Fall Risk Identification and Reduction Among the Gerontological Population at a Long-term Care Facility

Abstract Problem: Data obtained from the facility from February 2022 to July 2023 showed that there were a total of 110 falls at the facility with 51% resulting in injury. The facility also lacked a standardized fall assessment tool with minimal follow up after fall incidents. Context: A microsystem assessment of the geriatric population at the long-term care facility indicated the need for a standardized fall risk screening tool to accurately assess patients. Interventions: A staff presentation was created highlighting the high rate of falls at the facility as well as to educate on the implementation of the Morse Fall Scale. Additionally, a presentation was created for residents to provide education on factors that increase the risk of falls and prevention measures to encourage active participation in their care. Measures: Data from February 2022-July 2023 was obtained and organized in an electronic database created on a Google Sheet. To measure the outcome, the number of falls in January 2023 will be compared to data from January 2024 to determine if there has been a 20% decrease in resident falls. Results: Due to time constraints, the results will not be obtained. The expected outcome of this project is to reduce the number of falls in the facility by 20% within six months and prevent future incidents, as evidence shows that fall assessment and interventions can reduce falls rates by 20-30% (Morris & O\u27Riordan, 2017). Conclusion: Equipping the staff with a standardized electronic Morse Fall Scale assessment tool will improve the assessment of residents\u27 fall risk. Education provided to residents will allow them to be active and mindful in their own care ultimately reducing the fall rate and achieving the best patient outcomes

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Cache protection and decision making in the Cape ground squirrel (Xerus inauris)

