Dementia is one of the fastest growing diseases in Australia. General practitioners (GPs) are at the forefront of dementia diagnosis and management. However, the disease is complex and this can prevent timely diagnosis. A recent initiative in the Grampians region, Victoria, is addressing some of these challenges through a comprehensive, intuitive, online tool.
The aim of this article is to describe the process of developing and reasons for implementing the Dementia Pathways Tool, in the Grampians region, Victoria.
Designed in collaboration with GPs and practice nurses, the Dementia Pathways Tool promotes awareness of the first signs of dementia. It offers an informed approach to diagnosis, referral and ongoing management of people with the symptoms of dementia. This Tool provides practitioners – irrespective of their practice location – with access to an intuitive, online web-based repository of information. The Tool is publicly available and therefore accessible to all practitioners and the general public. Initial indications from statistics of the website are positive, but an evaluation will help inform the potential for broader applications of this Tool in the future.
The issue: dementia in Australia
Dementia is one of the fastest growing diseases in Australia. In 2013, 322,000 Australians were diagnosed with a dementia-related disease. The prevalence is expected to increase fourfold by 2050.1 Dementia has recently been listed as a national health priority area and a National Framework for Action on Dementia 2014–2018 is currently in development.2 The anticipated impact of the disease will have significant ramifications for Australia’s future health systems.3
General practitioners integral to dementia care
Dementia care in Australia is largely delivered by primary healthcare practitioners and general practitioners (GPs) have an essential role in the early identification of symptoms, of diagnosis in association with specialist support and in ongoing management. However, detecting and diagnosing dementia is complicated, as it does not have a unique set of presenting symptoms; this can lead to delays in prompt diagnosis.4–6 Other factors reported by GPs, including uncertainty of diagnosis, limited consultation times, denial of symptoms and distress by patients and families, may also reduce detection of the disease,7 leading to a significant time lag between symptom onset and diagnosis.6
In rural areas, where access to specialist dementia services is limited, primary health practitioners are integral to dementia diagnosis, ongoing patient support and management.8 However, GPs may experience difficulties with diagnosing dementia and in understanding the referral pathways for treatment and support. Currently, a ‘case-finding’ approach to diagnosis and ongoing care of patients with dementia ‘which involves assessing only those with symptoms or signs such as lost prescriptions and missed appointments, or other behaviours mentioned by family members…and others’9 resides with GPs through access to current information about the disease and use of suitable tools and assessments.9–11
The Australian Government’s Living Longer. Living Better initiative4 advocates that GPs and other health professionals should have greater access to training and education programs, to assist them with timely diagnosis of dementia.
An online resource is one method by which GPs can access current information about diseases, treatment and diagnosis. Knowledge-based repositories are easily updated and provide wide access to vast sources of information. Despite a dearth of research examining GPs’ usage of online resources, the limited international research indicates that the internet is increasingly used by physicians to access health information (including online medical information searches, use of electronic healthcare records and electronic transfer of patient records)12 and has broad appeal for sourcing reliable and relevant documents to assist with day-to-day medical practice.13 However, caution is required when using online resources – and for the online developers – in considering e-health communications that are interoperable, easy to use, engaging, accessible and accurate.14
The Dementia Pathways Project in the Grampians
In 2012, extensive consultation with GPs and practice nurses across the Grampians region identified that there was an incomplete understanding of available dementia services in the region. There were no localised pathways to assist primary health practitioners with diagnosis, timely referral to specialist services for further investigation of dementia or local support options pre/post-diagnosis.
These outcomes prompted the Dementia Pathways project, aimed at providing primary health practitioners (primarily GPs and practice nurses) with access to online information to assist with diagnosis, referral and ongoing management of patients with dementia (or presenting with the symptoms of dementia) in accordance with evidence-based guidelines to local support services.
Developing the online knowledge repository about dementia for the Grampians
The Grampians is an area of 48,000 km2 that is largely rural but incorporates the larger regional service centres of Ballarat, Ararat, Stawell and Horsham. The population is approximately 223,000 and 14% are aged 65–84 years (compared with the state average of 12.1%).15 Approximately 354 GPs work within the region.16
An online repository for information and knowledge management was chosen above other ‘traditional’ methods of information as it enables large amounts of information, from multiple, reputable sources to be accessed via the internet. Online information is also available for GPs (who have internet access) across a diverse geographic region.
Another advantage of presenting information via an online repository is the capacity to quickly and efficiently update information. This is especially important given the dynamic nature of information now available and the increasing involvement of private, philanthropic and voluntary providers within the health service system. A similar tool for GP mental health care support has previously been implemented in the Grampians region and was found to be an important resource for accessing mental health information for GPs and allied health professionals.17 Some of the features of this earlier project helped inform the Dementia Pathways Tool, although the Dementia Pathways Tool was enhanced by the support and contributions of stakeholders during the design and development and content of the Tool.
Staged development of the Dementia Pathways Tool
Partner organisations for the Dementia Pathways project included:
- Department of Health (Grampians) and project funder
- Grampians Medicare Local
- Federation University Australia’s Centre for eResearch and Digital Innovation (CeRDI).
The regional dementia project officer guided the project and adopted an inclusive management approach involving wide consultation with stakeholders. Subsequent development of the Dementia Pathways Tool comprised five stages, each building on the previous stage, requiring commitment to input in the development to successfully achieve the required outcomes. These stages are outlined in Table 1.
Table 1. The stages comprising the development of the Dementia Pathways Tool
Staged development of website
Stage and focus
Stage 1: Identifying the barriers to dementia diagnosis for GPs in the Grampians.
Extensive consultation of health service providers in the region was achieved through a survey that was developed in consultation with GPs, practice nurses and other health service providers.
The barriers in the Grampians to dementia diagnosis and management were identified as: incomplete understanding of available dementia services in the region; no localised pathways to assist primary health practitioners with diagnosis, timely referral to specialist services for further investigation of dementia, and local support options pre/post-diagnosis.
Stage 2: Steering the project.
A steering group (n = 12) was established comprising ‘stakeholders’; GPs and practice nurses.
The steering group met regularly and identified their preferences for visual display and presentation; navigational/pathway flow (and ease of use of online resource); website features, and content (prioritising what information was required about dementia, diagnosis, management, relevance of content, amount of information).
Discussion about the content of the Pathways Tool with the steering group was prompted by a series of scenarios and associated questions about doctor-patient consultations for dementia. Examples of other web-based dementia navigation tools from Australia and overseas were also presented to stakeholders to identify particular preferences for the display and content.
Stakeholders prioritised the content to be included in the Tool: clinical and management knowledge-base and tools; evidence-based guidelines and consultation checklists; screening tools, links to local dementia resources and services and referral options.
Stage 3: Provision of expert advice on the content of the Tool
Expert advice on the content for the Dementia Pathways Tool was provided by a Consultant Physician in Geriatric Medicine. Essential content, including national and international resources, was sourced.
Content for the Tool included: pathways for local referrals and supports; local resources; recommended assessments; investigation and review of cognitive decline (including key decision points for specialist referral or continued assessment/support); contact details about local support services for patients and carers; information about advance care plans.
Stage 4: Developing the Tool:
An interactive web-based tool was designed and developed following input at Stages 1–3.
Key features of the Tool:
- A split-screen and toggle menu to facilitate navigation of the Tool and enable access to relevant information via five key menu options (Awareness and recognition of significant symptoms; Diagnosis; Ongoing management and care; Palliative and end-of-life care; Family support). Users can access the menu items (located on the left of the split screen) through a pathway that branches out into successive, secondary menu items (See Figure 1 for example).
- A comprehensive keyword search and expandable information layers to provide additional options to search and retrieve specific content. Users can navigate quickly through the pathway using the menu items as a logical guide.
- Additional features of the website include: an interactive pathways map; a support tool and service directory of local contacts; referral pathways; links to other resources and websites; embedded assessment tools; and resource pages (includes MBS items).
Stage 5: Trial and launch of the Tool
Steering group members were invited to review the online Dementia Pathways Tool and provide feedback on all components of the Tool, including the visual display, pathway flow (consistency, ease of navigation), and content (relevance, language, sufficiency of information).
Feedback during the trial period enabled further changes and improvements to the Tool prior to its official launch in August 2013.
Informal, anecdotal feedback from steering group members during the trialling of the pathways was positive (‘The pathway software and information are absolutely brilliant’; ‘It is excellent’).
The Tool is available on the Grampians Medicare Local website: http://www.grampiansml.com.au/dpp/
|Figure 1. Dementia Pathways Tool menu, ‘Diagnosis’ page
Local uptake of the Dementia Pathways Tool
Preliminary feedback and visitor statistics to the website in the 9 months since the launch of the Dementia Pathways Tool have been positive. The number of page views has been constant, averaging approximately 500 page views per month since its launch in August 2013. The average time visitors spent on each page was 2 minutes and 6 seconds, and just under half of the recorded page views (1900) were of the main Dementia Pathway Tool content pages.
Other frequently visited pages included how to use the tool, assessment tools, project background, useful links, Medicare Benefits Schedule items and types of dementia.
Broader practice benefits
Although the Dementia Pathways Tool was designed and developed specifically for practitioners in the Grampians region and contains a host of local resources, the website has much broader appeal. As a publically accessible resource it offers all GPs and health professionals a web-based repository of dementia-related information, tools and resources to guide and enhance current assessment and referral practices.
This resource now enables dementia diagnosis to be made over a number of months, allowing the process to be broken into steps that are manageable within the primary care setting. The Tool facilitates informed management of the complexities and identified barriers to dementia diagnosis.
Furthermore, the quality of content, presentation and style has value for a range of other audiences (patients and carers), while the functionality of the Tool has the potential to be adapted for use in other areas of health, such as for cancer or diabetes, or with other mental health initiatives.
The provision of online information to support health providers within the practice setting should complement rather than supersede the knowledge of qualified and experienced health professionals about disease diagnosis and management.
The literature suggests that for many practitioners, including GPs in rural settings, barriers exist that limit timely diagnosis and affect ongoing management of dementia.5,7 The challenge of this project was to develop a tool that could address some of these identified barriers by consolidating knowledge through an internet tool that aids professionals’ development and practice.
Online support tools offer a means of gaining disease-specific and localised referral pathways that meet the needs of health professionals, irrespective of geographic location, and may overcome some of the barriers in dementia diagnosis for GPs in rural and regional areas.7,10,13 The Dementia Pathways Tool provides information about region-specific, specialist dementia services and supports, together with current, accurate and relevant information about dementia to assist GPs in their practice, providing information to aid in assessment and diagnosis, referral, management and ongoing care. Access to an intuitive, online resource may also address the time restraints that some rural practitioners have identified as limiting their capacity to detect dementia.7
The next stage in the continued development of this Tool is to conduct a formal evaluation. This is now being planned using qualitative and quantitative data collection methods that will provide insights into the use of the Tool within the rural and regional practice setting and to identify how GPs and practice nurses access and use this online repository.
Alison Ollerenshaw MAppSc, DipPM, Grad Dip AppSc (Prof Psychology), BA, Research Fellow, Centre for eResearch and Digital Innovation, Federation University Australia, Ballarat, VIC. email@example.com
Competing interests: None.
Provenance and peer review: Not commissioned, externally peer reviewed.
The author wishes to acknowledge the support received from staff at each of the partner organisations collaborating on this project. Particular thanks are extended to Carolyn Gargiulo (Department of Health, Grampians), Associate Professor Mark Yates (Deakin University and CDAMS, Ballarat Health Services), Heather Campbell (Grampians Medicare Local) and Dr Helen Thompson (Centre for eResearch and Digital Innovation, Federation University Australia) for ongoing support throughout this project and in providing valuable feedback on the development of this manuscript.
- Australian Institute of Health and Welfare. Dementia. Canberra: AIHW, 2015. Available at www.aihw.gov.au/dementia/ [Accessed 14 January 2014].
