Feasibility of a stepped wedge cluster RCT and concurrent observational sub-study to evaluate the effects of modified ward night lighting on inpatient fall rates and sleep quality: A protocol for a pilot trial

Background: Falls among hospitalised patients impose a considerable burden on health systems globally and prevention is a priority. Some patient-level interventions have been effective in reducing falls, but others have not. An alternative and promising approach to reducing inpatient falls is through the modification of the hospital physical environment and the night lighting of hospital wards is a leading candidate for investigation. In this pilot trial, we will determine the feasibility of conducting a main trial to evaluate the effects of modified night lighting on inpatient ward level fall rates. We will test also the feasibility of collecting novel forms of patient level data through a concurrent observational sub-study. Methods/design: A stepped wedge, cluster randomised controlled trial will be conducted in six inpatient wards over 14 months in a metropolitan teaching hospital in Brisbane (Australia). The intervention will consist of supplementary night lighting installed across all patient rooms within study wards. The planned placement of luminaires, configurations and spectral characteristics are based on prior published research and pre-trial testing and modification. We will collect data on rates of falls on study wards (falls per 1000 patient days), the proportion of patients who fall once or more, and average length of stay. We will recruit two patients per ward per month to a concurrent observational sub-study aimed at understanding potential impacts on a range of patient sleep and mobility behaviour. The effect on the environment will be monitored with sensors to detect variation in light levels and night-time room activity. We will also collect data on possible patient-level confounders including demographics, pre-admission sleep quality, reported vision, hearing impairment and functional status. Discussion: This pragmatic pilot trial will assess the feasibility of conducting a main trial to investigate the effects of modified night lighting on inpatient fall rates using several new methods previously untested in the context of environmental modifications and patient safety. Pilot data collected through both parts of the trial will be utilised to inform sample size calculations, trial design and final data collection methods for a subsequent main trial.

Content regulation

This entry discusses the origins and history of media content regulation, the reasons for content regulations, and their application to different media platforms. It discusses online content regulations and the concerns that have motivated such policies with particular reference to debates about internet filtering. It is noted that, as there is growing convergence of media content, platforms, devices, and services, the debates can be expected to shift from free speech and censorship on the internet and the social protection of internet users, to wider issues of media policy reform that include cultural policy and industry development in the digital economy.

Evaluating pasture species for less fertile soils in a subtropical aseasonal low rainfall zone

Grasses, legumes, saltbushes and herbs were evaluated at 6 sites in southern inland Queensland to identify potential pasture and forage plants for use on marginal cropping soils. The region experiences summer heat waves and severe winter frosts. Emphasis was on perennial plants, and native species were included. Seedlings were transplanted into the unfertilized fields in either summer or autumn to suit the growing season of plants, and watered to ensure estab-lishment. Summer-growing grasses were the most successful group, while cool season-growing perennials mostly failed. Summer legumes were disappointing, with Stylosanthes scabra and Indigofera schimperi performing best. Some lines such as I. schimperi and the Eragrostis hybrid cv. Cochise were assessed as potential weeds owing to low animal acceptance. Native Rhynchosia minima grew well at some sites and deserves more study. Cenchrus ciliaris was always easy to establish and produced the highest yields. Persistence of some Digitaria and Bothriochloa species, Eragrostis curvula and Fingerhuthia africana at specific sites was encouraging, but potential weediness needs careful assessment. Standard species were identified to represent the main forage types, such as Austrostipa scabra for cool season-growing grasses, for incorporation into future trials with new genetic materials. The early field testing protocol used should be considered for use elsewhere, if unreliable rainfall poses a high risk of establishment failure from scarce seed.

Educators’ perspectives about how older hospital patients can engage in a falls prevention education programme: A qualitative process evaluation

