Rehabilitation Nurses' Knowledge About Pain in Older Adults in Malta.

PURPOSE: Rehabilitation nurses require adequate knowledge about pain to improve patient experience and quality of care. We explored nurses' knowledge and attitudes towards pain in older adults in a large rehabilitation hospital in Malta. DESIGN: A cross-sectional study. METHODS: In total, 130 nurses received a short survey, which gathered sociodemographic data, information regarding usual pain management, and prior education on pain. A modified version of the Knowledge and Attitudes Survey Regarding Pain (KASRP) with 18 questions was used, alongside the 24-item Pain in the Older Adults' Knowledge Survey (POAKS). Non-parametric tests identified factors associated with KASRP and POAKS scores. RESULTS: Overall, 89 nurses completed the survey (response rate 68%). The median modified KASRP score was 50% (IQR 3.00), with only two nurses achieving the proposed "adequate" score of >80%. The median POAKS score was 79% (IQR 4.00). The only determinant of performance was nationality, with Maltese nurses performing better in POAKS than non-Maltese nurses (median 20.00 (3.00) vs. 16.50 (5.00); p = .003), indicating a possible language-related performance issue. Nurses scored poorly in some questions relating to analgesia administration, particularly opioids, as well as pain indicators and pain assessment. CONCLUSIONS: Rehabilitation nurses have fair knowledge of pain management in older people but require further education, particularly in opioid indications for pain management, pain expression, and assessment.

Potential disruptive effects of zoosporic parasites on peatland-based organic freshwater aquaculture: Case study from the Republic of Ireland.

Irish freshwater aquaculture holds great potential for aiding food security. However, its necessary expansion has been hampered by the adoption of important environmental EU directives. A novel peatland-based recirculating aquaculture multi-trophic pond system (RAMPS) was developed to assess its potential to assist in the sustainable development of industry whilst remaining aligned with environmental protection by adhering to organic aquaculture practices. Microalgae play a pivotal role in the farms' wastewater bioremediation. However, a collapse of the algal population within the system towards the end of the pilot study was observed. No relationship between physicochemical fluctuations and the collapse were indicated. Further investigations into the potential presence of biological agents were then conducted and fourteen species of zoosporic parasites from five different genera (Labyrinthula, Vampyrella, Amoeboaphelidium, Paraphelidium and Aphelidium) were identified after conducting next-generation sequencing (MinION). The presence of these species indicated the potential cause of algal collapse. Additionally, changes in weather conditions may have also contributed to the issue. Given the lack of data available on zoosporic parasites and their potential impact on organic aquaculture practices, additional research needs to be conducted. Developing a means to monitor and mitigate against these complex zoosporic parasites will inform food security, it will particularly help safeguard "organic" freshwater aquaculture where there is a reliance on using natural-based approaches to address disease mitigation. This information will in turn inform the replication of this RAMPs system in peatlands internationally creating local employment in green technologies, as communities' transition away from burning peat as fossil fuel. Also, zoosporic parasites may reduce important microalgae in peatland-based culture ponds that serve as exceptional sequesters of carbon. Findings of this study will inform related research that focus on the emergence of microbial pathogens in local aquatic ecosystems brought on by variances in climate.

Use of next generation sequencing and bioinformatics for profiling freshwater eukaryotic microalgae in a novel peatland integrated multi-trophic aquaculture (IMTA) system: Case study from the Republic of Ireland.

Development of integrated multi-trophic aquaculture (IMTA) systems constitutes a step change in the sustainable production of freshwater fish to meet emerging needs for high-protein foods globally. Recently, there has been a paradigm shift away from harvesting peat as a fuel towards the development of wettable peatland innovation (termed 'paludiculture'), such as aquaculture. Such eco-innovations support carbon sequestration and align with a balanced environmental approach to protecting biodiversity. This novel peatland-based IMTA process in the Irish midlands relies upon natural microalgae for waste treatment, recirculation and water quality where there is no use of pesticides or antibiotics. This novel IMTA system is powered with a wind turbine and the process has 'organic status'; moreover, it does not discharge aquaculture effluent to receiving water. However, there is a significant lack of understanding as to diversity of microalgae in this 'paludiculture'-based IMTA processes. This constitutes the first case study to use conventional microscopy combined with next-generation sequencing and bioinformatics to profile microalgae occurring in this novel IMTA system from pooled samples over a 12 month period in 2020. Conventional microscopy combined with classic identification revealed twenty genera of algae; with Chlorophyta and Charophyta being the most common present. However, algal DNA isolation, 16 s sequencing and bioinformatics revealed a combined total of 982 species from 341 genera across nine phyla from the same IMTA system, which emphasized a significant underestimation in the number and diversity of beneficial or potentially harmful algae in the IMTA-microbiome. These new methods also yield rich data that can be used by digital technologies to transform future monitoring and performance of the IMTA system for sustainability. The findings of this study align with many sustainability development goals of the United Nations including no poverty, zero hunger, good health and well-being, responsible consumption and production, climate change, and life below water.

