When evidence is not enough: the challenge of implementing fall prevention strategies

Problem

As the evidence-based movement has advanced in public health, changes in public health practices have lagged far behind creating a science to service gap. For example, science has produced effective falls prevention interventions for older adults. It now is clearer WHAT needs to be done to reduce injury and death related to falls. However, issues have arisen regarding HOW to assure the full and effective uses of evidence-based programs in practice.

Summary

Lessons learned from the science and practice of implementation provide guidance for how to change practices by developing new competencies, how to change organizations to support evidence-based practices, and how to change public health systems to align system functions with desired practices. The combination of practice, organization, and system change likely will produce the public health benefits that are the promise of evidence-based falls prevention interventions.

Impact on public health

For the past several decades, the emphasis has been solely on evidence-based interventions. Public health will benefit from giving equal emphasis to evidence-based implementation.

Impact on Industry

We now have over two decades of research on the effectiveness of fall prevention interventions. The quality of this research is judged by a number of credible international organizations, including the Cochrane Collaboration (http://www.cochrane.org/), the American and British Geriatrics Societies, and the Campbell Collaboration (http://www.campbellcollaboration.org/). These international bodies were formed to ponder and answer questions related to the quality and relevance of research. These developments are a good first step. However, while knowing WHAT to do (an evidence-based intervention) is critical, we also need to know HOW to effectively implement the evidence. Implementation, organization change, and system change methods produce the conditions that allow and support the full and effective use of evidence-based interventions. It is time to focus on utilization of implementation knowledge in public health. Without this focus the vast amount on new evidence being generated on the prevention of falls and related injuries among older adults will have little impact on their health and safety.     

Experimental analysis of friction stir forming for dissimilar material joining application

Mass reduction of automotive body structures is a critical part of achieving reduced CO₂ emissions in the automotive industry. There has been significant work on the application of ultra high strength steels and aluminum alloys. However, the next paradigm is the integrated use of both materials, which poses a challenge of how to join the dissimilar materials. Friction stir forming is a new manufacturing process for joining dissimilar materials. The concept of this process is stir heating one material and forming it into a mechanical interlocking joint with the second material. In this research the process was experimentally analyzed in a position controlled robotic friction stir welding machine between aluminum and steel workpieces. New tool geometries were evaluated toward the goal of optimizing joint strength. The significant process parameters were identified and their optimized settings for the current experimental conditions defined using a design of experiments methodology. A scanning electron microscope was used to characterize the bonding and joint structure for single and multi-pin configurations. Two failure modes, aluminum sheet peeling and bonding delamination, i.e. braze fracture, were identified. It was found that the presence of zinc coating on the steel and overall joint geometry greatly affected the joint strength. The aluminum–zinc braze joint appears to be the largest contributor to joint strength for the single-pin joint configuration. The multi-pin geometry enabled a distribution of load to the four pins following fracture of the braze for increased joint toughness and ductility. Thus, the FSF method has been shown to exhibit potential for joining of aluminum to steel.     

A Method for Spatially Explicit Representation of Sub-watershed Sediment Yield,Southern California,USA

We present here a method to integrate geologic, topographic, and land-cover data in a geographic information system to provide a fine-scale, spatially explicit prediction of sediment yield to support management applications. The method is fundamentally qualitative but can be quantified using preexisting sediment-yield data, where available, to verify predictions using other independent data sets. In the 674-km² Sespe Creek watershed of southern California, 30 unique “geomorphic landscape units” (GLUs, defined by relatively homogenous areas of geology, hillslope gradient, and land cover) provide a framework for discriminating relative rates of sediment yield across this landscape. Field observations define three broad groupings of GLUs that are well-associated with types, relative magnitudes, and rates of erosion processes. These relative rates were then quantified using sediment-removal data from nearby debris basins, which allow relatively low-precision but robust calculations of both local and whole-watershed sediment yields, based on the key assumption that minimal sediment storage throughout most of the watershed supports near-equivalency of long-term rates of hillslope sediment production and watershed sediment yield. The accuracy of these calculations can be independently assessed using geologically inferred uplift rates and integrated suspended sediment measurements from mainstem Sespe Creek, which indicate watershed-averaged erosion rates between about 0.6–1.0 mm year^?1 and corresponding sediment yields of about 2 × 10³ t km^?2 year^?1. A spatially explicit representation of sediment production is particularly useful in a region where wildfires, rapid urban development, and the downstream delivery of upstream sediment loads are critical drivers of both geomorphic processes and land-use management.     

