Seagrass ecosystem multifunctionality under the rise of a flagship marine megaherbivore.

Large grazers (megaherbivores) have a profound impact on ecosystem functioning. However, how ecosystem multifunctionality is affected by changes in megaherbivore populations remains poorly understood. Understanding the total impact on ecosystem multifunctionality requires an integrative ecosystem approach, which is especially challenging to obtain in marine systems. We assessed the effects of experimentally simulated grazing intensity scenarios on ecosystem functions and multifunctionality in a tropical Caribbean seagrass ecosystem. As a model, we selected a key marine megaherbivore, the green turtle, whose ecological role is rapidly unfolding in numerous foraging areas where populations are recovering through conservation after centuries of decline, with an increase in recorded overgrazing episodes. To quantify the effects, we employed a novel integrated index of seagrass ecosystem multifunctionality based upon multiple, well-recognized measures of seagrass ecosystem functions that reflect ecosystem services. Experiments revealed that intermediate turtle grazing resulted in the highest rates of nutrient cycling and carbon storage, while sediment stabilization, decomposition rates, epifauna richness, and fish biomass are highest in the absence of turtle grazing. In contrast, intense grazing resulted in disproportionally large effects on ecosystem functions and a collapse of multifunctionality. These results imply that (i) the return of a megaherbivore can exert strong effects on coastal ecosystem functions and multifunctionality, (ii) conservation efforts that are skewed toward megaherbivores, but ignore their key drivers like predators or habitat, will likely result in overgrazing-induced loss of multifunctionality, and (iii) the multifunctionality index shows great potential as a quantitative tool to assess ecosystem performance. Considerable and rapid alterations in megaherbivore abundance (both through extinction and conservation) cause an imbalance in ecosystem functioning and substantially alter or even compromise ecosystem services that help to negate global change effects. An integrative ecosystem approach in environmental management is urgently required to protect and enhance ecosystem multifunctionality.

A typology of caregiving spouses of geriatric patients without dementia: caring, worried, desperate.

BACKGROUND: An increasing number of older people in Germany receive care at home from family members, particularly from spouses. Family care has been associated not only with subjective burden but also with negative effects on caregivers' health. A heterogeneous group, caregivers are confronted with individual situational demands and use different available coping strategies. To date, little is known about the relationship between burden and coping by spousal caregivers, particularly in the context of geriatric patients without dementia. OBJECTIVES: The aim of this study is to explore the burden and coping strategies of caregiving spouses of geriatric patients without dementia and with a hospitalization within the last year. To help explore this population, a typology is presented that has been based on reported perceptions of home care burden and individual coping strategies. Furthermore, a case study is presented for each type of spousal caregiver. METHODS: The study used a concurrent mixed method design with a sample of nine spousal caregivers (mean age: 78.9 years). Four women and five men were recruited in an acute hospital setting during the TIGER study. Quantitative data were collected using a self-questionnaire and qualitative data were gathered through nine problem-centered interviews with spousal caregivers. The latter were subsequently analyzed utilizing the structured content analysis method. The data were then summarized to nine individual cases. Finally, the results were clustered using the empirically grounded construction of types and typologies. Each type of spousal caregiver is presented by a case study. RESULTS: Three types of caregiving spouses were identified: "The Caring Partner", "The Worried Manager" and "The Desperate Overburdened". These types differ primarily in the level of subjective burden and caregiving stress, the coping strategies, the motivation for caregiving, and expressed emotions. CONCLUSIONS: The development of this new typology of caregiving spouses could help health care professionals better understand caregiving arrangements and thus provide more targeted advice. TRIAL REGISTRATION: The TIGER study was registered with clinicaltrials.gov: NCT03513159 . Registered on April 17, 2018.

"EduKation demenz® Nursing" in the acute hospital setting : Evaluation of a dementia training program: a pilot study.

