Using the RE-AIM framework to translate a research-based falls prevention intervention into a community-based program: lessons learned

Problem

Exercise-based research interventions demonstrate reduced risk and rates of falls for community dwelling older adults; however, little is known about effective mechanisms for the translation, implementation, and maintenance of these interventions in community settings.

Method

The RE-AIM framework was used to assess the translatability of an effective exercise-based research intervention in a community setting. Questions included: Reach — Would the target population attend? Effectiveness — What was the adherence and compliance to the program? Were there individual improvements in falls risk factors? Adoption: Would staff at the center adopt the program and offer it past the funding period? Implementation — What adaptations, including optimal frequency and duration, should be made to meet the community needs, still adhere to core elements and achieve similar outcomes? Maintenance — Would the program be sustained by our community partners?

Discussion

The process of translating a controlled research intervention targeting older adults at risk of falls into a community setting was challenging. Licensed professionals developed the infrastructure to safely and effectively deliver the program. The end product was highly appealing program to our target audience, resulted in improved outcomes and was successfully adopted and maintained by the community partner.

Summary

Partnerships between community and healthcare providers are key to successful implementation of falls prevention interventions. Lessons learned from this experience can be applied to the translation of future exercise-based falls prevention interventions.     

Composition and management of rechargeable electric torch wastes in Ibadan,Nigeria

The consumption, disposal, material and chemical compositions of rechargeable electric torch wastes (RETWs) were investigated in Ibadan, Nigeria. Twenty-five RETWs of ten models were collected and disassembled. Their battery electrodes (BEs) and printed circuit boards (PCBs) were acid digested and leached using United States Environmental Protection Agency (USEPA) method 3050B and USEPA Method 1311, respectively. The digests and extracts were analysed for total and extractable Pb, Cd, Cr and Ni using atomic absorption spectrophotometer. The US Test method (CPSC-CH-E 1002-08) was used for digestion of the plastic components. Two hundred questionnaires were distributed to users in Ibadan to determine their usage of RETs and their management when spent. The results indicated that BEs contributed the highest percentage (44 %) component, followed by plastic (38 %). Other components include metal, PCBs, glass and wire. Of the respondents, 61.9 % dispose their spent torches in dumpsites. The mean ± SD concentrations of Pb, Cd, Cr and Ni in the BEs were 500 ± 109 g/kg, 3.94 ± 6.84 mg/kg, 0.33 ± 0.88 mg/kg, 1.68 ± 0.74 mg/kg respectively; in the PCBs, they were 684 ± 42 g/kg, 13.7 ± 17.8 mg/kg, 13.5 ± 10.2 mg/kg and 193 ± 437 mg/kg; and in the plastics, they were 14.1 g/kg, 5.33 mg/kg, 17 mg/kg, and 4.67 mg/kg respectively. The extractable Pb in BE (2670 mg/L) and PCBs (235 mg/L) exceeded the Toxicity Characteristics Leaching Procedure (TCLP) limit of 5 mg/L. RETWs present potential environmental problems in the absence of effective recycling.     

The Fernow Watershed Acidification Study: Ecosystem Acidification, Nitrogen Saturation and Base Cation Leaching

In 1989, a watershed acidification experiment was begun on the Fernow Experimental Forest in West Virginia, USA. Ammonium sulfate fertilizer (35.5 kg N ha⁻¹ yr⁻¹and 40.5 kg S ha⁻¹ yr⁻¹) was applied to a forested watershed (WS3) that supported a 20-year-old stand of eastern deciduous hardwoods. Additions of N and S are approximately twice the ambient deposition of nitrogen and sulfur in the adjacent mature forested watershed (WS4), that serves as the reference watershed for this study. Acidification of stream water and soil solution was documented, although the response was delayed, and acidification processes appeared to be driven by nitrate rather than sulfate. As a result of the acidification treatment, nitrate solution concentrations increased below all soil layers, whereas sulfate was retained by all soil layers after only a few years of the fertilization treatments, perhaps due to adsorption induced from decreasing sulfate deposition. Based on soil solution monitoring, depletion of calcium and magnesium was observed, first from the upper soil horizons and later from the lower soil horizons. Increased base cation concentrations in stream water also were documented and linked closely with high solution levels of nitrate. Significant changes in soil chemical properties were not detected after 12 years of treatment, however.     

