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.     

Prenatal diagnosis of Myhre syndrome with a heterozygous pathogenic variant in SMAD4 gene presented with thick nuchal translucency and cardiac abnormalities

Prenatal testing was performed in a 39-year-old Chinese pregnant woman referred for increased nuchal translucency measuring 5.7 mm. Non-invasive prenatal testing and SNP array study on amniotic fluid samples were normal. Whole exome sequencing (WES) was initiated further as the fetus had pericardial effusion of 1.2 mm, thickened myocardium over the right ventricular lateral wall and aberrant right subclavian artery. A detailed fetal echocardiogram also revealed persistent left superior vena cava and dilated coronary sinus at 20 weeks. From whole exome sequencing of the trio, a de novo heterozygous variant NM_005359.5(SMAD4): c.1499T>C (p.Ile500Thr) was detected. This pathogenic variant has been reported in the postnatal case cohort of Myhre syndrome. This condition is characterized by facial dysmorphism, intellectual disability, hearing loss, skeletal abnormalities and potential life threatening respiratory or cardiovascular manifestations. Termination of pregnancy was performed at 23 weeks. Small chins, pre-axial polydactyly, brachydactyly and clinodactyly were noted in the abortus. Ultrasound findings of increased nuchal translucency, thickened myocardium and pericardial effusion prompted further genetic evaluation for the prenatal diagnosis of Myhre syndrome by whole exome sequencing.     

Constructed wetlands integrated with microbial fuel cells for COD and nitrogen removal affected by plant and circuit operation mode

Environmental Science and Pollution Research - Organic matter and NH4+-N are two major pollutants in domestic sewage. This study evaluated the influence of plant and circuit operation mode on the...     

Experimental measurements and numerical simulations of the transport and retention of nanocrystal CdSe/ZnS quantum dots in saturated porous media: effects of pH,organic ligand,and natural organic matter

Environmental Science and Pollution Research - The risks of environmental exposures of quantum dot (QD) nanoparticles are increasing, but these risks are difficult to assess because fundamental...     

Climate change impacts on freshwater recreational fishing in the United States

We estimated the biological and economic impacts of climate change on freshwater fisheries in the United States (U.S.). Changes in stream temperatures, flows, and the spatial extent of suitable thermal habitats for fish guilds were modeled for the coterminous U.S. using a range of projected changes in temperature and precipitation caused by increased greenhouse gases (GHGs). Based on modeled shifts in available thermal habitat for fish guilds, we estimated potential economic impacts associated with changes in freshwater recreational fishing using a national-scale economic model of recreational fishing behavior. In general, the spatial distribution of coldwater fisheries is projected to contract, being replaced by warm/cool water and high-thermally tolerant, lower recreational priority (i.e., “rough”) fisheries. Changes in thermal habitat suitability become more pronounced under higher emissions scenarios and at later time periods. Under the highest GHG emissions scenario, by year 2100 habitat for coldwater fisheries is projected to decline by roughly 50 % and be largely confined to mountainous areas in the western U.S. and very limited areas of New England and the Appalachians. The economic model projects a decline in coldwater fishing days ranging from 1.25 million in 2030 to 6.42 million by 2100 and that the total present value of national economic losses to freshwater recreational fishing from 2009 to 2100 could range from $81 million to $6.4 billion, depending on the emissions scenario and the choice of discount rate.     

Evaluation of a Regional Monitoring Program’s Statistical Power to Detect Temporal Trends in Forest Health Indicators

Forests are socioeconomically and ecologically important ecosystems that are exposed to a variety of natural and anthropogenic stressors. As such, monitoring forest condition and detecting temporal changes therein remain critical to sound public and private forestland management. The National Parks Service’s Vital Signs monitoring program collects information on many forest health indicators, including species richness, cover by exotics, browse pressure, and forest regeneration. We applied a mixed-model approach to partition variability in data for 30 forest health indicators collected from several national parks in the eastern United States. We then used the estimated variance components in a simulation model to evaluate trend detection capabilities for each indicator. We investigated the extent to which the following factors affected ability to detect trends: (a) sample design: using simple panel versus connected panel design, (b) effect size: increasing trend magnitude, (c) sample size: varying the number of plots sampled each year, and (d) stratified sampling: post-stratifying plots into vegetation domains. Statistical power varied among indicators; however, indicators that measured the proportion of a total yielded higher power when compared to indicators that measured absolute or average values. In addition, the total variability for an indicator appeared to influence power to detect temporal trends more than how total variance was partitioned among spatial and temporal sources. Based on these analyses and the monitoring objectives of the Vital Signs program, the current sampling design is likely overly intensive for detecting a 5 % trend·year^?1 for all indicators and is appropriate for detecting a 1 % trend·year^?1 in most indicators.     

