Findings from three methods to identify falls in hospitals: Results from the Ambient Intelligent Geriatric Management system fall prevention trial

OBJECTIVE

To (a) compare characteristics of patients who fall with those of patients who did not fall; and (b) characterise falls (time, injury severity and location) through three fall reporting methods (incident system reports, medical notes and clinician reports).

METHODS

A substudy design within a stepped-wedge clinical trial was used: 3239 trial participants were recruited from two inpatient Geriatric Evaluation and Management Units and one general medicine ward in two Australian states. To compare the characteristics of patients who had fallen with those who had not, descriptive tests were used. To characterise falls through three reporting methods, bivariate logistic regressions were used.

RESULTS

Patients who had fallen were more likely than patients who had not fallen to be cognitively impaired (51% vs. 29%, p < 0.01), admitted with falls (38% vs. 28%, p = 0.01) and have poor health outcomes such as prolonged length of stay (24 [16-34] vs. 12 [8-19] days [IQR], p < 0.01) and less likely to be discharged directly to the community (62% vs. 47%, p < 0.01). Most falls were captured from medical notes (93%), with clinician (71%) and incident reports (68%) missing 21%-25% of falls. The proportion of injurious falls identified through incident reports was higher than medical records or clinician reports (40% vs. 34% vs. 37%).

CONCLUSIONS

This study reaffirms the need to improve reporting falls in incident systems and at clinical handover to the team leader. Research should continue to use more than one method of identifying falls, but include data from medical records. Many falls cause injury, resulting in poor health outcomes.

Evaluation of the Empower model of care for partial denture clients in a public oral health care setting

OBJECTIVE

To evaluate the effectiveness of the Empower model of care (EMC) on reducing the addition of teeth to removable partial dentures (RPD).

METHODS

Data reports were generated through the Titanium electronic database to retrieve all clients at Monash Dental Services (MHDS) who participated in the EMC or received an RPD prior to the implementation of EMC was assessed over a two-year period to determine if they had additional teeth added to their partial dentures (PD). A logistic regression was performed testing whether a combination of socio-demographic and clinical variables, provided a multivariate explanation of the EMC outcome.

RESULTS

Prior to EMC, 2034 patients attended MHDS requiring RPDs with 363 returning to have teeth added. From 2018 to 2020, 38 of 584 participants in EMC returned to have teeth added to their PDs. Those in the 'High' risk group were two times more likely to return requiring additional teeth (OR = 1.99; 95%CI:1.31-3.02); each additional year of age increased the odds of requiring additional teeth (OR = 1.03; 95%CI:1.02-1.04). Participants of the EMC were more than two times less likely to require additional teeth (OR = 0.42; 95%CI:0.29-0.59). The variance in requiring additional teeth accounted for using the full model was 9.1% (η2  = 0.091).

CONCLUSIONS

This analysis confirms the effectiveness of the EMC. This approach assists denture wearers to maintain good oral health and provides an effective way of managing public health funds by reducing denture repairs and additions. © 2023 Australian Dental Association.

Textile-Integrated Liquid Metal Electrodes for Electrophysiological Monitoring

Next generation textile-based wearable sensing systems will require flexibility and strength to maintain capabilities over a wide range of deformations. However, current material sets used for textile-based skin contacting electrodes lack these key properties, which hinder applications such as electrophysiological sensing. In this work, a facile spray coating approach to integrate liquid metal nanoparticle systems into textile form factors for conformal, flexible, and robust electrodes is presented. The liquid metal system employs functionalized liquid metal nanoparticles that provide a simple "peel-off to activate" means of imparting conductivity. The spray coating approach combined with the functionalized liquid metal system enables the creation of long-term reusable textile-integrated liquid metal electrodes (TILEs). Although the TILEs are dry electrodes by nature, they show equal skin-electrode impedances and sensing capabilities with improved wearability compared to commercial wet electrodes. Biocompatibility of TILEs in an in vivo skin environment is demonstrated, while providing improved sensing performance compared to previously reported textile-based dry electrodes. The "spray on dry-behave like wet" characteristics of TILEs opens opportunities for textile-based wearable health monitoring, haptics, and augmented/virtual reality applications that require the use of flexible and conformable dry electrodes.

