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Sample records for effective falls prevention

  1. Preventing Falls

    MedlinePLUS

    ... of falling. Exercises that improve balance, such as tai chi, are helpful. Your local health or senior center ... to prevent falls. Do balance exercises, such as tai chi. These types of exercises can lower the chances ...

  2. Preventing falls

    MedlinePLUS

    Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2009, Issue ...

  3. Preventing Falls

    MedlinePLUS

    ... Stay physically active. Regular exercise makes you stronger. Weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis. Lower-body strength exercises and balance exercises can help you prevent falls and avoid ...

  4. Effects of a multifactorial fall prevention program on balance, gait, and fear of falling in post-stroke inpatients

    PubMed Central

    Jung, Younuk; Lee, Kyeongbong; Shin, Seonhae; Lee, Wanhee

    2015-01-01

    [Purpose] This study investigated the effects of a multifactorial fall prevention program on balance, gait, and fear of falling in stroke patients. [Subjects] Twenty-five stroke patients were divided randomly into multifactorial fall prevention program group (n=15) and control treadmill group (n=10). [Methods] All interventions were applied for 30?min, five times per week, for five weeks. The fall prevention program included interventions based on the “Step Up to Stop Falls” initiative and educational interventions based on the Department of Health guidelines. For those in the treadmill group, the speed was increased gradually. The Korean falls efficacy scale and Korean activities-specific balance confidence scale were used to assess fear of falling. To assess balance and walking ability, the Korean performance-oriented mobility assessment scale and the 10-m and 6-minute walk tests were used. [Results] The fall prevention program interventions were found to be very effective at improving gait, balance, and fear of falling compared with the treadmill intervention and therefore seem appropriate for stroke patients. [Conclusion] A multifactorial fall prevention program is effective at improving balance, gait ability, and fear of falling. It is a more specific and broad intervention for reducing falls among inpatients in facilities and hospitals. PMID:26180337

  5. The Effectiveness of a Participatory Program on Fall Prevention in Oncology Patients

    ERIC Educational Resources Information Center

    Huang, Li-Chi; Ma, Wei-Fen; Li, Tsai-Chung; Liang, Yia-Wun; Tsai, Li-Yun; Chang, Fy-Uan

    2015-01-01

    Falls are known to be one of the most common in patient adverse events. A high incidence of falls was reported on patients with cancer. The purpose of this study was to explore the effect of a participatory program on patient's knowledge and self-efficacy of fall prevention and fall incidence in an oncology ward. In this quasi-experimental study,…

  6. Preventing Falls and Related Fractures

    MedlinePLUS

    ... Basics Falls and Fractures Preventing Falls and Related Fractures Publication available in: PDF (79 KB) Related Resources ... and reduce fracture risk. Prevention of Falls and Fractures Safety first to prevent falls: At any age, ...

  7. The Effects of an Education Program on Home Renovation for Fall Prevention of Korean Older People

    ERIC Educational Resources Information Center

    Jang, Miseon; Lee, Yeunsook

    2015-01-01

    This study aims to verify the effects of an education program on home renovation for fall prevention among older people, more specifically fall efficacy and home renovation intentions. A quasiexperimental study with nonequivalent control and comparative groups was conducted to demonstrate the effects of the education. A total of 51 older people


  8. The Effects of an Education Program on Home Renovation for Fall Prevention of Korean Older People

    ERIC Educational Resources Information Center

    Jang, Miseon; Lee, Yeunsook

    2015-01-01

    This study aims to verify the effects of an education program on home renovation for fall prevention among older people, more specifically fall efficacy and home renovation intentions. A quasiexperimental study with nonequivalent control and comparative groups was conducted to demonstrate the effects of the education. A total of 51 older people…

  9. Fall prevention in the elderly.

    PubMed

    Ungar, Andrea; Rafanelli, Martina; Iacomelli, Iacopo; Brunetti, Maria Angela; Ceccofiglio, Alice; Tesi, Francesca; Marchionni, Niccolò

