The STRATIFY tool and clinical judgment were poor predictors of falling in an acute hospital setting

Objective: To compare the effectiveness of the STRATIFY falls tool with nurses’ clinical judgments in predicting patient falls. Study Design and Setting: A prospective cohort study was conducted among the inpatients of an acute tertiary hospital. Participants were patients over 65 years of age admitted to any hospital unit. Sensitivity, specificity, and positive predictive value (PPV) and negative predictive values (NPV) of the instrument and nurses’ clinical judgments in predicting falls were calculated. Results: Seven hundred and eighty-eight patients were screened and followed up during the study period. The fall prevalence was 9.2%. Of the 335 patients classified as being ‘‘at risk’’ for falling using the STRATIFY tool, 59 (17.6%) did sustain a fall (sensitivity50.82, specificity50.61, PPV50.18, NPV50.97). Nurses judged that 501 patients were at risk of falling and, of these, 60 (12.0%) fell (sensitivity50.84, specificity50.38, PPV50.12, NPV50.96). The STRATIFY tool correctly identified significantly more patients as either fallers or nonfallers than the nurses (P50.027). Conclusion: Considering the poor specificity and high rates of false-positive results for both the STRATIFY tool and nurses’ clinical judgments, we conclude that neither of these approaches are useful for screening of falls in acute hospital settings.

Falling through the web : implications for internet introverts

Is the brain evolving and adapting to new technological environments such as that of Silicon Valley? This paper examines changes that are being observed and studied relating to a possible correlation between ‘excessive’ focus on technology and the emergence of diagnosable social, physical and mental health dysfunction. The author explores the possible role of university staff and student services in the duty of care toward students. Would it not be more ethical to provide education on healthy technology use and to provide evidence based therapy for those students who fall through the web? Currently students end up being excluded from their courses. Many suffer from social anxiety and depression and lack confidence and social skills to find or hold down a job. Currently many “hibernate” in their rooms for months or years frequently in a state of despair.

Falling behind : business use of social media

Australians are turning onto social media in their droves - nearly 90 per cent of our citizenry are online and more than 50 per cent of the population has a Facebook account.

SWIRLnet : portable anemometer network for wind speed measurements of land-falling tropical cyclones

Wind speed measurement systems are sparse in the tropical regions of Australia. Tropical cyclone wind speeds impacting communities are often ‘guestimated’ from analyzing damaged structures. A re-locatable anemometer system is required to enable measurements of wind speeds. This paper discusses design criteria of the tripods and tie down system, proposed deployment of the anemometers, instrumentation, and data logging. Preliminary assessment of the anemometer response indicates a reliable system for 1 second response, however, it is noted that the Australian building code and wind loading standard uses a moving average time of approximately 0.2 seconds for its wind speed design criteria.

Wind speed measurements of land-falling tropical cyclones using SWIRLnet, a portable anemometer network

Wind speed measurement systems are sparse in the tropical regions of Australia. Given this, tropical cyclone wind speeds impacting communities are seldom measured and often only ‘guestimated’ by analysing the extent of damage to structures. In an attempt to overcome this dearth of data, a re-locatable network of anemometers to be deployed prior to tropical cyclone landfall is currently being developed. This paper discusses design criteria of the network’s tripods and tie down system, proposed deployment of the anemometers, instrumentation and data logging. Preliminary assessment of the anemometer response indicates a reliable system for measuring the spectral component of wind with frequencies of approximately 1 Hz. This system limitation highlights an important difference between the capabilities of modern instrumentation and that of the Dines anemometer (around 0.2 seconds) that was used to develop much of the design criteria within the Australian building code and wind loading standard.

How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men?

BACKGROUND: Falls affect approximately one third of community-dwelling older adults each year and have serious health and social consequences. Fear of falling (FOF) (lack of confidence in maintaining balance during normal activities) affects many older adults, irrespective of whether they have actually experienced falls. Both falls and fear of falls may result in restrictions of physical activity, which in turn have health consequences. To date the relation between (i) falls and (ii) fear of falling with physical activity have not been investigated using objectively measured activity data which permits examination of different intensities of activity and sedentary behaviour. METHODS: Cross-sectional study of 1680 men aged 71-92 years recruited from primary care practices who were part of an on-going population-based cohort. Men reported falls history in previous 12 months, FOF, health status and demographic characteristics. Men wore a GT3x accelerometer over the hip for 7 days. RESULTS: Among the 12% of men who had recurrent falls, daily activity levels were lower than among non-fallers; 942 (95% CI 503, 1381) fewer steps/day, 12(95% CI 2, 22) minutes less in light activity, 10(95% CI 5, 15) minutes less in moderate to vigorous PA [MVPA] and 22(95% CI 9, 35) minutes more in sedentary behaviour. 16% (n = 254) of men reported FOF, of whom 52% (n = 133) had fallen in the past year. Physical activity deficits were even greater in the men who reported that they were fearful of falling than in men who had fallen. Men who were fearful of falling took 1766(95% CI 1391, 2142) fewer steps/day than men who were not fearful, and spent 27(95% CI 18, 36) minutes less in light PA, 18(95% CI 13, 22) minutes less in MVPA, and 45(95% CI 34, 56) minutes more in sedentary behaviour. The significant differences in activity levels between (i) fallers and non-fallers and (ii) men who were fearful of falling or not fearful, were mediated by similar variables; lower exercise self-efficacy, fewer excursions from home and more mobility difficulties. CONCLUSIONS: Falls and in particular fear of falling are important barriers to older people gaining health benefits of walking and MVPA. Future studies should assess the longitudinal associations between falls and physical activity.

