Using a community of practice to evaluate falls prevention activity in a residential aged care organisation: a clinical audit

Objective This study evaluates whether a community of practice (CoP) could conduct a falls prevention clinical audit and identify gaps in falls prevention practice requiring action. Methods Cross-sectional falls prevention clinical audits were conducted in 13 residential aged care (RAC) sites of a not-for-profit organisation providing care to a total of 779 residents. The audits were led by an operationalised CoP assisted by site clinical staff. A CoP is a group of people with a shared interest who get together to innovate for change. The CoP was made up of self-nominated staff representing all RAC sites and comprised of staff from various disciplines with a shared interest in falls prevention. Results All 13 (100%) sites completed the audit. CoP conduct of the audit met identified criteria for an effective clinical audit. The priorities for improvement were identified as increasing the proportion of residents receiving vitamin D supplementation (mean 41.5%, s.d. 23.7) and development of mandatory falls prevention education for staff and a falls prevention policy, as neither was in place at any site. CoP actions undertaken included a letter to visiting GPs requesting support for vitamin D prescription, surveys of care staff and residents to inform falls education development, defining falls and writing a falls prevention policy. Conclusion A CoP was able to effectively conduct an evidence-based falls prevention activity audit and identify gaps in practice. CoP members were well positioned, as site staff, to overcome barriers and facilitate action in falls prevention practice

Airborne coherent wind lidar measurements of the momentum flux profile from orographically induced gravity waves

In the course of the GW-LCYCLE II campaign, conducted in Jan/Feb 2016 from Kiruna, Sweden, coherent Doppler wind lidar (2 µm DWL) measurements were performed from the DLR Falcon aircraft to investigate gravity waves induced by flow across the Scandinavian Alps. During a mountain wave event on 28 January 2016, a novel momentum flux (MF) scan pattern with fore and aft propagating laser beams was applied to the 2 µm DWL. This allows us to measure the vertical wind and the horizontal wind along the flight track simultaneously with a high horizontal resolution of ≈800 m and hence enables us to derive the horizontal MF profile for a broad wavelength spectrum from a few hundred meters to several hundred kilometers. The functionality of this method and the corresponding retrieval algorithm is validated using a comparison against in situ wind data measured by the High Altitude and Long Range (HALO) aircraft which was also deployed in Kiruna for the POLSTRACC (Polar Stratosphere in a Changing Climate) campaign. Based on that, the systematic and random error of the wind speeds retrieved from the 2 µm DWL observations are determined. Further, the measurements performed on that day are used to reveal significant changes in the horizontal wavelengths of the vertical wind speed and of the leg-averaged momentum fluxes in the tropopause inversion layer (TIL) region, which are likely to be induced by interfacial waves as recently presented by Gisinger et al. (2020).</p

Improving engineering change management by introducing a standardised description for engineering changes for the automotive wiring harness

Engineering change management is a key part in the development of products that requires a lot of resources and time. A key problem is the lack of a shared ontology to describe engineering changes. This creates problems, additional effort and hinders the digitalisation of the engineering change management. This is especially true for the development of the automotive wiring harness where a low degree of automation together with the occurrence of many changes in a multi-variant system poses a big challenge. A description that is unambiguous, comprehensive and coherent is needed. The research presented in this paper tackles this problem. A standardised description for the engineering change management for the automotive wiring harness is introduced in this publication. The authors outline the approach that has been used to create a systematic description. The validation of the standardised description is based on two approaches: a case study of a development project and an ongoing development project. The validation shows that 94% of all engineering changes can be described in the proposed standardised way. Concepts where the standardised descriptions can be used to improve the engineering change process are outlined at the end of the paper. The paper thereby presents a way that directly improves the engineering change process and the product development process. It enables the further improvement of the engineering change management by providing a basis for an automatic processing, evaluation and implementation of engineering changes

