Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events

Aims and objectives To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. Background While there are evidence‐based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without. Design Critical incident technique. Methods Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south‐east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed. Results Three themes emerged from 23 reflective accounts of fall events: “direct observation is confounded by multiple observers” and “knowing the person has cognitive impairment is not enough,” and “want to rely on the guideline but unsure how to enact it.” While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment. Conclusions Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. Relevance to clinical practice To reduce falls, nurses can involve the family to support “knowing the patient” to enable prediction of impulsive actions; shift the focus of in‐service from lectures to specific case presentations, with collaborative analysis on person‐focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living.Full Tex

Does personality affect dietary intake?

The purpose of this review is to evaluate the evidence for an association between the Big Five dimensions of personality, dietary intake, and compliance to dietary recommendations. Poor diet is a known risk factor for overweight and obesity and associated chronic lifestyle diseases and it has been proposed that personality may be linked to dietary choices. Findings from cross-sectional surveys from different countries and cultures show a positive association between Openness and consumption of fruits and vegetables and between Conscientiousness and healthy eating. Although no evidence has been found that personality dimensions are associated with adherence to dietary recommendations over time, Conscientiousness is associated with a number of prosocial and health-promoting behaviors that include avoiding alcohol-related harm, binge-drinking, and smoking, and adherence to medication regimens. With emerging evidence of an association between higher Conscientiousness and lower obesity risk, the hypothesis that higher Conscientiousness may predict adoption of healthy dietary and other lifestyle recommendations appears to be supported

The incidence and make up of ability grouped sets in the UK primary school

The adoption of setting in the primary school (pupils ability grouped across classes for particular subjects) emerged during the 1990s as a means to raise standards. Recent research based on 8875 children in the Millennium Cohort Study showed that 25.8% of children in Year 2 were set for literacy and mathematics and a further 11.2% of children were set for mathematics or literacy alone. Logistic regression analysis showed that the best predictors of being in the top set for literacy or mathematics were whether the child was born in the Autumn or Winter and cognitive ability scores. Boys were significantly more likely than girls to be in the bottom literacy set. Family circumstances held less importance for setting placement compared with the child’s own characteristics, although they were more important in relation to bottom set placement. Children in bottom sets were significantly more likely to be part of a long-term single parent household, have experienced poverty, and not to have a mother with qualifications at NVQ3 or higher levels. The findings are discussed in relation to earlier research and the implications for schools are set out

Drift dynamics in microbial communities and the effective community size

The structure and diversity of all open microbial communities are shaped by individual births, deaths, speciation and immigration events; the precise timings of these events are unknowable and unpredictable. This randomness is manifest as ecological drift in the population dynamics, the importance of which has been a source of debate for decades. There are theoretical reasons to suppose that drift would be imperceptible in large microbial communities, but this is at odds with circumstantial evidence that effects can be seen even in huge, complex communities. To resolve this dichotomy we need to observe dynamics in simple systems where key parameters, like migration, birth and death rates can be directly measured. We monitored the dynamics in the abundance of two genetically modified strains of Escherichia coli, with tuneable growth characteristics, that were mixed and continually fed into 10 identical chemostats. We demonstrated that the effects of demographic (non‐environmental) stochasticity are very apparent in the dynamics. However, they do not conform to the most parsimonious and commonly applied mathematical models, where each stochastic event is independent. For these simple models to reproduce the observed dynamics we need to invoke an “effective community size”, which is smaller than the census community size

Decommissionable concrete? Adsorption of radionuclides by removable bio-mineralised hydroxyapatite layers

Decomissioning of concrete infrastructure at nuclear sites after years of use can be problematic and dangerous due to high levels of radioactivity, penetration of contamination into concrete and potentially large volumes of contaminated material. The depth of contamination within concrete ranges from mm to cm and contain many radioactive isotopes types such as C, U, Pu, Sr and Cs. Before decommissioning, concrete structures must be surface decontaminated to minimize waste volumes and reduce hazard. Techniques normally applied involve mechanical scabbing/scraping and high pressure blasting of concrete to remove layers of contamination. These techniques are expensive, unsafe for workers, and risk the spread of radioactive contamination. In addressing the above issues, this project aims to develop a novel decommissionable concrete tailored for safe, rapid decommissioning with minimal waste. Previous work in our group has shown that under certain conditions, bacteria can make bio-mineralized hydroxyapatite (HAp) which form layers as surfaces on cement [1]. The Ca from the HAp can substitute for other cations and we hypothesize that this mechanism would be relevant for radioactive isotopes such as Sr2+ and Cs+ and UO22+, by bonding to PO43-. These HAp layers can be engineered for easy removal at the end of life. Our poster presents promising results of the first stage in developing the adsorptive layer of hydroxyapatite (HAp) and show its powerful adsorptive properties for ions such as Sr2+ and Cs+ with promise for UO22+

Hydroxyapatite coatings on cement paste as barriers against radiological contamination

A novel method for precipitating hydroxyapatite (HAp) onto cement paste is investigated for protecting concrete infrastructure from radiological contamination. Legacy nuclear sites contain large volumes of contaminated concrete and are expensive and dangerous to decommission. One solution is to ‘design for decommissioning’ by confining contaminants to a thin layer. Current layering methods, including paints or films, offer poor durability over plant lifespans. Here, we present a mineral-HAp-coated cement, which innovatively serves as a barrier layer to radioactive contaminants (e.g. Sr, U). HAp is shown to directly mineralise onto a cement paste block in a layer several microns thick via a two-step process: first, applying a silica-based scaffold onto a cement paste block; and second, soaking the resulting block in a PO4-enriched Ringer’s solution. Strontium ingression was tested on coated and uncoated cement paste (~ 40 × 40 × 40mm cement, 450 mL, 1000 mg L− 1 Sr) for a period of 1-week. While both coated and uncoated samples reduced the solution concentration of Sr by half, Sr was held within the HAp layer of coated cement paste and was not observed within the cement matrix. In the uncoated samples, Sr had penetrated further into the block. Further studies aim to characterise HAp before and after exposure to a range of radioactive contaminants and to develop a method for mechanical layer separation

Taking an evaluative stance to decision-making about professional development options in early childhood education and care

This article builds on our ongoing work in conceptualising an ‘evaluative stance’ framework to assist in understanding how leaders in the field of early childhood education and care (ECEC) make decisions about the selection of professional development options for themselves and their staff. It introduces the notion that evaluative mindsets can be considered in terms of attitudes towards decision-making that are based on personal epistemologies. Drawing on data from semi-structured interviews, it explores the mindsets of six experienced leaders in two long-established ECEC organisations in Australia with respect to their decision-making about professional development. The article concludes with a consideration of the potential utility of the framework and the coding template used in this exploratory study

Secondary school pupils' preferences for different types of structured grouping practices

The aim of this paper is to explore pupils’ preferences for particular types of grouping practices an area neglected in earlier research focusing on the personal and social outcomes of ability grouping. The sample comprised over 5,000 year 9 pupils (aged 13-14 years) in 45 mixed secondary comprehensive schools in England. The schools represented three levels of ability grouping in the lower school (years 7 to 9). Pupils responded to a questionnaire which explored the types of grouping that they preferred and the reasons for their choices. The majority of pupils preferred setting, although this was mediated by their set placement, type of school, socio-economic status and gender. The key reason given for this preference was that it enabled work to be matched to learning needs. The paper considers whether there are other ways of achieving this avoiding the negative social and personal outcomes of setting for some pupils