSB beetles were attracted to both healthy arabica and robusta plants, and host plant volatiles played a key role in host selection. In addition, the beetles were attracted to the leaves of these coffee plants and also two species of cut stems from common shade trees; Spathodea campanulata (nandi flame) and Grevillea robusta (silver oak). Beetles were not attracted toward cut stems of Tectona grandis (teak) or Coffea arabica. GC-EAD and EAG experiments were then performed to identify host plant volatiles for these species, and these compounds were tested in field conditions to assess their effectiveness against the known chemical attractant pheromone. We found that the CWSB was attracted to our identified host volatile blend as much as the pheromone lure, although trap catches in general were very low. Having an understanding of the behavioral ecology of this pest can form the basis for new methods that use natural attractant and repellent plants to control the pests, reduce the cost of plantation pest management, and avoid the extensive use of insecticides.

Managing the unmanageable: reinstating the dingo for pastoral sustainability in Australian rangelands

The predominant grazing management system used in the arid rangelands regions of Australia, set stocking, is not conducive to sustainable land management. More appropriate grazing management systems based upon periodic rest periods for important pasture species have not been adopted by pastoralists because the unmanaged grazing pressure from animals such as goats and kangaroos has been too high. Dingoes are the only cost-effective and long-term management solution to the effect of unmanaged grazing by goats and kangaroos. Yet government funding targets dingo eradication in pastoral areas, and it does so by adopting misleading and scientifically inaccurate terms for describing dingoes.

Surveys of stink bug egg parasitism in Asia, Europe and North America, morphological taxonomy, and molecular analysis reveal the Holarctic distribution of Acroclisoides sinicus (Huang & Liao) (Hymenoptera, Pteromalidae)

Halyomorpha halysis an invasive, widespread stink bug for which only short-term solutions are currently available for pest control worldwide. The need for long-term management solutions forH. halyshas driven studies on augmentative and classical biological control of this species, especially by its egg parasitoids. Numerous investigations in Asia, USA, and Europe on native and exotic egg parasitoids ofH. halys, and the effects on non-target pentatomids, have improved the global knowledge of parasitoid-host relationships, uncovered new associations, and led to the discovery of new species. This trend continues withAcroclisoides sinicus, a pteromalid that was described in the 1980’s from Asia. In this work we report recent findings of this species in North America and Europe. Moreover, we propose thatAcroclisoides solussyn. nov., a species described originally from the USA, is conspecific withA. sinicusbased on morphological and molecular analysis.

Balancing conservation and utilization in spawning aggregation fisheries: a trade-off analysis of an overexploited marine fish

AbstractAlthough the management of fish spawning aggregations (FSAs) often requires a precautionary approach that initially emphasizes conservation, understanding the dynamics of spawning and interactions with fishing activities can help identify long-term management solutions that balance conservation with utilization. We designed a parsimonious, per-recruit model to evaluate the potential effects of seven time-closure scenarios implemented during the spawning season on egg production per recruit (EPR; a conservation metric) and yield per recruit (YPR; a fisheries metric) of Gulf corvina (Cynoscion othonopterus), a vulnerable marine fish that experiences persistent overfishing at its only known spawning grounds in the Gulf of California, Mexico. Three of the seven scenarios provided small-to-large increases in EPR (8–43%) accompanied by only small decreases in YPR (3–11%) that resulted in a sustainable fishery. Increased mortality of juveniles and small adults through targeted fishing or as bycatch in other fisheries, however, would erode the fisheries and conservation benefits of time closures. Our results demonstrate that information on spawning and fishing activities can be combined with stakeholder input to identify regulations that permit the sustainable harvesting of FSAs. Furthermore, the implementation of brief, temporal fishing effort restrictions can represent a viable, less restrictive alternative to marine protected areas for the management of FSAs.