- Australian Government, Department of Social Services. Ageing and Aged Care. Dementia. Canberra: Commonwealth of Australia, 2015. Available at www.dss.gov.au/our-responsibilities/ageing-and-aged-care/older-people-their-families-and-carers/dementia [Accessed 7 May 2015].
- Access Economics. Keeping dementia front of mind: incidence and prevalence 2009–2050. Available at www.fightdementia.org.au/common/files/NAT/20090800_Nat__AE_FullKeepDemFrontMind.pdf [Accessed 5 February 2014].
- Australian Government. Living Longer. Living Better. Canberra: Commonwealth of Australia, 2012. Available at www.flexiliving.org.au/files/2012/07/D0769-Living-Longer-Living-Better-SCREEN-070512.pdf [Accessed 7 May 2015].
- Alzheimer’s Australia. Early diagnosis of dementia. Canberra: Alzheimer’s Australia, 2010. Available at www.fightdementia.org.au/understanding-dementia/early-diagnosis-of-dementia.aspx [Accessed 8 January 2014].
- Phillips J, Pond D, Goode SM. Timely diagnosis of dementia. Can we do better? A Report for Alzheimer’s Australia. Paper 24. Canberra: Alzheimer’s Australia, 2011. Available at www.fightdementia.org.au/common/files/NAT/Timely_Diagnosis_Can_we_do_better.pdf [Accessed 8 May 2014].
- Greenway-Crombie A, Snow P, Disler P, Davis S, Pond D. Influence of rurality on diagnosing dementia in Australian general practice. Aust J Prim Health 2012;18:178–84.
- Szymczynsk P, Innes A, Mason A, Stark C. A review of diagnostic process and diagnostic support for people with dementia in rural areas. J Prim Care Community Health 2011;2:262–76.
- Pond D. Dementia – an update on management. Aust Fam Physician 2012;41:936–39.
- Parliament of Australia. House of Representatives Committee. Thinking Ahead. Report on the Inquiry into dementia: early diagnosis and intervention. Canberra: Commonwealth of Australia, 2013. Available at www.aph.gov.au/Parliamentary_Business/Committees/House_of_Representatives_Committees?url=haa/dementia/report.htm [Accessed 8 May 2014].
- Yates M, Pond D. The dementia pathways. Australian Doctor 2012 14 September;31–33.
- Ortega Egea JM, Gonzále MV, Menéndez MR. eHealth usage patterns of European general practitioners: a five-year (2002–2007) comparative study. Int J Med Inform 2010;79:539–53.
- Bernard E, Arnould M, Saint-Lary O, Duhot D, Hebbrecht G. Internet use for information seeking in clinical practice: A cross-sectional survey among French general practitioners. Int J Med Inform 2012;81:493–99.
- Kreps GL, Neuhauser L. New directions in eHealth communication: opportunities and challenges. Patient Educ Couns 2010;78:329–36.
- Victoria Government Department of Health. 2012 Regional Health Status Profile Grampians Region. Melbourne: State of Victoria, 2013. Available at docs.health.vic.gov.au/docs/doc/2012-Regional-Health-Status-Profile-Grampians-Region [Accessed 7 May 2015].
- Grampians Medicare Local. Community needs analysis report 2013. Available at www.grampiansml.com.au/cb_pages/files/needsanalysissummary.pdf [27 April 2015].
- Ollerenshaw A. Internet tool box for rural GPs to access mental health services information. Rural Remote Health 2009;9:1094.

Tá an díomhaoin ar cheann de na galair is mó a fhásann san Astráil. Tá cógairí ginearálta (GPs) ar thús cadhnaíochta i ndiagnosis agus i mbainistíocht na díomhaoin. Mar sin féin, tá an galar casta agus d'fhéadfadh sé seo diagnóis tráthúil a chosc. Tá tionscnamh le déanaí i réigiún Grampians, Victoria, ag tabhairt aghaidh ar chuid de na dúshláin seo trí uirlis chuimsitheach, intuitive, ar líne.
Is é is aidhm don alt seo cur síos a dhéanamh ar an bpróiseas chun an uirlis um Chonair Dementia a fhorbairt agus na cúiseanna leis an uirlis a chur i bhfeidhm, i réigiún Grampians, Victoria.
Dearadh i gcomhar le GPs agus altraí cleachtais, cuireann an uirlis 'Conair Dementia' feasacht ar na chéad chomharthaí de dhéimnithe. Cuireann sé cur chuige eolasach ar fáil maidir le diagnóis, atreorú agus bainistíocht leanúnach daoine a bhfuil comharthaí na néaltrú orthu. Soláthraíonn an uirlis seo rochtain do chleachtóirí  gan beann ar a suíomh cleachtais  ar stór faisnéise intuitive, ar líne bunaithe ar an ngréasán. Tá an uirlis ar fáil go poiblí agus dá bhrí sin tá sé inrochtana ag gach cleachtóir agus ag an bpobal i gcoitinne. Tá na táscairí tosaigh ó staitisticí an láithreáin ghréasáin dearfach, ach cabhróidh meastóireacht le faisnéis a fháil maidir le féidearthacht le haghaidh iarratais níos leithne ar an Uirlis seo sa todhchaí.
An cheist: an díomhaoin san Astráil
Tá an díomhaoin ar cheann de na galair is mó a fhásann san Astráil. In 2013, rinneadh 322,000 Astrálach a dhiagnóisiú le galar a bhaineann le díomhaoin. Táthar ag súil go méadóidh an forleithne ceithre huaire faoi 2050.1 Tá an díomhaoin liostaithe le déanaí mar réimse tosaíochta sláinte náisiúnta agus tá Creat Náisiúnta um Gníomhaíocht maidir le Díomhaoin 2014-2018 á fhorbairt faoi láthair.2 Beidh iarmhairtí suntasacha ag tionchar réamh-mheasta na galair ar chórais sláinte na hAstráile sa todhchaí.3
Dochtúirí ginearálta mar chuid lárnach de chúram na dímheolachta
Tá cúram na meabhair-chúis san Astráil á chur ar fáil go mór ag cleachtóirí cúraim sláinte bunscoile agus tá ról ríthábhachtach ag na lianna ginearálta i bhfiosrú luath na hairíonna, i gidiagnóis i gcomhar le tacaíocht speisialtóra agus i mbainistíocht leanúnach. Tá sé deacair, áfach, tinneas na meabhair-chinne a bhrath agus a dhiagnóisiú, toisc nach bhfuil sraith uathúil comharthaí aige; d'fhéadfadh sé seo moill a chur ar dhiagnóisiú luath.46 D'fhéadfadh fachtóirí eile a thuairiscigh GPs, lena n-áirítear éiginnteacht an dhiagnóis, amanna comhairliúcháin teoranta, diúltú na hairíonna agus géarchéim ag othair agus teaghlaigh, cur le bhrath na galair,7 rud a fhágann go bhfuil moill suntasach ama idir thús na hairíonna agus an diagnóis.6
I gceantair thuaithe, áit a bhfuil rochtain teoranta ar sheirbhísí speisialaithe dímaint, tá cleachtóirí sláinte bunscoile mar chuid lárnach de dhiagnóisíocht dímaint, tacaíocht leanúnach do othair agus bainistíocht.8 Mar sin féin, d'fhéadfadh deacrachtaí a bheith ag na gcleachtóirí ginearálta le diagnóisíocht dímaint agus le tuiscint a fháil ar na bealaí atreoraithe le haghaidh cóireála agus tacaíochta. Faoi láthair, tá cur chuige "cás-aimsiú" le diagnóis agus cúram leanúnach othair le tinneas na meabhair-chinne a bhaineann le measúnú a dhéanamh ar dhaoine a bhfuil comharthaí nó comharthaí acu, amhail oideas caillte agus coinneálacha caillte, nó iompar eile a luaigh baill teaghlaigh...agus daoine eile 9 ag na gPleighis Ghinearálta trí rochtain a fháil ar fhaisnéis reatha faoin ngalar agus úsáid a bhaint as uirlisí agus measúnuithe oiriúnacha.911
Tá an Rialtas Astrálach ag maireachtáil níos faide. Tá an tionscnamh Living Better4 ag moladh go mbeadh rochtain níos fearr ag GPs agus gairmithe sláinte eile ar chláir oiliúna agus oideachais, chun cabhrú leo diagnóisíocht tráthúil a dhéanamh ar dhímheas.
Is bealach amháin é acmhainn ar líne trína bhféadann GPs rochtain a fháil ar fhaisnéis reatha faoi ghalair, cóireáil agus diagnóis. Tá stórálacha eolais-bhunaithe in ann iad a nuashonrú go héasca agus cuireann siad rochtain leathan ar fhoinsí ollmhóra faisnéise ar fáil. In ainneoin easpa taighde a dhéanann scrúdú ar úsáid GPs ar acmhainní ar líne, léiríonn an taighde idirnáisiúnta teoranta go n-úsáideann lianna an Idirlíon go méadaithe chun rochtain a fháil ar fhaisnéis sláinte (lena n-áirítear cuardach faisnéise leighis ar líne, úsáid taifid leictreonacha cúraim sláinte agus aistrithe leictreonacha taifid othair) 12 agus tá achomharc leathan ann chun doiciméid iontaofa agus ábhartha a fháil chun cuidiú le cleachtas leighis laethúil.13 Mar sin féin, is gá a bheith cúramach agus acmhainní ar líne á n-úsáid  agus do na forbróirí ar líne  agus cumarsáidí e-shláinte atá idir-inoibritheach, éasca le húsáid, tarraingteach, inrochtana agus cruinn á n-athrú.14
Tionscadal na Bealaí um Dhímheas sna Grampians
I 2012, baineadh amach i gcomhairliúchán fairsing le GPs agus le hoibritheacha cleachtais ar fud réigiún Grampians nach raibh tuiscint iomlán ann ar sheirbhísí díomhaoin atá ar fáil sa réigiún. Ní raibh aon bhealaí áitiúla ann chun cuidiú le cleachtóirí sláinte bunscoile le diagnóis, atreorú tráthúil chuig seirbhísí speisialaithe chun tuilleadh imscrúdaithe a dhéanamh ar dhéimncití nó roghanna tacaíochta áitiúla roimh/tar éis an diagnóis.
Ba é an toradh sin a spreag an tionscadal Dementia Pathways, a bhí dírithe ar rochtain ar fhaisnéis ar líne a chur ar fáil do chleachtóirí sláinte bunscoile (le dochtúirí ginearálta agus altraí cleachtais go príomha) chun cuidiú le diagnóis, atreorú agus bainistiú leanúnach othair a bhfuil díomhaoin orthu (nó a bhfuil comharthaí díomhaoin orthu) de réir treoirlínte bunaithe ar fhianaise do sheirbhísí tacaíochta áitiúla.
An stór eolais ar líne maidir le tinneas na meabhair-chinne a fhorbairt do na Grampians
Is limistéar 48,000 km2 é na Grampians atá go mór i gceantar tuaithe ach ina bhfuil na hionaid seirbhíse réigiúnacha níos mó de Ballarat, Ararat, Stawell agus Horsham. Tá thart ar 223,000 duine ina gcónaí sa réigiún agus tá 14% 65-84 bliain d'aois (i gcomparáid le meán na stáit de 12.1%).15 Tá thart ar 354 GPs ag obair sa réigiún.16
Roghnaíodh stór ar líne le haghaidh bainistíochta faisnéise agus eolais thar mhodhanna eile traditúrtha faisnéise toisc go gcuireann sé ar chumas méideanna móra faisnéise, ó fhoinsí ilbhliantúla, measúla, a rochtain tríd an idirlíon. Tá faisnéis ar líne ar fáil freisin do GPs (a bhfuil rochtain acu ar an idirlíon) ar fud réigiún geografach éagsúil.