Microalgae as a natural ecological bioindicator for the simple real-time monitoring of aquaculture wastewater quality including provision for assessing impact of extremes in climate variance - A comparative case study from the Republic of Ireland.

Aquaculture is one of the fastest growing food producing industries globally, providing ~50% of fish for human consumption. However, the rapid growth of aquaculture presents a range of challenges including balancing environmental impact that can be influenced by variations in climatic conditions. Monitoring of physicochemical parameters is traditionally used to evaluate aquaculture output quality; however, this approach does not indicate the cumulative ecotoxicological effects on receiving waters. Specifically, this case study investigated the relationship between measuring traditional physicochemical parameters and the health of the alga Pseudokirchneriella subcapitata in order to evaluate the potential ecotoxicological effects of freshwater aquaculture on the receiving aquatic ecosystem in the Irish midlands. This constituted the first 2-year longitudinal study conducted in 2018 and 2019 that reports on the efficacy of using algae as a natural bioindicator to monitor and assess freshwater aquaculture wastewater from a traditional flow-through fish farm producing Eurasian Perch (Perca fluviatilis); monitoring was compared over a same six-month period in the same location each year. Findings demonstrated significant differences between the two monitoring periods when using P. subcapitata for assessing the quality of aquaculture intake (P = 0.030) and output (P = 0.039). No stimulatory effects were observed during 2019 unlike >50% rates experienced the previous year. These observations coincided with changes in climatic conditions whereby the 2018 period experienced extended levels of drought; whereas non-drought conditions were observed during 2019. Findings suggest that reliance upon traditional monitoring techniques may not provide sufficient robustness or versatility to address emerging issues, such as extremes in climate variance, which may influence the future intensive sustainability of freshwater aquaculture. This research supports the complementary use of P. subcapitata as a rapid and simple early-warning bioindicator for measuring aquaculture output quality on receiving aquatic ecosystems.

Novel use of peatlands as future locations for the sustainable intensification of freshwater aquaculture production - A case study from the Republic of Ireland.

There has been an increasing interest in enhancing freshwater aquaculture processes without hindering the progress of the Water Framework Directive. This constitutes the first study to describe a new concept in integrated multitrophic aquaculture (IMTA) that uses cutaway peatlands (bogs) to farm rainbow trout and Eurasian perch with associated organic status that is powered by wind energy and utilizes algae and duckweed to treat rearing water. Approximately 5% of Ireland comprises bogs that support natural ecosystems where there is a pressing need to develop alternative innovation to that of burning peat in order to reduce Ireland's carbon emissions. Specifically, this study evaluates water quality from this new IMTA where intake and terminal holding tank samples were evaluated from May to August 2019. Physicochemical parameters (temperature, pH, nitrogen, phosphorus, oxygen, suspended solids, hardness and alkalinity), and ecotoxicological bioassays (Pseudokirchneriella subcapitata and Daphnia pulex), were used to investigate the potential effects that introducing aquaculture processes may have on peatlands. Nitrite (P < 0.001), nitrate (P = 0.016), and chemical oxygen demand (P = 0.011), were the only physicochemical parameters that differed significantly between the intake and holding tank water indicating that water quality for the most part remained unchanged. Low levels of toxicity were observed between the bioassays suggested the introduction of the processes into the bog were unlikely to cause adverse effects on the ecosystem and the organisms therein. Observations were similar to or lower than those reported previously by other researchers for intensive flow-through aquaculture processes that discharge to receiving water. Findings from this study support the use of peatlands as future locations for integrated aquaculture processes.

Novel use of the alga Pseudokirchneriella subcapitata, as an early-warning indicator to identify climate change ambiguity in aquatic environments using freshwater finfish farming as a case study.