- Objectives Falls are the most frequent adverse event reported in hospitals. Patient and staff education delivered by trained educators significantly reduced falls and injurious falls in an older rehabilitation population. The purpose of the study was to explore the educators’ perspectives of delivering the education and to conceptualise how the programme worked to prevent falls among older patients who received the education. - Design A qualitative exploratory study. - Methods Data were gathered from three sources: conducting a focus group and an interview (n=10 educators), written educator notes and reflective researcher field notes based on interactions with the educators during the primary study. The educators delivered the programme on eight rehabilitation wards for periods of between 10 and 40 weeks. They provided older patients with individualised education to engage in falls prevention and provided staff with education to support patient actions. Data were thematically analysed and presented using a conceptual framework. - Results Falls prevention education led to mutual understanding between staff and patients which assisted patients to engage in falls prevention behaviours. Mutual understanding was derived from the following observations: the educators perceived that they could facilitate an effective three-way interaction between staff actions, patient actions and the ward environment which led to behaviour change on the wards. This included engaging with staff and patients, and assisting them to reconcile differing perspectives about falls prevention behaviours. - Conclusions Individualised falls prevention education effectively provides patients who receive it with the capability and motivation to develop and undertake behavioural strategies that reduce their falls, if supported by staff and the ward environment.

Different countries, same science classes: Students’ experiences of school science in their own words

This paper reviews the remarkably similar experiences of school science reported by high school students in Sweden, England, and Australia. It compares student narratives from interpretive studies by Lindahl, by Osborne and Collins, and by Lyons, identifying core themes relating to critical contemporary issues in science education. These themes revolve around the transmissive pedagogy, decontextualized content, and unnecessary difficulty of school science commonly reported by students in the studies. Their collective experiences are used as a framework for examining student conceptions of, and attitudes to, school science more generally, drawing on an extensive range of international literature. The paper argues that the experiences of students in the three studies provide important insights into the widespread declines in interest and enrolments in high school and university science courses.

The puzzle of falling enrolments in physics and chemistry courses: Putting some pieces together

This paper reports and discusses the principal findings of an Australian study exploring the decisions of high achieving Year 10 students about taking physics and chemistry courses (Lyons, 2003). The study used a ‘multiple worlds’ framework to explore the diverse background characteristics that previous quantitative research had shown were implicated in these decisions. Based on analyses of questionnaire and interview data, the study found that the students’ decisions involved the complex negotiation of a number of cultural characteristics within their school science and family worlds. Many of the students regarded junior high school science as irrelevant, uninteresting and difficult, leaving them with few intrinsic reasons for enrolling in senior science courses. The study found that decisions about taking physical science courses were associated with the resources of cultural and social capital within their families, and the degree to which these resources were congruent with the advantages of choosing these courses. The paper concludes that the low intrinsic value of school science and the erosion of its strategic value contribute to the reluctance of students to choose physical science courses in the senior school.

More equal than others?: Meeting the professional development needs of rural primary and secondary science teachers

It is often assumed that teachers in rural and remote schools are at a disadvantage when it comes to accessing professional development. But is there sufficient evidence to support this assumption? This paper reports findings from two national surveys comparing the professional development priorities of primary and secondary science teachers from metropolitan, provincial and remote schools. The research found that while teachers' unmet needs for some PD opportunities increased significantly with school remoteness, this was not the case for all opportunities. In teasing out the different PD priorities of primary and secondary science teachers, the paper provides evidence to help education authorities and professional organisations address the specific needs of teachers in different locations.

Should I stay or should I go?: Rural and remote students in first year university stem courses

Research on the achievement of rural and remote students in science and mathematics is located within a context of falling levels of participation in physical science and mathematics courses in Australian schools, and underrepresentation of rural students in higher education. International studies such as the Programme of International Student Assessment (PISA), have reported lower levels of mathematical and scientific literacy in Australian students from rural and remote schools (Thomson et al, 2011). The SiMERR national survey of science, mathematics and ICT education in rural and regional Australia (Lyons et al, 2006) identified factors affecting student achievement in rural and remote schools. Many of the issues faced by rural and remote students in their schools are likely to have implications on their university enrolments in science, technology, engineering and mathematics (STEM) courses. For example, rural and remote students are less likely to attend university in general than their city counterparts and higher university attrition rates have been reported for remote students nationally. This paper examines the responses of a sample of rural/remote Australian first year STEM students at Australian universities to two questions. These related to their intentions to complete the course; and whether -and if so, why- they had ever considered withdrawing from their course. Results indicated that rural students who were still in their course by the end of first year were no more or less likely to consider withdrawing than were their peers from more populous centres. However, almost 20% of the rural cohort had considered withdrawing at some stage in their course, and their explanations provide insights into the reasoning of those who may not persist with their courses at university. These results, in the context of the greater attrition rate of remote students from university, point to the need to identify factors that positively impact on rural and remote students’ interest and achievement in science and mathematics. It also highlights a need for future research into the particular issues remote students may face in deciding whether or not to do science at the two key transition points of senior school and university/TAFE studies, and whether or not to persist in their tertiary studies. This paper is positioned at the intersection of two problems in Australian education. The first is a context of falling levels of participation in physical science and mathematics courses in Australian universities. The second is persistent inequitable access to, and retention in, tertiary education for students from rural and remote areas. Despite considerable research attention to both of these areas over recent years these problems have thus far proved to be intractable. This paper therefore aims to briefly review the relevant Australian literature pertaining to these issues; that is, declining STEM enrolments, and the underrepresentation and retention of rural/remote students in higher education. Given the related problems in these two overlapping domains, we then explore the views of first year rural students enrolled in courses, in relation to their intentions of withdrawing (or not) and the associated reasons for their views.