Caching food provides a variety of benefits to an individual, such as the build up of reserves for periods when resources are depleted or to gain a disproportionate amount of an ephemeral resource. One of the risks to adopting this strategy is the potential for theft from food stores, by both conspecifics and/or other species. To reduce this theft, some species have evolved a range of cache protection mechanisms, such as placing food out of site of competitors. In this thesis, I examined various cache protection and decision-making processes exhibited by the Cape ground squirrel (Xerus inauris), a social rodent. Due to the sociality of this species, and therefore, the potential for high rates of cache loss, I predicted they would use a diverse range of behaviours to increase the survivability of stored food. I first described the natural caching behaviours of the Cape ground squirrel in their natural habitat. This species increased caching frequency just after the heaviest periods of rainfall, indicating that this behaviour might be controlled by the availability of food. They cache around a central burrow system, which classifies their cache type as “scatter hoarding”. In the second study, I investigated the effect of group size on caching and recovery behaviours. Group size in these ground squirrels showed daily fluctuations, and an increased number of individuals in a group had a negative impact on food cache survival. In response to fluctuations in group size, individuals did not change the spatial arrangement of caches, but I argued that this arrangement was a by-product of optimal cache placement and not a method to protect caches. With increased social competition, the ground squirrels seemed to maximise payoffs from food by consuming rather than caching items. The third study, focused on determining whether the cachers were sensitive to the attentive state of nearby conspecifics. Conspecifics were often observed competing with cachers immediately after a cache was deposited, and therefore ensuring audience members are inattentive to the cache event would decrease the chance a cache was stolen. There was a strong preference for individuals to cache when audience members were inattentive to the cache event. In addition, higher ranked individuals showed less sensitivity to these audience effects, possibly due to their ability to defend food items from conspecifics. In the fourth study I presented individuals with a choice between two food items of differing value: one item that was always artificially removed when cached and the other item that was not removed when cached. Although the two items only varied with respects to the payoff in caching, individuals reduced the amount of the removed items they both consumed or cached during the choice presentations. This avoidance to choose the removed food occurred over time, indicating that individuals were using information about the item’s payoff during cache recovery and this then impacted on successive decisions. Due to the lack of obvious landmarks at the study site, in the last experiment, I predicted that individuals might use positional cues from the sun as a reference point when caching and recovering food items. When caching food, individuals moved at consistent offset angles from the sun, moving in straight lines from the provisioning point to the cache point. When recovering food, individuals displayed some flexibility in the use of solar cues, which allowed them to retrieve food more efficiently. Food was retrieved sooner if there were a higher number of individuals present in the group. Overall, this thesis highlights the variety of decision-making processes individuals must undertake when caching food to ensure maximum profitability. I answered a number of questions on when animals cache, the decisions about what to cache and where to place caches. As this species is social, this decision-making is highly influenced by group members. This thesis provides much needed knowledge on the cache protection strategies used by mammals, where the majority of work has been conducted on birds. Research such as this will hopefully encourage other studies on mammals to determine how social living can lead to the evolution of counterstrategies to protect food stores. Das Verstecken von Futter bietet einige Vorteile, wie das Anlegen von Vorräten um Zeiten der Dürre zu überbrücken, oder das Speichern von überproportionalen Mengen von saisonal vorkommenden Ressourcen. Ein Risiko dieser Strategie ist die Möglichkeit das Artgenossen oder Tiere anderer Arten die angelegten Vorräte stehlen. Um das Risiko des Diebstahls zu verringern, haben verschiedene Arten Schutzmechanismen evolviert, wie zum Beispiel das Plazieren des Futters außerhalb der Sichtweite von Konkurrenten. In meiner Doktorarbeit habe ich unterschiedliche Arten der Vorratssicherung sowie unterschiedliche Entscheidungsprozesse eines sozialen Nagetieres, dem Kap-Borstenhörnchen (Xerus inauris), untersucht. Da diese Art in sozialen Gruppen lebt, und damit wahrscheinlich eine hohe Verlustrate angelegter Vorräte besteht, erwartete ich, dass Kap-Borstenhörnchen verschiedene Verhaltensweisen nutzen um die Beständigkeit ihrer Vorräte zu erhöhen. Zuerst beschreibe ich die natürlichen Verhalten der Kap-Borsteenhörnchen bei der Anlage von Vorräten in ihrem natürlichen Lebensarum. Diese Art erhöhte die Rate des Versteckens von Vorräten nach Zeiten mit starkem Regen, was andeutet, dass dieses Verhalten von dem Vorhandensein des Futters abhängig ist. Diese verteilt Art verteilt die unterschiedlichen Verstecke um eine zentrale Wohnhöhle, weshalb ihre Art der Vorratsanlage als „scatter-hoarding“ bezeichnet werden kann. Im zweiten Kapitel habe ich untersucht, wie die Größe der sozialen Gruppe das Anlegen und Wiederfinden von Vorräten beeinflusst. Die Gruppengröße verändert sich über den Tag hinweg und eine grössere Anzahl an Tieren in der Gruppe hatte einen negativen Einfluss auf die Wahrscheinlichkeit einen angelegten Vorrat wiederzufinden. Kap-Borstenhörnchen reagierten auf Änderungen der Gruppengröße nicht mit einer Änderung der räumlichen Anordnung ihrer Verstecke. Deshalb argumentiere ich, dass die Anordnung der Verstecke ein Nebenprodukt der optimalen Plazierung ist und nicht als Methode dient um die Verstecke zu schützen. Bei einer erhöhten Konkurrenz durch Artgenossen ist eine Möglichkeit der Gewinnmaximierung das Futter zu verzehren anstatt es zu verstecken, eine Strategie die bei Kap-Borstenhörnchen beobachtet wurde. Im dritten Kapitel untersuche ich, ob Tiere die gerade einen Vorrat anlegen die Aufmerksamkeit räumlicher naher Artgenossen wahrnehmen. Artgenossen wurden häufig dabei beobachtet, wie sie direkt nachdem ein Tier Futter versteckt hatte mit diesem um das Versteck kämpften. Dementsprechend würde sich die Wahrscheinlichkeit verstecktes Futter zu verlieren verringern, wenn versteckende Tiere sicher stellten, dass mögliche Zuschauer gerade unaufmerksam sind. Kap-Borstenhörnchen zeigten eine starke Präferenz dafür Futter genau dann zu verstecken, wenn mögliche Zuschauer unaufmerksam waren. Außerdem konnte ich zeigen, dass höherrangige Tiere weniger empfindlich auf mögliche Zuschauer reagierten, möglicherweise da sie die Fähigkeit besitzen Futter vor Artgenossen zu verteidigen. Im vierten Kapitel habe ich Tiere vor die Wahl zwischen zwei unterschiedlichen Futtertypen gestellt, wobei die Futterstücke eines Typs immer künstlich entfernt wurde, nachdem es versteckt worden war und das andere nicht. Obwohl sich die zwei Futtertypen nur hinsichtlich ihres Gewinns beim Verstecken unterschieden, verzehrten und versteckten die Individuen die Futterstücke vom Typen welches nach dem Verstecken entfernt wurde, deutlich weniger. Diese Vermeidung des wieder entfernten Futtertypen geschah erst nach einer Weile, was darauf hindeutet, dass die Individuen die Information über den Gewinn dieses Futterstückes beim Leeren des Versteckes abschätzen und für zukünftige Entscheidungen nutzen. Im letzten Kapitel testete ich ob Kap-Borstenhörnchen die Sonne als Referenzpunkt nutzen wenn sie Futter verstecken oder es wiederfinden, da auf dem Gelände andere offensichtliche Orientierungspunkte fehlen. Beim Verstecken von Futter bewegten sich die Tiere immer mit einem konstant verschobenen Winkel zur Sonne, und bewegten sich dabei gleichzeitig auf geraden Linien zwischen der Futterquelle und dem Ort des Verstecks. Beim Wiederfinden des Futters zeigten die Tiere Flexibilität bei der Nutzung der Sonne als Orientierungshilfe und entfernten Futter schneller wenn mehr Tiere in der Gruppe anwesend waren. Insgesamt zeigt diese Doktorarbeit die Vielfältigkeit der Entscheidungen welche Tiere treffen müssen wenn sie Vorräte anlegen, um den Gewinn zu maximieren. Ich habe verschiedene Fragen beantwortet, wie zum Beispiel wann die Tiere Futter verstecken, über die Entscheidungen was sie verstecken und wo sie ihre Verstecke plazieren. Da dies eine sehr gesellige Art ist, sind diese Entscheidungen stark von den Artgenossen in der Gruppe abhängig. Die meiste Forschung über Strategien zum Schutz von angelegten Vorräten wurde bisher an Vögeln gemacht, daher liefert diese Arbeit dringend benötigtes Wissen über diese Strategien bei Säugetieren. Forschung wie diese ermutigt hoffentlich andere Studien an Säugetieren um herauszufinden, wie das Leben in sozialen Gruppen zur Evolution von Strategien zum Schutz von Vorräten führen kann

