Reducing fall risk by improving balance control: development, evaluation and knowledge-translation of new approaches

Problem

Falling is a leading cause of serious injury, loss of independence, and nursing-home admission in older adults. Impaired balance control is a major contributing factor.

Methods

Results from our balance-control studies have been applied in the development of new and improved interventions and assessment tools. Initiatives to facilitate knowledge-translation of this work include setting up a new network of balance clinics, a research-user network and a research-user advisory board.

Results

Our findings support the efficacy of the developed balance-training methods, balance-enhancing footwear, neuro-prosthesis, walker design, handrail-cueing system, and handrail-design recommendations in improving specific aspects of balance control.

Impact on Knowledge Users

A new balance-assessment tool has been implemented in the first new balance clinic, a new balance-enhancing insole is available through pharmacies and other commercial outlets, and handrail design recommendations have been incorporated into 10 Canadian and American building codes. Work in progress is expected to have further impact.     

Creating Pedestrian Crash Scenarios in a Driving Simulator Environment

Objective: In 2012 in the United States, pedestrian injuries accounted for 3.3% of all traffic injuries but, disproportionately, pedestrian fatalities accounted for roughly 14% of traffic-related deaths (NHTSA 2014 NHTSA. Traffic Safety Facts 2012 Pedestrians. Washington, DC: Author; 2014. DOT HS 811 888. [Google Scholar]). In many other countries, pedestrians make up more than 50% of those injured and killed in crashes. This research project examined driver response to crash-imminent situations involving pedestrians in a high-fidelity, full-motion driving simulator. This article presents a scenario development method and discusses experimental design and control issues in conducting pedestrian crash research in a simulation environment. Driving simulators offer a safe environment in which to test driver response and offer the advantage of having virtual pedestrian models that move realistically, unlike test track studies, which by nature must use pedestrian dummies on some moving track.

Methods: An analysis of pedestrian crash trajectories, speeds, roadside features, and pedestrian behavior was used to create 18 unique crash scenarios representative of the most frequent and most costly crash types. For the study reported here, we only considered scenarios where the car is traveling straight because these represent the majority of fatalities. We manipulated driver expectation of a pedestrian both by presenting intersection and mid-block crossing as well as by using features in the scene to direct the driver's visual attention toward or away from the crossing pedestrian. Three visual environments for the scenarios were used to provide a variety of roadside environments and speed: a 20–30 mph residential area, a 55 mph rural undivided highway, and a 40 mph urban area.

Results: Many variables of crash situations were considered in selecting and developing the scenarios, including vehicle and pedestrian movements; roadway and roadside features; environmental conditions; and characteristics of the pedestrian, driver, and vehicle. The driving simulator scenarios were subjected to iterative testing to adjust time to arrival triggers for the pedestrian actions. This article discusses the rationale behind creating the simulator scenarios and some of the procedural considerations for conducting this type of research.

Conclusions: Crash analyses can be used to construct test scenarios for driver behavior evaluations using driving simulators. By considering trajectories, roadway, and environmental conditions of real-world crashes, representative virtual scenarios can serve as safe test beds for advanced driver assistance systems. The results of such research can be used to inform pedestrian crash avoidance/mitigation systems by identifying driver error, driver response time, and driver response choice (i.e., steering vs. braking).     

Engaging stakeholders in an adaptation process: governance and institutional arrangements in heat-health policy development in Adelaide, Australia

