Developing drowning prevention strategies for rivers through the use of a modified Delphi process

Introduction Internationally, rivers are a leading drowning location, yet little evidence exists evaluating river drowning prevention strategies. This study aims to use expert opinion to identify strategies more likely to be effective. Methods Using a modified Delphi process, a virtual panel of 30 experts from 12 countries considered, grouped and prioritised strategies for river drowning prevention. Proposed strategies were assessed against known evidence and suitability in high-income countries (HICs) as well as low-income and middle-income countries (LMICs) using expert opinion. The final phase consolidated a list of strategies whose effectiveness was assessed against 10 evidence-based river drowning scenarios. Results An initial list of 424 prevention strategies was refined to 22. After being assessed against the 10 scenarios, a final list of 13 strategies was derived. Strategies addressed alcohol consumption around rivers, flood mitigation, improving child supervision, learning to swim, increased lifejacket wear and achieving community-wide resuscitation skills. Discussion While all 13 strategies were assessed as being effective in both LMICs and HICs by at least 60% of the respondents, further work is required to define river drowning at a country level and therefore allow for effective solutions to be developed, particularly in LMICs. No strategy will be effective in isolation and must be implemented alongside policy and behaviour change, public awareness and education. Evaluation should be incorporated as part of any future implementation of strategies. Conclusion This Delphi process identified 13 drowning prevention strategies for rivers. Further research is required to validate the efficacy of these findings through implementation and evaluation

Observing patterns of river usage

Rivers are a leading location for drowning, yet little is known about people’s usage of these waterways. This pilot study aimed to test the use of direct observations to calculate river usage. Direct observations were conducted at regular intervals within defined zones at four river drowning locations in Australia (including weekends and the Australia Day national public holiday). Data recorded were date and time of observation; total people (including males, females, children, and adults); and number of people on, in, and beside the water. Univariate analysis with mean (SD) and range was conducted. Interrater reliability for observations was determined using the intraclass correlation coefficient (ICC) (one-way random-effects, average measures model), with a 95% confidence interval (CI). Across 149 time points, 309 observations resulted in 13,326 river interactions observed by multiple observers. There was an average of 39 people (M = 39.4, SD = 29.4, range = 0–137) per observation, 44 people (M = 44.2, SD = 32.7, range = 0–37) on an average weekend, and 97 people (M = 96.8, SD = 58.1, range = 20–190) on Australia Day. More females (M = 20.6, SD = 16.0, range = 0–83) than males (M = 18.3, SD = 14.5, range = 0–68) were observed. More people were observed in the water (M = 20.6, SD = 20.4, range = 0–84) than beside or on the water. Interrater reliability was excellent, consistently above 0.900 for all variables collected (apart from the variable of beside the river). Despite males accounting for 80% of river drowning fatalities, more females were observed than males. Increased visitation on the Australia Day public holiday may be linked to increased drowning risk. This study detailed a simple approach to data collection, exploring exposure within a defined zone at river locations. River usage is dynamic, with people’s movement in and out of the water changing their risk exposure. Observational-based data collection for drowning, particularly for rivers, is an important yet highly neglected area of research

Who rescues who? Understanding aquatic rescues in Australia using coronial data and a survey

Objective: To examine fatal drowning associated with aquatic rescues and prior self‐reported experience of undertaking an aquatic rescue in Australia. Methods: Previous aquatic rescue experience was sourced through the 2013 Queensland Computer Assisted Telephone Instrument Survey and compared to data on rescue‐related fatal unintentional drowning between 1 January 2006 and 31 December 2015. Results: Twenty‐three per cent (n=294/1291) of survey respondents had previously performed an aquatic rescue. Males (X2=35.2; p<0.001) were more likely to have performed a rescue; commonly at a beach/ocean/harbour location (X2=13.5; p<0.001). Females were more likely to have rescued a child (0‐4 years of age) (X2=29.2; p<0.001) from a swimming pool (X2=34.3; p<0.001). Fifty‐one people drowned while performing an aquatic rescue (Males=82.4%; 25–44 years of age=53.0%; beaches=54.9%). Conclusions: Drownings are prevented by bystanders; this is not without risk to the rescuer. Most people perform only one rescue in their life, often at a younger age, on an altruistic basis, of family members or young children. Community‐wide rescue skills, taught at a young age, with consideration for coastal, inland and swimming pool environments, may prevent drowning

Assembly and function of AP-3 complexes in cells expressing mutant subunits

The mouse mutants mocha and pearl are deficient in the AP-3 δ and β3A subunits, respectively. We have used cells from these mice to investigate both the assembly of AP-3 complexes and AP-3 function. In mocha cells, the β3 and μ3 subunits coassemble into a heterodimer, whereas the σ3 subunit remains monomeric. In pearl cells, the δ and σ3 subunits coassemble into a heterodimer, whereas μ3 gets destroyed. The yeast two hybrid system was used to confirm these interactions, and also to demonstrate that the A (ubiquitous) and B (neuronal-specific) isoforms of β3 and μ3 can interact with each other. Pearl cell lines were generated that express β3A, β3B, a β3Aβ2 chimera, two β3A deletion mutants, and a β3A point mutant lacking a functional clathrin binding site. All six constructs assembled into complexes and were recruited onto membranes. However, only β3A, β3B, and the point mutant gave full functional rescue, as assayed by LAMP-1 sorting. The β3Aβ2 chimera and the β3A short deletion mutant gave partial functional rescue, whereas the β3A truncation mutant gave no functional rescue. These results indicate that the hinge and/or ear domains of β3 are important for function, but the clathrin binding site is not needed

