“Are you still driving?” Metasynthesis of patient preferences for communication with health care providers

Aim: The aim of this study was to synthesize published qualitative studies to identify older adults' preferences for communication about driving with health care providers.

Background: Health care providers play a key role in addressing driving safety and driving retirement with older adults, but conversations about driving can be difficult. Guides exist for family members and providers, but to date less is known about the types of communication and messages older drivers want from their health care providers.

Design: A qualitative metasynthesis of studies published on or before October 10, 2014, in databases (PubMed, CINAHL, PsycINFO, and Web of Science) and grey literature was performed.

Review Methods: Twenty-two published studies representing 518 older adult drivers met the following inclusion criteria: the study (1) was about driving; (2) involved older drivers; (3) was qualitative (rather than quantitative or mixed methods); and (4) contained information on older drivers' perspectives about communication with health care providers.

Results: We identified 5 major themes regarding older adults' communication preferences: (1) driving discussions are emotionally charged; (2) context matters; (3) providers are trusted and viewed as authority figures; (4) communication should occur over a period of time rather than suddenly; and (5) older adults desire agency in the decision to stop driving.

Conclusion: Various stakeholders involved in older driver safety should consider older drivers' perspectives regarding discussions about driving. Health care providers can respect and empower older drivers—and support their family members—through tactful communication about driving safety and mobility transitions during the life course.     

Morphology-Related Isometric Trunk Strength of South African Manual Workers: Implications for Prevention of Occupational Low-Back Stress

Occupational back stress among manual workers in South Africa is now a cause of governmental concern. Yet no data on the back strength of the South African workforce have been published. This study represents a first step in reporting the trunk strength of Xhosa workers in South Africa, in absolute and size-relative terms. Thirty-five male manual workers were tested isometrically while making maximal extension and flexion efforts at 0°, 23°, 46°, 69°, and 92° of stoop. The results show nonlinearity of the extensor-to-flexor (E/F) ratio of the trunk musculature. The E/F ratio increases in deep stoop because of a drop in flexor torques. The data suggest that predictions of flexor from extensor torques or vice versa can confidently be made so long as testing is done away from the fully flexed position. Significant differences between morphologically gracile and robust workers in this sample are discussed. The study has implications for occupational rehabilitation and for prophylaxis, for whereas muscular strength alone may not protect the spine from occupational injury, muscular weakness certainly predisposes it.     

The emergence of climate change policy entrepreneurs in urban regions

Regional Environmental Change - The development of climate change policy in cities has been closely tied to the efforts of particular individuals, policy entrepreneurs. However, there is still much...     

Hydrologic monitoring tools for freshwater municipal planning in the Arctic: the case of Iqaluit,Nunavut, Canada

Freshwater and the services it provides are vital to both natural ecosystems and human needs; however, extreme climates and their influence on freshwater availability can be challenging for municipal planners and engineers to manage these resources effectively. In Arctic Canada, financial and human capital limitations have left a legacy of freshwater systems that underserve current communities and may be inadequate in the near future under a warming climate, growing population, and increasing demand. We address this challenge to community water resource planning by applying several novel water supply forecasting methods to evaluate the Apex River as an alternative freshwater source for Iqaluit, Nunavut (Canada). Surveys of water isotope composition of the Apex River and tributaries indicated that rainfall is the main source of water replenishment. This information was utilized to calibrate a water resource assessment that considered climate forecasting scenarios and their influence on supply, and alternative scenarios for freshwater management to better adapt to a changing climate. We found that under current climate and demand conditions, the freshwater supply of Iqaluit would be in a perpetual state of drawdown by 2024. Analysis of current infrastructure proposals revealed significant deficiencies in the supply extensions proposed whereby the Apex replenishment pipeline would only provide a 2-year extension to current municipal supply. Our heuristic supply forecast methods allowed for several alternative supply strategies to be rapidly evaluated, which will aid the community planning process by specifically quantifying the service life of the city’s current and future primary water supply.     

Industry,incidents and casualties in South West England: what is their relationship and are there social inequalities in their distribution?

This ecological study aimed, through the analysis of 1,146 wards in the South West of England (1998–2002), firstly, to examine whether chemical incidents and public casualties are more likely near complex industry (emissions to land, air or water: Integrated Pollution Control industry, IPC) or industry with emissions to air only (Local Air Pollution Control industry, LAPC). Secondly, the study examined whether industry, incidents and casualties are found close to deprivation. Social inequalities were examined across quintiles of wards. Fifty-two wards (4.5%) contained an IPC industry and 712 (62.1%) an LAPC. Incidents occurred in 132 wards (11.5%), with casualties in 59 (5.1%). Chemical incidents occurred more frequently in wards with LAPC (152, IPC 20); the same was true of casualties (211, 12). With each additional LAPC site in a ward, the risk of an incident rose by 22% (95% confidence interval [CI] 8–38%), suggesting a dose–response relationship. No clear social inequalities were found. In the South West of England, the public are more likely to be affected by an incident occurring at a simple LAPC site rather than a complex IPC site. This has implications for emergency planning which, at present, focusses most attention on the larger, more complex IPC sites.     