Record breaking heat waves have been recorded in Adelaide, Australia in recent years and climate change would likely increase the frequency, duration and severity of heat waves. This paper describes the governance and institutional arrangements during the development of an adaptation strategy (herein referred to as heat-health policy) for heat waves in Adelaide, Australia. In-depth, semi-structured interviews were conducted between June and August 2011 among 18 stakeholders who were involved in the participatory process during the development of the heat-health policy. Informed consent was obtained and interviews were recorded, transcribed verbatim and the data analysed using framework analysis. Interview data were supplemented by data gathered through a review of documents associated with the process. The results found that the process of developing the heat-health policy was initiated by the state government and comprised of stakeholders from both the state and non-state sectors. There was a high level of leadership and political commitment demonstrated during the process, given that the different players wanted a policy to be in place before any future heat wave. A Steering Committee was established that provided coordination and oversight in addition to the Emergency Management Act within the state which provided the legislative framework during the heat-health policy development process. Although the decision-making authority was controlled by a controlled by a public institution, to a larger extent, there was collaborative decision-making by virtue of the context in which the heat-health policy was developed. An assurance mechanism established during the process was among the factors that ensured accountability during the participatory process. Overall, the development of the heat-health policy in Adelaide was largely successful, attributed to the extent of political commitment from the state government and the sound institutional and legislative framework that facilitated the process. Good governance and institutional arrangements provide the enabling environment, the structures, systems and resources that would facilitate the development of adaptation strategies such as heat-health policies.     

Self-Reported Seat Belt Use in Four Countries: A Telephone Survey

A telephone survey was conducted in four countries in November 1998 to compare drivers in the United States with those in Australia, Canada, and the United Kingdom regarding their attitudes toward seat belts and belt use laws. More than 90 percent of the 2251 respondents said they thought seat belts are effective, but self-reported belt use was significantly lower in the United States than in the other countries. Respondents in Australia and the United Kingdom had similar views about what they thought were important reasons for using seat belts and had the highest self-reported use. Reasons given for using belts by Canadian and US respondents were quite similar to one another, yet US respondents had significantly lower self-reported use rates, a difference thought to be due to vigorous enforcement of the law in Canada. US drivers were less likely than Australian and UK drivers to say they used belts out of habit, to avoid a ticket, or because it is required by law and more likely to say they used belts for situational reasons. US drivers were least likely to be in favor of belt use laws. Canadian drivers reported the most experience being checked by police for belt use and were most likely to think that nonusers would be caught. US drivers in primary enforcement jurisdictions were more likely than those in secondary jurisdictions to think that drivers not using belts would be caught and more likely to say they always used belts. Results of this survey indicate that seat belt use in the United States could be increased by adoption of primary enforcement laws and highly visible enforcement programs of the type used in Canada, and that seat belt use could be increased in all countries by increasing the penalties for nonuse.     

Physical basis of coastal adaptation on tropical small islands

Small tropical islands are widely recognized as having high exposure and vulnerability to climate change and other natural hazards. Ocean warming and acidification, changing storm patterns and intensity, and accelerated sea-level rise pose challenges that compound the intrinsic vulnerability of small, remote, island communities. Sustainable development requires robust guidance on the risks associated with natural hazards and climate change, including the potential for island coasts and reefs to keep pace with rising sea levels. Here we review these issues with special attention to their implications for climate-change vulnerability, adaptation, and disaster risk reduction in various island settings. We present new projections for 2010–2100 local sea-level rise (SLR) at 18 island sites, incorporating crustal motion and gravitational fingerprinting, for a range of Intergovernmental Panel on Climate Change global projections and a semi-empirical model. Projected 90-year SLR for the upper limit A1FI scenario with enhanced glacier drawdown ranges from 0.56 to 1.01 m for islands with a measured range of vertical motion from ?0.29 to +0.10 m. We classify tropical small islands into four broad groups comprising continental fragments, volcanic islands, near-atolls and atolls, and high carbonate islands including raised atolls. Because exposure to coastal forcing and hazards varies with island form, this provides a framework for consideration of vulnerability and adaptation strategies. Nevertheless, appropriate measures to adjust for climate change and to mitigate disaster risk depend on a place-based understanding of island landscapes and of processes operating in the coastal biophysical system of individual islands.     

