The Energy-Water-Food Nexus.

As the global population grows in size and increasingly lives in cities, and with lifestyles based on greater material consumption, more attention is being given to the integrated system that supplies our energy, water, and food, the Nexus. There is also mounting concern about effects on the Nexus of climate change and damage to the natural environment that provides essential ecosystem services. Nexus analysis applies existing techniques, such as computational modelling and Life Cycle Assessment, but new frameworks and tools are needed, including those that will integrate societal and technical dimensions. Case studies show the vital role played by stakeholder involvement in clarifying issues, priorities, and values. They also demonstrate the importance of an integrated systems view of the complex interrelationships of the Nexus when planning effective remedies. Assessments conclude that transformative social and political change is needed to create new structures, markets, and governance to deal with the Nexus if we are to meet agreed-upon sustainable development goals.

The effect of structure directing agents on the ordering of fluoride ions in pure silica MFI zeolites.

The effect of different sizes of structure directing agents on the ordering of the fluoride ions in pure silica MFI zeolites has been determined using magic angle spinning solid state NMR. By synthesizing fluoride containing pure silica MFI zeolites using methyltributylammonium cations as the structure directing agent, it has been possible to change the type of ordering seen for the fluoride ions at room temperature from the previously reported dynamic to static disorder. An initial mechanism for how this fluoride ordering occurs is suggested based upon the coulombic interaction between the positive charge on the nitrogen and the negative fluoride ion, within the zeolite framework, with different sizes of tetraalkylammonium cations.

A novel perovskite based catalyst with high selectivity and activity for partial oxidation of methane for fuel cell applications.

Solid oxide fuel cells (SOFCs) have the potential to revolutionise the present fuel economy due to their higher fuel conversion efficiency compared with standard heat engines and the possibility of utilizing the heat produced in a combined heat and power system. One of the reasons they have yet to fulfil this potential is that the conventional anode material of choice, a nickel/yttria-stabilised zirconia cermet, requires a high temperature production process and under operating conditions is susceptible to carbon and sulphur poisoning. Perovskite-based materials have been proposed as potential anode materials for SOFCs due to their potentially high electronic conductivity and catalytic properties. One of the problems in realizing this potential has been their low catalytic activity towards methane reforming compared to conventional nickel based cermet materials. A nickel doped strontium zirconate material produced by low temperature hydrothermal synthesis is described which has high activity for methane reforming and high selectivity towards partial oxidation of methane as opposed to total oxidation products. Initial studies show a very low level of carbon formation which does not increase over time.

A methodology for the sustainability assessment of arsenic mitigation technology for drinking water.

In this paper we show how the process analysis method (PAM) can be applied to assess the sustainability of options to mitigate arsenic in drinking water in rural India. Stakeholder perspectives, gathered from a fieldwork survey of 933 households in West Bengal in 2012 played a significant role in this assessment. This research found that the 'most important' issues as specified by the technology users are cost, trust, distance from their home to the clean water source (an indicator of convenience), and understanding the health effects of arsenic. We show that utilisation of a technology is related to levels of trust and confidence in a community, making use of a composite trust-confidence indicator. Measures to improve trust between community and organisers of mitigation projects, and to raise confidence in technology and also in fair costing, would help to promote successful deployment of appropriate technology. Attitudes to cost revealed in the surveys are related to the low value placed on arsenic-free water, as also found by other investigators, consistent with a lack of public awareness about the arsenic problem. It is suggested that increased awareness might change attitudes to arsenic-rich waste and its disposal protocols. This waste is often currently discarded in an uncontrolled manner in the local environment, giving rise to the possibility of point-source recontamination.

Intensive care-management at home: an alternative to institutional care?

BACKGROUND: Care management and assessment of need are the cornerstones of the community care reforms in the UK. Although much of the research base has been on highly vulnerable older people, in practice, care management has been implemented for a wider group. OBJECTIVE: To examine how intensive care-management at home has developed. DESIGN: Postal survey of all local authority social services departments in England. METHOD: We used an overview questionnaire (85% response) and an old-age services questionnaire (77% response). We classified local authorities according to the presence or absence of seven indicators of intensive care management at home. RESULTS: 97% of social services departments had a goal of providing a community-based alternative to residential and nursing-home care. However, only 5% had specialist intensive care-management services for older people. Other key indicators of intensive care-management, such as devolved budgets, health service care managers, small caseloads and clear eligibility criteria, were uncommon. CONCLUSIONS: There was little evidence of intensive care-management at home in older peoples' services. This is of concern, given the move towards community-based provision for frail older people. Closer links between secondary health-care services (such as geriatric medicine) and intensive care-management at home may promote more effective care at home for those who are most vulnerable.