    2013-05-01

    Falls are frequent in the elderly and affect mortality, morbidity, loss of functional capacity and institutionalization. In the older patient the incidence of falls can sometimes be underestimated, even in the absence of a clear cognitive impairment, because it is often difficult to reconstruct the dynamics. It is quite common that forms due to syncope are associated with retrograde amnesia and in 40 to 60% of the cases falls happen in the absence of witnesses. The pathogenesis of falls is often multifactorial, due to physiological age-related changes or more properly pathological factors, or due to the environment. The identification of risk factors is essential in the planning of preventive measures. Syncope is one of major causes of falls. About 20% of cardiovascular syncope in patients older than 70 appears as a fall and more than 20% of older people with Carotid Sinus Syndrome complain of falls as well as syncope. These data clearly state that older patients with history of falls should undergo a cardiovascular and neuroautonomic assessment besides the survey of other risk factors. Multifactorial assessment requires a synergy of various specialists. The geriatrician coordinates the multidisciplinary intervention in order to make the most effective evaluation of the risk of falling, searching for all predisposing factors, aiming towards a program of prevention. In clear pathological conditions it is possible to enact a specific treatment. Particular attention must indeed be paid to the re-evaluation of drug therapy, with dose adjustments or withdrawal especially for antihypertensive, diuretics and benzodiazepines. The Guidelines of the American Geriatrics Society recommend modification of environmental hazards, training paths, hip protectors and appropriate use of support tools (sticks, walkers), which can be effective elements of a multifactorial intervention program. Balance exercises are also recommended. In conclusion, an initial assessment, supported by a comprehensive cardiovascular and neuroautonomic evaluation, allows for reaching a final diagnosis in most cases, demonstrating a key role in the real identification of the etiology of the fall and implementing the treatment measures. PMID:24133524

  10. Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls

    PubMed Central

    Irvine, Lisa; Conroy, Simon P.; Sach, Tracey; Gladman, John R. F.; Harwood, Rowan H.; Kendrick, Denise; Coupland, Carol; Drummond, Avril; Barton, Garry; Masud, Tahir

    2010-01-01

    Background: multifactorial falls prevention programmes for older people have been proved to reduce falls. However, evidence of their cost-effectiveness is mixed. Design: economic evaluation alongside pragmatic randomised controlled trial. Intervention: randomised trial of 364 people aged ?70, living in the community, recruited via GP and identified as high risk of falling. Both arms received a falls prevention information leaflet. The intervention arm were also offered a (day hospital) multidisciplinary falls prevention programme, including physiotherapy, occupational therapy, nurse, medical review and referral to other specialists. Measurements: self-reported falls, as collected in 12 monthly diaries. Levels of health resource use associated with the falls prevention programme, screening (both attributed to intervention arm only) and other health-care contacts were monitored. Mean NHS costs and falls per person per year were estimated for both arms, along with the incremental cost-effectiveness ratio (ICER) and cost effectiveness acceptability curve. Results: in the base-case analysis, the mean falls programme cost was Ł349 per person. This, coupled with higher screening and other health-care costs, resulted in a mean incremental cost of Ł578 for the intervention arm. The mean falls rate was lower in the intervention arm (2.07 per person/year), compared with the control arm (2.24). The estimated ICER was Ł3,320 per fall averted. Conclusions: the estimated ICER was Ł3,320 per fall averted. Future research should focus on adherence to the intervention and an assessment of impact on quality of life. PMID:20833862

