Falling in Acute Mental Health Settings for Older People : Who falls, where, when and why?

Copyright: © 2014 Dickinson A et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Falls, slips and trips are a major patient safety concern in hospital settings accounting for 26 per cent of all reported patient safety incidents in England. Mental health conditions and their treatments add further to fall risk but we have little information regarding who falls, where and when within mental health settings. Methods: This paper presents an overview of the pattern of falls by older patients within an in-patient mental health setting in the South of England using routine records completed by staff when a fall occurs. 920 fall reports over three years were analysed, and 7 focus groups were undertaken with ward staff to explore how staff understood falls and their experiences of using the falls reporting system. Results: In terms of diagnosis 40% of fallers had a primary functional diagnosis, 46% an organic mental health diagnosis (14% non-specific diagnosis), average age was 81.7 years (range 59 to 99 years; SD 8.3) and 57% were female. Approximately one quarter, 27%, of falls were observed by staff. Falls were not evenly distributed across either day of week or time of day, with peak times for falls on Tuesday and Saturday and morning (7-8 and 9-10am) and subsidiary peaks between noon and 1pm and early evening (5-6pm). Almost half of falls occurred in private spaces in the ward such as bedrooms, and 42% in public spaces such as sitting rooms. However 60% of falls in public spaces were unseen. Reporting in these settings was problematic for staff and patients were sometimes described as placing themselves on the floor as a consequence of their mental health condition. The average time to first fall was 5 weeks. Conclusions: Routine mapping of falls could be undertaken at ward and organization level and contribute to better understanding of the local factors contributing to falls. Exploring incident report data in focus groups with staff helped us and them to interpret the data and to understand some of the decision making staff engage in everyday when reporting falls.Peer reviewedFinal Published versio

Adoption of Web Based Technology to Facilitate Industrial Attachment Schemes in Tertiary Institutions: A Case Takoradi Polytechnic, Ghana

It is currently no doubt globally that Information Communication Technology (ICT) inventions and innovations have become integral part of our lives and also brought about significant changes and improvement in productivity at workplaces. A number of Institutions in Africa are yet to tap into the efficient and cost saving benefits of ICT innovations. Tertiary students especially those in the polytechnics are made to undergo industrial attachment in order to equip themselves with practical oriented skills and work ethics that cannot be fully acquired in the classroom.  This fits into the objective of establishing polytechnics, as other researchers have noted, as technological institutions with the responsibility for providing career-focused education and skills training in close collaboration with industry. However, the Industrial Liaison Office of various polytechnics who are to coordinate the linkage between industry and academia are overwhelmed by administrative tasks of placement of students in industry and associated supervisory duties. The authors adopted prototyping methodology to develop a Web-based Application for use by Industrial Liaison Office of Takoradi Polytechnic to help facilitate administrative processes of printing attachment letters and generating industrial attachment supervision list based on entries students fill online. Software development processes of the adopted methodology were carried out through to the final deployment stage. The Application is recommended for use by any institution which wants to use software to help facilitate their industrial attachment programme processes. Keywords: Takoradi Polytechnic, Portal, Industrial Liaison Office, students, letter

Genetic susceptibility to allergic bronchopulmonary aspergillosis in asthma: a genetic association study

Background: In patients with asthma, the fungus Aspergillus fumigatus can cause allergic bronchopulmonary aspergillosis (ABPA). Familial ABPA is reported, and some genetic factors have been associated with the disease, however, these are small studies (n ≤ 38) and do not explain all cases of ABPA.Methods: We analysed SNPs in 95 ABPA patients, comparing frequencies to 152 atopic asthmatic and 279 healthy controls. Twenty two genes were selected from literature, and 195 tagging SNPs were analysed for genetic association with ABPA using logistic regression corrected for multiple testing. We also analysed monocyte-derived macrophage gene expression before and during co-culture with A. fumigatus.Results: Seventeen ABPA-associated SNPs (ABPA v Atopic asthma) were identified. Three remained significant after correction for multiple testing; IL13 rs20541, IL4R rs3024656, TLR3 rs1879026. We also identified minor differences in macrophage gene expression responses in the ABPA group compared to the control groups.Conclusions: Multiple SNPs are now associated with ABPA. Some are novel associations. These associations implicate cytokine pathways and receptors in the aberrant response to A. fumigatus and susceptibility to ABPA, providing insights into the pathogenesis of ABPA and/or its complications. We hope these results will lead to increased understanding and improved treatment and diagnostics for ABPA

Interactions between soil fertility and climate drive variation in functional traits in New Zealand forests.