A Systematic Review and Meta-analysis of Interventions to Decrease Cyberbullying Perpetration and Victimization

Evidence suggests that cyberbullying among school-age children is related to problem behaviors and other adverse school performance constructs. As a result, numerous school-based programs have been developed and implemented to decrease cyberbullying perpetration and victimization. Given the extensive literature and variation in program effectiveness, we conducted a comprehensive systematic review and meta-analysis of programs to decrease cyberbullying perpetration and victimization. Our review included published and unpublished literature, utilized modern, transparent, and reproducible methods, and examined confirmatory and exploratory moderating factors. A total of 50 studies and 320 effect sizes spanning 45,371 participants met the review protocol criteria. Results indicated that programs significantly reduced cyberbullying perpetration (g = -0.18, SE = 0.05, 95% CI [-0.28, -0.09]) and victimization (g = -0.13, SE = 0.04, 95% CI [-0.21, -0.05]). Moderator analyses, however, yielded only a few statistically significant findings. We interpret these findings and provide implications for future cyberbullying prevention policy and practice.

Temporal and region-specific effects of sleep fragmentation on gut microbiota and intestinal morphology in Sprague Dawley rats

Sleep is a fundamental biological process, that when repeatedly disrupted, can result in severe health consequences. Recent studies suggest that both sleep fragmentation (SF) and dysbiosis of the gut microbiome can lead to metabolic disorders, though the underlying mechanisms are largely unclear. To better understand the consequences of SF, we investigated the effects of acute (6 days) and chronic (6 weeks) SF on rats by examining taxonomic profiles of microbiota in the distal ileum, cecum and proximal colon, as well as assessing structural and functional integrity of the gastrointestinal barrier. We further assayed the impact of SF on a host function by evaluating inflammation and immune response. Both acute and chronic SF induced microbial dysbiosis, more dramatically in the distal ileum (compared to other two regions studied), as noted by significant perturbations in alpha- and beta-diversity; though, specific microbial populations were significantly altered throughout each of the three regions. Furthermore, chronic SF resulted in increased crypt depth in the distal ileum and an increase in the number of villi lining both the cecum and proximal colon. Additional changes were noted with chronic SF, including: decreased microbial adhesion and penetration in the distal ileum and cecum, elevation in serum levels of the cytokine KC/GRO, and depressed levels of corticotropin. Importantly, our data show that perturbations to microbial ecology and intestinal morphology intensify in response to prolonged SF and these changes are habitat specific. Together, these results reveal consequences to gut microbiota homeostasis and host response following acute and chronic SF in rats.

Changes in delay discounting, substance use, and weight status across adolescence

OBJECTIVE

Higher rates of delay discounting have been consistently linked to maladaptive health behaviors, including substance use and overeating, among adults. Despite adolescence representing a critical period for the escalation of these risky health behaviors, little is known about the developmental course of delay discounting or how this construct relates to important health outcomes in youth. The current study examined change in delay discounting over time using a latent growth curve approach and the relation between growth in this construct and changes in substance use and body-mass index over a 6-year period.

METHOD

Participants included 247 adolescents (44% female) with a mean age of 13 at the initial assessment.

RESULTS

Findings suggest that, on average, rates of delay discounting are stable across adolescence; however, there are significant individual differences around this trajectory. Moreover, youth who demonstrate significant increases in delay discounting over time are also more likely to experience more rapid escalations of both substance use and Body Mass Index across adolescence.

CONCLUSIONS

Results indicate that delay discounting is an important trans-disease process among adolescents. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Schistosoma mansoni tetraspanning orphan receptor (SmTOR): a new vaccine candidate against schistosomiasis

One approach to fight against schistosomiasis is to develop an efficient vaccine. Schistosoma mansoni tetraspanning orphan receptor (SmTOR) might be a vaccine candidate, as it is a tegument membrane protein expressed most highly in cercariae. In this study we characterized the recombinant first extracellular domain of SmTOR (rSmTORed1) as having the expected property to bind C2 of complement similarly to a smaller peptide of the same domain, and to produce specific and high-titre antibodies in BALB/c mice immunized using complete Freund's adjuvant/incomplete Freund's adjuvant (CFA/IFA). Immunization was protective against parasite infection, as demonstrated by a significant decrease in worm burden in immunized BALB/c mice versus the control groups over two independent trials [64 and 45% reduction for mean adult worm burden in immunized versus phosphate-bufferd saline (PBS) injected mice]. Interestingly, infection by itself did not lead to the generation of anti-rSmTORed1 antibodies, corresponding to the low frequency of specific anti-rSmTORed1 antibodies detected in the sera of patients infected with S. mansoni (2/20; 10%). These data suggest that, as opposed to the natural infection during which SmTOR induces antibodies only rarely, immunization with its smaller first extracellular domain might be more efficient.