  11. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials

    PubMed Central

    2013-01-01

    Objective To determine whether, and to what extent, fall prevention exercise interventions for older community dwelling people are effective in preventing different types of fall related injuries. Data sources Electronic databases (PubMed, the Cochrane Library, Embase, and CINAHL) and reference lists of included studies and relevant reviews from inception to July 2013. Study selection Randomised controlled trials of fall prevention exercise interventions, targeting older (>60 years) community dwelling people and providing quantitative data on injurious falls, serious falls, or fall related fractures. Data synthesis Based on a systematic review of the case definitions used in the selected studies, we grouped the definitions of injurious falls into more homogeneous categories to allow comparisons of results across studies and the pooling of data. For each study we extracted or calculated the rate ratio of injurious falls. Depending on the available data, a given study could contribute data relevant to one or more categories of injurious falls. A pooled rate ratio was estimated for each category of injurious falls based on random effects models. Results 17 trials involving 4305 participants were eligible for meta-analysis. Four categories of falls were identified: all injurious falls, falls resulting in medical care, severe injurious falls, and falls resulting in fractures. Exercise had a significant effect in all categories, with pooled estimates of the rate ratios of 0.63 (95% confidence interval 0.51 to 0.77, 10 trials) for all injurious falls, 0.70 (0.54 to 0.92, 8 trials) for falls resulting in medical care, 0.57 (0.36 to 0.90, 7 trials) for severe injurious falls, and 0.39 (0.22 to 0.66, 6 trials) for falls resulting in fractures, but significant heterogeneity was observed between studies of all injurious falls (I2=50%, P=0.04). Conclusions Exercise programmes designed to prevent falls in older adults also seem to prevent injuries caused by falls, including the most severe ones. Such programmes also reduce the rate of falls leading to medical care. PMID:24169944

  12. Effects of a Randomized Controlled Recurrent Fall Prevention Program on Risk Factors for Falls in Frail Elderly Living at Home in Rural Communities

    PubMed Central

    Jeon, Mi Yang; Jeong, HyeonCheol; Petrofsky, Jerrold; Lee, Haneul; Yim, JongEun

    2014-01-01

    Background Falling can lead to severe health issues in the elderly and importantly contributes to morbidity, death, immobility, hospitalization, and early entry to long-term care facilities. The aim of this study was to devise a recurrent fall prevention program for elderly women in rural areas. Material/Methods This study adopted an assessor-blinded, randomized, controlled trial methodology. Subjects were enrolled in a 12-week recurrent fall prevention program, which comprised strength training, balance training, and patient education. Muscle strength and endurance of the ankles and the lower extremities, static balance, dynamic balance, depression, compliance with preventive behavior related to falls, fear of falling, and fall self-efficacy at baseline and immediately after the program were assessed. Sixty-two subjects (mean age 69.2±4.3 years old) completed the program – 31 subjects in the experimental group and 31 subjects in the control group. Results When the results of the program in the 2 groups were compared, significant differences were found in ankle heel rise test, lower extremity heel rise test, dynamic balance, depression, compliance with fall preventative behavior, fear of falling, and fall self-efficacy (p<0.05), but no significant difference was found in static balance. Conclusions This study shows that the fall prevention program described effectively improves muscle strength and endurance, balance, and psychological aspects in elderly women with a fall history. PMID:25394805

  13. Effects of Visual Biofeedback Training for Fall Prevention in the Elderly

    PubMed Central

    Kang, Kwon-Young

    2013-01-01

    [Purpose] The purpose of this study was to investigate the effects of six weeks of visual biofeedback training for prevention of falling in the elderly. The Tetrax system was used for visual biofeedback training. [Subjects and Methods] Thirty elderly persons (experimental group=15, control group=15) who were above 70 and under 80?years of age participated in biofeedback training. They were trained for 15 minutes a day, three times per week. We measured the weight distribution index, stability index, and fall index in the subjects using the Tetrax system, and paired t-tests were used to evaluate the changes before and after intervention. The difference between the groups was compared using an independent t-test. [Results] The experimental group showed significant differences in weight distribution index, stability index, and fall index. The control group showed no significant differences. According to the comparison of training effects between the two groups, the variables of stability index and fall index revealed a statistically significant difference. [Conclusion] The method of visual biofeedback training used in this study should be considered a therapeutic method for the elderly to improve weight distribution, stability, and effectiveness in preventing falls. PMID:24396196

  14. Fall prevention conceptual framework.

    PubMed

    Abraham, Sam

    2011-01-01

    Falls can have lasting psychological and physical consequences, particularly fractures and slow-healing processes, and patients may also lose confidence in walking. Injuries from falls lead to functional decline, institutionalization, higher health care costs, and decreased quality of life. The process related to the problem of patient falls in the hospital, using the nursing model developed by the theorist, Ida Jean Orlando, is explained in this article. The useful tool that provides guidance to marketers in this endeavor is Maslow's hierarchy of needs. During acute illness, individuals are greatly in need of satisfying their physiological needs. If these needs are not met, patients leave the hospital lacking a positive experience. Initial fall risk assessment is critical to plan intervention and individualize care plan. Interventions depend on the severity of fall risk factors. PMID:21537141

