Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses

OBJECTIVES: To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. DESIGN: Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. DATA SOURCES: Medline, CINAHL, Embase, PsychInfo, Cochrane Database, Clinical Trials Register, and hand searching of references from reviews and guidelines to January 2005. RESULTS: 1207 references were identified, including 115 systematic reviews, expert reviews, or guidelines. Of the 92 full papers inspected, 43 were included. Meta-analysis for multifaceted interventions in hospital (13 studies) showed a rate ratio of 0.82 (95% confidence interval 0.68 to 0.997) for falls but no significant effect on the number of fallers or fractures. For hip protectors in care homes (11 studies) the rate ratio for hip fractures was 0.67 (0.46 to 0.98), but there was no significant effect on falls and not enough studies on fallers. For all other interventions (multifaceted interventions in care homes; removal of physical restraints in either setting; fall alarm devices in either setting; exercise in care homes; calcium/vitamin D in care homes; changes in the physical environment in either setting; medication review in hospital) meta-analysis was either unsuitable because of insufficient studies or showed no significant effect on falls, fallers, or fractures, despite strongly positive results in some individual studies. Meta-regression showed no significant association between effect size and prevalence of dementia or cognitive impairment. CONCLUSION: There is some evidence that multifaceted interventions in hospital reduce the number of falls and that use of hip protectors in care homes prevents hip fractures. There is insufficient evidence, however, for the effectiveness of other single interventions in hospitals or care homes or multifaceted interventions in care homes.

It is always on your mind: experiences and perceptions of falling of older people and their carers and the potential of a mobile falls detection device

Background. Falls and fear of falling present a major risk to older people as both can affect their quality of life and independence. Mobile assistive technologies (AT) fall detection devices may maximise the potential for older people to live independently for as long as possible within their own homes by facilitating early detection of falls. Aims. To explore the experiences and perceptions of older people and their carers as to the potential of a mobile falls detection AT device. Methods. Nine focus groups with 47 participants including both older people with a range of health conditions and their carers. Interviews were audio recorded, transcribed verbatim, and thematically analysed. Results. Four key themes were identified relating to participants’ experiences and perceptions of falling and the potential impact of a mobile falls detector: cause of falling, falling as everyday vulnerability, the environmental context of falling, and regaining confidence and independence by having a mobile falls detector. Conclusion. The perceived benefits of a mobile falls detector may differ between older people and their carers. The experience of falling has to be taken into account when designing mobile assistive technology devices as these may influence perceptions of such devices and how older people utilise them.

Facebook & BlackBoard: comparative view of learning environments

For several years, online educational tools such as Blackboard have been used by Universities to foster collaborative learning in an online setting. Such tools tend to be implemented in a top-down fashion, with the institution providing the tool to the students and instructing them to use it. Recently, however, a more informal, bottom up approach is increasingly being employed by the students themselves in the form of social networks such as Facebook. With over 9,000 registered Facebook users at the beginning of this study, rising to over 12,000 at the University of Reading alone, Facebook is becoming the de facto social network of choice for higher education students in the UK, and there was increasing anecdotal evidence that students were actively learning via Facebook rather than through BlackBoard. To test the validity of these anecdotes, a questionnaire was sent to students, asking them about their learning experiences via BlackBoard and Facebook. The results show that students are making use of the tools available to them even when there is no formal academic content, and that increased use of a social networking tool is correlated with a reported increase in learning as a result of that use.

View-based approaches to spatial representation in human vision

In an immersive virtual environment, observers fail to notice the expansion of a room around them and consequently make gross errors when comparing the size of objects. This result is difficult to explain if the visual system continuously generates a 3-D model of the scene based on known baseline information from interocular separation or proprioception as the observer walks. An alternative is that observers use view-based methods to guide their actions and to represent the spatial layout of the scene. In this case, they may have an expectation of the images they will receive but be insensitive to the rate at which images arrive as they walk. We describe the way in which the eye movement strategy of animals simplifies motion processing if their goal is to move towards a desired image and discuss dorsal and ventral stream processing of moving images in that context. Although many questions about view-based approaches to scene representation remain unanswered, the solutions are likely to be highly relevant to understanding biological 3-D vision.