Multiple roles of clays in radioactive waste confinement – introduction

Abstract Geological disposal provides the safe long-term management solution for higher-activity radioactive waste. The development of a repository (or geological disposal facility) requires a systematic and integrated approach, taking into account the characteristics of the waste to be emplaced, the enclosing engineered barriers, and the host rock and its geological setting. Clays and clayey material are important in the development of many national geological disposal systems. Clays exhibit many interesting properties, and are proposed both as host rocks and as material for engineered barriers. Whatever their use, clays present various characteristics that make them high-quality barriers to the migration of radionuclides and chemical contaminants. As host rocks, clays are, in addition, hydrogeologically, geochemically and mechanically stable over geological timescales (i.e. millions of years).

Evidence Based Targeting of Cytokines for Conventional and the Potential Phytotherapies in Management of Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease that leads to chronic, systemic inflammatory reaction that primarily affects synovial joints. Current cytokine based therapies are effective and safe. However, they have a challenge of having short plasma half-life and even higher doses are required to manage the conditions. The processes involved in production using phage and viral technologies are expensive. Herbal medicines have been used for long and are considered safe and effective as medicines for many inflammatory related diseases. Many plants also posit as a potent anti-inflammatory agents. Evidence for use of herbal plants in both human and animal trials in studies suggest significant potential of application in herbal formulation in management of rheumatoid arthritis. Specifically, many studies suggest the direct effect of managing the agents of inflammation as a way of managing rheumatoid arthritis. Most evidence links the involvement of pro-inflammatory cytokines (interleukin-1, TNF-α, IFN-α, and NF-ÐoB) to the long term. It has also been suggested that the use of protective cytokines such as (Interleukin-4, Interleukin-6, Interleukin-8). Key pathways involve cyclooxygenase 1 and 2, 5-Lipooxygenase, formations of metalloproteinases, and inhibition of formation of prostaglandin E2. Use of herbal medicines has potential of improving joint conditions in rheumatoid arthritis. Use of herbal extracts offers better, cheap and affordable solution for long term management of rheumatoid arthritis in patients. They also show potential of offering multifunctional approaches to the management of the conditions through their anti-oxidative and anti-inflammatory mechanisms. Further studies are required to demonstrate the mechanisms involved in activation of protective cytokines in the management of rheumatoid arthritis.

In-lake measures for phosphorus control: The most feasible and cost-effective solution for long-term management of water quality in urban lakes

Both in-lake and catchment measures designed to reduce phosphorus (P) loading were implemented as part of a 12.3 million USD restoration project for the Minneapolis Chain of lakes in Minnesota (USA). Treatment wetlands, ‘in-pipe’ measures, and in-lake aluminum sulfate (alum) treatment were applied to restore water quality in the four urban lakes. Different alum dosing methods led to between 4 and 20+ (modeled) years of water quality improvements in these lakes after treatment and only one of the four lakes continues to meet water quality goals approximately 25 years after the project started. Due to limited space and poor performance, reduction of total external loads was low (1–13%) for three lakes. Changes to internal P sediment release rates after application of alum correlated well with epilimnetic total P (TP) concentrations in these lakes, indicating that improvements in water quality were mainly driven by reduced internal loading via in-lake measures. Substantial reductions to external P loading were only achieved at Cedar Lake (49%) via conversion of an existing natural area to a treatment wetland, but even Cedar Lake is no longer meeting management goals. When expressed in terms of dollars spent per unit P removed, in lake alum treatment was on average 50 times more effective than in-catchment measures. The results of this study indicate that substantial external nutrient reductions may not be adequate to sustainably maintain water quality in urban lakes and that continued in-lake management of P accumulated in lake sediment will not only be necessary, but will also be more cost efficient relative to in-catchment measures.

Continued declines of Redshank Tringa totanus breeding on saltmarsh in Great Britain: is there a solution to this conservation problem?

