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.     

Urban agriculture,civil interfaces and moving beyond difference: the experiences of plot holders in Dublin and Belfast

Recent literature suggests that a “shared politics of place” attained through joint activities fosters social integration and provides people with a means to practise co-operation [Baumann, G., 1996. Contesting culture: discourses of identity in multi-ethnic London. Cambridge: Cambridge University Press; Sanjek, R., 1998. The future of us all: race & neighbourhood policies in New York City. Ithaca, NY: Cornell University Press; Sennett, R., 2012. Together: the rituals, pleasures and politics of cooperation. UK: Penguin]. Such a “shared politics of place” is most likely to occur in the context of public space conceptualised broadly as “the setting for everyday spatial behaviour of individuals and communities, emphasizing ordinary activities of citizens” [Lownsbrough, H. and Beunderman, J., 2007. Equally spaced? Public space and interaction between diverse communities. London: Demos, p. 8]. Here we explore one element of such public space – urban agriculture sites – with a view to identifying the extent to which a “shared politics of place” can be created and nurtured among the cultivating citizenry. The paper draws on data collected on allotment gardening sites in two urban contexts: Dublin (Ireland) and Belfast (Northern Ireland) over the period 2009–2013. We demonstrate the centrality of allotment cultivation to the generation of solidarity, mutuality and trust among participating citizens. Individuals engaging in allotment gardening in both Dublin and Belfast create and sustain civil interfaces – dismantling barriers, exchanging knowledge, challenging stereotypes, generating empathy and getting on with the business of simply getting on with their lives. The modus operandi of allotment gardening is predicated on a willingness to disregard social and ethno-national categorisations while on site. This is not to deny that such differences exist and persist, but allotments offer a “space of potential” where those differences are, at least for a time, rendered less salient.     

Thermoplastic Starch (TPS)/Polylactic Acid (PLA) Blending Methodologies: A Review

Polylactic acid (PLA) and thermoplastic starch (TPS) are biodegradable polymers of biological origin, and the mixture of these polymers has been studied due to the desirable mechanical properties of PLA and the low processing cost of TPS. However, the TPS/PLA combination is thermodynamically immiscible due to the poor interfacial interaction between the hydrophilic starch granules and the hydrophobic PLA. To overcome these limitations, researchers studied the modification, processing, and properties of the mixtures as a strategy to increase the compatibility between phases. This review highlights recent developments, current results, and trends in the field of TPS/PLA-based compounds during the last two decades, with the main focus of improving the adhesion between the two components. The TPS/PLA blends were classified as plasticized, compatible, reinforced and with nanocomposites. This article presents, based on published research, TPS/PLA combinations, considering different methods with significant improvements in mechanical properties, with promising developments for applications in food packaging and biomedicine.

     

Estimating species occurrence, abundance, and detection probability using zero-inflated distributions

Researchers have developed methods to account for imperfect detection of species with either occupancy (presence absence) or count data using replicated sampling. We show how these approaches can be combined to simultaneously estimate occurrence, abundance, and detection probability by specifying a zero-inflated distribution for abundance. This approach may be particularly appropriate when patterns of occurrence and abundance arise from distinct processes operating at differing spatial or temporal scales. We apply the model to two data sets: (1) previously published data for a species of duck, Anas platyrhynchos, and (2) data for a stream fish species, Etheostoma scotti. We show that in these cases, an incomplete-detection zero-inflated modeling approach yields a superior fit to the data than other models. We propose that zero-inflated abundance models accounting for incomplete detection be considered when replicate count data are available.     