Is buntáiste eile é faisnéis a chur i láthair trí stór ar líne ná an cumas faisnéis a nuashonrú go tapa agus go héifeachtach. Tá sé seo tábhachtach go háirithe i bhfianaise nádúr dinimiciúil na faisnéise atá ar fáil anois agus rannpháirtíocht mhéadaithe soláthraithe príobháideacha, filantrópacha agus deonacha laistigh den chóras seirbhíse sláinte. Cuireadh uirlis den chineál céanna chun tacú le cúram sláinte meabhrach do GCannaisigh Ginearálta i bhfeidhm roimhe sin i réigiún na Grampians agus fuarthas gur acmhainn thábhachtach é chun rochtain a fháil ar fhaisnéis shláinte mheabhrach do GCannaisigh Ginearálta agus do ghairmithe sláinte comhghuaillíochta.17 Cabhraigh cuid de ghnéithe an tionscadail roimhe seo le hIonstraim Bealaí an Duineas a chur ar fáil, cé gur feabhsaíodh an Ionstraim Bealaí an Duineas trí thacaíocht agus ranníocaíochtaí na bpáirtithe leasmhara le linn dearadh agus forbairt agus ábhar an Ionstraime.
Forbairt chéimithe ar an uirlis um Chonair Diminsaíochta
I measc na n-eagraíochtaí comhpháirtíochta don tionscadal 'Sligheanna Dementia' bhí:
- Roinn Sláinte (Grampians) agus maoinitheoir tionscadail
- Grampians Medicare Áitiúil
- Ionad um E-Taighde agus Nuálaíocht Dhigiteach (CeRDI) Ollscoil na hAstráile.
Bhí an t-oifigeach tionscadail réigiúnach um dhímheas ag treorú an tionscadail agus ghlac sé cur chuige bainistíochta cuimsitheach a raibh comhairliúchán leathan le páirtithe leasmhara ann. Bhí cúig chéim ag forbairt an uirlis um Chonair Dementia ina dhiaidh sin, agus bhí gach céim ag tógáil ar an gcéim roimhe sin, rud a éilíonn tiomantas a thabhairt don fhorbairt chun na torthaí riachtanacha a bhaint amach go rathúil. Tá na céimeanna seo leagtha amach i dTábla 1.
Tábla 1. Na céimeanna a chuimsíonn forbairt an uirlis um Chonair Dementia
Forbairt chéimithe ar shuíomh gréasáin
Céim agus fócas
Céim 1: Na bacainní a shainaithint chun diagnóis dhímheasa a dhéanamh do GPs sna Grampians.
Rinneadh comhairliúchán fairsing le soláthraithe seirbhísí sláinte sa réigiún trí shuirbhé a forbraíodh i gcomhairle le GPs, altraí cleachtais agus soláthraithe seirbhísí sláinte eile.
Aithníodh na bacainní sna Grampians maidir le diagnóis agus bainistíocht díomhaoin mar: tuiscint neamhiomlán ar sheirbhísí díomhaoin atá ar fáil sa réigiún; gan bealaí áitiúla chun cuidiú le cleachtóirí sláinte bunscoile le diagnóis, atreorú tráthúil chuig seirbhísí speisialtóireachta chun tuilleadh imscrúdaithe a dhéanamh ar díomhaoin, agus roghanna tacaíochta áitiúla roimh/tar éis an diagnóis.
Céim 2: Stiúradh an tionscadail.
Bunaíodh grúpa stiúrtha (n = 12) ina raibh "pháirtithe leasmhara"; GPs agus altraí cleachtais.
Tháinig an grúpa stiúrtha le chéile go rialta agus shainaithin siad a gcuid roghanna maidir le taispeáint agus cur i láthair amhairc; sreabhadh na loingseoireachta/chonair (agus éascaíocht úsáide acmhainne ar líne); gnéithe láithreán gréasáin, agus ábhar (a chur ar thús cén fhaisnéis a bhí ag teastáil faoi dhímheas, diagnóis, bainistíocht, ábharthacht an ábhair, méid na faisnéise).
Bhí roinnt cásanna agus ceisteanna gaolmhara faoi chomhairliúcháin idir dochtúir agus othar le haghaidh díomhaoin mar thús le plé leis an ngrúpa stiúrtha maidir le hábhar an uirlis Pathways. Cuireadh samplaí d'uirlisí nascleanúna dhímheasa eile ar an ngréasán ó Astráil agus thar lear i láthair do pháirtithe leasmhara chun roghanna ar leith a aithint don taispeáint agus don ábhar.
D'aistrigh páirtithe leasmhara an t-ábhar a bheidh le cur san Uirlis ar thús cadhnaíochta: bonn eolais agus uirlisí cliniciúla agus bainistíochta; treoirlínte bunaithe ar fhianaise agus seiceálacha comhairliúcháin; uirlisí scagála, naisc le hacmhainní agus seirbhísí díomhaoin áitiúla agus roghanna atreoraithe.
Céim 3: Treoir a sholáthar maidir le hábhar an Uirlis
Thug Dochtúir Comhairleach i Leigheas Geriatric comhairle saineolach ar ábhar an Dlí-Scrúdaithe Dementia. Baineadh ábhar riachtanach, lena n-áirítear acmhainní náisiúnta agus idirnáisiúnta, as.
Áirítear ar ábhar an uirlis: cosáin le haghaidh atreoruithe agus tacaíochtaí áitiúla; acmhainní áitiúla; measúnuithe molta; imscrúdú agus athbhreithniú ar laghdú cognaíoch (lena n-áirítear príomhphointí cinnidh le haghaidh atreoruithe speisialtóra nó measúnú/tacaíocht leanúnach); sonraí teagmhála faoi sheirbhísí tacaíochta áitiúla d'othair agus do chúramóirí; faisnéis faoi phleananna cúraim réamhbhunaithe.
Céim 4: An uirlis a fhorbairt:
Dearadh agus forbraíodh uirlis idirghníomhach ar líne tar éis a d'aontaíodh ag Céimeanna 13.
Príomhghnéithe an Uirlis:
- Roghchlár scáileáin roinnte agus toghla chun nascleanúint an Uirlis a éascú agus rochtain a thabhairt ar fhaisnéis ábhartha trí chúig phríomhroghchlár rogha (Féachaint agus aitheantas comharthaí suntasacha; Diagnosis; Bainistíocht agus cúram leanúnach; Cúram pailiatúil agus deireadh saoil; Tacaíocht do theaghlaigh). Is féidir le húsáideoirí rochtain a fháil ar na míreanna roghchlár (a bhfuil suite ar chlé den scáileán scoilte) trí shlí a bhrainseann amach i míreanna roghchlár iarmhartacha, tánaisteach (Féach Fíor 1 mar shampla).
- Cuardach cuimsitheach focal-riachtanach agus sraitheanna faisnéise in-leathnaithe chun roghanna breise a sholáthar chun ábhar ar leith a chuardach agus a aisghabháil. Is féidir le húsáideoirí dul go tapa tríd an mbealach ag baint úsáide as míreanna an roghchlár mar threoir loighciúil.
- Áirítear le gnéithe breise an láithreáin ghréasáin: léarscáil idirghníomhach bealaí; uirlis tacaíochta agus clár seirbhíse teagmhálacha áitiúla; bealaí atreoraithe; naisc le hacmhainní agus le suíomhanna gréasáin eile; uirlisí measúnaithe luite; agus leathanaigh acmhainní (lena n-áirítear míreanna MBS).
Céim 5: Triail agus seoladh na hIonstraime
Tugadh cuireadh do bhaill an ghrúpa stiúrtha athbhreithniú a dhéanamh ar an uirlis ar líne um Chonair Dementia agus aiseolas a thabhairt ar chomhpháirteanna uile an uirlis, lena n-áirítear an taispeáint amhairc, sreabhadh an chonair (comhleanúnacht, éascaíocht na loingseoireachta), agus ábhar (ábharthacht, teanga, leordhóthanacht na faisnéise).
Ba cheart an t-údarás inniúil a bheith in ann an t-eolas a fháil a bhaineann le hionstraimí a chur ar fáil don phobal agus a chur ar fáil don phobal i gcomhréir le hAirteagal 5 de Rialachán (AE) Uimh.
Bhí aiseolas neamhfhoirmiúil, an-scríobh ó bhaill an ghrúpa stiúrtha le linn thrialaithe na mbealaí dearfach (Tá bogearraí agus faisnéis na bealaí iontach iontach; Tá sé den scoth).
Tá an uirlis ar fáil ar shuíomh gréasáin Grampians Medicare Local: http://www.grampiansml.com.au/dpp/
Fíor 1. Bealaí na dímheolais Menu uirlisí, leathanach Diagnóis
An t-Ionad um Chonair Dementia a Fheidhmiú go hIonadach
Tá na réamh-aiseolas agus staitisticí cuairteoirí ar an suíomh gréasáin i rith na 9 mhí ó seoladh an uirlis um Chonair Dementia dearfach. Tá líon na bhfeictear leathanaigh seasmhach, ar an meán thart ar 500 leathanach amharc in aghaidh na míosa ó seoladh é i mí Lúnasa 2013. Ba é an meán-am a chaith cuairteoirí ar gach leathanach 2 nóiméad agus 6 soicind, agus bhí beagán faoi leath na n-amharc leathanaigh taifeadta (1900) ar na príomh-leathanaigh ábhar Dímheas Pathway Tool.
I measc na leathanaigh eile a thugtar cuairt orthu go minic bhí conas an uirlis a úsáid, uirlisí measúnaithe, cúlra tionscadail, naisc úsáideacha, míreanna Scéim Sochair Medicare agus cineálacha dementia.
Buntáistí praiticiúla níos leithne
Cé gur dearadh agus gur forbraíodh an Fhoirm um Chonair Dementia go sonrach do chleachtóirí i réigiún na Grampians agus go bhfuil go leor acmhainní áitiúla ann, tá tarraingt i bhfad níos leithne ag an suíomh Gréasáin. Mar acmhainn atá inrochtana go poiblí, cuireann sé stór ar líne de fhaisnéis, uirlisí agus acmhainní a bhaineann le damáiste ciallmhar ar fáil do gach GC agus do ghairmithe sláinte chun treoir a thabhairt do chleachtais reatha measúnaithe agus atreoraithe agus chun iad a fheabhsú.
Is féidir leis an acmhainn seo diagnóis dhímheasa a dhéanamh thar roinnt míonna, rud a ligeann don phróiseas a bhriseadh ina chéimeanna is féidir a bhainistiú laistigh de shuíomh na cúraim bhunúsach. Éascaíonn an uirlis bainistiú eolasach ar na castachtaí agus na bacainní a shainaithnítear maidir le diagnóis dhímheasa.
Ina theannta sin, tá luach ag cáilíocht an ábhair, an chur i láthair agus an stíl do raon lucht féachana eile (othair agus cúramóirí), agus tá acmhainn ag feidhmiúlacht an uirlis a oiriúnú le húsáid i réimsí eile sláinte, amhail le haghaidh ailse nó diaibéiteas, nó le tionscnaimh eile meabhairshláinte.
Ba cheart go gcuirfeadh soláthar faisnéise ar líne chun tacú le soláthraithe sláinte laistigh den chreat cleachtais eolais ghairmiúil oilte agus taithíithe sláinte maidir le diagnóis agus bainistíocht galar i gcomharc le chéile seachas a chur ina ionad.
Tugann an litríocht le fios go bhfuil bacainní ann do go leor cleachtóirí, lena n-áirítear GPs i suíomhanna tuaithe, a chuireann teorainn le diagnóis tráthúil agus a dhéanann difear do bhainistiú leanúnach na himníochta.5,7 Ba é dúshlán an tionscadail seo uirlis a fhorbairt a d'fhéadfadh aghaidh a thabhairt ar chuid de na bacainní sainaitheanta seo trí eolas a chomhdhlúthú trí uirlis idirlín a chabhraíonn le forbairt agus cleachtas na gairmithe.