A Flexible Inventory of Survey Items for Environmental Concepts Generated via Special Attention to Content Validity and Item Response Theory

We demonstrate how many important measures of belief about the environmental suffer from poor content validity and inadequate conceptual breadth (dimensionality). We used scholarship in environmental science and philosophy to propose a list of 13 environmental concepts that can be held as beliefs. After precisely articulating the concepts, we developed 85 trial survey items that emphasized content validity for each concept. The concepts’ breadth and the items’ content validity were aided by scrutiny from 17 knowledgeable critics. We administered the trial items to 449 residents of the United States and used item response theory to reduce the 85 trial items to smaller sets of items for use when survey brevity is required. The reduced sets offered good predictive ability for two environmental attitudes (R2 = 0.42 and 0.46) and indices of pro-environmental behavior (PEB, R2 = 0.23) and behavioral intention (R2 = 0.25). The predictive results were highly interpretable, owing to their robust content validity. For example, PEB was predicted by the degree to which one believes nature to be sacred, but not by the degree of one’s non-anthropocentrism. Concepts with the greatest overall predictive ability were Sacredness and Hope. Belief in non-anthropocentrism had little predictive ability for all four response variables—a claim that previously could not have been made given the widespread poverty of content validity for items representing non-anthropocentrism in existing instruments. The approach described here is especially amenable to incremental improvement, as other researchers propose more informative survey items and potentially important concepts of environmental beliefs we overlooked

Endovascular treatment of thoracoabdominal aortic aneurysms

ObjectiveThis study assessed the role of multibranched stent grafts for thoracoabdominal aortic aneurysm (TAAA) repair.MethodsSelf-expanding covered stents were used to connect the caudally directed cuffs of an aortic stent graft with the visceral branches of a TAAA in 22 patients (16 men, 6 women) with a mean age of 76 ± 7 years. All patients were unfit for open repair, and nine had undergone prior aortic surgery. Customized aortic stent grafts were inserted through surgically exposed femoral (n = 16) or iliac (n = 6) arteries. Covered stents were inserted through surgically exposed brachial arteries. Spinal catheters were used for cerebrospinal fluid pressure drainage in 22 patients and for and spinal anesthesia in 11.ResultsAll 22 stent grafts and all 81 branches were deployed successfully. Aortic coverage as a percentage of subclavian-to-bifurcation distance was 69% ± 20%. Mean contrast volume was 203 mL, mean blood loss was 714 mL, and mean hospital stay was 10.9 days. Two patients (9.1%) died perioperatively: one from guidewire injury to a renal arterial branch and the other from a medication error. Serious or potentially serious complications occurred in 9 of 22 patients (41%). There was no paraplegia, renal failure, stroke, or myocardial infarction among the 20 surviving patients. Two patients (9.1%) underwent successful reintervention: one for localized intimal disruption and the other for aortic dissection, type I endoleak, and stenosis of the superior mesenteric artery. One patient has a type II endoleak. Follow-up is >1 month in 19 patients, >6 months in 12, and >12 months in 8. One branch (renal artery) occluded for a 98.75% branch patency rate at 1 month. The other 80 branches remain patent. There are no signs of stent graft migration, component separation, or fracture.ConclusionsMultibranched stent graft implantation eliminates aneurysm flow, preserves visceral perfusion, and avoids many of the physiologic stresses associated with other forms of repair. The results support an expanded role for this technique in the treatment of TAAA

On giant shoulders: How a seamount affects the microbial community composition of seawater and sponges