  15. Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects

    PubMed Central

    2010-01-01

    Preventing falls and fall-related fractures in the elderly is an objective yet to be reached. There is increasing evidence that a supplementation of vitamin D and/or of calcium may reduce the fall and fracture rates. A vitamin D-calcium supplement appears to have a high potential due to its simple application and its low cost. However, published studies have shown conflicting results as some studies failed to show any effect, while others reported a significant decrease of falls and fractures. Through a 15-year literature overview, and after a brief reminder on mechanism of falls in older adults, we reported evidences for a vitamin D action on postural adaptations - i.e., muscles and central nervous system - which may explain the decreased fall and bone fracture rates and we underlined the reasons for differences and controversies between published data. Vitamin D supplementation should thus be integrated into primary and secondary fall prevention strategies in older adults. PMID:20937091

  16. Tailored Prevention of Inpatient Falls

    PubMed Central

    ZUYEV, LYUBOV; BENOIT, ANGELA N.; CHANG, FRANK Y.; DYKES, PATRICIA C.

    2011-01-01

    Patient falls and fall-related injuries are serious problems in hospitals. The Fall TIPS application aims to prevent patient falls by translating routine nursing fall risk assessment into a decision support intervention that communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to the care team, patients, and family members. In our design and implementation of the Fall TIPS toolkit, we used the Spiral Software Development Life Cycle model. Three output tools available to be generated from the toolkit are bed poster, plan of care, and patient education handout. A preliminary design of the application was based on initial requirements defined by project leaders and informed by focus groups with end users. Preliminary design partially simulated the paper version of the Morse Fall Scale currently used in hospitals involved in the research study. Strengths and weaknesses of the first prototype were identified by heuristic evaluation. Usability testing was performed at sites where research study is implemented. Suggestions mentioned by end users participating in usability studies were either directly incorporated into the toolkit and output tools, were slightly modified, or will be addressed during training. The next step is implementation of the fall prevention toolkit on the pilot testing units. PMID:20975543

  17. Translation of an Effective Tai Chi Intervention Into a Community-Based Falls-Prevention Program

    PubMed Central

    Li, Fuzhong; Harmer, Peter; Glasgow, Russell; Mack, Karin A.; Sleet, David; Fisher, K. John; Kohn, Melvin A.; Millet, Lisa M.; Mead, Jennifer; Xu, Junheng; Lin, Mei-Li; Yang, Tingzhong; Sutton, Beth; Tompkins, Yvaughn

    2008-01-01

    Tai Chi—Moving for Better Balance, a falls-prevention program developed from a randomized controlled trial for community-based use, was evaluated with the RE-AIM framework in 6 community centers. The program had a 100% adoption rate and 87% reach into the target older adult population. All centers implemented the intervention with good fidelity, and participants showed significant improvements in health-related outcome measures. This evidence-based tai chi program is practical to disseminate and can be effectively implemented and maintained in community settings. PMID:18511723