Cuireann uirlisí tacaíochta ar líne bealach ar fáil chun bealaí atreoraithe a fháil a bhaineann go sonrach le galar agus a bhaineann go háitiúil agus a chomhlíonann riachtanais ghairmithe sláinte, is cuma cén áit geografach a bhfuil siad, agus d'fhéadfadh siad roinnt de na bacainní a shárú maidir le diagnóis dementia a dhéanamh ar GPs i gceantair thuaithe agus réigiúnacha.7,10,13 Soláthraíonn an uirlis Bealaí Dementia faisnéis faoi sheirbhísí agus tacaíochtaí dementia speisialtóireachta a bhaineann go sonrach le réigiún, mar aon le faisnéis reatha, cruinn agus ábhartha faoi dhímheas chun cabhrú le GPs ina ngníomhaíocht, ag soláthar faisnéise chun cuidiú le diagnóis agus measúnú, atreorú, bainistíocht agus cúram leanúnach. D'fhéadfadh rochtain ar acmhainn intuitive, ar líne dul i ngleic leis na srianta ama a d'aithin roinnt cleachtóirí tuaithe mar theorannú ar a gcumas chun damáiste a bhrath.7
Is é an chéad chéim eile i bhforbairt leanúnach an Uirlis seo meastóireacht fhoirmiúil a dhéanamh. Tá sé beartaithe anois é sin a dhéanamh trí mhodhanna bailíochta agus cainníochtúla a bhailiú a thabharfaidh léargas ar úsáid an uirlis i gcomhthéacs na cleachtais tuaithe agus réigiúnacha agus a shainaithneoidh conas a rachaidh do gcleachtóirí ginearálta agus do na hoibrithe altraí cleachtais ar an stór ar líne seo agus a úsáidfidh siad é.
Alison Ollerenshaw MAppSc, DipPM, Grad Dip AppSc (Prof Psychology), BA, Comhalta Taighde, Ionad um E-Taighde agus Nuálaíocht Dhigiteach, Ollscoil na hAstráile, Ballarat, VIC. email@example.com
Úinéirí:
Provenance and peer review: Ní dhéantar é a choimisiúnú, déantar athbhreithniú seachtrach ar an ábhar.
Ba mhaith leis an údar an tacaíocht a fuair sé ó fhoireann gach ceann de na heagraíochtaí comhpháirtíochta a d'oibrigh sa tionscadal seo a aithint. Go háirithe, ba mhaith liom buíochas a ghabháil le Carolyn Gargiulo (Roinne Sláinte, Grampians), an tOllamh Comhlach Mark Yates (Ollscoil Deakin agus CDAMS, Seirbhísí Sláinte Ballarat), Heather Campbell (Grampians Medicare Local) agus an Dr Helen Thompson (Ionad um E-Taighde agus Nuálaíocht Dhigiteach, Ollscoil Chónaidhm na hAstráile) as a dtacaíocht leanúnach ar feadh an tionscadail agus as aiseolas luachmhar a chur ar fáil maidir le forbairt an lámhscríbhinní seo.
- Institiúid Sláinte agus Leasa na hAstráile. Dímheas. Canberra: AIHW, 2015. Ar fáil ag www.aihw.gov.au/dementia/ [Ar fáil 14 Eanáir 2014].
- Rialtas na hAstráile, Roinn na Seirbhísí Sóisialta. Ag dul in aois agus cúram aosach. Dímheas. Canberra: Comh-Rialtas na hAstráile, 2015. Ar fáil ag www.dss.gov.au/our-responsibilities/ageing-and-aged-care/older-people-their-families-and-carers/dementia [Accessed 7 May 2015].
- Geilleagar Rochtain. Ag coinneáil díomhaoin i gcuimhne: minicíocht agus forleithne 20092050. Ar fáil ag www.fightdementia.org.au/common/files/NAT/20090800_Nat__AE_FullKeepDemFrontMind.pdf [Ar fáil 5 Feabhra 2014].
- Rialtas na hAstráile. Ag maireachtáil níos faide. Beo níos fearr. Canberra: Comh-Rialtas na hAstráile, 2012. Tá sé ar fáil ag www.flexiliving.org.au/files/2012/07/D0769-Living-Longer-Living-Better-SCREEN-070512.pdf [Ar fáil an 7 Bealtaine 2015].
- Alzheimer's an Astráil. Dearadh luath ar dhéimhniú. Canberra: Alzheimer's Australia, 2010. Tá sé ar fáil ag www.fightdementia.org.au/understanding-dementia/early-diagnosis-of-dementia.aspx [Ar fáil ar 8 Eanáir 2014].
- Phillips J, Pond D, Goode SM. Diagnóis tráthúil ar dhéimhniú. An féidir linn níos fearr a dhéanamh? Tuarascáil do Alzheimer's Australia. Páipéar 24. Canberra: Alzheimer's Australia, 2011. Tá sé ar fáil ag www.fightdementia.org.au/common/files/NAT/Timely_Diagnosis_Can_we_do_better.pdf [Ar fáil 8 Bealtaine 2014].
- Greenway-Crombie A, Snow P, Disler P, Davis S, Pond D. Tionchar na tuaithe ar dhiagnóisiú na meabhair-chinnteachta i gcleachtas ginearálta na hAstráile. Aust J Prim Health 2012;18:17884.
- Szymczynsk P, Innes A, Mason A, Stark C. Athbhreithniú ar phróiseas diagnóiseachta agus tacaíocht diagnóiseachta do dhaoine le tinneas díomhaoin i gceantair thuaithe. J Prim Care Community Health 2011;2:26276.
- Pond D. Dementia  nuashonrú ar bhainistiú. Aust Fam Physician 2012;41:93639.
- Parlaimint na hAstráile. Coiste na dTeach Ionadaithe. Ag Smaoineamh Go Roimh-Aois. Tuarascáil ar an Suirbhé ar Dhímheas: diagnóis luath agus idirghabháil. Canberra: Comh-Rialtas na hAstráile, 2013. Ar fáil ag www.aph.gov.au/Parliamentary_Business/Committees/House_of_Representatives_Committees?url=haa/dementia/report.htm [Ar fáil 8 Bealtaine 2014].
- Yates M, Pond D. Na cosáin dhimmens. Dochtúir na hAstráile 2012 14 Meán Fómhair;3133.
- Ortega Egea JM, Gonzále MV, Menéndez MR. Patrúin úsáide eHealth i measc lianna ginearálta Eorpacha: staidéar comparáideach cúig bliana (20022007). Int J Med Inform 2010;79:53953.
- Bernard E, Arnould M, Saint-Lary O, Duhot D, Hebbrecht G. Úsáid Idirlín chun faisnéis a lorg i gcleachtas cliniciúil: Suirbhé tras-chroí i measc lianna ginearálta na Fraince. Int J Med Inform 2012;81:49399.
- Kreps GL, Neuhauser L. Treochtaí nua i gcumarsáid eHealth: deiseanna agus dúshláin. Counsel Oideachas Othar 2010;78:32936.
- Roinn Sláinte Rialtais Victoria. Próifíl Staidse Sláinte Réigiúnach 2012 Réigiún Grampians. Melbourne: Stát Victoria, 2013. Tá sé ar fáil ag docs.health.vic.gov.au/docs/doc/2012-Regional-Health-Status-Profile-Grampians-Region [Ar fáil an 7 Bealtaine 2015].
- Grampians Medicare Áitiúil. Tuarascáil ar Anailís Ar riachtanais an Chomhphobail 2013. Ar fáil ag www.grampiansml.com.au/cb_pages/files/needsanalysissummary.pdf [27 Aibreán 2015].
- Ollerenshaw A. Ciste uirlisí idirlín do GPs tuaithe chun rochtain a fháil ar fhaisnéis faoi sheirbhísí meabhairshláinte. Sláinte Iardheisceart na Tuaithe 2009;9:1094.


This post begins a short series about child-led weaning. What is it? Who does it? What are the common concerns and myths? The process of weaning — whether led by the child, the mother, a doctor, or society’s expectations — is an emotional, personal, and rather fascinating one.
Let’s start off with a discussion about these questions:
- Can a child self-wean under the age of one?
- What events are commonly misinterpreted as a desire to wean?
- Should a child be weaned under the age of one?
Yes, infants do wean before their first birthdays… all the time! In some countries (such as Norway), it’s not considered practical to continue breastfeeding after one year because that’s when parents return to work full-time, and so it’s virtually unheard of to breastfeed after this age. But in situations wherein children have more flexibility for self-weaning (child-led weaning), such as with a stay-at-home mother, will they do so at their own behest before the age of one? If they have stopped nursing, was it truly permanent self-weaning or was the refusal to breastfeed due to a nursing strike or other situational circumstance?
Child-led weaning means a child nurses until there’s no longer a nutritive or emotional need, as indicated by the child. An infant under the age of one should get virtually all of his nutrition from milk (human ideally, or formula), so he wouldn’t self-wean for nutritional reasons unless solids have become prioritized in his diet over milk (human milk does supply a valuable amount of nutrition after one year, however–please visit the “Medicine in Human Milk” section for more information.).
I highly recommend all articles by Katherine A. Dettwyler, PhD, who provides thoroughly researched insight into “The Natural Age of Weaning” from an anthropological standpoint. From this view, the natural weaning age for humans is biologically expected to be between 2.5-7 years old.
Imagine this: the minimum natural weaning age according to this range is actually considered slightly above the Western culture’s norm for a maximum! But biological evolution hasn’t caught up with our historically immature child-rearing routines yet. This is evidenced by the typical development and loss of milk teeth (baby teeth) and the timeline for maxillofacial muscle and jaw development, which may be abnormally compromised from the start by bottle-feeding. I do not mean to suggest deformity as a result of bottle-feeding; however, the link between bottle-feeding or being breastfed less than one year and the risk of needing braces is convincing (researchers at Johns Hopkins School of Public Health conducted a large study that showed the longer a child breastfeeds, the less likely the child will have misaligned teeth later on).
Priscilla Young Colletto discusses “nature’s norm” in “Beyond Toddlerhood: The Breastfeeding Relationship Continues”:
“[M]any primates wean their offspring when they are erupting their first permanent molars. First permanent molar eruption occurs around 5.5 to 6.0 years in modern humans. It is interesting to note that achievement of adult immune competence in humans also occurs at approximately six years of age, suggesting that throughout our recent evolutionary past, the active immunities provided by breast milk were normally available to the child until about this age…
Our evolutionary past has produced an organism that relies on breastfeeding to provide the context for physical, cognitive and emotional development. The non-human primate data suggest that human children are designed to receive all of the benefits of breast milk and breastfeeding for an absolute minimum of two and a half years, and an apparent upper limit of around seven years. Natural selection has favored those infants with a strong, genetically coded blueprint that programs them to expect nursing to continue for a number of years after birth and results in the urge to suckle remaining strong for this entire period.”
Often, it’s a decreased amount of time with the mother, the mother’s disinterest in continuing to breastfeed and possibly the projection of her feelings upon the child, a plan to quit for her own reasons, early prioritizing of solid foods, or most commonly a temporary nursing strike that is to blame for early cessation of nursing.
- Baby is easily distracted
- Decreased milk supply
- Eruption of teeth
- Increased focus on milestones/developmental periods
- Medications (maternal or child)
- Nursing strikes (see below for many examples)
- Overuse of pacifiers/bottles
- Premature or forceful introduction of solids
- Restricting nursing by over-scheduling
- Restricting nursing after returning to work
How long will you nurse your child? It’s totally up to you! Click here to find out the benefits your child has received if breastfed for a few days; 4-6 weeks; 3-6 months; 6 months; 9 months; a year or more.
Though a typical child won’t naturally self-wean under the age of one, that doesn’t mean you should force yourself to breastfeed for longer than you want if it conflicts with what’s truly best for you. It’s your body -– do what you are comfortable with. A child is better off with a mother who’s content with her decisions than one who’s outright miserable. There’s nothing to be ashamed about if you really want or need to wean. Any breast milk is better than no breast milk. Do what you can to provide the most breast milk you for the longest duration that you can. Babies need sane mamas, not crazies (for many mamas, breastfeeding keeps the crazies at bay -– for others, breastfeeding just simply IS crazy).