Seamounts represent ideal systems to study the influence and interdependency of environmental gradients at a single geographic location. These topographic features represent a prominent habitat for various forms of life, including microbiota and macrobiota, spanning benthic as well as pelagic organisms. While it is known that seamounts are globally abundant structures, it still remains unclear how and to which extent the complexity of the sea floor is intertwined with the local oceanographic mosaic, biogeochemistry, and microbiology of a seamount ecosystem. Along these lines, the present study aimed to explore whether and to what extent seamounts can have an imprint on the microbial community composition of seawater and of sessile benthic invertebrates, sponges. For our high-resolution sampling approach of microbial diversity (16S rRNA gene amplicon sequencing) along with measurements of inorganic nutrients and other biogeochemical parameters, we focused on the Schulz Bank seamount ecosystem, a sponge ground ecosystem which is located on the Arctic Mid-Ocean Ridge. Seawater samples were collected at two sampling depths (mid-water, MW, and near-bed water, BW) from a total of 19 sampling sites. With a clustering approach we defined microbial microhabitats within the pelagic realm at Schulz Bank, which were mapped onto the seamount's topography and related to various environmental parameters (such as suspended particulate matter, SPM; dissolved inorganic carbon, DIC; silicate, SiO−4; phosphate, PO3−4; ammonia, NH+4; nitrate, NO2−3; nitrite, NO−2; depth; and dissolved oxygen, O2). The results of our study reveal a “seamount effect” (sensu stricto) on the microbial mid-water pelagic community at least 200 m above the sea floor. Further, we observed a strong spatial heterogeneity in the pelagic microbial landscape across the seamount, with planktonic microbial communities reflecting oscillatory and circulatory water movements, as well as processes of bentho-pelagic coupling. Depth, NO2−3, SiO−4, and O2 concentrations differed significantly between the determined pelagic microbial clusters close to the sea floor (BW), suggesting that these parameters were presumably linked to changes in microbial community structures. Secondly, we assessed the associated microbial community compositions of three sponge species along a depth gradient of the seamount. While sponge-associated microbial communities were found to be mainly species-specific, we also detected significant intra-specific differences between individuals, depending on the pelagic near-bed cluster they originated from. The variable microbial phyla (i.e. phyla which showed significant differences across varying depth, NO2−3, SiO−4, O2 concentrations, and different from local seawater communities) were distinct for every sponge species when considering average abundances per species. Variable microbial phyla included representatives of both those taxa traditionally counted for the variable community fraction and taxa counted traditionally for the core community fraction. Microbial co-occurrence patterns for the three examined sponge species Geodia hentscheli, Lissodendoryx complicata, and Schaudinnia rosea were distinct from each other. Over all, this study shows that topographic structures such as the Schulz Bank seamount can have an imprint (seamount effect sensu lato) on both the microbial community composition of seawater and sessile benthic invertebrates such as sponges by an interplay between the geology, physical oceanography, biogeochemistry, and microbiology of seamounts

On giant shoulders: How a seamount affects the microbial community composition of seawater and sponges