  18. EFFECTS OF MOVEABLE PLATFORM TRAINING IN PREVENTING SLIP-INDUCED FALLS IN OLDER ADULTS

    PubMed Central

    Parijat, Prakriti; Lockhart, Thurmon E

    2011-01-01

    Identifying effective interventions is vitalin preventing slip-induced fall accidents in older adults. The purpose of the current study was to evaluate the efficacy of moveable platform training in improving recovery reactions and reducing fall frequency in older adults. Twenty-four older adults were recruited and randomly assigned to two groups (training and control). Both groups underwent three sessions including baseline slip, training, and transfer of training on a slippery surface. Both groups experienced two slips on a slippery surface, one during the baseline and the other (after two weeks) during the transfer of training session. In the training session, the training group underwent twelve simulated slips using a moveable platform while the control group performed normal walking trials. Kinematic, kinetic, and EMG data were collected during all the sessions. Results indicated a reduced incidence of falls in the training group during the transfer of training trial as compared to the control group. The training group was able to transfer proactive and reactive control strategies learned during training to the second slip trial. The proactive adjustments include increased center-of-mass velocity and transitional acceleration after training. Reactive adjustments include reduction in muscle onset and time to peak activations of knee flexors and ankle plantarflexors, reduced ankle and knee coactivation, reduced slip displacement, and reduced time to peak knee flexion, trunk flexion, and hip flexion velocities. In general, the results indicated a beneficial effect of perturbation training in reducing slip severity and recovery kinematics in healthy older adults. PMID:22134467

  19. Osteosarcopenic obesity and fall prevention strategies.

    PubMed

    Hita-Contreras, Fidel; MartĂ­nez-Amat, Antonio; Cruz-DĂ­az, David; PĂ©rez-LĂłpez, Faustino R

    2015-02-01

    Sarcopenia, obesity, and osteoporosis are three interrelated entities which may share common pathophysiological factors. In the last decades, overall survival has drastically increased. Postmenopausal women, due to their estrogen depletion, are at higher risk of developing any of these three conditions or the three, which is termed osteosarcopenic obesity. One of the most common health problems among these patients is the elevated risk of falls and fractures. Falls and fall-related injuries are one of the major causes of mortality and morbidity in older adults, and have a significant impact on social, economical and health-related costs. Several extrinsic and intrinsic risk factors have been described that play a role in the etiology of falls. A therapeutic approach to osteosarcopenic obesity aimed at the prevention of falls must include several factors, and act on those risk elements which can be effectively modified. An adequate weight-loss diet and a good nutritional intake, with an appropriate amount of vitamin D and the right protein/carbohydrates ratio, may contribute to the prevention of falls. The recommendation of physical exercise, both traditional (resistance or aerobic training) and more recent varieties (Tai Chi, Pilates, body vibration), can improve balance and positively contribute to fall prevention, whether by itself or in combination with other therapeutic strategies. Finally, a pharmacological approach, especially one focused on hormone therapy, has shown to have a positive effect on postmenopausal women's balance, leading to a decreased risk of falls. PMID:25533145

  20. Effectiveness of muscle strengthening and description of protocols for preventing falls in the elderly: a systematic review

    PubMed Central

    Ishigaki, Erika Y.; Ramos, Lidiane G.; Carvalho, Elisa S.; Lunardi, Adriana C.

    2014-01-01

    Background Falls are a geriatric syndrome that is considered a significant public health problem in terms of morbidity and mortality because they lead to a decline in functional capacity and an impaired quality of life in the elderly. Lower limb muscle strengthening seems to be an effective intervention for preventing falls; however, there is no consensus regarding the best method for increasing lower limb muscle strength. Objectives To analyze the effectiveness of lower limb muscle strengthening and to investigate and describe the protocols used for preventing falls in elderly subjects. Method We performed a systematic review of randomized and controlled clinical trials published between 2002 and 2012 in the databases PubMed, EMBASE, Scopus, Web of Science, and PEDro that cited some type of lower limb muscle strengthening protocol and that evaluated the incidence of falls as the primary outcome exclusively in elderly subjects. Twelve studies met the inclusion criteria. Qualitative analysis was performed by independent reviewers applying the PEDro scale. Results The data obtained from the selected studies showed lower fall rates in the intervention groups compared to controls. Six studies described the lower limb muscle strengthening protocol in detail. High methodological quality was found in 6 studies (PEDro score ≄7/10 points). Conclusions The methodological quality of the studies in this area appears to leave little doubt regarding the effectiveness of lower limb strengthening exercises for preventing falls in elderly subjects, however the interventions in these studies were poorly reported. PMID:24760166