Science, ICT and Mathematics Education in Rural and Regional Australia: The SiMERR National Survey

The SiMERR National Survey was one of the first priorities of the National Centre of Science, Information and Communication Technology and Mathematics Education for Rural and Regional Australia (SiMERR Australia), established at the University of New England in July 2004 through a federal government grant. With university based ‘hubs’ in each state and territory, SiMERR Australia aims to support rural and regional teachers, students and communities in improving educational outcomes in these subject areas. The purpose of the survey was to identify the key issues affecting these outcomes. The National Survey makes six substantial contributions to our understanding of issues in rural education. First, it focuses specifically on school science, ICT and mathematics education, rather than on education more generally. Second, it compares the different circumstances and needs of teachers across a nationally agreed geographical framework, and quantifies these differences. Third, it compares the circumstances and needs of teachers in schools with different proportions of Indigenous students. Fourth, it provides greater detail than previous studies on the specific needs of schools and teachers in these subject areas. Fifth, the analyses of teacher ‘needs’ have been controlled for the socio-economic background of school locations, resulting in findings that are more tightly associated with geographic location than with economic circumstances. Finally, most previous reports on rural education in Australia were based upon focus interviews, public submissions or secondary analyses of available data. In contrast, the National Survey has generated a sizable body of original quantitative and qualitative data.

Choosing physical science courses: The importance of cultural and social capital in the enrolment decisions of high achieving students

This paper reports and discusses findings from a recent study which explored the science enrolment decisions of high achieving, or ‘science proficient’ secondary level students in Australia (Lyons 2003). The research was prompted by the increasing reluctance of such students to enrol in postcompulsory science courses, particularly in physics and chemistry. The study investigated the influences on students’ deliberations about taking a range of science courses. However, this report confines itself to decisions about enrolling in the physical sciences. The paper summarises the students’ experiences and conceptions of school science, as well as the characteristics of their ‘family worlds’ found to be influential in their decisions1. The paper discusses the important roles of cultural and social capital in these decisions, and concludes that enrolment in physical science courses was associated with congruence between the students’ conceptions of school science, and characteristics of their family backgrounds.

Effective earth and space science analogies

There are several good reasons why Earth and Space Science should be a part of any science curriculum. Nearly everything we do each day is connected in some way to the Earth: to its land, oceans, atmosphere, plants and animals. By 2025, eight billion people will live on Earth. If we are to continue extracting resources to maintain a high quality of life, then it is important that our children are scientifically literate in a way that allows them to exploit the Earth’s resources in a sustainable way. People who understand how earth systems work can make informed decisions and may be able to help resolve issues surrounding clean water, urban planning and development, global climate change and the use and management of natural resources.

Global Media and National Policies : The Return of the State

Conventional wisdom views globalization as a process that heralds the diminishing role or even 'death' of the state and the rise of transnational media and transnational consumption, that defy state control or regulation. This book questions these assumptions and shows that the nation-state never left and is still a force to be reckoned with.

National media regulations in an age of convergent media: Beyond globalisation, neo-liberalism and internet freedom theories

There is a widely held view that the nation-state has become less central to media and communications policy over the last two decades. As Jan van Cuilenberg and Denis McQuail (2003, p. 181) observed in their overview of trends in communications policy-making, 'the old normative media policies have been challenged and policy-makers are searching for a new communications policy paradigm'. There are characteristically five factors put forward as to why the nation-state has become less central to media in the twenty-first century