Implementing the evidence for preventing falls among community-dwelling older people: a systematic review

Problem and objective

The translation of the evidence-base for preventing falls among community-dwelling older people into practice has been limited. This study systematically reviewed and synthesised the effectiveness of methods to implement falls prevention programmes with this population.

Methods

Articles published between 1980 and May 2010 that evaluated the effects of an implementation strategy. No design restrictions were imposed. A narrative synthesis was undertaken.

Results

15 studies were identified. Interventions that involved the active training of healthcare professionals improved implementation. The evidence around changing the way people who fall are managed within primary care practices, and, layperson, peer or community delivered models was mixed.

Impact on industry

Translating the evidence-base into practice involves changing the attitudes and behaviours of older people, healthcare professionals and organisations. However, there is a need for further evaluation on how this can be best achieved.     

Diphenylmethane diisocyanate self-polymerization: Thermal hazard evaluation and proof of runaway reaction in gram scale

Thermal analysis by differential scanning calorimetry and thermogravimetric/differential thermal analysis mass spectrometry, adiabatic calorimetry, a gram-scale heating test, and infrared spectroscopy were performed to evaluate the thermal hazards of diphenylmethane diisocyanate (MDI) and prove the occurrence of a runaway reaction. The self-polymerization of MDI was found to occur at about 340 °C under rapid heating conditions. Carbon dioxide was eliminated and heat was generated to allow polymerization. Under adiabatic and closed conditions, the runaway reaction of MDI can begin at least from 220 °C. Besides it is highly probable that the runaway reaction of MDI can begin from a lower temperature in an actual process scale. More heat was generated than in the previous case and the pressure rose rapidly. A closed 2-mm-thick glass vessel exploded because of the runaway reaction of MDI even if the temperature was lower than 300 °C. Therefore, MDI could cause fatal runaway reactions below 300 °C, where MDI had been assumed to self-polymerize by eliminating carbon dioxide previously.     

Total mercury loadings in sediment from gold mining and conservation areas in Guyana

The Low Carbon Development Strategy proposed in June 2009 by the government of Guyana in response to the Reducing Emissions from Deforestation and Forest Degradation in Developing Countries program has triggered evaluation of forest-related activities, thereby acting as a catalyst for improvements in Guyana's small- to medium-scale gold mining industry. This has also shed light on areas committed to conservation, something that has also been handled by Non Governmental Organizations. This paper compares water quality and mercury concentrations in sediment from four main areas in Guyana, two that are heavily mined for gold using mercury amalgamation methods (Arakaka and Mahdia) and two that are considered conservation areas (Iwokrama and Konashen). Fifty-three sediment and soil mercury loadings ranged from 29 to 1,200 ng/g and averaged 215 ± 187 ng/g for all sites with similar averages in conservation and mining areas. Sediment loadings are within the range seen in French Guiana and Suriname, but conservation area samples had higher loadings than the corresponding uncontaminated baselines. Type of ore and location in the mining process seemed to influence mercury loadings. Mercury sediment loadings were slightly positively correlated with pH (correlation coefficient = 0.2; p value < 0.001) whereas no significant correlations were found with dissolved oxygen or turbidity.     

Chemical and biological evaluation of a reaction mixture of R-(+)-limonene/ozone: Formation of strong airway irritants

The airway irritation of a reaction mixture of R-(+)-limonene and ozone was evaluated by a mouse bioassay in which sensory irritation, bronchoconstriction and pulmonary irritation were measured. Significant sensory irritation (33% reduction of mean respiratory rate) was observed by dynamic exposure of the mice, during 30 min, to a ca. 16 s old reaction mixture of ozone and limonene. The initial concentrations were nominally 4 ppm O₃ and 48 ppm limonene. After reaction, the residual O₃ was <0.03 ppm. Conventional analytical chemical methods were used to measure the formation of readily identified and stable products. Besides the expected products, 1-methyl-4-acetylcyclohexene (AMCH), 3-isopropenyl-6-oxoheptanal (IPOH), formaldehyde and formic acid, autooxidation products of limonene and a series of compounds (i.e., acetone, acrolein and acetic acid), which may or may not be artefacts, were identified. Addition of the sensory irritation effects of the residual reactants and all the identified compounds could not explain the observed sensory irritation effect. This suggests that one or more strong airway irritants were formed. Since limonene is common in the indoor air, and ozone is infiltrated from outdoors and/or produced indoors (e.g., by photocopiers), such oxidation reactions may be relevant for indoor air quality.     