Plant functional traits provide a mechanistic approach to understanding the processes of environmental filtering and community assembly. Variation along environmental gradients results in changes in the adaptive values of traits. Climate and soil fertility are two dominant factors that drive these patterns of trait variation. These two factors simultaneously select for traits during environmental filtering. However, we do not understand how interactions between climate and soil fertility influence the variation in community-level traits of multiple plant organs. The roles of traits in New Zealand forests are also yet to be studied at a national scale. This thesis aimed to determine the adaptive values of multiple functional traits across broad climate and soil fertility gradients in New Zealand forests. This was achieved by the following methods. Data were collected for leaf, stem, root, seed, flowering, and whole-plant traits from the 64 most common native trees in forests nationwide. Community composition and soil properties were measured at 324 plots across the country. For each plot, long-term average climate data were extracted from a model. A variable representing variation in soil fertility in the plots was derived by principal components analysis (PCA). Community-weighted mean (CWM) functional traits, i.e. average trait values weighted by the abundance of species, were calculated for each plot. Dimensionality of the specie-trait matrix was determined by PCA. Multiple linear regression was used to model the variation of each of the CWM traits as functions of mean annual temperature (MAT), vapour pressure deficit (VPD), soil fertility, soil fertility × MAT interaction, soil fertility × VPD interaction, total basal area and topography. Five dimensions of trait variation were identified among New Zealand trees. Soil fertility was a more significant predictor of CWM traits than either of the climate variables. However, both of the interaction effects were significant for most traits and overrode the importance of the main effects. For example, in sites with high fertility soil, leaf economics traits varied from ‘slow’ in cool and dry conditions to ‘fast’ in warm and moist conditions, but in sites with low fertility, these traits were ‘slow’ in all climates. Therefore, the adaptive values of multiple functional traits of New Zealand forests varied depending on both soil fertility and climate. This thesis provides the first recognition of the significant roles of the interaction effects between soil fertility and climate in driving variation in CWM traits from multiple plant organs. Climate and soil fertility interact in a way that influences CWM trait values independently from the influence of each environmental variable. These interactions are suspected to be important globally and should be tested for worldwide to confirm the generality of their effects. In conclusion, this thesis demonstrates that studying the relationships between CWM traits and soil fertility or climate independently is insufficient, when attempting to understand the process of environmental filtering. It is critical that the interaction effects between climate and soil fertility are included in future studies to enhance our understanding and ability to predict community-level responses to processes such as climate change

Long-term effects of allergen sensitization and exposure in adult asthma: a prospective study.

BACKGROUND: : We investigated the effects of sensitization and exposure to common domestic allergens on longitudinal changes in lung function and bronchial hyperresponsiveness. METHODS: : Subjects attended 2 visits that were 4 years apart. Skin prick testing was performed and household dust samples were collected for quantification of mite, dog, and cat allergens at baseline. Measurements of lung function, exhaled nitric oxide, and bronchial hyperresponsiveness were completed at both visits. RESULTS: : Dust samples were collected in 165 of the 200 subjects completing both visits. Mean length of follow-up was 47 months. Bronchial hyperresponsiveness, measured at both visits in 86 subjects, deteriorated in those exposed to high mite allergen levels compared with those not exposed [mean (95% CI) doubling dose change PD20 = -0.44 (-1.07 to 0.19) vs 0.82 (0.27 to 1.36)], but improved in those exposed to high dog allergen levels compared with those not exposed [1.10 (0.33 to 1.86) vs 0.10 (-0.39 to 0.58)]. The associations were significant in the multivariate models. Cat allergen exposure was not associated with any changes in lung function, exhaled nitric oxide, or bronchial hyperresponsiveness. CONCLUSIONS: : In a 4-year prospective cohort of persons with asthma, exposure to high levels of dust mite allergens at baseline was associated with a subsequent increase in bronchial hyperresponsiveness

Prospectus, November 9, 1994

https://spark.parkland.edu/prospectus_1994/1020/thumbnail.jp