BACKGROUND: An increasing number of people with dementia (PwD) are being hospitalized due to acute conditions. The surrounding conditions and procedures in acute hospitals are not oriented to the special needs of this vulnerable patient group. The behavior of PwD poses particular challenges and burdens for nursing staff. OBJECTIVE: The aim of this pilot study was to evaluate the effectiveness of a 2-day dementia training program with a self-reflection component compared to a standard 1.5­h training of nursing staff caring for PwD in acute hospitals. METHODS: A nonrandomized pretest-posttest study with a control group was conducted in three German acute hospitals. Through a questionnaire, nursing staff caring for PwD were examined for potential changes in attitude, strain and confidence levels. The intervention group (n = 32) received a 2-day training program, "EduKation demenz® Nursing", the control group (n = 36) participated in a short,1.5­h dementia training. RESULTS: Compared to the control group, the intervention group demonstrated statistically significant improvement in perceived strain (p = 0.007) and in confidence in caring for PwD (p < 0.001). There were positive but not significant changes in attitude (p = 0.176). CONCLUSION: "EduKation demenz® Nursing", a 2-day training program with a self-reflection component, could provide more effective support for nursing staff in acute hospitals caring for PwD than a 1.5­h training. Results indicate, however, that general conditions in acute hospitals should be changed to allow nursing staff to apply the knowledge gained.

Screening for caregivers at risk: Extended validation of the short version of the Burden Scale for Family Caregivers (BSFC-s) with a valid classification system for caregivers caring for an older person at home.

BACKGROUND: Informal caregivers' (CGs') subjective burden is an important aspect of the care situation because it is linked to various outcomes such as health, mortality risk, institutionalization, and caregiving style. The aims of this study were a) to examine the convergent and discriminant validity of the 10-item short version of the Burden Scale for Family Caregivers (BSFC-s) and b) to develop a valid classification system for interpreting BSFC-s scores. METHODS: In this cross-sectional study, we analyzed data obtained from 386 informal CGs who applied for an initial grade or upgrade of the care level for the care recipient at the Medical Service of Compulsory Health Insurance Funds of Bavaria (Germany). To validate the BSFC-s, we analyzed the reliability and the convergent/discriminant validity. We calculated correlations with the short form of the Giessen Symptom Complaints List (GBB-24), the Caregiver Strain Index (CSI), the personal further development sub-scale of the Berlin Inventory of Caregivers' Burden with Dementia Patients (BIZA-D), and other scales for establishing informal CGs' situations. To develop the classification system, we compared the percentile ranks of the GBB-24 with the respective BSFC-s sum scores and their distributions and derived three classification categories. RESULTS: Results confirmed the convergent and discriminant validity of the BSFC-s (GBB-24: r = 0.68; CSI: r = 0.70; BIZA-D: r = 0.16; p < 0.001). For informal CGs with low subjective burden, the risk of physical psychosomatic complaints was elevated to a less than average level (BSFC-s scores of 0-4). In those with a moderate subjective burden (BSFC-s scores of 5-14), the risk was elevated. In those with a high burden (BSFC-s scores of 15-30), the risk was substantially elevated. CONCLUSIONS: The BSFC-s is a valid scale for measuring subjective burden in informal CGs. The risk of physical psychosomatic complaints, which is a consequence of subjective CG burden, can be determined by using the valid classification system to deduce the necessity for action and to give concrete recommendations for interventions. The BSFC-s should therefore be employed as a screening instrument in medical contexts and in counseling services for informal CGs.

["EduKation demenz®". Psychoeducative training program for relatives of people with dementia]. / "EduKation demenz®". Psychoedukatives Schulungsprogramm für Angehörige von Menschen mit Demenz.