To make things easier, you can try taking advantage of a nursing strike (more on that below), or try the “don’t offer, don’t refuse” method. If you intend to mother-led wean, read this to learn how to do it with love. Weaning should always be done slowly (hence the word “wean” by definition), not abruptly–no matter the age of the child. Remember that mothers also benefit from following a natural weaning timeline, or at least a gradual one. Too-sudden weaning can contribute to maternal depression. If you must wean abruptly such as for medical reasons, you can find helpful advice here for coping with the often confusing, emotionally conflicting adjustment period that often occurs for both mother and child.
Links by Kelly Bonyata, BS, IBCLC of KellyMom:
There’s more useful information here than I could possibly paraphrase and give proper justice, so click around and explore them all.
Click here for more weaning resources on my page, including myths, tips, stories, and books.

Tosaíonn an post seo le sraith ghearr faoi dhíbhreathnú faoi stiúir leanaí. Cad é? Cé a dhéanann é? Cad iad na hábhair imní agus na miotais is coitianta? Is próiseas mothúchánach, pearsanta, agus suimiúil é an próiseas díghníomhaithe - cibé acu an leanbh, an mháthair, dochtúir nó ionchais an tsochaí a stiúrann é.
Tosaímid ag plé leis na ceisteanna seo:
- An féidir le leanbh féin-wean faoi aois a haon?
- Cad iad na himeachtaí a mheastar go minic mar mhian le díghlasáil?
- An chóir leanbh a weaned faoi aois a bliana?
Sea, déantar leanaí a fhéachaint roimh a gcéad lá breithe... an t-am ar fad! I roinnt tíortha (mar an Iorua), ní mheastar go bhfuil sé praiticiúil leanúint le beathú cíche tar éis bliana toisc go bhfuil sé sin nuair a fhilleann tuismitheoirí ar ais go dtí obair lánaimseartha, agus mar sin tá sé beagnach gan éisteacht le beathú cíche tar éis an aois seo. Ach i gcásanna ina bhfuil níos mó solúbthachta ag leanaí maidir le féin-fhiacha (fhiacha faoi stiúir an linbh), mar shampla le máthair a fhanann sa bhaile, an ndéanfaidh siad é sin de réir a n-eis féin roimh aois a bliana? Má stop siad le cothabháil, an raibh sé i ndáiríre mar gheall ar fhéin-fhuascailt buan nó an raibh an diúltú cothabháil a dhéanamh mar gheall ar stailc cothaitheora nó ar imthosca eile?
Ciallaíonn díghlasáil faoi stiúir an linbh go ndéantar leanbh a chothabháil go dtí nach bhfuil gá cothaitheach nó mothúchánach ann a thuilleadh, de réir mar a léiríonn an leanbh é. Ba chóir go bhfaigheadh leanbh faoi bhun bliana d'aois a chothú go léir ó bhainne (daonna go hidéalach, nó foirmle), mar sin ní dhéanfadh sé féin-fhuascailt ar chúiseanna cothaithe mura bhfuil tosaíocht tugtha do shoiléir ina réim bia thar bainne (tá bainne daonna ag soláthar méid luachmhar cothaithe tar éis bliana, áfach, tabhair cuairt ar an alt Medicine in Human Milk le haghaidh tuilleadh faisnéise. )
Molaim go mór gach alt a scríobh Katherine A. Dettwyler, PhD, a thugann léargas cuimsitheach ar an "The Natural Age of Weaning" ó thaobh anantrópaolaíochta de. Ón tuairim seo, táthar ag súil go mbeidh an aois nádúrtha fionnuar do dhaoine idir 2.5-7 bliana d'aois go bitheolaíoch.
Smaoinigh ar seo: meastar go bhfuil an aois íosta nádúrtha fhrithghínithe de réir an raon seo i ndáiríre beagán os cionn an uasteorainn atá ag an gcultúr Thiar! Ach ní raibh an éabhlóid bitheolaíoch tar éis teacht suas le ár gnáthamh leanaí a thógáil atá neamh-aosta go stairiúil go fóill. Léirítear é seo trí fhorbairt agus caillteanas tipiciúil fiacla bainne (fiacla na mban) agus an t-amlíne d'fhorbairt muscle maxillofacial agus an fhál, a d'fhéadfadh a bheith faoi chois neamhghnácha ón tús le bialann-tithíochta. Nílim ag iarraidh a rá go bhfuil míchruinn mar thoradh ar bhotella-feed; áfach, tá an nasc idir bhotella-feed nó a bheith ag seinm níos lú ná bliain amháin agus an baol go mbeidh braces ag teastáil ina luí (d'oibrigh taighdeoirí in Ollscoil Sláinte Poiblí Johns Hopkins staidéar mór a léirigh cé chomh fada agus a bheas leanbh ag seinm, is lú seans go mbeidh fiacla míshlíne ag an leanbh níos déanaí).
Phrísteann Priscilla Young Colletto "normaíocht an nádúr" i "Beyond Toddlerhood: The Breastfeeding Relationship Continues":
[M]athann go leor primates a gcuid sliocht nuair a bhíonn a gcéad molars buan á dtarraingt acu. Tarlaíonn an chéad éirí amach buan molar thart ar 5.5 go 6.0 bliain i ndaoine nua-aimseartha. Tá sé suimiúil a thabhairt faoi deara go dtarlaíonn cumas imdhíonachta aosach i ndaoine freisin ag thart ar sé bliana d'aois, rud a thugann le tuiscint go raibh na haimirceacha gníomhacha a sholáthraíonn bainne cíche ar fáil go gnáth don leanbh go dtí thart ar an aois seo ...
Tá ár n-am atá caite éabhlóideach tar éis orgánach a tháirgeadh a thacaíonn le beathú cíche chun an comhthéacs a sholáthar d'fhorbairt fhisiceach, cognaíoch agus mhothúchánach. Tugann na sonraí maidir le primates neamhdhaonna le tuiscint go bhfuil leanaí daonna deartha chun na buntáistí go léir a bhaineann le bainne cíche agus le beathú cíche a fháil ar feadh íosmhéid iomlán dhá bhliain go leith, agus teorainn uachtarach le feiceáil thart ar seacht mbliana. Tá rogha nádúrtha ag fabhraí na leanaí sin le bpleanphriont láidir, códaithe géiniteach a chláraíonn iad a bheith ag súil go leanfaidh an altranas ar feadh roinnt blianta tar éis an bhreith agus mar thoradh air sin fanann an t-éileamh ar chothú láidir don tréimhse iomlán seo.
Is minic a bhíonn sé mar gheall ar laghdú ar an am a chaitear leis an máthair, ar neamhshuim na máthair chun leanúint ar aghaidh ag cothú cíche agus b'fhéidir go bhfuil sí ag cur a mothúchán ar an leanbh, ar phlean chun stop a chur leis ar a cúiseanna féin, ar thosaíocht luath a thabhairt do bhia soladach, nó ar stailc sealadach na n-iníonacha is coitianta a bhíonn an chúis leis an scoirín a scor go luath.
- Tá an leanbh distracted go héasca
- Laghdú ar an soláthar bainne
- Éirthíocht fiacla
- Díriú níos mó ar chéimeanna/réimsí forbartha
- Leigheasanna (máthair nó leanbh)
- Stailc na n-iníon (féach thíos le haghaidh go leor samplaí)
- Tréimhseáil iomarcach
- Tógadh soladach roimh am nó le feabhas
- Srian a chur ar altranas trí ró-chlárú
- Teorann ar altranas tar éis dul ar ais go dtí an obair
Cé chomh fada is féidir leat do leanbh a chothú? Tá sé go hiomlán suas leat! Cliceáil anseo chun na buntáistí a fuair do leanbh má tá sé ag tabhairt cíche ar feadh cúpla lá; 4-6 seachtaine; 3-6 mhí; 6 mhí; 9 mhí; bliain nó níos mó a fháil amach.
Cé nach ndéanfaidh leanbh tipiciúil féin-fhuíogadh faoi bhun bliana d'aois, ní chiallaíonn sé sin gur chóir duit tú féin a chur iallach ar mháithreacht níos faide ná mar a theastaíonn uait más i gcontúirt é leis an rud is fearr duitse i ndáiríre. Is é do chorp - déan an rud is compordach leat. Tá leanbh níos fearr le máthair atá sásta lena chinntí ná le duine atá míshásta go hiomlán. Níl aon ní le náire a bheith ort má tá tú ag iarraidh nó ag teastáil go mór ó dheochanna a dhíol. Tá bainne cíche ar bith níos fearr ná gan bainne cíche ar bith. Déan an méid is féidir leat chun an bainne cíche is mó a sholáthar duit ar feadh an tréimhse is faide is féidir leat. Ní gá do na páistí máithreacha ciallmhar, ní máithreacha craiceáilte (do go leor máithreacha, coinníonn beathú cíche na mairteacha ar shiúl -  do dhaoine eile, is é an beathú cíche go simplí craiceáilte).
Chun rudaí a dhéanamh níos éasca, is féidir leat triail a bhaint as stailc na n-iníon (níos mó faoi sin thíos), nó triail a bhaint as an modh "ná tabhair, ná diúltaigh". Má tá sé ar intinn agat an t-imreoir a bheith ag tabhairt na breithe, léigh an t-alt seo chun foghlaim conas é a dhéanamh le grá. Ba cheart an t-easnamh a dhéanamh go mall i gcónaí (mar sin an focal "easnamh" de réir sainmhíniú), ní go tobann, is cuma cén aois atá ag an leanbh. Cuimhnigh go mbainfidh máithreacha leas freisin as a bheith ag leanúint amlíne nádúrtha na fíochta, nó ar a laghad amlíne céim ar chéim. D'fhéadfadh an t-easnamh ró-thráthúil cur le dúlagar na máthar. Má tá tú ag teastáil ó weaning go tobann mar shampla ar chúiseanna leighis, is féidir leat a fháil anseo comhairle cabhrach chun déileáil leis an tréimhse oiriúnaithe is minic mearbhall, mothúchánach a thitim go minic do mháthair agus leanbh araon.
Nascanna ag Kelly Bonyata, BS, IBCLC de KellyMom:
Tá níos mó faisnéise úsáideach anseo ná mar a d'fhéadfainn a athfhocail agus a thabhairt ceartas cuí, mar sin cliceáil timpeall agus iniúchadh a dhéanamh orthu go léir.
Cliceáil anseo le haghaidh níos mó acmhainní díghníomhaithe ar mo leathanach, lena n-áirítear miotais, leideanna, scéalta, agus leabhair.


Access to classified information is
|“||[t]he ability and opportunity to obtain knowledge of classified information. Persons have access to classified information if they are permitted to gain knowledge of the information or if they are in a place where they would be expected to gain such knowledge. Persons do not have access to classified information by being in a place where classified information is kept if security measures prevent them from gaining knowledge of the information.||”|
- A favorable determination of eligibility for access has been made by an agency head or the agency head's designee (i.e., the person has been granted an appropriate security clearance);
- The person has signed an approved non-disclosure agreement; and
- The person has a need-to-know the information.
- "Overview" section: U.S. National Intelligence: An Overview 2011, at 62.

Tá rochtain ar fhaisnéis rúnaicmithe
                                                                                Tá rochtain ag daoine ar fhaisnéis rúnaicmithe má cheadaítear dóibh eolas a fháil ar an bhfaisnéis nó má bhíonn siad in áit ina mbeifear ag súil go bhfaigheadh siad eolas den sórt sin. Ní féidir le daoine rochtain a fháil ar fhaisnéis rúnaicmithe trí bheith in áit ina gcoimeádtar faisnéis rúnaicmithe má chuireann bearta slándála cosc orthu eolas a fháil ar an bhfaisnéis.
