Using the RE-AIM framework to translate a research-based falls prevention intervention into a community-based program: lessons learned

Problem

Exercise-based research interventions demonstrate reduced risk and rates of falls for community dwelling older adults; however, little is known about effective mechanisms for the translation, implementation, and maintenance of these interventions in community settings.

Method

The RE-AIM framework was used to assess the translatability of an effective exercise-based research intervention in a community setting. Questions included: Reach — Would the target population attend? Effectiveness — What was the adherence and compliance to the program? Were there individual improvements in falls risk factors? Adoption: Would staff at the center adopt the program and offer it past the funding period? Implementation — What adaptations, including optimal frequency and duration, should be made to meet the community needs, still adhere to core elements and achieve similar outcomes? Maintenance — Would the program be sustained by our community partners?

Discussion

The process of translating a controlled research intervention targeting older adults at risk of falls into a community setting was challenging. Licensed professionals developed the infrastructure to safely and effectively deliver the program. The end product was highly appealing program to our target audience, resulted in improved outcomes and was successfully adopted and maintained by the community partner.

Summary

Partnerships between community and healthcare providers are key to successful implementation of falls prevention interventions. Lessons learned from this experience can be applied to the translation of future exercise-based falls prevention interventions.     

Cx43 regulates mechanotransduction mechanisms in human preterm amniotic membrane defects

Objective

The effects of mechanical stimulation in preterm amniotic membrane (AM) defects were explored.

Methods

Preterm AM was collected from women undergoing planned preterm caesarean section (CS) due to fetal growth restriction or emergency CS after spontaneous preterm prelabour rupture of the membranes (sPPROM). AM explants near the cervix or placenta were subjected to trauma and/or mechanical stimulation with the Cx43 antisense. Markers for nuclear morphology (DAPI), myofibroblasts (αSMA), migration (Cx43), inflammation (PGE₂) and repair (collagen, elastin and transforming growth factor β [TGFβ₁]) were examined by confocal microscopy, second harmonic generation, qPCR and biochemical assays.

Results

In preterm AM defects, myofibroblast nuclei were highly deformed and contractile and expressed αSMA and Cx43. Mechanical stimulation increased collagen fibre polarisation and the effects on matrix markers were dependent on tissue region, disease state, gestational age and the number of fetuses. PGE₂ levels were broadly similar but reduced after co-treatment with Cx43 antisense in late sPPROM AM defects. TGFβ₁ and Cx43 gene expression were significantly increased after trauma and mechanical stimulation but this response dependent on gestational age.

Conclusion

Mechanical stimulation affects Cx43 signalling and cell/collagen mechanics in preterm AM defects. Establishing how Cx43 regulates mechanosignalling could be an approach to repair tissue integrity after trauma.     

Turner syndrome-omphalocele association: Incidence,karyotype, phenotype and fetal outcome

Objective

Omphalocele is known to be associated with genetic anomalies like trisomy 13, 18 and Beckwith–Wiedemann syndrome, but not with Turner syndrome (TS). Our aim was to assess the incidence of omphalocele in fetuses with TS, the phenotype of this association with other anomalies, their karyotype, and the fetal outcomes.

Method

Retrospective multicenter study of fetuses with confirmed diagnosis of TS. Data were extracted from a detailed questionnaire sent to specialists in prenatal ultrasound.

Results

680 fetuses with TS were included in this analysis. Incidence of small omphalocele in fetuses diagnosed ≥12 weeks was 3.1%. Including fetuses diagnosed before 12 weeks, it was 5.1%. 97.1% (34/35) of the affected fetuses had one or more associated anomalies including increased nuchal translucency (≥3 mm) and/or cystic hygroma (94.3%), hydrops/skin edema (71.1%), and cardiac anomalies (40%). The karyotype was 45,X in all fetuses. Fetal outcomes were poor with only 1 fetus born alive.

Conclusion

TS with 45,X karyotype but not with X chromosome variants is associated with small omphalocele. Most of these fetuses have associated anomalies and a poor prognosis. Our data suggest an association of TS with omphalocele, which is evident from the first trimester.     

Seasonal trend and source identification of polycyclic aromatic hydrocarbons associated with fine particulate matters (PM2.5) in Isfahan City,Iran, using diagnostic ratio and PMF model

Environmental Science and Pollution Research - Particulate matters (PMs) and their associated chemical compounds such as polycyclic aromatic hydrocarbons (PAHs) are important factors to evaluate...     

Uncertainty propagation in vegetation distribution models based on ensemble classifiers

Ensemble learning techniques are increasingly applied for species and vegetation distribution modelling, often resulting in more accurate predictions. At the same time, uncertainty assessment of distribution models is gaining attention. In this study, Random Forests, an ensemble learning technique, is selected for vegetation distribution modelling based on environmental variables. The impact of two important sources of uncertainty, that is the uncertainty on spatial interpolation of environmental variables and the uncertainty on species clustering into vegetation types, is quantified based on sequential Gaussian simulation and pseudo-randomization tests, respectively. An empirical assessment of the uncertainty propagation to the distribution modelling results indicated a gradual decrease in performance with increasing input uncertainty. The test set error ranged from 30.83% to 52.63% and from 30.83% to 83.62%, when the uncertainty ranges on spatial interpolation and on vegetation clustering, respectively, were fully covered. Shannon’s entropy, which is proposed as a measure for uncertainty of ensemble predictions, revealed a similar increasing trend in prediction uncertainty. The implications of these results in an empirical distribution modelling framework are further discussed with respect to monitoring setup, spatial interpolation and species clustering.     