Barriers and Opportunities for Integrating Social Science into Natural Resource Management: Lessons from National Estuarine Research Reserves

The need for cross-disciplinary scientific inquiries that facilitate improved natural resource management outcomes through increased understanding of both the biophysical and human dimensions of management issues has been widely recognized. Despite this broad recognition, a number of obstacles and barriers still sometimes challenge the successful implementation of cross-disciplinary approaches. Improving understanding of these challenges and barriers will help address them and thereby foster appropriate and effective utilization of cross-disciplinary approaches to solve natural resource management challenges. This research uses a case study analysis of the United States National Estuarine Research Reserve System to improve understanding of the critical factors that influence practitioners’ decisions related to incorporating social science into their natural resource management work. The case study research is analyzed and evaluated within a Theory of Planned Behavior framework to (1) determine and describe the factors that predict practitioners’ intent to incorporate social science into their natural resource related activities and (2) recommend potential strategies for encouraging and enabling cross-disciplinary approaches to natural resource management. The results indicate that National Estuarine Research Reserve practitioners’ decisions related to incorporating social science are primarily influenced by (1) confidence in their own capability to incorporate social science into their work and (2) beliefs about whether the outcomes of incorporating social science into their work would be valuable or beneficial.     

Ocean fertilization for geoengineering: A review of effectiveness,environmental impacts and emerging governance

Dangerous climate change is best avoided by drastically and rapidly reducing greenhouse gas emissions. Nevertheless, geoengineering options are receiving attention on the basis that additional approaches may also be necessary. Here we review the state of knowledge on large-scale ocean fertilization by adding iron or other nutrients, either from external sources or via enhanced ocean mixing. On the basis of small-scale field experiments carried out to date and associated modelling, the maximum benefits of ocean fertilization as a negative emissions technique are likely to be modest in relation to anthropogenic climate forcing. Furthermore, it would be extremely challenging to quantify with acceptable accuracy the carbon removed from circulation on a long term basis, and to adequately monitor unintended impacts over large space and time-scales. These and other technical issues are particularly problematic for the region with greatest theoretical potential for the application of ocean fertilization, the Southern Ocean. Arrangements for the international governance of further field-based research on ocean fertilization are currently being developed, primarily under the London Convention/London Protocol.     

d-Pinitol as a key oviposition stimulant for sulfur butterfly, Colias erate: chemical basis for female acceptance of host- and non-host plants

The sulfur butterfly, Colias erate, utilizes various legumes as host plants. We examined the chemical constituents of its primary host plant, Trifolium repens (white clover), to identify phytochemicals inducing oviposition by C. erate females. Since one of the four aqueous subfractions prepared from a methanolic extract of the plant has previously been shown to be the most responsible for the oviposition-stimulatory activity exerted by the plant, chemical analyses were conducted of the fraction concerned. Activity-directed fractionation of the subfraction by ion-exchange chromatography revealed that the key substance(s) resided in the neutral fraction. Preparative TLC of the neutral fraction and subsequent spectral analyses identified d-(+)-pinitol, glycerin, methyl β-d-glucoside, and myo-inositol as characteristic components together with ubiquitous sugars (e.g., sucrose and glucose). Of these, only pinitol singly evoked significant oviposition responses at concentrations over 0.05%. In dual-choice bioassays, however, females laid significantly more eggs on pinitol solutions admixed with glycerin or methyl β-d-glucoside than on pinitol alone. Two cyanoglucosides, linamarin, and lotaustralin, occurring in the other aqueous subfractions, also synergistically increased the oviposition response in combination with pinitol. The results clearly indicated that pinitol is a crucial oviposition stimulant involved in host recognition, while glycerin, methyl β-d-glucoside, linamarin, and lotaustralin function as synergists. We further examined the oviposition responses of C. erate females to aqueous fractions, along with their chemical compositions, that had been prepared from five other host plants and a non-host plant, Aristolochia debilis (Aristolochiaceae), on which oviposition occasionally took place in an outdoor cage during the experiments. The plant species accepted by ovipositing females were all found to contain pinitol in amounts enough to induce egg laying by the butterfly, thus leading to the conclusion that pinitol serves as the essential mediator in recognizing and accepting potential host plants.     

Preferences and tradeoffs in nectar temperature and nectar concentration in the Asian hive bee Apis cerana

Honey bee foragers need to asses and make trade-offs between a number of potentially conflicting floral attributes. Here, we investigate multi-attribute decision making in the eastern honey bee, Apis cerana, when foraging on food sources that varied in warmth and sucrose concentration. We show that foragers prefer warm (30 °C) sucrose solution over cool (10 °C) sucrose solution and concentrated (30 % w/w) sucrose solution over dilute (15 % w/w) sucrose solution. When we offered the preferred sucrose concentration (30 % w/w) at the less-preferred temperature (10 °C), and the less-preferred sucrose concentration (15 % w/w) at the preferred temperature (30 °C), foragers prioritized warmth by choosing the warmer, but lower concentration solution. When the temperature difference was less extreme, bees preferred more concentrated cooler syrup (30 % ww at 15 °C over 15 % 30 °C). However, the addition of a decoy item to the choice set had a significant effect on the bees' preferences. Our results highlight the critical importance of considering context effects when measuring the foraging preferences of animals.