Use of the revised World Health Organization cluster survey methodology to classify measles-rubella vaccination campaign coverage in 47 counties in Kenya, 2016

<div><p>Introduction</p><p>To achieve measles elimination, two doses of measles-containing vaccine (MCV) are provided through routine immunization services or vaccination campaigns. In May 2016, Kenya conducted a measles-rubella (MR) vaccination campaign targeting 19 million children aged 9 months–14 years, with a goal of achieving ≥95% coverage. We conducted a post-campaign cluster survey to estimate national coverage and classify coverage in Kenya’s 47 counties.</p><p>Methods</p><p>The stratified multi-stage cluster survey included data from 20,011 children in 8,253 households sampled using the recently revised World Health Organization coverage survey methodology (2015). Point estimates and 95% confidence intervals (95% CI) of national campaign coverage were calculated, accounting for study design. County vaccination coverage was classified as ‘pass,’ ‘fail,’ or ‘intermediate,’ using one-sided hypothesis tests against a 95% threshold.</p><p>Results</p><p>Estimated national MR campaign coverage was 95% (95% CI: 94%-96%). Coverage differed significantly (p < 0.05) by child’s school attendance, mother’s education, household wealth, and other factors. In classifying coverage, 20 counties passed (≥95%), two failed (<95%), and 25 were intermediate (unable to classify either way). Reported campaign awareness among caretakers was 92%. After the 2016 MR campaign, an estimated 93% (95% CI: 92%–94%) of children aged 9 months to 14 years had received ≥2 MCV doses; 6% (95% CI: 6%–7%) had 1 MCV dose; and 0.7% (95% CI: 0.6%–0.9%) remained unvaccinated.</p><p>Conclusions</p><p>Kenya reached the MR campaign target of 95% vaccination coverage, representing a substantial achievement towards increasing population immunity. High campaign awareness reflected the comprehensive social mobilization strategy implemented in Kenya and supports the importance of including strong communications platforms in future vaccination campaigns. In counties with sub-optimal MR campaign coverage, further efforts are needed to increase MCV coverage to achieve the national goal of measles elimination by 2020.</p></div

Estimated coverage with two doses of measles-containing vaccine (MCV) after the 2016 measles-rubella (MR) campaign in Kenya.

<p>(A) Graph of the number of MCV doses received by one-year age cohort, including the MCV1 and MCV2 doses provided by routine immunization services, the MR campaign dose, and previous measles campaign doses as documented by vaccination cards, campaign finger-markings and caregivers’ recall. (B) Map of two-dose MCV coverage of children aged 9 months–14 years by county.</p

Socio-demographic characteristics of respondents in the measles-rubella vaccination coverage survey—Kenya, 2016.

<p>Socio-demographic characteristics of respondents in the measles-rubella vaccination coverage survey—Kenya, 2016.</p

Estimated proportion of children by age group and number of measles doses received at the end of the measles-rubella vaccination campaign—Kenya, 2016.

<p>Estimated proportion of children by age group and number of measles doses received at the end of the measles-rubella vaccination campaign—Kenya, 2016.</p

Classification of measles-rubella campaign vaccination coverage by county—Kenya, 2016.

<p>Coverage point estimates (one-sided upper and lower 95% confidence bounds [1-S 95% CB]) for children aged 9 months–14 years by country are graphed and printed in the columns to the right of the graph, along with the design effects (DE), intra-cluster correlation coefficients (ICC), and effective sample sizes (ESS = observed sample size / DE; where DE <1.0, a DE of 1.0 was used to calculate ESS). County coverages colored in green were classified as ‘passing,’ or likely to have coverage ≥95% (i.e., lower confidence bound was >95%). Coverages depicted in yellow were classified as ‘intermediate,’ or unable to confidently classify as above or below 95% given the survey sample size (i.e., upper and lower confidence bounds straddled the 95% threshold). Coverages shown in red were classified as ‘failing,’ or likely to have coverage <95% (i.e., upper confidence bound was below 95%).</p