Thermoplastic Starch (TPS)/Polylactic Acid (PLA) Blending Methodologies: A Review

Polylactic acid (PLA) and thermoplastic starch (TPS) are biodegradable polymers of biological origin, and the mixture of these polymers has been studied due to the desirable mechanical properties of PLA and the low processing cost of TPS. However, the TPS/PLA combination is thermodynamically immiscible due to the poor interfacial interaction between the hydrophilic starch granules and the hydrophobic PLA. To overcome these limitations, researchers studied the modification, processing, and properties of the mixtures as a strategy to increase the compatibility between phases. This review highlights recent developments, current results, and trends in the field of TPS/PLA-based compounds during the last two decades, with the main focus of improving the adhesion between the two components. The TPS/PLA blends were classified as plasticized, compatible, reinforced and with nanocomposites. This article presents, based on published research, TPS/PLA combinations, considering different methods with significant improvements in mechanical properties, with promising developments for applications in food packaging and biomedicine.

     

Age group differences in collision risk

Introduction

The purpose of the current study was to examine differences in factors associated with self-reported collision involvement of three age groups of drivers based on a large representative sample of Ontario adults. Method: This study was based on data from the CAMH Monitor, an ongoing cross-sectional telephone survey of Ontario adults 18 years and older from 2002 to 2005. Three age groups were examined: 18-34 (n = 1,294), 35-54 (n = 2,428), and 55+ (n = 1,576). For each age group sample, a logistic regression analysis was conducted of self-reported collision involvement in the last 12 months by risk factor measures of driving exposure (kilometers driven in a typical week, driving is stressful, and driving on busy roads), consuming five or more drinks of alcohol on one occasion (past 12 months), cannabis use (lifetime, and past 12 months), and driving after drinking among drinkers (past 12 months), controlling for demographics (gender, region, income, and marital status). Results: The study identified differences in factors associated with self-reported collision involvement of the three age groups of adult drivers. The logistic regression model for the youngest group revealed that drivers who reported that driving was stressful at least some of the time, drank five or more drinks on an occasion, and drove after drinking had an increased risk of collision involvement. For the middle age group, those who reported using cannabis in the last 12 months had significantly increased odds of reporting collision involvement. None of the risk factor measures showed significant associations with collision risk for older drivers (aged 55+). Impact: The results suggest potential areas for intervention and new directions for future research.     

Cost‐Effective Sediment Dredge Disposal Options for Small Craft Harbors in Canada

Sediment dredge disposal options were reviewed to improve cost‐effectiveness and environmental safety for dredging of coastal sediments at the Department of Fisheries and Oceans Small Craft Harbours (DFO‐SCH) program in Canada. Historically, contaminated dredge sediments exceeding federal guidelines were disposed of in nearby landfills. Recent federal regulatory changes in sediment quality guidelines adopted by provincial regulators in Canada has resulted in updates to guidelines for disposal of contaminated solids in landfills. Updates now require specific and general disposal options for contaminated dredge material destined for land‐based disposal, resulting in more expensive disposal in containment cells (if contaminated sediments exceed federal guidelines). However, as part of this study, a leachate testing method was applied to contaminated sediments to simulate migration of potential contaminants in groundwater. Using this approach, leachate quality was compared to federal freshwater criteria and drinking water quality guidelines for compliance with new regulations. Leachate testing performed on the highest sediment contaminant concentrations triggered less than 2 percent potable water exceedances, meaning that most dredge spoils could be disposed of in privately owned or provincially operated landfill sites, providing less expensive disposal options compared to containment cell disposal. Current dredge disposal practices were reviewed at 35 harbor sites across Nova Scotia and their limitations identified in a gap analysis. Improved site management was developed following this review and consultation with interested marine stakeholders. New disposal options and chemical analyses were proposed, along with improvements to cost efficiencies for management of dredged marine sediments in Atlantic Canada. © 2013 Wiley Periodicals, Inc.