A geomatics-based approach for the derivation of the spatial distribution of sediment transport processes in periglacial mountain environments

Within this paper modern techniques such as satellite image analysis and tools provided by geographic information systems (GIS.) are exploited in order to extend and improve existing techniques for mapping the spatial distribution of sediment transport processes. The processes of interest comprise mass movements such as solifluction, slope wash, dirty avalanches and rock- and boulder falls. They differ considerably in nature and therefore different approaches for the derivation of their spatial extent are required. A major challenge is addressing the differences between the comparably coarse resolution of the available satellite data (Landsat TM/ETM+, 30 in x 30 m) and the actual scale of sediment transport in this environment. A three-stepped approach has been developed which is based on the concept of Geomorphic Process Units (GPUs): parameterization, process area delineation and combination. Parameters include land cover from satellite data and digital elevation model derivatives. Process areas are identified using a hierarchical classification scheme utilizing thresholds and definition of topology. The approach has been developed for the Karkevagge in Sweden and could be successfully transferred to the Rabotsbekken catchment at Okstindan, Norway using similar input data. Copyright (C) 2008 John Wiley & Sons, Ltd.

Quantifying sediment transport processes in periglacial mountain environments at a catchment scale using geomorphic process units

The research record on the quantification of sediment transport processes in periglacial mountain environments in Scandimvia dates back to the 1950s. A wide range of measurements is. available, especially from the Karkevagge region of northern Sweden. Within this paper satellite image analysis and tools provided by geographic information systems (GIS) are exploited in order to extend and improve this research and to complement geophysical methods. The processes of interest include mass movements such as solifluction, slope wash, dirty avalanches and rock-and boulder falls. Geomorphic process units have been derived in order to allow quantification via GIS techniques at a catchment scale. Mass movement rates based on existing Field measurements are employed in the budget calculation. In the Karkevagge catch ment. 80% of the area can be identified either as a source area for sediments or as a zone where sediments are deposited. The overall budget for the slopes beneath the rockwalls in the Karkevagge is approximately 680 t a(-1) whilst about 150 : a-1 are transported into the fluvial System.

Terrestrial implications for the maritime geoarchaeological resource: A view from the Lower Palaeolithic

Stone tools and faunal remains have been recovered from the English Channel and the North Sea through trawling, dredging for aggregates, channel clearance, and coring. These finds highlight the potential for a maritime Lower Palaeolithic archaeological resource. It is proposed here that any Lower Palaeolithic artefacts, faunal remains, and sediments deposited in the maritime zone during dry, low-stand phases were once (and may still be) contextually similar to their counterparts in the terrestrial Lower Palaeolithic records of north-western Europe. Given these similarities, can interpretive models and analytical frameworks developed for terrestrial archaeology be profitably applied to an assessment of the potential value of any maritime resource? The terrestrial geoarchaeological resource for the Lower Palaeolithic is dominated by artefacts and ecofacts that have been fluvially reworked. The spatio-temporal resolution of these data varies from entire river valleys and marine isotope stages to river channel gravel bar surfaces and decadal timescales, thus supporting a variety of questions and approaches. However, the structure of the terrestrial resource also highlights two fundamental limitations in current maritime knowledge that can restrict the application of terrestrial approaches to any potential maritime resource: (i) how have the repetitive transgressions and regressions of the Middle and Late Pleistocene modified the terrace landforms and sediments associated with the river systems of the English Channel and southern North Sea basins?; and (ii) do the surviving submerged terrace landforms and fluvial sedimentary deposits support robust geochronological models, as is the case with the classical terrestrial terrace sequences? This paper highlights potential approaches to these questions, and concludes that the fluvial palaeogeography, Pleistocene fossils, and potential Lower Palaeolithic artefacts of the maritime geoarchaeological resource can be profitably investigated in future as derived, low-resolution data sets, facilitating questions of colonisation, occupation, demography, and material culture.