BACKGROUND: During the course of dementia there is frequently a decline in the quality of interpersonal relationships between the patient and the family caregivers. This is mainly caused by a very critical attitude of the family caregiver to the patient and by the limited ability of the family caregiver to empathically communicate with the patient. This relational disorder significantly contributes to the perceived burden of the family caregiver. OBJECTIVE: This study was carried out to investigate whether the ability of family caregivers to empathically communicate can be strengthened, their emotional attitude towards the patient can be improved and their perceived burden and symptoms of depression can be reduced through a special communication-oriented psychoeducational intervention. MATERIAL AND METHODS: Within the framework of a controlled study for confounding factors 121 family caregivers participated in a 10-week group intervention "EduKation demenz®," whereas the 93 family caregivers of the control group received detailed self-help literature. The before and after surveys were conducted using a standardized questionnaire. RESULTS: Compared to the control group the intervention group displayed a statistically significant difference in all target parameters: more empathic communication with the patient (confounder-controlled difference of change in the intervention group versus control group 0.69, p = 0.023), a less critical attitude towards the patient (confounder-controlled difference of change in the intervention group versus control group 2.11, p = 0.027), reduction in the perceived burden from disrupted communication (confounder-controlled difference of change in the intervention group versus control group 1.76, p = 0.038) and decreased symptoms of depression for caregivers with ≥ 33 points in the general depression scale (ADS-K, p = 0.028). CONCLUSION: Family caregivers of people with dementia clearly did not benefit from direct information transfer through the extensive offer of self-help literature to the same extent as the psychoeducational group intervention.

Tailored e-Health services for the dementia care setting: a pilot study of 'eHealthMonitor'.

BACKGROUND: The European eHealthMonitor project (eHM) developed a user-sensitive and interactive web portal for dementia care: the eHM Dementia Portal (eHM-DP). It aims to provide targeted and personalized support for informal caregivers of people with dementia in a home-based care setting. The objective of the pilot study was to obtain feedback on the eHM-DP from two user perspectives (caregivers and medical professionals), focusing on caregiver empowerment, decision aid, and the perceived benefits of the eHM-DP. METHODS: The study on the eHM-DP was conducted from March 2014 to June 2014. The methodological approach followed a user-participatory design with a total number of 42 participants. The study included caregivers of people with dementia and medical professionals (MPs) from the metropolitan region of Erlangen-Nürnberg (Bavaria, Germany). Study participants were interviewed face-to-face with semi-structured, written interviews. RESULTS: Caregivers indicated a high degree of perceived support by the eHM-DP and of provided decision aid. In total, 89 % of caregivers and 54 % of MPs would use the eHM-DP if access were provided. The primary benefits participants perceived were the acquisition of individualized information, computerized interaction between caregivers and MPs, empowerment in health-related decisions and comprehensive insights into the progress of the disease. Major recommendations for improving the eHM-DP encompassed: an active search functionality based on predefined terms, the implementation of a chatroom for caregivers, an upload function and alerts for MPs, as well as the overall design. CONCLUSIONS: Our study is the first to have provided new insights and results on an interactive and needs-oriented web portal, endeavouring towards empowerment and assistance in decision making for caregivers as well as MPs within the realm of caring for patients with dementia. The acceptance and willingness to use the eHM-DP emphasizes the potential of eHealth services for community-based dementia care settings.

Safety of liver resection and effect on quality of life in patients with benign hepatic disease: single center experience.

BACKGROUND: Although liver resection has long been established for selected patients with benign hepatic disease, the success of surgical treatment of these patients cannot be evaluated exclusively through postoperative morbidity and mortality. Therefore, the aim of the study was to prove the safety of liver resection in the treatment of benign liver tumors and to evaluate the effect of surgical treatment on the patients' quality of life. METHODS: A total of 146 patients who underwent liver resection because of benign liver tumors were included in this study. Postoperative outcome was assessed and patients evaluated their quality of life before surgery and at the present time using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (QLQ C-30). RESULTS: The rate of serious (> grade 2) complications was 4.1% with no postoperative death. The quality of life assessment revealed an overall improvement of general health status after resection (0.7 vs. 0.56, p < 0.001) and additionally a significant reduction of 6 out of 9 symptoms. Furthermore, compelling benefits in the patients' social and emotional coping could be detected after surgery. CONCLUSIONS: Liver resection for benign liver disease is a safe procedure and leads to a significant improvement of quality of life in selected patients.

Mimicry of emergent traits amplifies coastal restoration success.