A Systems-Based Conceptual Framework for Assessing the Determinants of a Social License to Operate in the Mining Industry

The concept of a “social license to operate” (SLO) was coined in the 1990s and gained popularity as one way in which “social” considerations can be addressed in mineral development decision making. The need for a SLO implies that developers require the widespread approval of local community members for their projects to avoid exposure to potentially costly conflict and business risks. Only a limited amount of scholarship exists on the topic, and there is a need for research that specifically addresses the complex and changeable nature of SLO outcomes. In response to these challenges, this paper advances a novel, systems-based conceptual framework for assessing SLO determinants and outcomes in the mining industry. Two strands of systems theory are specifically highlighted—complex adaptive systems and resilience—and the roles of context, key system variables, emergence, change, uncertainty, feedbacks, cross-scale effects, multiple stable states, thresholds, and resilience are discussed. The framework was developed from the results of a multi-year research project which involved international mining case study investigations, a comprehensive literature review, and interviews conducted with mining stakeholders and observers. The framework can help guide SLO analysis and management efforts, by encouraging users to account for important contextual and complexity-oriented elements present in SLO settings. We apply the framework to a case study in Alaska, USA before discussing its merits and challenges. We also illustrate knowledge gaps associated with applications of complex adaptive systems and resilience theories to the study of SLO dynamics, and discuss opportunities for future research.     

Oregon Hydrologic Landscapes: A Classification Framework1

Wigington, Parker J., Jr., Scott G. Leibowitz, Randy L. Comeleo, and Joseph L. Ebersole, 2012. Oregon Hydrologic Landscapes: A Classification Framework. Journal of the American Water Resources Association (JAWRA) 1‐20. DOI: 10.1111/jawr.12009 Abstract: There is a growing need for hydrologic classification systems that can provide a basis for broad‐scale assessments of the hydrologic functions of landscapes and watersheds and their responses to stressors such as climate change. We developed a hydrologic landscape (HL) classification approach that describes factors of climate‐watershed systems that control the hydrologic characteristics of watersheds. Our assessment units are incremental watersheds (i.e., headwater watersheds or areas draining directly into stream reaches). Major components of the classification include indices of annual climate, climate seasonality, aquifer permeability, terrain, and soil permeability. To evaluate the usefulness of our approach, we identified 30 rivers with long‐term streamflow‐gauging records and without major diversions and impoundments. We used statistical clustering to group the streams based on the shapes of their annual hydrographs. Comparison of the streamflow clusters and HL distributions within river basin clusters shows that the Oregon HL approach has the ability to provide insights about the expected hydrologic behavior of HLs and larger river basins. The Oregon HL approach has potential to be a useful framework for comparing hydrologic attributes of streams and rivers in the Pacific Northwest.     

Shifts within ecological modernization in South Africa: Deliberation, innovation and institutional opportunities

Sustainable development is now widely accepted as a policy framework in planning and development both internationally and in South Africa. Within this framework, technocentric scientific approaches to environmental management, which are reflective of weak ecological modernization, have dominated environmental practice both in the developed and developing world. South Africa is a country in transition and as a result environmental law and policy have undergone significant reform. However, implementation and practice remains embedded within a weak ecological modernization approach. Through the lens of two case studies reflecting changing approaches and practices within state institutions, this paper explores the shifts taking place in the construction, adaptation and application of policy frameworks and tools used in the drive towards sustainability in South Africa. The research uses critical approaches to ecological modernization (Hajer, 1995; Christoff, 1996) and deliberative policy analysis (Hajer and Wagenaar, 2003; Hajer, 2003, 2003; Hajer, 2004) to explore these shifts. It suggests that the shift towards strong ecological modernization has taken place as a result of the adaptation of international practice to the South Africa context, the global acceptance of more integrated approaches, the opportunities for change that 'institutional ambiguity' and 'multi-signification' create, and pockets of innovation that have developed when intellectual actors shift the boundaries of environmental practice.     

Simulating the influences of various fire regimes on caribou winter habitat.

Caribou are an integral component of high-latitude ecosystems and represent a major subsistence food source for many northern people. The availability and quality of winter habitat is critical to sustain these caribou populations. Caribou commonly use older spruce woodlands with adequate terrestrial lichen, a preferred winter forage, in the understory. Changes in climate and fire regime pose a significant threat to the long-term sustainability of this important winter habitat. Computer simulations performed with a spatially explicit vegetation succession model (ALFRESCO) indicate that changes in the frequency and extent of fire in interior Alaska may substantially impact the abundance and quality of winter habitat for caribou. We modeled four different fire scenarios and tracked the frequency, extent, and spatial distribution of the simulated fires and associated changes to vegetation composition and distribution. Our results suggest that shorter fire frequencies (i.e., less time between recurring fires) on the winter range of the Nelchina caribou herd in eastern interior Alaska will result in large decreases of available winter habitat, relative to that currently available, in both the short and long term. A 30% shortening of the fire frequency resulted in a 3.5-fold increase in the area burned annually and an associated 41% decrease in the amount of spruce-lichen forest found on the landscape. More importantly, simulations with more frequent fires produced a relatively immature forest age structure, compared to that which currently exists, with few stands older than 100 years. This age structure is at the lower limits of stand age classes preferred by caribou from the Nelchina herd. Projected changes in fire regime due to climate warming and/or additional prescribed burning could substantially alter the winter habitat of caribou in interior Alaska and lead to changes in winter range use and/or population dynamics.