- Tá cinneadh fabhrach déanta ag ceann gníomhaireachta nó ag duine a ainmníonn ceann na gníomhaireachta maidir le incháilitheacht le haghaidh rochtana (i.e. go bhfuil cead slándála iomchuí tugtha don duine);
- Tá comhaontú neamhfhoilsiú formheasta sínithe ag an duine; agus
- Tá gá ag an duine an fhaisnéis a fháil.
- Rannán "Tuairim: Fógraíocht Náisiúnta na Stát Aontaithe: Tuairim 2011, ag 62.


static syntax analysis
refers to debugging
that can be done via inspection of the code for a program, without actually running the program.
See Also edit
- static analyzers
- another list by Cameron Laird
- Brace-level pretty printer
- Statically verifying arithmetic and regular expressions
- AM 2007-08-18: an idea to check such various Tcl "sublanguages" as the arithmetic and regular expressions
- Source Code Comprehension Tools
- an older list
- Comparison of Static Tcl Code Validity Testers
- an comparison done circa 1997 by the developer of TclTutor.
Description editStatic syntax analysis
is the process of looking at a text file and attempting to identify errors, warnings, etc. from the text without executing the code. This is tricky to do in-depth because in an interpretive environment, programmers often make use of dynamic techniques for code generation, etc. These dynamic code fragments typically won't be evaluated during a static syntax sweep. Another short-coming, at least as far as procheck and frink go, is that they operate only on the source code specified on the command line. This means that calls to autoload
ed or source
d commands are treated as unknowns, unless the file in which they are defined was specified before
programmer will be familar with a program called lint
; this program provides static syntax analysis for C.
Analysing C edit
- open-source GUI frontent to source-code searching tools. Primarily designed to work with cscope, but also works with cs.
- logiscope c rulechecker
- a proprietary product that allows users to define and verify coding rules in Tcl
- is a new Constraint-Based Testing tool for verifying safety-critical C programs. By using a mixture of symbolic and numerical analyses (namely static single assignment form, constraint propagation, integer linear relaxation and search-based test data generation), it addresses three distinct applications in a single framework: structural test data generation, counter-example generation and partial program proving.
Euclide is written in Prolog
with a Tcl interface and a Tk GUI.
Analyzing Tcl edit
- source code formatter with syntax and style checking
- reads one or more Tcl scripts and checks them for correctness, conflicts and even a little style.
- reads one Tcl script and fixes indentation. Simplistic and open source.
- includes a syntax checker for Tcl and XOTcl code
- has a program called tclchecker that does static syntax
- a component of TclPro
- a macro system that can be used as a programmable SSA tool.
- appears to do at least some sorts of SSA [Does SoftGuard deserve its own page in the Wiki? I think so. Anyone familar with it? The web page mentions sgxCP profiling, sgxCT tracing, sgxDbg procedure debugging, sgxRSM resource standard metrics, and sgxTVC variable consistency testing]
- Source Navigator
- code-analysis and comprehention tool that provides a graphic framework for understanding and re-engineering large or complex software projects
- bracecheck, by Andreas Leitgeb
- a "mostly heuristic script ... which compares bracing with indentation ..."
- tclCheck, by Lindsay Marshall
- A very simple C program that carries out a sanity check for brackets and their nesting.
- advanced syntax checker for Tcl, TclOO, XOTcl, ITcl code with html generation.
- Count lines, find mismatched braces/quotes.
- A static analysis tool for Tcl 7.6 and Tk 4.2 programs.
- tcl_cruncher (download)
- transforms nice Tcl 7.x/TclX/Itcl sources into an ugly but faster standard output: it removes all unneeded white spaces, ; , all comments, etc... the result is unreadable, but can be twice as fast & as small than original. It can also be used to check syntax of your programs.
- [Rust] program that scans tcl for command injection.

anailís sintéise chobhsaitheach
tagraíonn sé do dhearbhuáil
Is féidir é sin a dhéanamh trí iniúchadh a dhéanamh ar chód clár, gan an clár a rith i ndáiríre.
Féach freisin Edit
- anailíséirí statacha
- liosta eile ag Cameron Laird
- Clódóir álainn ar leibhéal brace
- Fíorú staitistiúil arithmetic agus focail rialta
- AM 2007-08-18: smaoineamh chun seiceáil ar "fo-theangacha" Tcl éagsúla mar na hidirmheán agus na hidirfhocail rialta
- Uirlisí Tuiscint Cód Foinse
- liosta níos sine
- Comparáid le tástálaithe bailíochtaithe cód Tcl statach
- comparáid a rinne forbróir TclTutor timpeall 1997.
Cur síos editAnailís sintéise chobhsaí
Is é an próiseas chun breathnú ar chomhad téacs agus iarracht a dhéanamh earráidí, rabhaidh, srl. a aithint. ón téacs gan an cód a chur i gcrích. Tá sé seo deacair a dhéanamh go domhain toisc go mbíonn cláraitheoirí i dtimpeallacht léirmhínithe go minic ag baint úsáide as teicnící dinimiciúla chun cód a ghiniúint, etc. Ní dhéanfar na codanna dinimiciúla seo a mheas de ghnáth le linn scuab sintéise statach. Is é an t-easpa eile, ar a laghad chomh fada agus a théann procheck agus frink, nach n-oibríonn siad ach ar an gcód foinse a shonraítear ar an líne ordaithe. Ciallaíonn sé seo go glaonna chun autoload
foinse
d déileáiltear le horduithe mar neamhfhoirmeacha, mura sonraíodh an comhad ina ndéantar iad a shainiú roimhe sin
Beidh cláróir a bheith familiar le clár ar a dtugtar lint
; soláthraíonn an clár seo anailís sintéise statach do C.
Anailís a dhéanamh ar C edit
- GUI foinse oscailte a thabharfaidh aghaidh ar uirlisí cuardaigh cód foinse. Dearadh go príomha chun oibriú le cscope, ach oibríonn sé le cs freisin.
- logiscóp agus seiceálaí rialacha
- táirge dílseánaigh a ligeann d'úsáideoirí rialacha códaithe a shainiú agus a fhíorú i Tcl
- is uirlis nua tástála bunaithe ar shrian é chun cláir C atá criticiúil maidir le sábháilteacht a fhíorú. Trí mheascadh anailíseacha siombalacha agus uimhriúla a úsáid (ar a dtugtar foirm sannta aonair statach, leathnú srianta, scíth líneach iomlánach agus giniúint sonraí tástála bunaithe ar chuardach), déileálann sé le trí fheidhmchlár ar leith i gcreat amháin: giniúint sonraí tástála struchtúrtha, giniúint frithshampla agus dearadh clár páirteach.
Scríobhadh Euclid i Prolog
le comhéadan Tcl agus le GUI Tk.
Anailís a dhéanamh ar Tcl edit
- formáidóir cód foinse le seiceáil sintéise agus stíl
- léann sé scripte Tcl amháin nó níos mó agus seiceálann sé iad ar cheartas, ar choimhlintí agus fiú ar stíl bheag.
- léann sé scripte Tcl amháin agus socraíonn sé indentation. Simplistic agus foinse oscailte.
- cuimsíonn sé seiceálaí sintéise do chód Tcl agus XOTcl
- Tá clár ar a dtugtar tclchecker a dhéanann sintéise statach
- comhpháirt de TclPro
- córas macró a d'fhéadfaí a úsáid mar uirlis SSA in-chláraithe.
- is cosúil go ndéanann sé ar a laghad roinnt cineálacha SSA [An bhfuil SoftGuard i dteideal a leathanach féin sa Wiki? Sílim go bhfuil. An bhfuil aon duine ar eolas leis? Luaitear ar an leathanach gréasáin próifílú sgxCP, rianú sgxCT, debugging nós imeachta sgxDbg, tomhaisí caighdeánacha acmhainne sgxRSM, agus tástáil chomhsheasmhachta athromaitheach sgxTVC]
- Fhoinse Navigator
- uirlis anailíse cód agus tuiscint a sholáthraíonn creat grafach chun tionscadail bhrabhsálaí móra nó casta a thuiscint agus a ath-innealtóireacht
- bracecheck, ag Andreas Leitgeb
- "scripte heuristic den chuid is mó ... a dhéanann comparáid idir bracing agus indentation ... "
- tclCheck, ag Lindsay Marshall
- Clár C an-simplí a dhéanann seiceáil sanity do braicéid agus a n-inneall.
- seiceálaí sintéise chun cinn do chód Tcl, TclOO, XOTcl, ITcl le gineadh html.
- Líonanna a chomhaireamh, braces/cuótaí neamhthiománacha a aimsiú.
- uirlis anailíse statach do chláir Tcl 7.6 agus Tk 4.2.
- tcl_cruncher (luchtaigh)
- déanann sé foinsí Tcl 7.x/TclX/Itcl áille a athrú go toradh caighdeánach uafásach ach níos tapúla: baineann sé na spásanna bána gan gá, , , gach trácht, etc ... níl an toradh inléite, ach is féidir é a bheith dhá uair níos tapúla agus níos lú ná an bunaidh. Is féidir é a úsáid freisin chun sintéacs do chláir a sheiceáil.
- [Rust] clár a scanadh TCL le haghaidh instealladh ordaithe.


More horrendous news for the beleaguered elephant: Forest elephants, a sub-species of elephant living in an area that had been considered a sanctuary in the Central African country of Gabon, are rapidly being picked off by illegal poachers, who are primarily coming from the bordering country of Cameroon. More than 80 percent have been taken in a decade–a loss of about 25,000 elephants– researchers report in the February 20 issue of Current Biology.
“Because Gabon is thought to hold the largest remaining population of forest elephants, the implication is that forest elephants are in even more trouble than previously believed,” says John Poulsen of Duke University and the Agence Nationale des Parcs Nationaux in Gabon. “With less than 100,000 elephants across all of Central Africa, the subspecies is in danger of extinction if governments and conservation agencies do not act fast,” the assistant professor of tropical ecology at Duke’s Nicholas School of the Environment warned in a news release about the finding.
“We can no longer assume that apparently large and remote protected areas will conserve species–poachers will go anywhere that a profit can be made.” — John Poulsen of Duke University
“We can no longer assume that apparently large and remote protected areas will conserve species–poachers will go anywhere that a profit can be made,” Poulsen said. “A corollary of this is that cross-border poaching is a major threat to species protection, and bilateral and multilateral efforts are essential for conservation. Species cross borders, and so do poachers.”
According to the news statement:
The researchers estimated the number of elephants in the forest in 2014 using established methods based on surveys of elephant dung. They then compared population size estimates for the year 2014 to estimates that had been calculated in the same way in 2004.
Poulsen says they were not surprised to find that forest elephants had declined in recent years. But they were surprised to see that the forest elephants had suffered so much in just ten years’ time.
The researchers say the most important step to saving forest elephants is to reduce the demand for ivory.
“China’s recently announced ban of domestic ivory trade will help enormously, if it is effectively implemented,” he says. “The international community needs to put pressure on all remaining nations that allow the trade so that all legal trade is stopped. We need conservation funds and political will to put a stop to the slaughter.”
Recognizing Forest Elephants as a Distinct Species
The researchers also advocate for recognizing forest elephants as a distinct species, separate from African savanna elephants. Such a distinction is supported by genetic and morphological evidence and would help to draw attention to the forgotten forest elephants.
Despite the findings, Poulsen says he is optimistic that forest elephants will survive, although they will most likely exist only in restricted areas within well-protected national parks. Their decline will surely be felt throughout the forest and beyond.
“Elephants are ecosystem engineers that play major roles in seed dispersal, nutrient cycling, and browsing and damage to vegetation,” Poulsen says. “We have very little idea about how the removal of elephants from large extents of Central African forest is going to alter forest composition and structure, and thus the ecosystem services that the forests provide.”