Residential and nursing home care of elderly people with cognitive impairment: prevalence, mortality and costs.

Cognitive impairment among residents has considerable resource implications for both individuals and those responsible for publicly funded care. Two linked surveys were carried out in England: (1) a longitudinal study followed 2500 admissions to publicly funded care up to 42 months after admission; and (2) a cross-sectional survey of 618 homes collected information about 11,900 residents. Information was collected about cognitive impairment using the Minimum Data Set Cognitive Performance Scale. Cognitive impairment was associated with source of funding and type of home. Although level of cognitive impairment has some effect, fees and costs were most influenced by type of home. At the same level of impairment, self-funded residents were more likely to be located in relatively low-cost settings than publicly funded residents. In independent homes fees were lower for publicly funded than for self-funded residents. Overall median length of stay of publicly funded admissions was 18 months. For the most part length of stay was not associated with level of cognitive impairment on admission. It is concluded that more information is needed about the effect of quality of care on people with cognitive impairment in different settings. If the same quality of care can be achieved in residential and nursing homes, the evidence would suggest that changes in placement policies could result in potential savings to the public purse.

Care management and the care programme approach: towards integration in old age mental health services.

OBJECTIVE: To examine the relationship between care management arrangements and the Care Programme Approach (CPA) in the context of old age mental health services and, particularly, dementia services. METHOD: The information reported is from a national study of care management arrangements, funded by the Department of Health. A response rate of 77% was obtained from local authority social services departments. RESULTS: In old age mental health services over half of the respondents reported joint screening arrangements for health and social care, almost four-fifths reported both joint criteria for the allocation of key workers and a clear definition of monitoring responsibilities. Of the latter over two-fifths were reported as being the same in care management and the CPA. Forty-six per cent of respondents provided a specialist service for people with dementia. Three-fifths of respondents reported that they did not apply CPA to people with dementia who were in receipt of care management or did so in less than 20% of cases. Where the CPA was applied it was more likely that a priority would be accorded to care management. A quarter of respondents reported the shared use of assessment documentation for people with dementia. DISCUSSION: The findings are set in the context of service developments to date and the implementation of the two systems of community based coordinated care for older people with mental health problems. Inter-authority variations are noted and the potential for greater service integration within the current legislative framework assessed.

Emerging models of care management for older people and those with mental health problems in the United Kingdom.

Care management has emerged as a central component in the development of community-based care in many countries. It has been government policy for providers of social services to develop care management systems in the United Kingdom since 1993. This paper examines the extent to which it is possible to begin to discern models of care from the different care management arrangements which are now emerging. First, the background to changes in policy and the role of care management in the UK social care system are discussed; second, evidence from the early phases of care management development in the UK is also examined; and third, based upon the pilot phase of a major national study of care management, the key dimensions of variation in care management through which models may be constituted are identified.

An evaluation of an alternative to long-stay hospital care for frail elderly patients: I. The model of care.

Recent UK government policy has advocated the development of case management to provide more coordinated care at home for vulnerable people. This paper describes a service model whereby case managers, with devolved budgets, employed by the social services department, were located in a geriatric multidisciplinary team to provide an alternative for patients requiring long-stay hospital care. As well as co-ordinating packages of care, case managers were responsible for deploying the time of home care assistants, multi-purpose workers who assisted health care staff and undertook home help tasks. The role of case managers within the multidisciplinary team is explained and the tasks undertaken by home care assistants are identified. Home care assistants undertook a wider range of activities than either home helps or nurses, covering both personal and domestic care tasks.

An evaluation of an alternative to long-stay hospital care for frail elderly patients: II. Costs and effectiveness.

This paper provides the main findings of an evaluation of a service to provide alternative care at home for patients receiving long-stay hospital care. Elderly people receiving the service were compared with a group of similar patients in an adjacent health district. The paper presents data on length of time at home and in hospital, changes in quality of life and care of elderly people, and effects upon informal carers for the two groups. Elderly people receiving community-based care had a higher quality of life, and there was no evidence of greater stress upon their carers. The community-based service, although it involved extra costs to the social services department, had lower costs for the health service and society as a whole than long-stay hospital provision. It is concluded that the model of care can effectively integrate the new approach of case management into an existing geriatric multidisciplinary team.