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Countering climate challenges requires genuine multi-layered approaches in cooperation with various stakeholders. Spanning 20 years, the Asia-Pacific Network for Global Change Research (APN) has been facilitating the research community to provide regional and grassroots results and solutions, while acting as a mechanism to encourage science-policy-stakeholder dialogue. This paper outlines the relevance of APN projects to IPCC policymaking by laying out knowledge products and lessons learned from the projects. It also narrates how regional research and capacity building assist in responding to the increasing urgency across climate change and the SDGs. A synthesis of project-generated knowledge was garnered from research and capacity development studies conducted under the auspices of APN to identify their scope and level of policy relevance. A combined typology and solution scanning with Likert scale as relevance rating was employed to categorize contribution against key themes of the IPCC sixth assessment report. Findings suggest 115 distinct and relevant projects completed mostly in Southeast Asia, South Asia and Temperate East Asia, with many of them asserting community-based adaptation and mitigation surrounding issues on ecosystems and biodiversity, extreme weather events, water-food-energy nexus, sustainable waste management, and climate education. Findings also show 163 knowledge products in which majority of them (66.87%) were peer-reviewed journal articles, 11.04% were reports, 7.98% were policy briefs, 6.75% were guidelines and tools, 4.91% were books and 2.45% were perspectives and opinions. With the evolving synergies between global climate targets and the SDGs, it is recommended that APN solidify its role in science-policy partnerships and networking by creating improved interlinkages for disseminating knowledge gaps filled and in replicating lessons learned and best practices found in APN knowledge products. In addition to science-policy dialogues and output synthesis, a regular review of APN research and capacity development outcomes will help in realizing these important aspects toward wider policy impact., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Older adults with complex medical conditions are vulnerable during care transitions. Poor care transitions can lead to poor patient outcomes and frequent readmissions to the hospital., Factors Contributing to Suboptimal Care Transitions: Key factors related to ineffective care transitions, which can lead to suboptimal patient outcomes, include poor cross-site communication and collaboration; lack of awareness of patient wishes, abilities, and goals of care; and incomplete medication reconciliation. Fundamental elements for effective care transitions put forth by The Joint Commission for effective care transitions include interdisciplinary coordination and collaboration of patient care in care transitions, shared accountability by all clinicians involved in care transitions, and provision of appropriate support and follow-up after discharge., Review of Four Existing Models of Care Transitions: Consideration of four existing care transitions models representing different health care settings-Care Transitions Intervention® Guided Care, Interventions to Reduce Acute Care Transfers (INTERACT®), Home Health Model of Care Transitions-revealed that they are important but limited in their impact on transitions across health care settings., Proposal of the Integrated Care Transitions Approach: An innovative approach, Integrated Care Transitions Approach (ICTA), is proposed that incorporates the best practices of the four models discussed in this article and factors identified as essential for an effective care transition while addressing limitations of existing transitional care models. ICTA's four key characteristics and seven key elements are unique and stem from factors that help achieve effective care transitions., (Copyright © 2018 The Joint Commission. All rights reserved.)

For nursing home residents with advanced dementia, very little evidence is available to show clinical benefit from enteral tube feeding. Although no randomized clinical trials have been done, considerable evidence from studies of weaker design strongly suggest that tube feeding does not reduce the risks of death, aspiration pneumonia, pressure ulcers, other infections, or poor functional outcome. Nationally, however, utilization is high and highly variable. System-wide incentives favor use of tube feeding, and may influence substitute decision-makers, bedside clinicians, gastroenterologists, and administrators regardless of patient preferences or putative medical indications. Underlying the widespread use of this marginally effective therapy is a basic misunderstanding about malnutrition and about aspiration pneumonia. The face value of tube feeding is strong indeed. In addition to the general faith in intervention, the impulse to "do something" when things are going poorly, financial incentives favor tube feeding for gastroenterologists, hospitals, and nursing homes. The desire to avoid regulatory sanctions, bad publicity, and liability exposure creates a further incentive for nursing homes to provide tube feeding. Rational, evidence-based use of tube feeding in advanced dementia will depend fundamentally on improved education. Reimbursement schemes require significant modification to limit the irrational use of tube feeding. Nursing home regulations based more securely on scientific evidence would likely reduce nonbeneficial tube feeding, as would evidence-based tort reform. Quality improvement initiatives could create positive incentives. Realigning incentives in these ways could, we believe, improve the quality of care, quality of life, and safety of these vulnerable individuals, likely with reduced costs of care.

Objective: To describe the knowledge and attitudes of nursing home (NH) surveyors before and after a brief educational intervention related to nutrition and involuntary weight loss in nursing home residents., Design: A questionnaire covering knowledge and attitudes about nutrition was given 1 month before and 6 months after a targeted educational intervention., Participants and Setting: State of Maryland nursing home surveyors., Measurements: A 24-item questionnaire of NH surveyor knowledge (11 items) and attitudes (13 items) regarding issues related to nutrition and involuntary weight loss in NH residents., Results: Overall surveyors' knowledge scores increased from 68% (SD, 17%) pre-intervention to 76% (SD, 18%) post-intervention (P = .11). Knowledge related to the lack of the effect of tube feeding on survival in NH residents with end-stage dementia was the only knowledge item that improved significantly with the intervention (39% correct pre-intervention and 68% correct post-intervention, P = .04). There were no changes in attitudes toward the diagnosis or treatment of nutrition after the intervention., Conclusion: Overall, NH surveyor knowledge related to nutrition and involuntary weight loss varied widely across topic areas. Neither knowledge nor attitudes were substantially affected by a brief educational intervention. Development of effective educational interventions for NH surveyors should be a priority for stakeholders in NH care.