Researchers from the National Parks Agency of Gabon, the University of South Florida, the Max Planck Institute for Ornithology, the World Wildlife Fund Central Africa Regional Program Office, Gabon’s Institute for Tropical Ecology Research, and the University of Stirling conducted the study with Poulsen. Duke-affiliated co-authors were Connie Clark, Amelia Meier, Cooper Rosin, Sarah Moore, Sally Koerner and Vincent Medjibe.
The 2004 and 2014 surveys used in the new study were funded by four agencies: the U.S. Fish and Wildlife Service, the World Wildlife Fund, the Wildlife Conservation Society, and the Convention on the International Trade in Endangered Species of Wild Fauna and Flora’s Monitoring the Illegal Killing of Elephants program.
CITATION: ”Poaching Empties Central African Wilderness of Forest Elephants,” John R. Poulsen, Sally E. Koerner, Sarah Moore, Vincent P. Medjibe, Stephen Blake, Connie J. Clark, Mark Ella Akou, Michael Fay, Amelia Meier, Joseph Okouyi, Cooper Rosen and Lee J.T. White; Current Biology; Feb. 20, 2017. DOI: 10.1016/j.cub.2017.01.023
Current Biology (@CurrentBiology, published by Cell Press, is a bimonthly journal that features papers across all areas of biology. Current Biology strives to foster communication across fields of biology, both by publishing important findings of general interest and through highly accessible front matter for non-specialists.
Blog post based on news materials provided by Current Biology and Duke University.
Related post: 11,000 Elephants Slaughtered in African Forest (by J. Michael Fay, 2013)

Tá níos mó nuacht uafásach don eilifint atá faoi bhagairt: Tá eilifintí foraoise, fo-chineál eilifint a chónaíonn i gceantar a measadh a bheith ina ionad coiscthe i dtír na hAfraice Láir Gabon, á dtáirgeadh go tapa ag sealgairí neamhdhleathacha, a thagann go príomha ó thír theoranta na Camaróin. Tá níos mó ná 80 faoin gcéad tógtha le deich mbliana - caillteanas de thart ar 25,000 fíon - a thuairiscigh taighdeoirí i dtionól Feabhra 20 de Current Biology.
"Toisc go meastar go bhfuil an daonra is mó de na fíl foraoise fágtha ag Gabon, is é an tuiscint go bhfuil fíl foraoise i bhfadhb níos mó ná mar a chreidtear roimhe seo", a deir John Poulsen ó Ollscoil Duke agus an Agence Nationale des Parcs Nationaux i Gabon. "Le níos lú ná 100,000 elephant ar fud na hAfraice Láir, tá an fho-chineál i mbaol a extinction más rud é go rialtais agus gníomhaireachtaí caomhnaithe nach gníomhú go tapa",An t-aidhmeannach ollamh na heicil thrópaiceach ag Duke Nicholas Scoil na Comhshaoil rabhadh i nuachtlitir faoi an teacht.
Ní féidir linn a thuilleadh a mheas go mbeidh limistéir chosanta mór agus iargúlta cosanta speicis a chaomhnú  rachaidh bracairí in áit ar bith is féidir brabús a dhéanamh.  John Poulsen ó Ollscoil Duke
Ní féidir linn a thuilleadh a mheas go mbeidh limistéir chosanta atá mór agus iargúlta go soiléir a chaomhnóidh speicis  rachaidh bracairí áit ar bith is féidir brabús a dhéanamh,  dúirt Poulsen. Is é an corollair seo ná go bhfuil an bracaíocht trasteorann ina bhagairt mhór ar chosaint speicis, agus tá iarrachtaí déthaobhacha agus iltaobhacha ríthábhachtach chun iad a chaomhnú. Tá speicis ag trasnú teorainneacha, agus tá an oiread sin ag sealgairí.
De réir na ráiteas nuachta:
Rinne na taighdeoirí meastachán ar líon na n-eilifint sa choille in 2014 ag baint úsáide as modhanna bunaithe ar suirbhéanna ar dhroim na n-eilifint. Tá an méid sin i gcomhréir le prionsabal na hIarratas a rinneadh i dtaca le hIarscríbhinn II a ghabhann leis an Rialachán seo.
Deir Poulsen nach raibh ionadh orthu a fháil amach go raibh laghdú tagtha ar eilifintí foraoise le blianta beaga anuas. Ach bhí iontas orthu a fheiceáil go raibh an oiread sin fulaingt tagtha ar na fíl foraoise i gceann deich mbliana amháin.
Deir na taighdeoirí gurb é an chéim is tábhachtaí chun elephants foraoise a shábháil ná an t-éileamh ar iora a laghdú.
"Cuideoidh toirmeasc a d'fhógair an tSín ar thrádáil intíre na fíonchaora go mór, má chuirtear i bhfeidhm go héifeachtach é", a deir sé. Caithfear brú a chur ar an bpobal idirnáisiúnta ar na náisiúin eile go léir a cheadaíonn an trádáil ionas go stopfar gach trádáil dhlíthiúil. Tá cistí caomhnaithe agus toil pholaitiúil ag teastáil uainn chun deireadh a chur leis an mbás.
Aithint na n-eilifintí foraoise mar speiceas ar leith
Tacaíonn na taighdeoirí freisin le heilifintí foraoise a aithint mar speiceas ar leith, ar leithligh ó eilifintí savanna na hAfraice. Tacaíonn fianaise géiniteach agus mhorfolaíochta le difríocht den sórt sin agus cabhródh sé le aird a tharraingt ar na fílíní foraoise dearmadta.
In ainneoin na bhforais, deir Poulsen go bhfuil sé dóchasach go mairfidh elephants foraoise, cé go mbeidh siad ann is dóichí ach amháin i limistéir srianta laistigh de pháirceanna náisiúnta dea-chosaithe. Beidh a n-ionsaí cinnte a bhraitheann ar fud an fhoraois agus níos faide.
Is innealtóirí éiceachórais iad na fílíní a bhfuil ról mór acu i scaipeadh síolta, i rothlú cothaithigh, agus i mbrógáil agus i damáiste do fhéithíocht,  a deir Poulsen. Tá an-bheag tuairim againn faoi conas a dhéanfaidh an t-eilifint a bhaint as foraoisí móra na hAfraice Láir comhdhéanamh agus struchtúr na foraoisí a athrú, agus dá bhrí sin na seirbhísí éiceachórais a sholáthraíonn na foraoisí.
Rinne taighdeoirí ó Ghníomhaireacht Páirceanna Náisiúnta Gabon, Ollscoil Florida Theas, Institiúid Max Planck le haghaidh Ornithology, Oifig Clár Réigiúnach na hAfraice Lárnach an Chiste Domhnálaíochta Domhanda, Institiúid Taighde Éiceolaíochta Trópaiceach Gabon, agus Ollscoil Stirling an staidéar le Poulsen. Bhí Connie Clark, Amelia Meier, Cooper Rosin, Sarah Moore, Sally Koerner agus Vincent Medjibe mar chomh-údair atá cleamhnaithe le Duke.
Bhí ceithre ghníomhaireacht ag maoiniú na suirbhéanna 2004 agus 2014 a úsáideadh sa staidéar nua: Seirbhís Iascaigh agus Fiadhúlra, an Ciste Fiadhúlra Domhanda, an Cumann um Chaomhnú Fiadhúlra, agus an Coinbhinsiún maidir leis an Trádáil Idirnáisiúnta i Speicis i mbaol Fiadhúlra agus Floraí ag Monatóireacht ar an gclár marú mídhleathach na n-eilifint.
TITLE: Poaching Emties Central African Wilderness of Forest Elephants, John R. Poulsen, Sally E. Koerner, Sarah Moore, Vincent P. Medjibe, Stephen Blake, Connie J. Clark, Mark Ella Akou, Michael Fay, Amelia Meier, Joseph Okouyi, Cooper Rosen agus Lee J.T. Bán; Bithíocht reatha; Feabhra 20, 2017. DOI: 10.1016/j.cub.2017.01.023
Is iris dhá mhíle é Current Biology (@CurrentBiology, a fhoilsíonn Cell Press, a léiríonn páipéir ar fud gach réimse bitheolaíochta. Déanann Bithíocht reatha iarracht cumarsáid a chothú ar fud réimsí na bitheolaíochta, trí thorthaí tábhachtacha leasa ghinearálta a fhoilsiú agus trí ábhar tosaigh atá inrochtana go han-leathan do neamh-eolaithe.
Post blog bunaithe ar ábhair nuachta a sholáthraíonn Current Biology agus Ollscoil Duke.
Post gaolmhar: 11,000 Elephant Slaughtered in African Forest (de J. Michael Fay, 2013)


Tips from Other Journals
Assessing the Risk of Rupture with Intracranial Aneurysms
Am Fam Physician. 1999 Apr 15;59(8):2311-2312.
Intracranial aneurysms are relatively common in the United States, with a reported incidence of 0.2 to 10 percent of the population, or 10 million to 15 million persons. Most intracranial aneurysms do not rupture; therefore, the need for surgical management is controversial, because little is known about the natural history of these lesions and the risks associated with their repair. Investigators for the International Study of Unruptured Intracranial Aneurysms evaluated the risks associated with repair of unruptured aneurysms and also explained the natural history of this condition.
The study consisted of retrospective and prospective components. The purpose of the retrospective component was to describe the natural history of unruptured intracranial aneurysms. Inclusion criteria for this group encompassed patients who had at least one intracranial aneurysm, regardless of symptoms. Patients were also eligible if they had had a previous aneurysm at another site that spontaneously ruptured or was treated surgically. Patients with a traumatic or mycotic aneurysm or one that measured less than 2 mm were excluded from the study.
The purpose of the prospective component was to assess treatment-related morbidity and mortality in patients with newly diagnosed unruptured intracranial aneurysm. Inclusion criteria for this group were similar to those of the retrospective group, except that investigators decided whether to include patients with or without planned surgical or endovascular intervention in this component of the study.
All patients underwent cerebral angiography to identify the size, presence and location of the aneurysms. Follow-up was conducted with a variety of methods, including annual questionnaires, telephone interviews and chart reviews. End points of the study included the incidence of intracranial hemorrhage, stroke and death. In addition, evidence of surgery-related complications, such as neurologic deficits and mortality, was recorded for patients in the prospective group.
A total of 1,449 patients from centers in the United States, Canada and Europe made up the retrospective group. Mean patient age was 52 years, and approximately 75 percent of the patients were women. In this group, 1,085 patients had single aneurysms, and 364 had multiple lesions. Signs and symptoms that led to the diagnosis were, in order of frequency, headaches, ischemic cerebrovascular disease, cranial nerve deficits, aneurysmal mass effect, ill-defined spells, seizures, and subdural or intracerebral hemorrhage. Principal risk factors in this group included a history of hypertension and its treatment, and smoking. Thirty-two patients experienced confirmed ruptures during the 10-year follow-up. The two significant predictors of rupture were a lesion size greater than 10 mm and a location at the basilar tip or in the posterior cerebral distribution. In addition, patients with a history of rupture were about 11 times more likely to experience subsequent rupture than patients who had not had a previous rupture.
A total of 1,172 patients were enrolled in the prospective group. The clinical presentations that resulted in the diagnosis of aneurysms in these patients were similar to those in the retrospective group, as were the principal risk factors. Intracranial surgery was performed on 996 of these patients. Overall surgical morbidity and mortality were approximately 16 percent at 30 days and 15 percent at one year after surgery. These figures included a total of 34 deaths, of which 30 were related to the surgery. Age was the only independent predictor of a poor surgical outcome, with patients over 64 years of age having the worst outcome.
The authors conclude that for patients with no history of subarachnoid hemorrhage, the likelihood of rupture of a cerebral aneurysm less than 10 mm in size is extremely small. Patients with a history of subarachnoid hemorrhage were 11 times more likely to experience a rupture. Moreover, the risks of morbidity and mortality from surgical intervention exceed the risk of rupture in patients with small aneurysms even 7.5 years after diagnosis, with or without planned surgical or endovascular intervention.
