The extra resource burden of in-hospital falls: A cost of falls study

Objective: To quantify the additional hospital length of stay (LOS) and costs associated with in-hospital falls and fall injuries in acute hospitals in Australia. Design, setting and participants: A multisite prospective cohort study conducted during 2011–2013 in the control wards of a falls prevention trial (6-PACK). The trial included all admissions to 12 acute medical and surgical wards of six Australian hospitals. In-hospital falls data were collected from medical record reviews, daily verbal reports by ward nurse unit managers, and hospital incident reporting and administrative databases. Clinical costing data were linked for three of the six participating hospitals to calculate patient-level costs. Outcome measures: Hospital LOS and costs associated with in-hospital falls and fall injuries for each patient admission. Results: We found that 966 of a total of 27 026 hospital admissions (3.6%) involved at least one fall, and 313 (1.2%) at least one fall injury, a total of 1330 falls and 418 fall injuries. After adjustment for age, sex, cognitive impairment, admission type, comorbidity and clustering by hospital, patients who had an in-hospital fall had a mean increase in LOS of 8 days (95% CI, 5.8–10.4; P < 0.001) compared with non-fallers, and incurred mean additional hospital costs of $6669 (95$3888–$9450; P < 0.001). Patients with a fall-related injury had a mean increase in LOS of 4 days (95$4727; 95% CI, −$568 to$10 022; P = 0.080). Conclusion: Patients who experience an in-hospital fall have significantly longer hospital stays and higher costs. Programs need to target the prevention of all falls, not just the reduction of fall-related injuries

The Social and Economic Long Term Monitoring Program (SELTMP) 2014: Recreation in the Great Barrier Reef

[Extract] Introduction.\ud People love to spend their recreational time visiting the Great Barrier Reef World Heritage Area (GBRWHA), (GBRMPA, 2009), and many people are doing it! The recent SELTMP surveys revealed that 95% of residents of coastal town adjacent to the GBR had visited the GBRWHA for recreation at least once, and 87% had visited in the previous 12 months. Many of these visits appeared to be to a mainland beach to walk, swim, and relax. However, 68% of people who told us about their recent trips had been beyond the mainland beach to islands, reefs, shoals, etc., to take part in activities such as fishing, snorkelling and diving. Other activities include boating, sailing, jet skiing, camping, kayaking, sight-seeing, photography, and wildlife viewing, to name a few. Recreational visitors are currently very satisfied with their use of the Marine Park.\ud \ud While most trips beyond the beach were made by ferry, about a third of these trips were accessed by residents' own or someone else's boat. While not everyone is using their vessel very frequently, vessel registration by coastal residents has increased substantially in recent years (Old Department of Transport, unpublished data, 2011).\ud \ud Given all of this activity, it is not surprising that recreation in the GBRWHA provides significant social and cultural benefits as well as many health and wellbeing benefits associated with the psychological interaction with nature (Synergies Economic Consulting, 2012). In economic terms, recreation (defined by Deloitte Access Economics as GBR catchment residents visiting an island, sailing, boating and fishing), contributed $126m in direct value or$243.9m value added to the Australian economy in 2011/12 (Deloitte Access Economics, 2013). This estimate did not include beach visits.\ud Importantly, recreation differs from tourism. The Great Barrier Reef Marine Park Authority define recreation as an independent visit for enjoyment that is not part of a commercial operation (GBRMPA, 2012). For the purposes of the SELTMP Surveys (outline following), any resident of the GBR catchment who visits the GBRWHA is included within recreation; while tourists are defined as those residing outside of the GBR catchment

Advances in monitoring the human dimension of natural resource systems: an example from the Great Barrier Reef

The aim of this paper is to demonstrate the feasibility and potential utility of decision-centric social-economic monitoring using data collected from Great Barrier Reef (Reef) region. The social and economic long term monitoring program (SELTMP) for the Reef is a novel attempt to monitor the social and economic dimensions of social-ecological change in a globally and nationally important region. It represents the current status and condition of the major user groups of the Reef with the potential to simultaneously consider trends, interconnections, conflicts, dependencies and vulnerabilities. Our approach was to combine a well-established conceptual framework with a strong governance structure and partnership arrangement that enabled the co-production of knowledge. The framework is a modification of the Millennium Ecosystem Assessment and it was used to guide indicator choice. Indicators were categorised as; (i) resource use and dependency, (ii) ecosystem benefits and well-being, and (iii) drivers of change. Data were collected through secondary datasets where existing and new datasets were created where not, using standard survey techniques. Here we present an overview of baseline results of new survey data from commercial-fishers (n =210), marine-based tourism operators (n =119), tourists (n =2877), local residents (n =3181), and other Australians (n =2002). The indicators chosen describe both social and economic components of the Reef system and represent an unprecedented insight into the ways in which people currently use and depend on the Reef, the benefits that they derive, and how they perceive, value and relate to the Reef and each other. However, the success of a program such as the SELTMP can only occur with well-translated cutting-edge data and knowledge that are collaboratively produced, adaptive, and directly feeds into current management processes. We discuss how data from the SELTMP have already been incorporated into Reef management decision-making through substantial inclusion in three key policy documents

Exploring Alternative Futures in the Anthropocene

Many challenges posed by the current Anthropocene epoch require fundamental transformations to humanity’s relationships with the rest of the planet. Achieving such transformations requires that humanity improve its understanding of the current situation and enhance its ability to imagine pathways toward alternative, preferable futures. We review advances in addressing these challenges that employ systematic and structured thinking about multiple possible futures (futures-thinking). Over seven decades, especially the past two, approaches to futures-thinking have helped people from diverse backgrounds reach a common understanding of important issues, underlying causes, and pathways toward optimistic futures. A recent focus has been the stimulation of imagination to produce new options. The roles of futures-thinking in breaking unhelpful social addictions and in conflict resolution are key emerging topics. We summarize cognitive, cultural, and institutional constraints on the societal uptake of futures-thinking, concluding that none are insurmountable once understood

The Social and Economic Long Term Monitoring Program (SELTMP) 2013: Drivers of change in the Great Barrier Reef

[Extract] Introduction. The Great Barrier Reef region, including the people and industries it supports, is influenced by a range of drivers from global to local scales. We define a driver as any natural or human-induced factor that directly or indirectly causes a change in the GBR system (see SELTMP 2011 for a more in-depth discussion of drivers). Drivers are important to monitor so that we are able: •To understand mechanisms of change in the variables we monitor •To anticipate and begin to predict outcomes •To document the context or "backdrop" of change — in 25 years' time, what will we need to know to interpret change? These drivers themselves change over time (Figure 1) and the direction, magnitude and speed of change can be uncertain; hence monitoring programs need to be adaptive (Lindenmayer and Likens 2009). In this chapter we: 1. Present drivers that were identified in eight SELTMP end user meetings in 2011, the first year of SELTMP, and then present comparative data from a workshop in 2013. 2. We then show how we categorised drivers identified in 2011 and from this, define six driver categories to be monitored. We focus on indirect drivers of change (MEA 2003) — underlying causes of pressures on the GBR —which are most relevant to the social and economic dimensions of the reef. Direct drivers such as biophysical processes of climate change and run-off are monitored by other research programs. However, SELTMP is interested in perceptions of climate change and policies to address it, for example. 3. Present "wishlist" indicators identified by the Drivers of Change Working Group or in the literature for each of the six key categories of drivers, and some of the data collected. Some categories, such as social and cultural drivers, and politics and management, are not easily generalised, and can be highly specific to the GBR region and the different end user groups