Restoration is becoming a vital tool to counteract coastal ecosystem degradation. Modifying transplant designs of habitat-forming organisms from dispersed to clumped can amplify coastal restoration yields as it generates self-facilitation from emergent traits, i.e. traits not expressed by individuals or small clones, but that emerge in clumped individuals or large clones. Here, we advance restoration science by mimicking key emergent traits that locally suppress physical stress using biodegradable establishment structures. Experiments across (sub)tropical and temperate seagrass and salt marsh systems demonstrate greatly enhanced yields when individuals are transplanted within structures mimicking emergent traits that suppress waves or sediment mobility. Specifically, belowground mimics of dense root mats most facilitate seagrasses via sediment stabilization, while mimics of aboveground plant structures most facilitate marsh grasses by reducing stem movement. Mimicking key emergent traits may allow upscaling of restoration in many ecosystems that depend on self-facilitation for persistence, by constraining biological material requirements and implementation costs.

Dementia and well-being: A conceptual framework based on Tom Kitwood's model of needs.

The topic of well-being is becoming increasingly significant as a key outcome measure in dementia care. Previous work on personhood of individuals with dementia suggests that their subjective well-being can be described in terms of comfort, inclusion, identity, occupation and attachment The study aimed to examine Tom Kitwood's model of psychological needs and well-being in dementia based on the self-report of individuals with moderate or severe dementia and to differentiate and elaborate this model in the light of the empirical qualitative data. Nineteen inhabitants of a special long-term care unit were interviewed using a semi-structured interview. Data were analysed using content analysis. Thirty components within Kitwood's model have been identified. A conceptual framework of subjective well-being in dementia was developed based on a theoretical background. The study was able to find indications that Kitwood's model has empirical relevance. Nevertheless, it requires to be extended by the domain agency. Furthermore, the study suggests that individuals with dementia are important informants of their subjective well-being.

[Gedächtniszentrum Erlangen (Memory Centre Erlangen) - Gerontopsychiatric Day-Care] / Gedächtniszentrum Erlangen - eine teilstationäre gerontopsychiatrische Einrichtung.

Two years ago the multiprofessional team of the Memory Centre Erlangen took up its work. Besides complete diagnoses of the cause of memory impairment, the work of the Memory Centre focusses on a special cognitive stimulation intervention. After completing assessment, namely self- and non-self anamnesis, psychometric tests and medical examinations, an individual treatment program for every patient will be development. In most instances the treatment program includes the participation in a special cognitive training. Adapting the SIMA-Program, psychomotor exercises, encoding strategies, retrieval techniques, attention and general cognitive speed arc trained in a group of 10 memory-impaired patients. After the 12-week treatment period a postintervention assessment is conducted in the same order as the preintervention assessment to evaluate the efficacy of the treatment. The data of a first evaluating study limited by sample size (20 patients) reveale that this intervention effects in a positive way the patient's cognitive performance. Patients with MCI (Mild Cognitive Impairment) show significant improvement in attention, general cognitive speed and short-term memory. Even patients with a dementia-diagnosis appeare to benefit from the cognitive stimulating intervention: After a 12-week time period no deterioration of cognitive ability is observed. Besides in attention, general cognitive speed and short-term memory an improvement can be reported.

[Erlangen Memory Center--a partial inpatient gerontopsychiatric facility]. / Gedächtniszentrum Erlangen--eine teilstationäre gerontopsychiatrische Einrichtung.

Two years ago the multiprofessional team of the Memory Centre Erlangen took up its work. Besides complete diagnoses of the cause of memory impairment, the work of the Memory Centre focusses on a special cognitive stimulation intervention. After completing assessment, namely self- and non-self anamnesis, psychometric tests and medical examinations, an individual treatment program for every patient will be development. In most instances the treatment program includes the participation in a special cognitive training. Adapting the SIMA-Program, psychomotor exercises, encoding strategies, retrieval techniques, attention and general cognitive speed arc trained in a group of 10 memory-impaired patients. After the 12-week treatment period a postintervention assessment is conducted in the same order as the preintervention assessment to evaluate the efficacy of the treatment. The data of a first evaluating study limited by sample size (20 patients) reveal that this intervention effects in a positive way the patient's cognitive performance. Patients with MCI (Mild Cognitive Impairment) show significant improvement in attention, general cognitive speed and short-term memory. Even patients with a dementia-diagnosis appeare to benefit from the cognitive stimulating intervention: After a 12-week time period no deterioration of cognitive ability is observed. Besides in attention, general cognitive speed and short-term memory an improvement can be reported.