In vitro synergistic interaction between amide piplartine and antimicrobial peptide dermaseptin against Schistosoma mansoni schistosomula and adult worms

Schistosomiasis is one of the world's major public health problems, and praziquantel is the only available drug to treat this notable neglected disease. Drug combinations have been considered an important strategy for treatment of infectious diseases, which might enhance therapeutic efficacy and delaying resistance. In this study, we have examined the in vitro activities of the amide piplartine and the antimicrobial peptide dermaseptin 01 administered singly or in combination against Schistosoma mansoni of different ages including 3-hour-old and 7-day-old schistosomula and 49-day-old adult schistosomes as well as on egg output by adult worms. We calculated the median lethal concentrations (LC(50)) of 7.87 and 17.99 μM on 49-day-old adults, 11.02 and 71.58 μM on 7-day-old schistosomula, and 70.87 and 98.42 μM on 3-hour-old schistosomula for piplartine and dermaseptin, respectively. Most Piplartine/dermaseptin combinations showed synergistic effect, with combination index (CI) values less than 0.9 when S. mansoni adults or schistosomula were simultaneously incubated with both drugs in vitro; synergy between these two compounds was also indicated using isobolograms. Additionally, we observed alterations on the tegumental surface of schistosomula and adult schistosomes by means of laser scanning confocal microscopy. Furthermore, egg laying of surviving worms was considerably more reduced when exposed to the piplartine/dermaseptin combinations than each drug alone, and this inhibition was irreversible. This is the first report on the synergistic effect between piplartine and dermaseptin against S. mansoni and opens the route to further studies (e.g. in vivo) to characterize this combination in greater detail.

Cervicovaginal psammoma bodies in endosalpingiosis. A case report

BACKGROUND

The presence of psammoma bodies on cervicovaginal smears is a rare finding. These structures have usually been associated with malignant tumors, particularly ovarian carcinoma. However, a review of the literature reveals that up to 50% of these patients will have psammoma bodies in association with benign conditions; thus, this finding does not always correlate with the presence of a malignant tumor.

CASE

An asymptomatic, nulliparous woman had psammoma bodies on a cervicovaginal smear. Evaluation, including cervical conization, endometrial sampling, laparoscopy with pelvic washings and ovarian biopsy, revealed cervical intraepithelial neoplasia 1, endosalpingiosis and numerous psammoma bodies in all specimens except from the cervix. Follow-up examinations at three and six months were negative.

CONCLUSION

The finding of psammoma bodies in a Pap smear is not always associated with the presence of a pelvic malignancy.

Characterization of lipopolysaccharide heterogeneity in Salmonella enteritidis by an improved gel electrophoresis method

Salmonella enteritidis field isolates of different phage types and pathogenicities were assessed for changes in lipopolysaccharide (LPS) structure, using an improved method of polyacrylamide gel electrophoresis (PAGE) that revealed the same degree of structural detail as mass spectroscopy. The method allowed characterization of an LPS chemotype that may be associated, regardless of phage type, with increased virulence of S. enteritidis. The virulent variant SE6-E21, which efficiently contaminates eggs and yields high numbers of organisms from chick spleens, had an O-antigen/core ratio of 2.8, as determined from gels by densitometry, and 1.67 micrograms of mannose per microgram of 2-keto-3-deoxy-octulosonic acid (KDO), while the avirulent variant SE6-E5 had O-antigen/core ratios of 1.2 and 1.00. The association between O antigen and virulence was also seen on analysis of five new field isolates. One of the new field isolates generated a mixed population of smooth and semismooth variants in agreement with its mixed virulence in chicks. When LPS was purified from large-volume cultures, only the most virulent isolate yielded high amounts of O antigen (1.6 micrograms of mannose per microgram of KDO), while the other isolates had ratios characteristic of semismooth variants (< or = 1.0 microgram of mannose per microgram of KDO), including the isolate of mixed virulence. These results indicate that the improved PAGE method might provide a rapid, sensitive, in vitro assessment of field isolate virulence prior to the performance of definitive infectivity trials.