Pilot study comparing the influence of different types of exercise intervention on the fear of falling in older adults

Background: Individuals who fear falling may restrict themselves from performing certain activities and may increase their risk of falling. Such fear, reflected in the form of falls efficacy, has been measured in only a small number of studies measuring the effectiveness of exercise interventions in the elderly. This may be due to the various types of exercise that can be performed. Hence the effectiveness of exercise on falls efficacy is relatively understudied. Therefore, there is a need to measure falls efficacy as an outcome variable when conducting exercise interventions in the elderly. Methods: A total of 43 elderly community-dwelling volunteers were recruited and randomly allocated to a conventional exercise intervention, a holistic exercise intervention, or a control group. The interventions were performed 2 days per week for 10 weeks. Falls efficacy was measured at baseline and at the completion of the interventions using the Modified Falls Efficacy Scale (MFES). Results: Within group comparisons between baseline and follow-up indicated no significant improvements in falls efficacy, however, the difference for the conventional exercise group approached statistical significance (baseline 8.9 to follow-up 9.3; P = 0.058). Within group comparisons of mean difference MFES scores showed a significant difference between the conventional exercise group and the control group (conventional exercise group 0.4 vs control group −0.6; P < 0.05). Conclusion: Given the lack of significant improvements in falls efficacy found for any of the groups, it cannot be concluded whether a conventional or a holistic exercise intervention is the best approach for improving falls efficacy. It is possible that the characteristics of the exercise interventions including specificity, intensity, frequency and duration need to be manipulated if the purpose is to bring about improvements in falls efficacy.

Fear of falling in vision impairment

Falls are the leading cause of injury-related morbidity and mortality among older adults. In addition to the resulting physical injury and potential disability after a fall, there are also important psychological consequences, including depression, anxiety, activity restriction, and fear of falling. Fear of falling affects 20 to 43% of community-dwelling older adults and is not limited to those who have previously experienced a fall. About half of older adults who experience fear of falling subsequently restrict their physical and everyday activities, which can lead to functional decline, depression, increased falls risk, and reduced quality of life. Although there is clear evidence that older adults with visual impairment have higher falls risk, only a limited number of studies have investigated fear of falling in older adults with visual impairment and the findings have been mixed. Recent studies suggest increased levels of fear of falling among older adults with various eye conditions, including glaucoma and age-related macular degeneration, whereas other studies have failed to find differences. Interventions, which are still in their infancy in the general population, are also largely unexplored in those with visual impairment. The major aims of this review were to provide an overview of the literature on fear of falling, its measurement, and risk factors among older populations, with specific focus on older adults with visual impairment, and to identify directions for future research in this area.

Falling Weight Deflectometer (FWD) tests on granular pavement reinforced with geogrids– Case study

The use of geogrids in granular pavement layers could increase the modulus and the stiffness of granular layer and hence the required layer thickness can be reduced. Though, geogrids are being used in granular pavements to provide lateral restraint, bearing capacity, and membrane tension support, very limited studies have been carried out to investigate the effects of geogrids on modulus and stiffness of granular layer. In this study, two sections of a granular pavement were constructed: one with a geogrid at the bottom of the base layer and the other without a geogrid. Two sections were then tested using Falling Weight Deflectometer (FWD) and FWD results were analysed to determine the effect of geogrid on the overall modulus and stiffness of the granular pavement. The results suggested that the pavement section with geogrid has higher overall modulus and deflection ratio compared to the pavement section without geogrid.

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.

Shear-imposed falling film

The study of a film falling down an inclined plane is revisited in the presence of imposed shear stress. Earlier studies regarding this topic (Smith, J. Fluid Mech., vol. 217, 1990, pp. 469-485; Wei, Phys. Fluids, vol. 17, 2005a, 012103), developed on the basis of a low Reynolds number, are extended up to moderate values of the Reynolds number. The mechanism of the primary instability is provided under the framework of a two-wave structure, which is normally a combination of kinematic and dynamic waves. In general, the primary instability appears when the kinematic wave speed exceeds the speed of dynamic waves. An equality criterion between their speeds yields the neutral stability condition. Similarly, it is revealed that the nonlinear travelling wave solutions also depend on the kinematic and dynamic wave speeds, and an equality criterion between the speeds leads to an analytical expression for the speed of a family of travelling waves as a function of the Froude number. This new analytical result is compared with numerical prediction, and an excellent agreement is achieved. Direct numerical simulations of the low-dimensional model have been performed in order to analyse the spatiotemporal behaviour of nonlinear waves by applying a constant shear stress in the upstream and downstream directions. It is noticed that the presence of imposed shear stress in the upstream (downstream) direction makes the evolution of spatially growing waves weaker (stronger).

Falling through the cracks: are European directives and international conventions the panacea for freshwater nature conservation?

There are many ways of practising freshwater nature conservation: from strict legislative protection of individual species considered rare or threatened to protecting whole lakes or long stretches of rivers; from practical conservation management at a local scale to integrated catchment management at the river basin scale; and from the encouragement of better habitat management through codes of good practice to statutory control of pollution or abstraction. Whatever the mechanism, an essential pre-requisite is a way of choosing where to put the effort, especially when resources for nature conservation are severely limited. The aim of this article is to review the contribution from four specific international measures to the task of assigning priorities for conservation. The 1990s saw the introduction of two European directives (the Habitats Directive (HD) and the Water Framework Directive (WFD)) and one international convention (the Biodiversity Convention (CBD)) each with the potential for influencing, to a greater or lesser extent, the conservation of freshwater habitats and species. This article also discusses a much older convention – the Ramsar Convention – adopted in 1971 specifically to help tackle the conservation and management of wetlands and aquatic ecosystems. Although the authors have focused mainly on the UK, the subject is relevant to other parts of Europe and beyond. The article explores the degree to which these measures help in identifying the most important fresh waters for conservation, and asks whether or not they present the right conservation message to a wide audience.