Seamounts represent ideal systems to study the influence and interdependency of environmental gradients at a single geographic location. These topographic features represent a prominent habitat for various forms of life, including microbiota and macrobiota, spanning benthic as well as pelagic organisms. While it is known that seamounts are globally abundant structures, it still remains unclear how and to which extent the complexity of the sea floor is intertwined with the local oceanographic mosaic, biogeochemistry, and microbiology of a seamount ecosystem. Along these lines, the present study aimed to explore whether and to what extent seamounts can have an imprint on the microbial community composition of seawater and of sessile benthic invertebrates, sponges. For our high-resolution sampling approach of microbial diversity (16S rRNA gene amplicon sequencing) along with measurements of inorganic nutrients and other biogeochemical parameters, we focused on the Schulz Bank seamount ecosystem, a sponge ground ecosystem which is located on the Arctic Mid-Ocean Ridge. Seawater samples were collected at two sampling depths (mid-water, MW, and near-bed water, BW) from a total of 19 sampling sites. With a clustering approach we defined microbial microhabitats within the pelagic realm at Schulz Bank, which were mapped onto the seamount's topography and related to various environmental parameters (such as suspended particulate matter, SPM; dissolved inorganic carbon, DIC; silicate, SiO−4; phosphate, PO3−4; ammonia, NH+4; nitrate, NO2−3; nitrite, NO−2; depth; and dissolved oxygen, O2). The results of our study reveal a “seamount effect” (sensu stricto) on the microbial mid-water pelagic community at least 200 m above the sea floor. Further, we observed a strong spatial heterogeneity in the pelagic microbial landscape across the seamount, with planktonic microbial communities reflecting oscillatory and circulatory water movements, as well as processes of bentho-pelagic coupling. Depth, NO2−3, SiO−4, and O2 concentrations differed significantly between the determined pelagic microbial clusters close to the sea floor (BW), suggesting that these parameters were presumably linked to changes in microbial community structures. Secondly, we assessed the associated microbial community compositions of three sponge species along a depth gradient of the seamount. While sponge-associated microbial communities were found to be mainly species-specific, we also detected significant intra-specific differences between individuals, depending on the pelagic near-bed cluster they originated from. The variable microbial phyla (i.e. phyla which showed significant differences across varying depth, NO2−3, SiO−4, O2 concentrations, and different from local seawater communities) were distinct for every sponge species when considering average abundances per species. Variable microbial phyla included representatives of both those taxa traditionally counted for the variable community fraction and taxa counted traditionally for the core community fraction. Microbial co-occurrence patterns for the three examined sponge species Geodia hentscheli, Lissodendoryx complicata, and Schaudinnia rosea were distinct from each other. Over all, this study shows that topographic structures such as the Schulz Bank seamount can have an imprint (seamount effect sensu lato) on both the microbial community composition of seawater and sessile benthic invertebrates such as sponges by an interplay between the geology, physical oceanography, biogeochemistry, and microbiology of seamounts

Biomechanical analysis of a synthetic femoral spiral fracture model: Do end caps improve retrograde flexible intramedullary nail fixation?

<p>Abstract</p> <p>Background</p> <p>Elastic Stable intramedullary Nailing (ESIN) of dislocated diaphyseal femur fractures has become an accepted method for the treatment in children and adolescents with open physis. Studies focused on complications of this technique showed problems regarding stability, usually in complex fracture types such as spiral fractures and in older children weighing > 40 kg. Biomechanical in vitro testing was performed to evaluate the stability of simulated spiral femoral fractures after retrograde flexible titanium intramedullary nail fixation with and without End caps.</p> <p>Methods</p> <p>Eight synthetic adolescent-size femoral bone models (Sawbones^®with a medullar canal of 10 mm and a spiral fracture of 100 mm length identically sawn by the manufacturer) were used for each group. Both groups underwent retrograde fixation with two 3.5 mm Titanium C-shaped nails inserted from medial and lateral entry portals. In the End Cap group the ends of the nails of the eight specimens were covered with End Caps (Synthes Company, Oberdorf, Switzerland) at the distal entry.</p> <p>Results</p> <p>Beside posterior-anterior stress (4.11 Nm/mm vs. 1.78 Nm/mm, p < 0.001), the use of End Caps demonstrated no higher stability in 4-point bending compared to the group without End Caps (anterior-posterior bending 0.27 Nm/mm vs. 0.77 Nm/mm, p < 0.001; medial-lateral bending 0.8 Nm/mm vs. 1.10 Nm/mm, p < 0.01; lateral-medial bending 0.53 Nm/mm vs. 0.86 Nm/mm, p < 0.001) as well as during internal rotation (0.11 Nm/° vs. 0.14 Nm/°, p < 0.05). During compression in 9°- position and external rotation there was no statistical significant difference (0.37 Nm/° vs. 0.32 Nm/°, p = 0.13 and 1.29 mm vs. 2.18 mm, p = 0.20, respectively) compared to the "classic" 2-C-shaped osteosynthesis without End Caps.</p> <p>Conclusion</p> <p>In this biomechanical study the use of End Caps did not improve the stability of the intramedullary flexible nail osteosynthesis.</p