Influence of synoptic and mesoscale meteorology on ozone pollution potential for San Joaquin Valley of California

The distribution of historical ozone levels for a region is tabulated as a function of its prevailing synoptic and mesoscale influences. Meteorological patterns are determined sequentially from extended records of hourly surface wind measurements sampling relevant low-level flows. A visualization method is presented to readily indicate the likelihoods for exceedances to occur under a variety of meteorological conditions. The study domain is San Joaquin Valley (SJV) of California, which is divided into three subregions (North, Central, and South). Each day from May–October of 1996–2004 is labeled using synoptic (single-day) and mesoscale (intra-day) patterns. Emissions levels are assumed roughly constant for this period following the introduction of reformulated gasoline to California. Synoptic motions largely control the regional SJV ozone pollution potential; the same single-day patterns are identified for all three SJV subregions. Additionally, a unique mesoscale flow feature is identified in each subregion that strongly affects its ozone levels: flows through minor Coast Range gaps for N-SJV, the Fresno Eddy for C-SJV, and flows through Mojave Pass for S-SJV. The strength of each mesoscale feature is characterized using 1-h surface u or v wind components that explain local ozone pollution potentials.     

Snapshot of Vibrio parahaemolyticus densities in open and closed shellfish beds in Coastal South Carolina and Mississippi

Vibrio parahaemolyticus is a Gram negative, halophilic bacterium that is ubiquitous in warm, tropical waters throughout the world. It is a major cause of seafood-associated gastroenteritis and is generally associated with consumption of raw or undercooked seafood, especially oysters. This study presents a snapshot of total V. parahaemolyticus densities in surface waters and shellstock American oysters (Crassostrea virginica) from open and closed shellfish harvesting areas, as well as “more rural areas” on two different US coasts, the Atlantic and the Gulf. Sampling was conducted from 2001 to 2003 at five sites near Charleston/Georgetown, SC and at four locations in the Gulfport/Pascagoula, MS area. V. parahaemolyticus numbers were determined by a direct plating method using an alkaline-phosphatase-labeled DNA probe targeting the species-specific thermolabile hemolysin gene (tlh) that was used for identification of bacterial isolates. The greatest difference between the two coasts was salinity; mean salinity in SC surface waters was 32.9 ppt, whereas the mean salinity in MS waters was 19.2 ppt, indicating more freshwater input into MS shellfish harvesting areas during the study period. The mean V. parahaemolyticus numbers in oysters were almost identical between the two states (567.4 vs. 560.1 CFU/g). Bacterial numbers in the majority of surface water samples from both states were at or below the limit of detection (LOD?=?<10 CFU/mL). The bacterial concentrations determined during this study predict a low public health risk from consumption of oysters in shellfish growing areas on either the Gulf or the Atlantic US coast.     

Orientation in the intertidal salt-marsh collembolan Anurida maritima

We investigated the cues used by the intertidal insect Anurida maritima (Apterygota: Collembola) to orient to the appropriate zone in which to seek shelter during high tide. Our experiments clearly ruled out any significant role for magnetic, local topographic, slope or celestial cues. Instead, we suggest that the difference between the appearance of the up-shore and the down-shore horizon is the major cue used by the collembolans. When a mirror was used to duplicate either of the two horizons, the insects were not able to orient. The insects moved towards an artificially dark horizon (the reverse of the mirror) placed down-shore, the opposite of their usual direction of movement. The insects had an endogenous circatidal rhythm of phototactic behaviour: most of the population was always negatively phototactic, but between 2 and 7 h after low tide, a significant proportion of the population became positively phototactic. This is the first demonstration of an endogenous tidal rhythm of orientation in an insect. Received: 31 May 1999 / Received in revised form: 1 February 2000 / Accepted: 19 February 2000     

Review and meta-analysis of 82 studies on end-of-life management methods for source separated organics

This article reports on a literature review and meta-analysis of 82 studies, mostly life cycle assessments (LCAs), which quantified end-of-life (EOL) management options for organic waste. These studies were reviewed to determine the environmental preferability, or lack thereof, for a number of EOL management methods such as aerobic composting (AC), anaerobic digestion (AD), gasification, combustion, incineration with energy recovery (often denoted as waste-to-energy incineration), mechanical biological treatment, incineration without energy recovery (sometimes referenced by just the word “incineration”), and landfill disposal with and without energy recovery from generated methane. Given the vast differences in boundaries as well as uncertainty and variability in results, the LCAs among the 82 studies provided enough data and results to make conclusions regarding just four EOL management methods – aerobic composting, anaerobic digestion, mass burn waste-to-energy (WTE), and landfill gas-to-energy (LFGTE). For these four, the LCAs proved sufficient to determine that aerobic composting and anaerobic digestion are both environmentally preferable to either WTE or LFGTE in terms of climate change impacts.For climate change, LCA results were mixed for WTE versus LFGTE. Furthermore, there is a lack of empirically reliable estimates of the amount of organics input to AD that is converted to energy output versus remaining in the digestate. This digestate can be processed through aerobic composting into a compost product similar to the compost output from aerobic composting, assuming that the same type of organic materials are managed under AD as are managed via AC. The magnitude of any trade-off between generation of energy and production of compost in an AD system appears to be critical for ranking AC and AD for differing types of organics diversion streams. These results emphasize how little we generally know, and exemplify the fact that in the reviewed literature no single EOL management method consistently topped all other management options across all environmental impacts, and that future studies must strive to match existing analytical boundaries and alternatives assessed to increase knowledge if as a community we expect to be able to make even more generalized conclusions.