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.

An exploratory study to assess the activity of the acarine growth inhibitor, fluazuron, against Sarcoptes scabei infestation in pigs

Background: The most common treatments for scabies in human and veterinary settings are topical 5% permethrin or systemic treatment with ivermectin. However, these treatments have very little activity against arthropod eggs, and therefore repeated treatment is frequently required. In-vitro, biochemical and molecular studies have demonstrated that human mites are becoming increasingly resistant to both acaricides. To identify alternate acaricides, we undertook a pilot study of the in vivo activity of the benzoylphenyl urea inhibitor of chitin synthesis, fluazuron, in pigs with sarcoptic mange. Findings: Pigs (n = 5) were infested with S. scabei var suis, and randomised to treatment at the start of peak infestation with fluazuron at a dose of 10 mg/kg/day per os for 7 days (n = 3) or no treatment (n = 2). Clinical scores, skin scrapings for mite counts and blood sampling for pharmacokinetic analysis were undertaken. Fluazuron was well absorbed in treated pigs with measureable blood levels up to 4 weeks post treatment. No adverse effects were observed. Modest acaricidal activity of the compound was observed, with a reduction in severity of skin lesions in treated pigs, as well as a reduction in number of scabies mite's early life stages. Conclusions: The moderate efficacy of fluazuron against scabies mites indicates a lead to the development of alternate treatments for scabies, such as combination therapies that maybe applicable for human use in the future.

A systematic review of studies identifying predictors of poor return to work outcomes following workplace injury

BACKGROUND: Injuries occurring in the workplace can have serious implications for the health of the individual, the productivity of the employer and the overall economic community. OBJECTIVE: The objective of this paper is to increase the current state of understanding of individual demographic and psychosocial characteristics associated with extended absenteeism from the workforce due to a workplace injury. METHODS: Studies included in this systematic literature review tracked participants' return to work status over a minimum of three months, identified either demographic, psychosocial or general injury predictors of poor return to work outcomes and included a heterogeneous sample of workplace injuries. RESULTS: Identified predictors of poor return to work outcomes included older age, female gender, divorced marital status, two or more dependent family members, lower education levels, employment variables associated with reduced labour market desirability, severity or sensitive injury locations, negative attitudes and outcome perceptions of the participant. CONCLUSIONS: There is a need for clear and consistent definition and measurement of return to work outcomes and a holistic theoretical model integrating injury, psychosocial and demographic predictors of return to work. Through greater understanding of the nature of factors affecting return to work, improved outcomes could be achieved.

An Experimental Study to Show the Effect of Thermal Stress on Thermal Contact Conductance at Sub-megapascal Contact Pressures

Experimental studies are presented to show the effect of thermal stresses on thermal contact conductance (TCC) at low contact pressures. It is observed that in a closed contact assembly, contact pressure acting on the interface changes with the changing temperature of contact members. This change in contact pressure consequently causes variations in the TCC of the junction. A relationship between temperature change and the corresponding magnitude of developed thermal stress in a contact assembly is determined experimentally. Inclusion of a term called temperature dependent load correction factor is suggested in the theoretical model for TCC to make it capable of predicting TCC values more accurately in contact assemblies that experience large temperature fluctuations. [DOI: 10.1115/1.4001615]

A pilot study to determine the movements of buoy line used in the crab pot fishery to assess bottlenose dolphin entanglement

A pilot study on the characteristics of crab pot buoy line movements to assess bottlenose dolphin entanglement was conducted from 19 September to 30 September 2005 in the Charleston Harbor, Charleston, South Carolina. The objectives of this study were to determine: 1) the movements of the buoy line in the water at various tidal stages, current strengths, lengths of line, and water depth, 2) if lead-core rope was a better alternative to nylon rope, 3) and if the manner of deployment of the gear affected the suspension of the line in the water and on the bottom. Diamond braided nylon (#10) rope of varying length (20 ft. – 80 ft.) were used during 31 trials and stiffened (polypropylene lead-core) rope was used in four trials. Observations of the buoy line movements were captured with an Atlantis underwater camera attached to a Digital DPC-1000 video recorder. Results from this study showed that: 1) the method used for deployment was important in keeping the buoy line from arcing or coiling, 2) little to no arcing occurred in water current velocities of >0.20 m/s, 3) rope lengths of ≥50 ft. deployed in <10 ft. of water produced waving in the water column and arcing on the bottom, 4) slack tide was a period of increased risk of entanglement for bottlenose dolphins, and 5) poly lead-core rope was not a good alternative to nylon rope unless in deep water with strong water current velocities. This pilot study produced questions that can be used for future studies on the characteristics of buoy line movements in the crab pot fishery as it relates to bottlenose dolphin entanglements.