Aquaculture is one of the fastest growing food producing industries in the world. This dramatic increase in growth has raised many environmental concerns. Evaluation of fish farm effluent is frequently assessed by physicochemical parameters. This approach indicates potential degradation caused by the effluent and not cumulative effects on aquatic ecosystems. This study investigated relationships between physicochemical parameters (temperature, pH, conductivity, nitrogen, phosphorus, oxygen and suspended solids), typically used to assess water quality with the Pseudokirchneriella subcapitata algal bioassay, which evaluated the potential ecotoxicological effects that freshwater fish farm effluent has on its receiving ecosystems and organisms. Influent and effluent samples were collected from a freshwater farm facility every two weeks from April 2018 to October 2018 in the Republic of Ireland. This monitoring period coincided with one of the warmest and driest periods recorded by meteorological stations in the Republic of Ireland. Physicochemical analyses were found to be similar to those in other farm studies. After exposure of algae to the effluent, stimulation of algal growth rates increased by >50%. This stimulation was observed during periods of increased temperatures which were as a result of heat wave and drought conditions experienced during monitoring. Correlation studies identified a moderately strong relationship between algal stimulation and temperature (r = -0.619). This study discovered that removal of Lemna minor (aquatic plant), impacted strongly on the freshwater farm pond-process to cope with nitrates. The constructed wetland system was unable to efficiently treat nitrates and phosphates during conditions of drought. These findings indicate that standard water quality parameters may not be applicable to inform appropriate suitability of fish farm effluent for discharge to receiving water. The research conducted in this study has suggested a potential toolbox that includes P. subcapitata may provide an early warning system for adverse effects as a result of climate change.

Cost and outcome of behavioural activation versus cognitive behaviour therapy for depression (COBRA): study protocol for a randomised controlled trial.

BACKGROUND: Cognitive behaviour therapy (CBT) is an effective treatment for depression. However, CBT is a complex therapy that requires highly trained and qualified practitioners, and its scalability is therefore limited by the costs of training and employing sufficient therapists to meet demand. Behavioural activation (BA) is a psychological treatment for depression that may be an effective alternative to CBT and, because it is simpler, might also be delivered by less highly trained and specialised mental health workers. METHODS/DESIGN: COBRA is a two-arm, non-inferiority, patient-level randomised controlled trial, including clinical, economic, and process evaluations comparing CBT delivered by highly trained professional therapists to BA delivered by junior professional or para-professional mental health workers to establish whether the clinical effectiveness of BA is non-inferior to CBT and if BA is cost effective compared to CBT. Four hundred and forty patients with major depressive disorder will be recruited through screening in primary care. We will analyse for non-inferiority in per-protocol and intention-to-treat populations. Our primary outcome will be severity of depression symptoms (Patient Health Questionnaire-9) at 12 months follow-up. Secondary outcomes will be clinically significant change and severity of depression at 18 months, and anxiety (General Anxiety Disorder-7 questionnaire) and health-related quality of life (Short-Form Health Survey-36) at 12 and 18 months. Our economic evaluation will take the United Kingdom National Health Service/Personal Social Services perspective to include costs of the interventions, health and social care services used, plus productivity losses. Cost-effectiveness will explored in terms of quality-adjusted life years using the EuroQol-5D measure of health-related quality of life. DISCUSSION: The clinical and economic outcomes of this trial will provide the evidence to help policy makers, clinicians and guideline developers decide on the merits of including BA as a first-line treatment of depression. TRIAL REGISTRATION: Current Controlled Trials ISRCTN27473954.

The effect of low-dye taping on rearfoot motion and plantar pressure during the stance phase of gait.

BACKGROUND: Low-dye (LD) taping is commonly used to reduce rearfoot pronation. No studies have previously investigated the effectiveness of LD taping using both plantar pressure distribution (F-Scan) and 3-D (CODA) analysis of rearfoot motion. METHODS: 20 healthy subjects with a navicular drop test exceeding 10 mm participated in the study. T tests were used to determine whether significant (p < 0.05) differences in plantar pressure and rearfoot motion occurred with LD taping. RESULTS: LD taping resulted in statistically significant increases in peak plantar pressure in the lateral midfoot (p = 0.000), along with significant decreases in pressure in the medial forefoot (p = 0.014), and the medial (p = 0.000) and lateral hindfoot (p = 0.007). No significant changes occurred in the medial midfoot (p = 0.794) or lateral forefoot (p = 0.654). When assessed using motion analysis, taping resulted in a statistically significant decrease in rearfoot pronation (p = 0.006), supination (p = 0.025) and total rearfoot range of motion (p = 0.000). The mean rearfoot position during stance was not significantly different however (p = 0.188). CONCLUSION: LD taping is associated with alterations in peak plantar pressure in the midfoot and forefoot that indicate reduced pronation with LD taping. However, LD taping appears to reduce both pronation and supination in the rearfoot, rather than simply reducing pronation, when assessed using 3D motion analysis. Therefore, it would appear that LD taping does indeed reduce pronation, by restricting rearfoot motion in general, rather than pronation specifically. The degree of change observed with LD taping was however very small, and further research is needed to clarify the clinical significance of these initial findings.