The International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med. December 10, 1998;339:1725–33.
Copyright © 1999 by the American Academy of Family Physicians.
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Leideanna ó Irisí Eile
Measúnú ar an mbaol a bhaineann le briseadh le aneurysms intracranialacha
Tá mé i mo chónaí i gCathair na mBan. 1999 Apr 15;59(8):2311-2312.
Tá aneurysms intracranialacha coitianta go leor sna Stáit Aontaithe, agus tuairiscíodh go bhfuil 0.2 go 10 faoin gcéad den daonra, nó 10 milliún go 15 milliún duine, i gceist leo. Ní bhriseann an chuid is mó de na aneurysms intracranialacha; dá bhrí sin, tá an gá le bainistiú máinliachta conspóideach, toisc nach bhfuil mórán ar eolas faoi stair nádúrtha na léasaí seo agus na rioscaí a bhaineann lena n-athchóiriú. Rinne imscrúdaitheoirí don Staidéar Idirnáisiúnta ar Aneurysms Intracranial Unruptured meastóireacht ar na rioscaí a bhaineann le haisiú aneurysms unruptured agus mhínigh siad stair nádúrtha an choinníoll seo freisin.
Bhí comhpháirteanna aisghabhálacha agus ionchais sa staidéar. Ba é cuspóir an chomhpháirt athsheachadta stair nádúrtha aneurysms intracranialacha neamh-scríofa a thuairisciú. Cuimsíodh critéir chuimsiú don ghrúpa seo othair a raibh aneurysm intracranialach amháin ar a laghad acu, beag beann ar na hairíonna. Bhí othair incháilithe freisin má bhí aneurysm acu roimhe sin ag suíomh eile a bhris go spontáineach nó a ndearnadh cóireáil máinliachta orthu. Níor cuireadh othair a raibh aneurysm traumatic nó mycotic acu nó a bhí níos lú ná 2 mm ar a mhéid as an staidéar.
Ba é cuspóir an chomhpháirte ionchasach morbidity agus mortality a bhaineann le cóireáil a mheas i gcás othair a ndearnadh aneurysm intracranialach neamh- phlé a dhiagnóisiú le déanaí. Bhí critéir chuimsiú don ghrúpa seo cosúil leis na critéir a bhí ag an ngrúpa athsheachtrach, ach amháin gur chinn taighdeoirí cibé acu a chuimsiú othair le nó gan idirghabháil máinliachta nó endovascular pleanáilte sa chomhpháirt seo den staidéar.
Rinneadh angiografaíocht inchinn a dhéanamh ar gach othar chun méid, láithreacht agus suíomh na aneurysms a aithint. Rinneadh an t-athbhreithniú trí mhodhanna éagsúla, lena n-áirítear ceistneoirí bliantúla, agallaimh teileafóin agus athbhreithnithe ar chairt. I measc na pointí deiridh den staidéar bhí an t- imeacht de fhuil aistrithe intracranialach, stróc agus bás. Ina theannta sin, taifeadadh fianaise ar choimhlintí a bhaineann le máinliacht, mar shampla easnamh néarlógach agus básmhaireacht, do othair sa ghrúpa ionchais.
Bhí 1,449 othar san iomlán ó ionaid sna Stáit Aontaithe, i gCeanada agus san Eoraip sa ghrúpa athsheachtrach. Ba é 52 bliain d' aois an othair an meán, agus ba mhná thart ar 75 faoin gcéad de na hothair. Sa ghrúpa seo, bhí aneurysms aonair ag 1,085 othar, agus bhí léasaí ilbhliantúla ag 364. Ba iad na comharthaí agus na hairíonna a thug an diagnóis, in ord minicíochta, tinneas ceirbreacha iscaimiceach, easnamh néaróg cranial, éifeacht mais aneurysmal, spells neamhshainithe, coisithe, agus hemorrhage subdural nó intracerebral. I measc na bpríomhfhachtóirí riosca sa ghrúpa seo bhí hipertine sa stair agus a chóireáil, agus caitheamh tobac. Bhí sé dearbhaithe go raibh briseadh ag tríocha is dhá othar le linn na leanta 10- bliain. Ba iad an dá réamhaisnéisí suntasacha maidir le briseadh méid léasaí níos mó ná 10 mm agus suíomh ag an gcroílár basilar nó sa dáileadh inchinn iarmharach. Ina theannta sin, bhí seans 11 uair níos mó ag othair a raibh rothar acu i stair go mbeadh rothar ina dhiaidh sin acu ná othair nach raibh rothar acu roimhe sin.
Cuireadh 1, 172 othar san áireamh sa ghrúpa ionchais. Bhí na cur i láthair cliniciúil a d'fhág go ndearnadh diagnóis aneurysms sna hothair seo cosúil leis na cinn sa ghrúpa athsheiceáil, mar a bhí na príomhfhachtóirí riosca. Rinneadh máinliacht intracranialach ar 996 d' othair seo. Bhí an morbidity agus an mortality máinliachta i gcoitinne thart ar 16 faoin gcéad ag 30 lá agus 15 faoin gcéad ag bliain amháin tar éis an máinliachta. Áirítear leis na figiúirí seo 34 bhás ar fad, agus bhí 30 díobh bainteach leis an bpróiseas máinliachta. Ba é an aois an t-aon réamh- thuarthóir neamhspleách ar thoradh droch- máinliachta, agus ba é an toradh is measa ag othair os cionn 64 bliana d'aois.
Tugann na húdair i gcrích nach bhfuil an dóchúlacht go dtarlóidh rupture aneurysm ceiribileach de mhéid níos lú ná 10 mm an-bheag i gcás othair nach bhfuil aon hemorrhage subarachnoid acu. Bhí 11 uair níos mó seans ann go mbeadh rothar ag othair a raibh fuil subarachnoid acu roimhe seo. Ina theannta sin, tá na rioscaí maidir le morgáiste agus bás ó idirghabháil máinliachta níos mó ná an riosca le titim i gcás othair a bhfuil aneurysms beaga acu fiú 7. 5 bliana tar éis an diagnóis, le nó gan idirghabháil máinliachta nó endovascular pleanáilte.
An Staidéar Idirnáisiúnta ar Imscrúdaitheoirí Aneurysms Intracranial Unruptured. Aneurysms intracranialacha neamh-scraptha riosca scraptha agus rioscaí idirghabhála máinliachta. N Ing J Med. 10 Nollaig, 1998;339:172533.
Copyright © 1999 ag Acadamh Mheiriceá na Dochtúirí Teaghlaigh.
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April 05, 2012
In 2010, there were 10.5 million individuals classified as "working poor" (persons who spent at least 27 weeks in the labor force—that is, working or looking for work—but whose incomes still fell below the official poverty level); the number of working poor was little changed from 2009.
The working-poor rate—the ratio of the working poor to all individuals in the labor force for at least 27 weeks—was 7.2 percent, also little different from the previous year's figure (7.0 percent).
Among those who were in the labor force for 27 weeks or more in 2010, about the same number of men (5.3 million) and women (5.2 million) were classified as working poor. The working-poor rate, however, continued to be higher for women (7.6 percent) than for men (6.7 percent) in 2010.
There were 4.8 million workers who lived below the poverty threshold and usually worked full time in 2010. Full-time workers were less likely to be among the working poor than were part-time workers. Among persons in the labor force for 27 weeks or more, 4.2 percent of those usually employed full time were classified as working poor, compared with 15.1 percent of part-time workers.
The likelihood of being classified as working poor greatly diminishes as workers attain higher levels of education. Only about 1.0 million college graduates were classified as working poor in 2010, compared with 2.9 million workers with less than a high school diploma and 3.9 million workers who were high school graduates with no college. Among college graduates, 2.1 percent of those who were in the labor force for at least 27 weeks were classified as working poor, compared with 21.4 percent of those with less than a high school diploma and 9.2 percent of those workers who were high school graduates with no college.
These data are from the Current Population Survey. To learn more, see "A Profile of the Working Poor, 2010" (PDF). These data were collected in the 2011 Annual Social and Economic Supplement to the Current Population Survey.
Bureau of Labor Statistics, U.S. Department of Labor, The Economics Daily, Working poor rate 7.2 percent in 2010 at https://www.bls.gov/opub/ted/2012/ted_20120405.htm (visited October 25, 2021).

An 5 Aibreán, 2012
I 2010, bhí 10.5 milliún duine aonair aicmithe mar "pobail bhochta oibre" (daoine a chaith 27 seachtaine ar a laghad sa lucht saothair - is é sin, ag obair nó ag lorg oibre - ach a raibh a n-ioncam fós faoi bhun an leibhéal bochtaineachta oifigiúil); ní raibh mórán athraithe ar líon na ndaoine bochta oibre ó 2009.
Ba é an ráta bochta oibre - an cóimheas idir bochta oibre agus gach duine sa lucht saothair ar feadh 27 seachtaine ar a laghad - 7.2 faoin gcéad, rud nach raibh mórán difriúil leis an bhfigiúr den bhliain roimhe sin (7.0 faoin gcéad).
I measc na ndaoine a bhí i bhfórsa saothair ar feadh 27 seachtaine nó níos mó in 2010, bhí thart ar an líon céanna fir (5.3 milliún) agus mná (5.2 milliún) aicmithe mar lucht saothair bochta. Bhí an ráta d'oibrithe bochta, áfach, níos airde i measc na mban (7.6 faoin gcéad) ná i measc na bhfear (6.7 faoin gcéad) in 2010.
Bhí 4.8 milliún oibrí ann a bhí ina gcónaí faoi bhun an tairseach bochtaineachta agus a bhí ag obair go lánaimseartha de ghnáth in 2010. Bhí an seans go mbeadh oibrithe lánaimseartha i measc na ndaoine bochta oibre níos lú ná oibrithe páirtaimseartha. I measc na ndaoine a bhí ag obair ar feadh 27 seachtaine nó níos mó, bhí 4.2 faoin gcéad de na daoine a bhí fostaithe go lánaimseartha de ghnáth aicmithe mar dhaoine bochta a bhí ag obair, i gcomparáid le 15.1 faoin gcéad de na hoibrithe páirtaimseartha.
Laghdaíonn an dóchúlacht go ndéanfar iad a aicmiú mar oibrithe bochta go mór de réir mar a shroich oibrithe leibhéil níos airde oideachais. Ní raibh ach thart ar 1.0 milliún céimí coláiste aicmithe mar shaothair bhochta in 2010, i gcomparáid le 2.9 milliún oibrí a raibh níos lú ná dioplóma ardscoile acu agus 3.9 milliún oibrí a bhí céimithe ardscoile gan coláiste. I measc céimithe coláiste, bhí 2.1 faoin gcéad de na daoine a bhí sa lucht saothair ar feadh 27 seachtaine ar a laghad aicmithe mar phobail bhochta oibre, i gcomparáid le 21.4 faoin gcéad de na daoine a raibh níos lú ná dioplóma ardscoile acu agus 9.2 faoin gcéad de na hoibrithe sin a bhí céimithe ardscoile gan coláiste.
Tá na sonraí seo ó Fhiosrúchán ar an Daonra reatha. Chun tuilleadh eolais a fháil, féach "A Profile of the Working Poor, 2010" (PDF). Bailíodh na sonraí seo sa Leasú Bliantúil Sóisialta agus Eacnamaíoch do Thoscadh Daonra reatha 2011.
Ba é an Bainistíocht Staidrimh Oibre, Roinn Oibre na Stát Aontaithe, The Economics Daily, ráta bochtaineachta oibre 7.2 faoin gcéad in 2010 ag https://www.bls.gov/opub/ted/2012/ted_20120405.htm (a ndearnadh cuairt air an 25 Deireadh Fómhair, 2021).