Capsule: Over 50% of saltmarsh breeding Common Redshank have been lost since 1985, with current conservation management having only limited success at halting these declines. Aims: To update population size and trend estimates for saltmarsh-breeding Redshank in Britain, and to determine whether conservation management implemented since 1996 has been successful in influencing grazing intensity and Redshank population trends. Methods: A repeat national survey of British saltmarsh was conducted in 2011 at sites previously visited in 1985 and 1996. Redshank breeding density and grazing pressure were recorded at all sites; the presence of conservation management was additionally recorded for English sites. Results from all three national surveys were used to update population size and trend estimates, and to investigate changes in grazing pressure and breeding density on sites with and without conservation management. Results: Of the 21 431 pairs breeding on saltmarsh in 1985, 11 946 pairs remained in 2011, with the highest proportion of this population found in East Anglia. From 1985, British breeding densities declined at a rate of 1 pair km−2 year−1, representing a loss of 52.8% of breeding pairs over 26 years, although regional trends varied across different time periods. Grazing pressures did not change markedly with conservation management. Redshank declines were less severe on conservation-managed sites in East Anglia and the South of England where grazing pressures remained low, though were more severe on conservation-managed sites in the North West where heavy grazing persisted. Conclusion: Saltmarsh-breeding Redshank declines continue and are likely to be driven by a lack of suitable nesting habitat. Conservation management schemes and site protection implemented since 1996 appear not to be delivering the grazing pressures and associated habitat conditions required by this species, particularly in the North West of England, though habitat changes may not be linked to unsuitable grazing management in all regions. An in-depth understanding of grazing practices, how conservation management guidelines could be improved, and the likely success of more long-term management solutions is needed urgently.

Silver oxide nanocrystals anchored on titanate nanotubes and nanofibers: promising candidates for entrapment of radioactive iodine anions

Iodine radioisotopes are released into the environment by the nuclear industry and medical research institutions using radioactive materials. The (129)I(-) anion is one of the more mobile radioactive species due to a long half-life, and it is a great challenge to design long-term management solutions for such radioactive waste. In this study, a new adsorbent structure with the potential to efficiently remove radioactive iodine anions (I(-)) from water is devised: silver oxide (Ag2O) nanocrystals firmly anchored on the surface of titanate nanotubes and nanofibers via coherent interfaces between Ag2O and titanate phases. I(-) anions in fluids can easily access the Ag2O nanocrystals and be efficiently trapped by forming AgI precipitate that firmly attaches to the adsorbent. Due to their one-dimensional morphology, the new adsorbents can be readily dispersed in liquids and easily separated after purification; and the adsorption beds loaded with the adsorbents can permit high flux. This significantly enhances the adsorption efficiency and reduces the separation costs. The proposed structure reveals a new direction in developing efficient adsorbents for the removal of radioactive anions from wastewater.

Response of intertidal macrobenthic communities and primary producers to mitigation measures in a temperate estuary

The main goal of this study was to evaluate the response of intertidal macrobenthic communities associated with Zostera noltii meadows in a temperate estuary (Mondego, Portugal) to the application of mitigation measures aimed at decreasing eutrophication symptoms. In order to assess possible ecological improvements regarding the seagrass habitat and associated macrobenthic communities, data from four different periods, corresponding to the prevailing conditions of distinct systems, were considered. This study (1) gives concrete examples of pathways of benthic intertidal communities’ degradation and recovery; (2) it analyses a long-term dataset (covering almost 25 years) of intertidal communities from a southern European estuary; (3) it is focused on a worldwide problem, and so has potentially far-reaching interest; (4) it exemplifies some of what may be the consequences of the dialogue between science and managers; (5) it assesses the impact and effectiveness of a large-scale mitigation intervention paid for by public funding.The application of preliminary mitigation measures (in 1998) and the full re-establishment of the communication between the two estuarine subsystems (in 2006) allowed for an improvement in the macrobenthic condition and confirmed that hydrologic conditions in the estuary have been the major drivers of the changes observed over the last two decades. However, evaluating the efficiency of the large-scale intervention proved to be a complex task since different communities showed distinct pathways and momentums of recovery.The present study provided valuable insights concerning sustainable long-term management solutions regarding the Mondego Estuary. These particular insights could therefore be useful as a management action guideline applied to other estuarine ecosystems undergoing similar eutrophication problems.