Interagency Resource Teams: a Model for Collaborative Approaches to Environmental Education

Abstract: The Undergraduate Interagency Resource Teams at the White Mountain Research Station of the University of California were created in 1994 to support resource-agency mandates and academic research objectives by providing qualified students who can learn, apply, and improve research and agency monitoring protocols. Drawing from documented elements of other successful internship programs, we identified four basic components that we believe may enhance the potential success of the interns: (1) self-directed learning methodologies, (2) multidisciplinary approaches to science, (3) reflection on and documentation of intern learning, and (4) principles of a positive work environment, including teamwork, conflict resolution, and effective communication. During a 10-week summer session, the Interagency Resource Teams expose approximately 17 students to the professional worlds of natural resource agencies and research scientists. In this environment, we have also observed that the internship program not only exposes students to resource management careers but may also help bridge the gap between resource agency specialists and academic researchers.     

p53 sequence polymorphisms in late-stage leukemic Mytilus edulis are homologous with M. trossulus p53

Mytilus edulis and M. trossulus are key species in marine intertidal communities that develop a leukemia-like haemic neoplasia at increased incidences at some polluted sites. The tumor-suppressor p53, known to be involved in this disease, was proposed as a biomarker based on sequence polymorphisms in M. trossulus. In this study, p53 mRNA sequence variations in normal and diseased M. edulis were compared with those reported previously for M. trossulus for caged individuals of both species submerged in Burrard Inlet (49°20′16.57″N 123°13′51.37″) in 2007 and 2010. Thirty-seven single nucleotide polymorphisms (SNPs) were detected in M. edulis p53 that formed high linkage disequilibrium blocks associated with late-stage leukemia (p < 0.05). These were found at loci that were more homologous with M. trossulus than with healthy M. edulis p53-predicted haplotypes. Increased susceptibility to this cancer might be due to, in part, p53 alleles containing these SNPs.     

Rain forest fragmentation and the proliferation of successional trees

The effects of habitat fragmentation on diverse tropical tree communities are poorly understood. Over a 20-year period we monitored the density of 52 tree species in nine predominantly successional genera (Annona, Bellucia, Cecropia, Croton, Goupia, Jacaranda, Miconia, Pourouma, Vismia) in fragmented and continuous Amazonian forests. We also evaluated the relative importance of soil, topographic, forest dynamic, and landscape variables in explaining the abundance and species composition of successional trees. Data were collected within 66 permanent 1-ha plots within a large (approximately 1000 km2) experimental landscape, with forest fragments ranging from 1 to 100 ha in area. Prior to forest fragmentation, successional trees were uncommon, typically comprising 2-3% of all trees (> or =10 cm diameter at breast height [1.3 m above the ground surface]) in each plot. Following fragmentation, the density and basal area of successional trees increased rapidly. By 13-17 years after fragmentation, successional trees had tripled in abundance in fragment and edge plots and constituted more than a quarter of all trees in some plots. Fragment age had strong, positive effects on the density and basal area of successional trees, with no indication of a plateau in these variables, suggesting that successional species could become even more abundant in fragments over time. Nonetheless, the 52 species differed greatly in their responses to fragmentation and forest edges. Some disturbance-favoring pioneers (e.g., Cecropia sciadophylla, Vismia guianensis, V. amazonica, V. bemerguii, Miconia cf. crassinervia) increased by >1000% in density on edge plots, whereas over a third (19 of 52) of all species remained constant or declined in numbers. Species responses to fragmentation were effectively predicted by their median growth rate in nearby intact forest, suggesting that faster-growing species have a strong advantage in forest fragments. An ordination analysis revealed three main gradients in successional-species composition across our study area. Species gradients were most strongly influenced by the standlevel rate of tree mortality on each plot and by the number of nearby forest edges. Species-composition also varied significantly among different cattle ranches, which differed in their surrounding matrices and disturbance histories. These same variables were also the best predictors of total successional-tree abundance and species richness. Successional-tree assemblages in fragment interior plots (>150 m from edge), which are subjected to fragment area effects but not edge effects, did not differ significantly from those in intact forest, indicating that area effects per se had little influence on successional trees. Soils and topography also had little discernable effect on these species. Collectively, our results indicate that successional-tree species proliferate rapidly in fragmented Amazonian forests, largely as a result of chronically elevated tree mortality near forest edges and possibly an increased seed rain from successional plants growing in nearby degraded habitats. The proliferation of fast-growing successional trees and correlated decline of old-growth trees will have important effects on species composition, forest dynamics, carbon storage, and nutrient cycling in fragmented forests.