The Victoria Falls 1900-1940: Landscape, tourism and the geographical imagination

This article is about the politics of landscape ideas, and the relationship between landscape, identity and memory. It explores these themes through the history of the Victoria Falls, and the tourist resort that developed around the waterfall after 1900. Drawing on oral and archival sources, including popular natural history writing and tourist guides, it investigates African and European ideas about the waterfall, and the ways that these interacted and changed in the course of colonial appropriations of the Falls area. The tourist experience of the resort and the landscape ideas promoted through it were linked to Edwardian notions of Britishness and empire, ideas of whiteness and settler identities that transcended new colonial borders, and to the subject identities accommodated or excluded. Cultures of colonial authority did not develop by simply overriding local ideas, they involved fusions, exchanges and selective appropriations of them. The two main African groups I am concerned with here are the Leya, who lived in small groups around the Falls under a number of separate chiefs, and the powerful Lozi rulers, to whom they paid tribute in the nineteenth century. The article highlights colonial authorities' celebration of aspects of the Lozi aristocracy's relationship with the river, and their exclusion of the Leya people who had a longer and closer relationship with the waterfall. It also touches on the politics of recent attempts to reverse this exclusion, and the controversial rewriting of history this has involved.

The sediment trapping efficiency of the macro-tidal Daly Estuary, tropical Australia

Field studies were carried out on the water and sediment dynamics in the tropical, macro-tidal, Daly Estuary. The estuary is shallow, very-turbid, about 100 km long, and the entrance is funnel-shape. In the wet, high flow season, normal tidal ranges can be suppressed in the estuary, depending on inflow rates, and freshwater becomes dominant up to the mouth. At that time a fraction of the fine sediment load is exported offshore as a bottom-tagging nepheloid layer after the sediment falls out of suspension of the thin, near-surface, river plume. The remaining fraction and the riverine coarse sediment form a large sediment bar 10 km long, up to 6 m in height and extending across the whole width of the channel near the mouth. This bar, as well as shoals in the estuary, partially pond the mid- to upper-estuary. This bar builds up from the deposition of riverine sediment during a wet season with high runoff and can raise mean water level by up to 2 m in the upper estuary in the low flow season. This ponding effect takes about three successive dry years to disappear by the sediment forming the bar being redistributed all over the estuary by tidal pumping of fine and coarse sediment in the dry season, which is the low flow season. The swift reversal of the tidal currents from ebb to flood results in macro-turbulence that lasts about 20 min. Bed load transport is preferentially landward and occurs only for water currents greater than 0.6 m s(-1). This high value of the threshold velocity suggests that the sand may be cemented by the mud. The Daly Estuary thus is a leaky sediment trap with an efficiency varying both seasonally and inter-annually. (c) 2006 Elsevier Ltd. All rights reserved.

Simulated global-mean sea level changes over the last half-millennium

Simulations of the last 500 yr carried out using the Third Hadley Centre Coupled Ocean-Atmosphere GCM (HadCM3) with anthropogenic and natural (solar and volcanic) forcings have been analyzed. Global-mean surface temperature change during the twentieth century is well reproduced. Simulated contributions to global-mean sea level rise during recent decades due to thermal expansion (the largest term) and to mass loss from glaciers and ice caps agree within uncertainties with observational estimates of these terms, but their sum falls short of the observed rate of sea level rise. This discrepancy has been discussed by previous authors; a completely satisfactory explanation of twentieth-century sea level rise is lacking. The model suggests that the apparent onset of sea level rise and glacier retreat during the first part of the nineteenth century was due to natural forcing. The rate of sea level rise was larger during the twentieth century than during the previous centuries because of anthropogenic forcing, but decreasing natural forcing during the second half of the twentieth century tended to offset the anthropogenic acceleration in the rate. Volcanic eruptions cause rapid falls in sea level, followed by recovery over several decades. The model shows substantially less decadal variability in sea level and its thermal expansion component than twentieth-century observations indicate, either because it does not generate sufficient ocean internal variability, or because the observational analyses overestimate the variability.