Migratory Birds: Ecology and Conservation. A report on the BOU’s Annual Conference held at the University of Leicester, 5–7 April 2011

In April 2011, the British Ornithologist’s Union’s annual conference took place at the University of Leicester. The theme of this year’s conference was the ecology and conservation of migratory birds, and talks ranged from those focussed on either breeding, migration or wintering ecology, to those linking two or more of these and trying to build a more complete picture of the complex problems faced by long distance migrants. Talks also covered recent technological advances, which are increasingly allowing us intriguing new insights, particularly into the seasonal movements and wintering areas of some of the most declining species. Finally, talks examined the policy challenges associated with protecting migratory species and how best to tackle flyway-scale conservation of migratory birds.

Effect of a Thermal Gradient on Iron-Clay Interactions

AbstractDisposal facilities in deep geological formations are considered to be a possible solution for long-term management of high-level nuclear waste (HLW). The design of the repository generally consists of a multiple-barrier system including Fe-based canisters and a clay backfill material. The Fe-clay system will undergo a thermal gradient in time and space, the heat source being the HLW inside the canisters. In the present paper, the effect of a thermal gradient in space on Fe-smectite interactions was investigated. For this purpose, a tube-in-tube experimental device was developed and an 80–300ºC thermal gradient was applied to a mixture of MX80 bentonite, metallic Fe (powder and plate), magnetite, and fluid over periods of 1 to 10 months. Transformed and newly formed clay minerals were characterized by scanning electron microscopy, transmission electron microscopy, X-ray diffraction, and Mössbauer spectroscopy. The main mineralogical transformations were similar to those described for batch experiments: smectite was destabilized into an Fe-enriched trioctahedral smectite and Fe-serpentine or chlorite as a function of the experimental conditions. Newly formed clay was observed all along the walls of the gold tube. Their crystal chemistry was clearly different from the clays observed in the hot and cold part of the tubes. The thermal diffusion of elements was also observed, especially that of Mg, which migrated toward the hottest parts of the tubes. In the end, the thermal gradient affected the redox equilibria; more reduced conditions were observed in the hotter parts of the tubes.

Long-Term Radioactive Waste Management in the United Kingdom—Nirex Perspective

This paper sets out the background to and history of radioactive waste management in the United Kingdom (UK). It describes the lessons learned from past attempts to implement a long-term management solution, and outlines the UK Government’s current initiatives to put in place a publicly acceptable policy. The paper explains the role of Nirex, the body charged with providing the UK with safe, environmentally sound and publicly acceptable options for the long-term management of radioactive materials. It also addresses, from a Nirex perspective, issues relating to the future of radioactive waste management in the UK.

LONG-TERM OUTCOME OF INCONTINENT ILEOVESICOSTOMY MANAGEMENT OF SEVERE LOWER URINARY TRACT DYSFUNCTION

Purpose We evaluated the extended 5-year followup outcome of incontinent ileovesicostomy. Materials and Methods We reviewed the charts of 25 men and 13 women with a mean age of 44.9 years who underwent incontinent ileovesicostomy, including the original 23 patients whom we reported on in 1993. Mean followup was 52 months. We compared the incidence of complications before and after ileovesicostomy as well as long-term urinary tract status. Results Before ileovesicostomy the incidence of serious complications associated with an indwelling catheter was significant, including poor bladder compliance in 50% of cases, urosepsis in 45%, hydronephrosis in 21%, renal struvite calculi in 18%, urethrocutaneous fistula in 18%, autonomic dysreflexia in 13% and bladder calculi in 2%. After conversion to ileovesicostomy our data show that 83 to 91% of this high risk population maintained a normal upper urinary tract and normal bladder storage compliance. Conclusions Compared with preoperative status the incidence of postoperative complications was relatively low and they were readily corrected. Ileovesicostomy is an excellent long-term management solution for severe lower urinary tract dysfunction in patients who are unable to perform intermittent self-catheterization.