Effects of Flooding and Tamarisk Removal on Habitat for Sensitive Fish Species in the San Rafael River,Utah: Implications for Fish Habitat Enhancement and Future Restoration Efforts

Tamarisk removal is a widespread restoration practice on rivers in the southwestern USA, but impacts of removal on fish habitat have rarely been investigated. We examined whether tamarisk removal, in combination with a large spring flood, had the potential to improve fish habitat on the San Rafael River in southeastern Utah. We quantified habitat complexity and the distribution of wood accumulation in a tamarisk removal site (treated) and a non-removal site (untreated) in 2010, 1 year prior to a large magnitude and long-duration spring flood. We used aerial imagery to analyze river changes in the treated and untreated sites. Areas of channel movement were significantly larger in the treated site compared to the untreated site, primarily because of geomorphic characteristics of the channel, including higher sinuosity and the presence of an ephemeral tributary. However, results suggest that tamarisk removal on the outside of meander bends, where it grows directly on the channel margins, can promote increased channel movement. Prior to the flood, wood accumulations were concentrated in sections of channel where tamarisk had been removed. Pools, riffles, and backwaters occurred more frequently within 30 m upstream and downstream of wood accumulations compared to areas within 30 m of random points. Pools associated with wood accumulations were also significantly larger and deeper than those associated with random points. These results suggest that the combination of tamarisk removal and wood input can increase the potential for channel movement during spring floods thereby diversifying river habitat and improving conditions for native fish.     

COMPARISON OF HSPF OUTPUTS USING FTABLES GENERATED WITH FIELD SURVEY AND DIGITAL DATA1

ABSTRACT: The Hydrological Simulation Program‐FORTRAN (HSPF) describes discharge from a stream reach based on function tables (FTABLES) that relate stream stage, surface area, volume, and discharge. For this study, five FTABLE scenarios were compared to assess their effect on daily discharge rates predicted using HSPF. Four “field‐based” FTABLE scenarios were developed using detailed cross section surveys collected at predefined intervals along 14 reaches in the study watershed. A fifth “digital‐based” scenario was developed using digital elevation models (DEMs) and Natural Resource Conservation Service (NRCS) Regional Hydraulic Geometry Curves. The Smirnov k‐sample test was used to compare average daily discharge rates simulated with HSPF using the five FTABLE scenarios. No significant difference in simulated stream discharge was found (p = 0.99) between the five FTABLE scenarios. Additional examination of the four field‐based scenarios revealed that the number of cross sections per stream reach used to generate FTABLES had little effect on the resulting stage discharge relationship. These findings suggest that FTABLES generated using digital data are a viable option when simulating stream discharge with HSPF and that if field data are used to generate FTABLES, using fewer cross sections will not adversely affect simulated discharge predictions.     

Evaluation of Operational National Weather Service Gridded Flash Flood Guidance over the Arkansas Red River Basin

National Oceanic and Atmospheric Administration's National Weather Service (NWS) flash flood warnings are issued by Weather Forecast Offices and are underpinned by information from the Flash Flood Guidance (FFG) system operated by the River Forecast Centers (RFCs). This study focuses on the quantitative evaluation and limitations of the FFG system using reported flash flood cases in 2010 and 2011. The flash flood reports were obtained from the NWS Storm Event database for the Arkansas‐Red Basin RFC (ABRFC). The current FFG system at the ABRFC provides gridded flash flood guidance (GFFG) system using the NWS Hydrology Laboratory‐Research Distributed Hydrologic Model to translate the upper zone soil moisture to estimates of Soil Conservation Service Curve Numbers. Comparisons of the GFFG and real‐time Multisensor Precipitation Estimator‐derived Quantitative Precipitation Estimate for the same duration and location were used to analyze the success of the system. Typically, the six‐hour duration was characterized by higher probability of detection values than the three‐hour duration, which highlights the difficulty of hydrologic process estimation for shorter time scales. The current system does not take into account physical characteristics such as land use, including irrigated agricultural farm and urban areas, hence, overly dry soil moisture estimates over these areas can lower the success rate of the GFFG product.     

How to facilitate (or discourage) community-based research: recommendations based on a Canadian survey

The impact of the extreme heat wave that affected Melbourne, Australia, in two distinct phases in January and February 2009 was severe, with 374 (heat) and 173 (bushfire) excess deaths. Whilst the human health issues have been covered in detail in policy and academic arenas, much less attention has been paid to the adverse impacts on urban infrastructure. Analysis of this event, underpinned by participatory actor-based research, has shown that the impacts were experienced disproportionately across different infrastructure types. For water, telecommunications and airports, the impacts were relatively minor and the impact on rail transport and roads (and to a lesser extent, seaports) was of moderate significance, whereas research findings indicate that the electricity sector was found to be the most vulnerable. This paper focuses on the sectors that were worst impacted: electricity, rail and road transport. Commentary identifies the direct and indirect impacts of the heat event, including associated cascading effects, as well as considering actual and potential adaptation responses both before and after the event. Concluding, the authors reflect on the implications of the heat wave for urban resilience, emphasising the crucial importance of understanding the urban environment as a complex and interconnected system.