Lipid and protein utilisation during early development of yellowtail kingfish (<Emphasis Type="Italic">Seriola lalandi</Emphasis>)

The pelagic yellowtail kingfish Seriola lalandi has become a target species for aquaculture in Asia and Australasia. Australasian production is reliant on larviculture from eggs of captive brood stock; however, knowledge regarding the nutritional requirements of larvae of this species is still scarce, particularly in relation to lipids. As a first step in establishing these requirements, eggs and larvae from captive S. lalandi brood stock were examined for differences in total protein, total lipid and lipid classes between individual spawning events, over the spawning season, and during larval development from fertilisation to 15 days post hatch. Results indicate that total protein egg⁻¹ varied significantly between individual spawning events within a season, but neither total lipid nor total protein egg⁻¹ varied significantly across the spawning season. Brood stock egg lipids were made up of approximately 60% phospholipid, 25% wax and/or sterol esters (WE), 15% triacylglycerol (TAG), and small amounts of sterols and free fatty acids. During the early larval period, both WE and TAG were utilised concurrently for energy. The larvae experienced very high mortality around 5–7 days post hatch, which coincided with very low levels of all neutral lipid classes. Although many other factors may also influence larval mortality, these results indicate that lipid provisioning may be an important factor in larval survival during the critical period around first-feeding in this species. Examination of ratios of TAG:ST, often used as a condition index in fish larvae, suggested that some of the larvae were suffering from starvation. However, as egg-derived WE appears to provide a significant source of energy during the early larval period in S. lalandi, it is suggested that WE should be included in any index of larval nutritional state.     

Efficacy of stable isotope ratios in assigning endangered migrants to breeding and wintering sites.

A primary constraint on effective conservation of migratory animals is our inability to track individuals through their annual cycle. One such animal is the endangered southwestern subspecies of the Willow Flycatcher, which is difficult to distinguish from conspecifics. Identifying wintering regions used by the endangered subspecies would be an important step in formulating an effective conservation strategy. Our objective was to use stable isotope ratios as a means of identifying wintering sites of Southwestern Willow Flycatchers. We analyzed stable isotope ratios of carbon, nitrogen, and hydrogen from feathers of breeding and wintering Willow Flycatchers. Based on winter samples, we document a positive trend in hydrogen isotope ratios across latitude. We also found that Willow Flycatchers use C4 food webs south of 8 degrees N latitude, but we found no evidence of use of C4 food webs farther north. Nitrogen stable isotope ratios of feathers showed no discernable geographic variation. Discriminant function analyses, based on stable isotope ratios of wintering Willow Flycatchers, were only useful (>50% accurate) for assigning individuals to winter regions if the regions were large and the threshold probability for assignment was relatively high. When using these discriminant functions, most breeding samples of Southwestern Willow Flycatchers were assigned to two wintering regions: central Mexico and Ecuador. We think that assignment of Southwestern Willow Flycatchers to Ecuador is unrealistic. Given the large percentages of samples that could not be classified with certainty, we are not confident that these two regions are truly more likely to harbor wintering Southwestern Willow Flycatchers than other winter regions. We think our inconclusive results are due primarily to weak and nonlinear gradients in isotope ratios across the winter range of Willow Flycatchers.     

Fluorides in groundwater and its impact on health

Fluoride is a naturally occurring toxic mineral present in drinking water and causes yellowing of teeth, tooth problems etc. Fluorspar, Cryolite and Fluorapatite are the naturally occurring minerals, from which fluoride finds its path to groundwater through infiltration. In the present study two groundwater samples, Station I and Station II at Hyderabad megacity, the capital of Andhra Pradesh were investigated for one year from January 2001 to December 2001. The average fluoride values were 1.37 mg/l at Station I and 0.91 mg/l at Station II. The permissible limit given by BIS (1983) 0.6-1.2 mg/l and WHO (1984) 1.5 mg/l for fluoride in drinking water. The groundwaters at Station I exceeded the limit while at Station II it was within the limits. The study indicated that fluoride content of 0.5 mg/l is sufficient to cause yellowing of teeth and dental problems.     

