Mobility and strength training with and without protein supplements for pre-frail or frail older adults with low protein intake: the Maximising Mobility and Strength Training (MMoST) feasibility randomised controlled trial protocol.

Background Frailty is a common syndrome affecting older people and puts them at risk of hospitalisation, needing care or death. First signs of frailty include reduced muscle strength and mobility decline. A key cause of mobility decline as we age is sarcopenia (age related reduction in muscle strength and mass). Poor nutrition contributes to sarcopenia. A shortfall in protein is associated with reduced muscle mass and strength. This may be due to inadequate intake but also because older people have higher protein needs, especially those with multimorbidity. We need to develop effective treatment to reduce or slow the onset of frailty and mobility decline. Exercise is a recommended treatment. Protein supplements to address the shortfall in protein have the potential to enhance the benefit of regular exercise in frail or pre-frail older adults. This has yet to be definitively demonstrated. Aim To establish the feasibility of conducting an RCT evaluating mobility and strength training with or without protein supplements for people over 60 years old who are frail or pre-frail with a low protein intake. Methods A multicentre, parallel, 2-group, feasibility RCT. Participants (recruitment target = 50) with problems walking, low protein intake and classified as frail or pre-frail will be recruited from four NHS Physiotherapy community services. Participants will be randomised (secure computer-generated: 1:1) to receive 24 weeks of mobility and strength training (delivered in 16 group sessions plus home exercises) or 24 weeks of mobility and strength training with daily protein supplements. Primary feasibility objectives are to estimate 1) ability to screen and recruit eligible participants, 2) intervention fidelity, adherence, and tolerance and 3) retention of participants at follow up. Secondary objectives are to 1) test data collection procedures, 2) assess data completeness and 3) confirm sample size calculation for a definitive RCT. Registration ISRCTN Registry (ISRCTN30405954; 18/10/2022).

As people get older, they may become frail and become less able to deal with illness or injury. People with frailty are more likely to fall or need care. We need to find ways to stop people becoming frail or slow the progress of frailty so older people can live independently. Exercise is a treatment for frailty that can improve muscle strength and walking. Including extra protein in an older person's diet may also help. Protein provides the building blocks for muscles, but many older people do not eat enough protein. Taking extra protein while exercising may increase the benefits of exercise, but we do not know if it reduces frailty or improves walking and quality of life. We want to conduct a large clinical trial comparing mobility and strength training plus extra protein to training alone. This study aims to test if it is possible to carry out a large trial by finding out:       â€¢   Can we recruit enough participants with low protein intake?       â€¢   Do participants attend the exercise classes and take the protein supplements?       â€¢   Do participants attend follow-up assessments? We aim to recruit up to 50 older people who are frail/at risk of frailty and have low protein intake. We will identify participants via NHS Community Trusts, from an existing cohort study and by advertising in the community. Participants are randomly allocated to training plus protein or training only. Training involves muscle strengthening, balance, and walking exercises. Participants will attend a weekly exercise class with a physiotherapist for 16 weeks and do exercises at home once/week. They are then asked to exercise at home twice weekly for a further 8 weeks. Half the participants will take extra protein while exercising. At enrolment and 8 months later, we collect information on frailty, walking ability, muscle strength and quality of life.

Building local community commitment to wetlands restoration: a case study of the Cache River Wetlands in southern Illinois, USA.

Natural resource professionals are increasingly faced with the challenges of cultivating community-based support for wetland ecosystem restoration. While extensive research efforts have been directed toward understanding the biophysical dimensions of wetland conservation, the literature provides less guidance on how to successfully integrate community stakeholders into restoration planning. Therefore, this study explores the social construction of wetlands locally, and community members' perceptions of the wetland restoration project in the Cache River Watershed of southern Illinois, where public and private agencies have partnered together to implement a large-scale wetlands restoration project. Findings illustrate that the wetlands hold diverse and significant meanings to community members and that community members' criteria for project success may vary from those identified by project managers. The case study provides managers with strategies for building community commitment such as engaging local citizens in project planning, minimizing local burdens, maximizing local benefits, and reducing uncertainty.

Modeling energy savings from urban shade trees: an assessment of the CITYgreen energy conservation module.

CITYgreen software has become a commonly used tool to quantify the benefits of urban shade trees. Despite its frequent use, little research has been conducted to validate results of the CITYgreen energy conservation module. The first objective of this study is to perform a familiar application of CITYgreen software to predict the potential energy savings contribution of existing tree canopies in residential neighborhoods during peak cooling summer months. Unlike previous studies utilizing CITYgreen, this study also seeks to assess the software's performance by comparing model results (i.e., predicted energy savings) with actual savings (i.e., savings derived directly from energy consumption data provided by the electric utility provider). Homeowners in an older neighborhood with established trees were found to use less energy for air-conditioning than homeowners in a recently developed site. Results from the assessment of model performance indicated that CITYgreen more accurately estimated the energy savings in the highly vegetated, older neighborhood.

A dynamic model for intertemporal allocation of old-growth forests in the Pacific Northwest.

Across the globe, continued policy debates regarding the management of old-growth forests center around the difficult task of balancing economic and ecological considerations. Though the forests of the Pacific Northwest United States are among the most studied old-growth ecosystems, ecological and economic analyses have yielded public land management directives that remain controversial. Specifically, the recently adopted Northwest Forest Plan lacks explicit goals for maintaining intergenerational equity for the use of forest resources and the diversity of old-growth ecosystems. Unlike previous studies which rely on monetary quantification of costs and benefits, this study develops and applies a conceptual framework for evaluating socially optimal Pacific Northwest old-growth forest utilization strategies. Conditions for the optimal management of old-growth forests are derived using dynamic programming. The objective function synthesizes relevant biological and economic attributes of the old-growth allocation problem. Results in the form of extraction paths are compared given social pressure for consumptive and non-consumptive benefits, as well as different planning horizons, rates of social time preference, and environmental variance. Lengthening the planning horizon results in a vast divergence of optimal policies in the absence of discounting. Extraction rates appear to approach zero as the planning horizon approaches infinity. While higher rates of social time preference increase the rate of extraction, forest stocks remaining at the terminal time period equal levels remaining with a lower discount rate. Increasing environmental variance results in a higher level of stock remaining at the terminal time period. This analysis, while specific to the old-growth controversy of the Pacific Northwest, does provide general guidelines for addressing similar problems of multiple uses of natural areas, particularly where such uses are mutually incompatible, or where one use may be irreversibly destructive to another.