Modeling compensated root water and nutrient uptake

Plant root water and nutrient uptake is one of the most important processes in subsurface unsaturated flow and transport modeling, as root uptake controls actual plant evapotranspiration, water recharge and nutrient leaching to the groundwater, and exerts a major influence on predictions of global climate models. In general, unsaturated models describe root uptake relatively simple. For example, root water uptake is mostly uncompensated and nutrient uptake is simulated assuming that all uptake is passive, through the water uptake pathway only. We present a new compensated root water and nutrient uptake model, implemented in HYDRUS. The so-called root adaptability factor represents a threshold value above which reduced root water or nutrient uptake in water- or nutrient-stressed parts of the root zone is fully compensated for by increased uptake in other soil regions that are less stressed. Using a critical value of the water stress index, water uptake compensation is proportional to the water stress response function. Total root nutrient uptake is determined from the total of active and passive nutrient uptake. The partitioning between passive and active uptake is controlled by the a priori defined concentration value c_max. Passive nutrient uptake is simulated by multiplying root water uptake with the dissolved nutrient concentration, for soil solution concentration values below c_max. Passive nutrient uptake is thus zero when c_max is equal to zero. As the active nutrient uptake is obtained from the difference between plant nutrient demand and passive nutrient uptake (using Michaelis–Menten kinetics), the presented model thus implies that reduced passive nutrient uptake is compensated for by active nutrient uptake. In addition, the proposed root uptake model includes compensation for active nutrient uptake, in a similar way as used for root water uptake. The proposed root water and nutrient uptake model is demonstrated by several hypothetical examples, for plants supplied by water due to capillary rise from groundwater and surface drip irrigation.     

Predictability of marine nematode biodiversity

In this paper, we investigated: (1) the predictability of different aspects of biodiversity, (2) the effect of spatial autocorrelation on the predictability and (3) the environmental variables affecting the biodiversity of free-living marine nematodes on the Belgian Continental Shelf. An extensive historical database of free-living marine nematodes was employed to model different aspects of biodiversity: species richness, evenness, and taxonomic diversity. Artificial neural networks (ANNs), often considered as “black boxes”, were applied as a modeling tool. Three methods were used to reveal these “black boxes” and to identify the contributions of each environmental variable to the diversity indices. Since spatial autocorrelation is known to introduce bias in spatial analyses, Moran's I was used to test the spatial dependency of the diversity indices and the residuals of the model. The best predictions were made for evenness. Although species richness was quite accurately predicted as well, the residuals indicated a lack of performance of the model. Pure taxonomic diversity shows high spatial variability and is difficult to model. The biodiversity indices show a strong spatial dependency, opposed to the residuals of the models, indicating that the environmental variables explain the spatial variability of the diversity indices adequately. The most important environmental variables structuring evenness are clay and sand fraction, and the minimum annual total suspended matter. Species richness is also affected by the intensity of sand extraction and the amount of gravel of the sea bed.     

Soil pollution in day-care centers and playgrounds in Norway: national action plan for mapping and remediation

Systematic geochemical mapping based on sampling and analysis of surface soils (0–2 cm) has been carried out in several Norwegian cities. The soils in the oldest parts of the cities are contaminated with metals (especially Pb) and polycyclic aromatic hydrocarbons (PAH). Due to the fact that children are often in contact with surface soil, it was realized that special focus had to be directed towards soils in day-care centers and playgrounds. The first mapping and remedy program was initiated in Trondheim in 1996. Here, the importance of copper–chromium–arsenic (CCA)-pressure-impregnated wood in playing equipment as a pollution source for soils was documented, and a process was started with the aim to ban this product. Soils from day-care centers in the inner city of Bergen were polluted to a degree that required remediation in 45% out of 87 centers, mainly due to high concentrations of Pb and benzo(a)pyrene. In Oslo, 38% of 700 day-care centers needed remediation due to soil pollution by Pb, BaP, Cd, Hg, Ni and PCB. Removal of CCA-impregnated wood was necessary in more than half of the day-care centers The Norwegian parliament has decided to investigate all outdoor playing areas in day-care centers, playgrounds and schoolyards in Norway, starting in 2007 with day-care centers in the ten largest cities and five most important industrial areas. The Norwegian Institute of Public Health has developed quality criteria for soils in day-care centers and playgrounds for As, Cd, Cr⁶⁺, Hg, Ni, Pb, zinc, PAH_sum16, benzo(a)pyrene, and PCB_sum7. The Geological Survey of Norway has developed guidance for mapping of soil pollution (sampling, chemical analysis and reporting) in day-care centers. Especially the sampling strategy has been developed in the period 1996–2007, and the preferred sampling strategy is to collect at least 10 samples of surface soil (0–2 cm) from (1) “original soil” on the site, (2) artificial man-made “hills”, and (3) soils used for growing vegetables. A total number of 2,000 day-care-centres are to be investigated, and necessary remediation should be completed before the end of 2010.