An enzyme-linked immunosorbent assay for the determination of dioxins in contaminated sediment and soil samples

A 96-microwell enzyme-linked immunosorbent assay (ELISA) method was evaluated to determine PCDDs/PCDFs in sediment and soil samples from an EPA Superfund site. Samples were prepared and analyzed by both the ELISA and a gas chromatography/high resolution mass spectrometry (GC/HRMS) method. Comparable method precision, accuracy, and detection level (8 ng kg(-1)) were achieved by the ELISA method with respect to GC/HRMS. However, the extraction and cleanup method developed for the ELISA requires refinement for the soil type that yielded a waxy residue after sample processing. Four types of statistical analyses (Pearson correlation coefficient, paired t-test, nonparametric tests, and McNemar's test of association) were performed to determine whether the two methods produced statistically different results. The log-transformed ELISA-derived 2,3,7,8-tetrachlorodibenzo-p-dioxin values and log-transformed GC/HRMS-derived TEQ values were significantly correlated (r=0.79) at the 0.05 level. The median difference in values between ELISA and GC/HRMS was not significant at the 0.05 level. Low false negative and false positive rates (<10%) were observed for the ELISA when compared to the GC/HRMS at 1,000 ng TEQ kg(-1). The findings suggest that immunochemical technology could be a complementary monitoring tool for determining concentrations at the 1,000 ng TEQ kg(-1) action level for contaminated sediment and soil. The ELISA could also be used in an analytical triage approach to screen and rank samples prior to instrumental analysis.     

Partitioning and removal of perfluorooctanoate during rain events: the importance of physical-chemical properties

The potential for airborne emissions to undergo long-range transport or to be removed from the atmosphere is influenced by their physical-chemical properties. When perfluorooctanate (PFO) enters the environment, its physical-chemical properties can vary significantly, depending on whether it exists as an acid, a salt, or a dissociated ion. A summary of the physical-chemical properties of the three most likely environmental states: ammonium perfluorooctanoate (APFO), perfluorooctanoic acid (PFOA) and the dissociated perfluorooctanoate anion (PFO(-)) is presented to illustrate the distinct environmental properties of each. The most volatile species, PFOA, is shown to have a pH-dependent air-water partitioning coefficient (K(aw)). The variability of K(aw) with pH influences the potential for vapor formation from aqueous environments, including rain events. Using the pH-dependent K(aw) and measured rain and air concentrations, it is shown that vapor-phase PFOA is not likely to be present above measurable levels of 0.2 ng m(-3) (12 parts per quadrillion v/v) during a rain event. Because rain concentrations determined in this work are comparable to measurements in other parts of North America, it is unlikely that rain events are a significant source of vapor-phase PFOA for the general North American region. It is shown that PFOA exists primarily in the particle phase in ambient air near direct sources of emissions and is efficiently scavenged by rain droplets, making wet deposition an important removal mechanism for emissions originating as either PFOA or APFO. Washout ratios of particle-associated PFO were determined to range between 1 x 10(5) and 5 x 10(5), in the same range as other semi-volatile compounds for which wet deposition is an important mechanism for atmospheric removal and deposition onto soils and water bodies.     

Weather-mediated natural selection on arrival time in cliff swallows (Petrochelidon pyrrhonota)

An unusually long period of cold weather in May 1996 caused extensive mortality among insectivorous cliff swallows (Petrochelidon pyrrhonota) in the northern and central Great Plains. We analyzed how viability selection affected spring arrival time in a migratory Nebraska population by comparing capture histories of survivors with those of birds known to have died and by documenting how arrival time changed in the year following the selection event. Surviving birds had significantly later first-capture dates (an index of arrival time) in the years prior to selection than those that died; a significant selection differential suggested directional selection for birds that arrived later. Colony sites were occupied significantly later following the selection event, and the distribution of first-capture dates in the season after selection was significantly shifted toward later arrivals. Offspring of the survivors tended to arrive later than birds of the same age prior to the selection event. While major weather-caused mortality events of this magnitude are rare in the study area, spells of cold weather severe enough to cause limited mortality are frequent in April and early May. At least 25 probable mortality events of varying severity were identified in the last 50 years based on climatological data. Periodic weather-mediated selection against early arrival constrains the cliff swallow’s breeding season and may partly prevent directional selection for earlier nesting. Received: 19 October 1999 / Received in revised form: 15 January 2000 / Accepted: 24 January 2000