Anomalous Behavior of Ru for Catalytic Oxidation: A Theoretical Study of the Catalytic Reaction CO + 1/2 O_2 --> CO_2

Recent experiments revealed an anomalous dependence of carbon monoxide oxidation at Ru(0001) on oxygen pressure and a particularly high reaction rate. Below we report density functional theory calculations of the energetics and reaction pathways of the speculated mechanism. We will show that the exceptionally high rate is actuated by a weakly but nevertheless well bound (1x1) oxygen adsorbate layer. Furthermore it is found that reactions via scattering of gas-phase CO at the oxygen covered surface may play an important role. Our analysis reveals, however, that reactions via adsorbed CO molecules (the so-called Langmuir-Hinshelwood mechanism) dominate.Comment: 5 pages, 4 figures, Phys. Rev. Letters, Feb. 1997, in prin

Reducing the burden of injury: An intersectoral preventive approach is needed

Injuries constitute the second largest contributor to the Western Cape burden of disease (BoD), after major infectious diseases caused by HIV/AIDS and tuberculosis and ahead of mental health disorders and cardiovascular and childhood diseases. The Provincial Health Department instituted the BoD Reduction Project to improve health surveillance for planning and resource allocation, review risk factors, and prioritise interventions to reduce the overall BoD

Evaluation of Aluminum Speciation Using Synthetic and Natural Samples: Final Report

published or submitted for publicationis peer reviewedOpe

Cervical spine immobilisation is only required in drowning patients at high risk of axial loading of the spine

Objectives: Wave forced impacts are known to result in cervical spine injuries (CSI) and approximately 20% of drownings in Australia occur at the beach. The most common mechanism of injury in studies examining the frequency of CSI in drowning patients is shallow water diving. The aim of the present study was to determine what proportion of CSIs occurring in bodies of water experienced a concomitant drowning injury in a location where wave forced impacts are likely to be an additional risk factor. Methods Electronic medical records at the Sunshine Coast Hospital and Health Service EDs, Queensland Ambulance Service case records and Surf Life Saving Queensland data between 1 January 2015 and 21 April 2021 were manually linked. Outcomes recorded included victim demographics, scene information, hospital course and patient disposition. Results Ninety-one of 574 (15.9%) CSIs occurred in a body of water with risk of drowning. However, only 4 (4.3%) had a simultaneous drowning injury, representing 0.8% (4/483) of drowning presentations. Ten (10.9%) patients reported loss of consciousness, including the four with drowning. The principal mechanism of CSI was a wave forced impact (71/91, 78%). Most injuries occurred at the beach (79/91, 86.8%). Delayed presentation was common (28/91, 31%). A history of axial loading was 100% sensitive when indicating imaging. Conclusions The combination of CSI and drowning is uncommon. Cervical spine precautions are only required in drowning patients with signs or a history, or at high risk of, axial loading of the spine. This paper supports the move away from routine cervical spine precautions even in a high-risk population

Addressing gaps in our understanding of the drowning patient: a protocol for the retrospective development of an Utstein style database and multicentre collaboration

Introduction: This retrospective observational study aims to create a comprehensive database of the circumstances of drowning (including care provided and outcomes of care) to report against the Utstein style for drowning (USFD) for patients presenting to the emergency department (ED). Four areas will be examined: a feasibility study of the USFD; a comparison of classification and prognostication systems; examination of indications and efficacy of different ventilation strategies; and differences in the circumstances, severity, treatment and outcomes of drowning by sex and gender. Methods and analysis: This protocol outlines retrospective data collection for all patients presenting to EDs of the Sunshine Coast Hospital and Health Service in Queensland, Australia with the presenting problem or discharge diagnosis of drowning or immersion between 2015 and 2022. Patients computerised health records (emergency medical service record, pathology, radiology results, medical and nursing notes for ED, inpatient units and intensive care units) will be used to extract data for entry into an USFD database. Descriptive (eg, median, IQR) and inferential statistical analyses (eg, analysis of variance) will be used to answer the separate research questions. Development of an International Drowning Registry using the USFD dataset and the Research Electronic Data Capture (REDCap) web application is discussed. Ethics and dissemination: This study has been approved by Metro North Human Research and Ethics Committee (Project No: 49754) and James Cook University Human Research Ethics Committee (H8014). It has been endorsed by national drowning prevention organisations Royal Life Saving Society Australia (RLSSA) and Surf Life Saving Australia (SLSA). Study findings will provide data to better inform clinical management of drowning patients and provide an evidence base on sex and gender differences in drowning. Results will be disseminated through peer review publications, conference presentations and media releases. Results will also be disseminated through RLSSA and SLSA membership of the Australian and New Zealand Resuscitation Council and the Australian Water Safety Council

A scoping review of female drowning: an underexplored issue in five high-income countries

Background: Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. Methods: A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines. Results: The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females). Conclusion: Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning