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.

Incubation success of released hand-reared pheasants Phasianus colchicus compared with wild ones

We investigated previously observed but unexplained differences in incubation success between wild and hand-reared common pheasants Phasianus colchicus. Hand-reared birds are widely released in late summer in Britain and elsewhere to supplement wild stocks for shooting purposes. We radio-tracked 53 wild and 35 previously released reared female pheasants occupying simultaneously the same areas on a game-keepered estate in eastern England between February and mid July 1999 and 2000. Predation of adult birds was comparatively low for both wild and reared birds, and overall survival did not differ between years or between groups. However, of 52 nests incubated by wild females 49% hatched, whereas of 30 nests incubated by reared pheasants only 22% hatched. Mayfield estimates of daily nest survival probability thus differed significantly between groups. However, predation of eggs was similar for both wild and reared birds. Instead the observed difference in hatch rates was due to nest abandonment, with more reared females (41%) deserting apparently unmolested nest sites than wild females (6%).

Dendrimers: a new class of nanoscopic containers and delivery devices

Dendrimers and hyperbranched polymers are a relatively new class of materials with unique molecular architectures and dimensions in comparison to traditional linear polymers. This review details recent notable advances in the application of these new polymers in terms of the development of new polymeric delivery systems. Although comparatively young, the developing field of hyperbranched drug delivery devices is a rapidly maturing area and the key discoveries in drug-conjugate systems amongst others are highlighted. As a consequence of their ideal hyperbranched architectures, the utilisation of host-guest chemistries in dendrimers has been included within the scope of this review. (C) 2003 Elsevier Ltd. All rights reserved.

The use of wireless data communication and body sensing devices to evaluate occupants' comfort in buildings

Physiological parameters measured by an embedded body sensor system were demonstrated to respond to changes of the air temperature in an office environment. The thermal parameters were monitored with the use of a wireless sensor system that made possible to turn any existing room into a field laboratory. Two human subjects were monitored over daily activities and at various steady-state thermal conditions when the air temperature of the room was altered from 22-23°C to 25-28°C. The subjects indicated their thermal feeling on questionnaires. The measured skin temperature was distributed close to the calculated mean skin temperature corresponding to the given activity level. The variation of Galvanic Skin Response (GSR) reflected the evaporative heat loss through the body surfaces and indicated whether sweating occurred on the subjects. Further investigations are needed to fully evaluate the influence of thermal and other factors on the output given by the investigated body sensor system.

Problems in the coupling of eye and hand in the sequential movements of children with developmental coordination disorder

Background: Shifting gaze and attention ahead of the hand is a natural component in the performance of skilled manual actions. Very few studies have examined the precise co-ordination between the eye and hand in children with Developmental Coordination Disorder (DCD). Methods This study directly assessed the maturity of eye-hand co-ordination in children with DCD. A double-step pointing task was used to investigate the coupling of the eye and hand in 7-year-old children with and without DCD. Sequential targets were presented on a computer screen, and eye and hand movements were recorded simultaneously. Results There were no differences between typically developing (TD) and DCD groups when completing fast single-target tasks. There were very few differences in the completion of the first movement in the double-step tasks, but differences did occur during the second sequential movement. One factor appeared to be the propensity for the DCD children to delay their hand movement until some period after the eye had landed on the target. This resulted in a marked increase in eye-hand lead during the second movement, disrupting the close coupling and leading to a slower and less accurate hand movement among children with DCD. Conclusions In contrast to skilled adults, both groups of children preferred to foveate the target prior to initiating a hand movement if time allowed. The TD children, however, were more able to reduce this foveation period and shift towards a feedforward mode of control for hand movements. The children with DCD persevered with a look-then-move strategy, which led to an increase in error. For the group of DCD children in this study, there was no evidence of a problem in speed or accuracy of simple movements, but there was a difficulty in concatenating the sequential shifts of gaze and hand required for the completion of everyday tasks or typical assessment items.

How active gaze informs the hand in sequential pointing movements

Visual information is vital for fast and accurate hand movements. It has been demonstrated that allowing free eye movements results in greater accuracy than when the eyes maintain centrally fixed. Three explanations as to why free gaze improves accuracy are: shifting gaze to a target allows visual feedback in guiding the hand to the target (feedback loop), shifting gaze generates ocular-proprioception which can be used to update a movement (feedback-feedforward), or efference copy could be used to direct hand movements (feedforward). In this experiment we used a double-step task and manipulated the utility of ocular-proprioceptive feedback from eye to head position by removing the second target during the saccade. We confirm the advantage of free gaze for sequential movements with a double-step pointing task and document eye-hand lead times of approximately 200 ms for both initial movements and secondary movements. The observation that participants move gaze well ahead of the current hand target dismisses foveal feedback as a major contribution. We argue for a feedforward model based on eye movement efference as the major factor in enabling accurate hand movements. The results with the double-step target task also suggest the need for some buffering of efference and ocular-proprioceptive signals to cope with the situation where the eye has moved to a location ahead of the current target for the hand movement. We estimate that this buffer period may range between 120 and 200 ms without significant impact on hand movement accuracy.

Coding of visual space during motor preparation: approaching objects rapidly modulate corticospinal excitability in hand-centered coordinates

Defensive behaviors, such as withdrawing your hand to avoid potentially harmful approaching objects, rely on rapid sensorimotor transformations between visual and motor coordinates. We examined the reference frame for coding visual information about objects approaching the hand during motor preparation. Subjects performed a simple visuomanual task while a task-irrelevant distractor ball rapidly approached a location either near to or far from their hand. After the distractor ball appearance, single pulses of transcranial magnetic stimulation were delivered over the subject's primary motor cortex, eliciting motor evoked potentials (MEPs) in their responding hand. MEP amplitude was reduced when the ball approached near the responding hand, both when the hand was on the left and the right of the midline. Strikingly, this suppression occurred very early, at 70-80ms after ball appearance, and was not modified by visual fixation location. Furthermore, it was selective for approaching balls, since static visual distractors did not modulate MEP amplitude. Together with additional behavioral measurements, we provide converging evidence for automatic hand-centered coding of visual space in the human brain.

A comparison of the Oxford and Manus intelligent hand prostheses

Historically, commercial hand prosthesis have adopted a low level of innovation mainly due to the strict conditions such a system must undergo. The difficult feedback to the prosthesis user has limited the functional range of commercial systems. Nevertheless, the use of advanced sensors in combination with performing hand mechanisms and microcontrollers could lead to more natural and functional prototypes. The Oxford and Manus intelligent hand prostheses are examples of innovative approaches. This paper compares and contrasts the technological solutions implemented in both systems to address the design conditions.

Offering 802.11 MAC frame transport over multiband OFDM for consumer devices

A method to map all the variants of the IEEE 802.11 MAC frames into the Multiband OFDM based ECMA-368 Physical standard is proposed, without contravening the standard. The transportation of IEEE 802.11 MAC frames over ECMA-368 allows for the migration current of Wireless LAN applications towards a Wireless Personal Area Network (WPAN) solution. This system benefits the Consumer Electronics Market as the high data-rate WPAN is capable of transporting broadcast-quality video while the same system can also transport existing applications available today, maintaining existing effort, products and backward-compatibility(1).

Combining Human and Machine Brains - Practical systems in information & control

In this paper a look is taken at how the use of implant technology can be used to either increase the range of the abilities of a human and/or diminish the effects of a neural illness, such as Parkinson's Disease. The key element is the need for a clear interface linking the human brain directly with a computer. The area of interest here is the use of implant technology, particularly where a connection is made between technology and the human brain and/or nervous system. Pilot tests and experimentation are invariably carried out apriori to investigate the eventual possibilities before human subjects are themselves involved. Some of the more pertinent animal studies are discussed here. The paper goes on to describe human experimentation, in particular that carried out by the author himself, which led to him receiving a neural implant which linked his nervous system bi-directionally with the internet. With this in place neural signals were transmitted to various technological devices to directly control them. In particular, feedback to the brain was obtained from the fingertips of a robot hand and ultrasonic (extra) sensory input. A view is taken as to the prospects for the future, both in the near term as a therapeutic device and in the long term as a form of enhancement.

Therapeutic potential of computer to cerebral cortex implantable devices

In this article, an overview of some of the latest developments in the field of cerebral cortex to computer interfacing (CCCI) is given. This is posed in the more general context of Brain-Computer Interfaces in order to assess advantages and disadvantages. The emphasis is clearly placed on practical studies that have been undertaken and reported on, as opposed to those speculated, simulated or proposed as future projects. Related areas are discussed briefly only in the context of their contribution to the studies being undertaken. The area of focus is notably the use of invasive implant technology, where a connection is made directly with the cerebral cortex and/or nervous system. Tests and experimentation which do not involve human subjects are invariably carried out a priori to indicate the eventual possibilities before human subjects are themselves involved. Some of the more pertinent animal studies from this area are discussed. The paper goes on to describe human experimentation, in which neural implants have linked the human nervous system bidirectionally with technology and the internet. A view is taken as to the prospects for the future for CCCI, in terms of its broad therapeutic role.