Translation of falls prevention knowledge into action in hospitals: what should be translated and how should it be done?

Introduction

Falls prevention evidence has changed and evolved over time with positive and negative studies revealing that a “one-size fits all” approach is not the solution. Care must be taken to critically appraise the evidence and the potential applicability of that evidence to the specific hospital setting.

Method

A narrative account of the evolution of research evidence in this field is first presented. How this evidence should be applied in clinical practice is challenging, with a lack of translational evidence for the hospital setting we draw on broader theory of translating knowledge to action.

Conclusions

The journey should begin with formation of a management and engagement committee. A review of existing practices and the difference between existing practice and evidence-based practice should be undertaken to identify the “evidence-practice gap.” Engagement with staff is recommended to inform a plan for practice change. Plans for resourcing, targeting, and evaluating these strategies should also be undertaken.

Impact on Industry

This paper will assist hospitals to identify and implement evidence based falls prevention strategies leading to an improvement in patient safety.     

Mercury measurement and control in a CO2-enriched flue gas

Oxycombustion is being considered as a promising solution to carbon capture and sequestration. Standard sampling and measurement methods may or may not be valid under oxycombustion conditions because the flue gas differs significantly from that of conventional air-blown coal combustion.Bench-scale tests were conducted to evaluate the measurement validity of continuous mercury monitors (CMMs), with and without a flue gas preconditioning unit, in a simulated oxycombustion flue gas with varied CO₂ concentrations. Tests also included mercury capture with activated carbon in typical oxyfuel combustion flue gas. Research data indicated that highly concentrated CO₂ streams affect the accuracy of the mass flow rate and the subsequent gaseous mercury measurement, although this is specific to the type of CMM. Concentrated CO₂ streams also induced solid precipitation in the wet-chemistry conversion unit and resulted in a biased measurement of the gas-phase mercury. Flue gas dilution appeared to provide accurate measurement of total gas-phase mercury and be applicable to mercury measurement in highly concentrated CO₂ streams, although mercury speciation appeared to be problematic and will require additional modification and validation. Mercury capture with activated carbon under CO₂-enriched conditions showed similar performance to typical high-acid coal combustion flue gas.     

The effect of maternal body size on embryo survivorship in the broods of pregnant male pipefish

The occurrence of male pregnancy in the family Syngnathidae (seahorses, pipefishes, and sea dragons) provides an exceptionally fertile system in which to investigate issues related to the evolution of parental care. Here, we take advantage of this unique reproductive system to study the influence of maternal body size on embryo survivorship in the brood pouches of pregnant males of the broad-nosed pipefish, Syngnathus typhle. Males were mated with either two large females, two small females, a large then a small female, or a small then a large female. Our results show that offspring survivorship depends on an interaction between female body size and the number of eggs transferred by the female. Eggs of larger females deposited in large numbers are more likely to result in viable offspring than eggs of smaller females laid in large numbers. However, when females deposited smaller numbers of eggs, the eggs from smaller females were more likely to produce viable offspring compared to those from larger females. We found no evidence that this result was based on mating order, the relative sizes of competing females, or egg characteristics such as dry weight of eggs. Additionally, male body size did not significantly influence the survivorship of offspring during brooding. Our results suggest that the factors underlying offspring survivorship in pipefish may be more complex than previously believed, with multiple factors interacting to determine the fitness of individual offspring within the broods of pregnant males.     

The loss of an indigenous constructed landscape following British invasion of Australia: An insight into the deep human imprint on the Australian landscape

Indigenous people play an integral role in shaping natural environments, and the disruption to Indigenous land management practices has profound effects on the biosphere. Here, we use pollen, charcoal and dendrochronological analyses to demonstrate that the Australian landscape at the time of British invasion in the 18th century was a heavily constructed one—the product of millennia of active maintenance by Aboriginal Australians. Focusing on the Surrey Hills, Tasmania, our results reveal how the removal of Indigenous burning regimes following British invasion instigated a process of ecological succession and the encroachment of cool temperate rainforest (i.e. later-stage vegetation communities) into grasslands of conservation significance. This research provides empirical evidence to challenge the long-standing portrayal of Indigenous Australians as low-impact ‘hunter-gatherers’ and highlights the relevance and critical value of Indigenous fire management in this era of heightened bushfire risk and biodiversity loss.     

A Sediment Budget for an Urbanizing Watershed, 1951‐1996, Montgomery County, Maryland,U.S.A.1

Abstract: Despite widespread interest, few sediment budgets are available to document patterns of erosion and sedimentation in developing watersheds. We assess the sediment budget for the Good Hope Tributary, a small watershed (4.05 km²) in Montgomery County, Maryland, from 1951‐1996. Lacking monitoring data spanning the period of interest, we rely on a variety of indirect and stratigraphic methods. Using regression equations relating sediment yield to construction, we estimated an upland sediment production of 5,700 m³ between 1951 and 1996. Regression equations indicate that channel cross‐sectional area is correlated with the extent of development; these relationships, when combined with historical land use data, suggest that upland sediment yield was augmented by 6,400 m³ produced by enlargement of first‐order and second‐order stream channels. We used dendrochronology to estimate that 4,000 m³ of sediment was stored on the floodplain from 1951‐1996. The sediment yield from the watershed, obtained by summing upstream contributions, totals 8,100 m³ of sediment, or 135 tons/km²/year. These results indicate that upland erosion, channel enlargement, and floodplain storage are all significant components of the sediment budget of our study area, and all three are approximately equal in magnitude. Erosion of “legacy” floodplain sediments originally deposited during poor agricultural practices of the 19th and early 20th Centuries has likely contributed between 0 and 20% of the total sediment yield, indicating that these remobilized deposits are not a dominant component of the sediment yield of our study area.     

Optimizing Human Intestinal Enteroids for Environmental Monitoring of Human Norovirus

Human noroviruses (HuNoV) are the leading cause of gastrointestinal illness and environmental monitoring is crucial to prevent HuNoV outbreaks. The recent development of a HuNoV cell culture assay in human intestinal enteroids (HIEs) has enabled detection of infectious HuNoV. However, this complex approach requires adaptation of HIEs to facilitate HuNoV replication from environmental matrixes. Integrating data from 200 experiments, we examined six variables: HIE age, HIE basement membrane compounds (BMC), HuNoV inoculum processing, HuNoV inoculum volume, treatment of data below limit of detection (LOD), and cutoff criteria for determining positive HuNoV growth. We infected HIEs with HuNoV GII.4 Sydney positive stool and determined 1.4 × 10³ genome equivalents per HIE well were required for HuNoV replication. HIE age had minimal effect on assay outcomes. LOD replacement and cutoff affected data interpretation, with lower values resulting in higher estimated HuNoV detection. Higher inoculum volumes lead to minimal decreases in HuNoV growth, with an optimal volume of 250uL facilitating capture of low concentrations of HuNoVs present in environmental isolates. Processing of HuNoV inoculum is valuable for disinfection studies and concentrating samples but is not necessary for all HIE applications. This work enhances the HuNoV HIE cell culture approach for environmental monitoring. Future HIE research should report cell age as days of growth and should clearly describe BMC choice, LOD handling, and positive cutoff.