  1. Cost effectiveness of patient education for the prevention of falls in hospital: economic evaluation from a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital inpatients. Falls can threaten both immediate and longer-term health and independence. There is need to identify cost-effective means for preventing falls in hospitals. Hospital-based falls prevention interventions tested in randomized trials have not yet been subjected to economic evaluation. Methods Incremental cost-effectiveness analysis was undertaken from the health service provider perspective, over the period of hospitalization (time horizon) using the Australian Dollar (A$) at 2008 values. Analyses were based on data from a randomized trial among n = 1,206 acute and rehabilitation inpatients. Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research. The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients. Results The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$14,591 (2008). The education program cost A$526 (2008) to prevent one cognitively intact patient becoming a faller and A$294 (2008) to prevent one fall based on primary trial data. These estimates were unstable due to high variability in the hospital costs accrued by individual patients involved in the trial. There was a 52% probability the complete program was both more effective and less costly (from the health service perspective) than providing usual care alone. Decision tree modeling sensitivity analyses identified that when provided in real life contexts, the program would be both more effective in preventing falls among cognitively intact inpatients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0%. Conclusions This economic evaluation was designed to assist health care providers decide in what circumstances this intervention should be provided. If the proportion of cognitively intact patients falling on a ward under usual care conditions is 4% or greater, then provision of the complete program in addition to usual care will likely both prevent falls and reduce costs for a health service. Trial registration Australia and New Zealand Clinical Trials Register: ACTRN12608000015347. PMID:23692953

  2. It Takes a Village to Prevent Falls: Reconceptualizing Fall Prevention and Management for Older Adults

    PubMed Central

    Ganz, David A.; Alkema, Gretchen E.; Wu, Shinyi

    2013-01-01

    Systematic evidence reviews support the efficacy of physical activity programs and multifactorial strategies for fall prevention. However, community settings where fall prevention programs occur often differ substantially from the research settings in which efficacy was first demonstrated. Because of these differences, alternative approaches are needed to judge the adequacy of fall prevention activities occurring as part of standard medical care or community efforts. This paper uses the World Health Organization Innovative Care for Chronic Conditions (ICCC) framework to rethink how fall prevention programs might be implemented routinely in both medical and community settings. We highlight examples of innovative programs and policies that provide fall prevention strategies consistent with the ICCC framework, and provide evidence where available on the effects of these strategies on processes and outcomes of care. We close by proposing a “no wrong door” approach to fall prevention and management, in which older adults who are found to be at risk for falls in either a medical or community setting are linked to a standard fall risk evaluation across three domains (physical activity, medical risks and home safety). PMID:18676787

  3. A care bundle approach to falls prevention.

    PubMed

    Sutton, Debbie; Windsor, Julie; Husk, Janet

    Falls cause harm and distress to NHS inpatients every year. One hospital's implementation of a regional FallSafe project has increased the use of evidence-based measures to prevent falls. The project relied on a network of falls champions, who were nurses or healthcare assistants who taught and inspired their colleagues to implement care bundles. PMID:24915673

  4. Exercise May Prevent Harmful Falls in Men

    MedlinePLUS

    ... 157087.html Exercise May Prevent Harmful Falls in Men Males made greater gains than women, study says ... 4, 2016 (HealthDay News) -- Regular exercise reduces older men's risk of serious injuries from falls, a new ...

  5. Falls prevention: Identification of predictive fall risk factors.

    PubMed

    Callis, Natalie

    2016-02-01

    Patient falls are the most common adverse safety event in hospitals and healthcare facilities nationwide. There are many risk factors associated with inpatient falls such as medications, unsteady gait, alteration in mental status, and environmental hazards. Risk assessment is the primary intervention for falls prevention. This study aims to provide a detailed review of the literature to identify and synthesize research evidence on risk factors that may contribute to patient falls in the adult inpatient hospital setting that are not captured by current fall risk assessment tools. After the identification of those key risk factors not found on the most common fall risk assessment tools, the results of this review will be used to develop a new evidence based fall risk assessment tool. PMID:26856489

  6. Patient Engagement in Hospital Fall Prevention.

    PubMed

    Tzeng, Huey-Ming; Yin, Chang-Yi

    2015-01-01

    Injurious falls are the most prevalent in-hospital adverse event, and hospitalized patients are at a greater risk of falling than the general population. Patient engagement in hospital fall prevention could be a possible approach to reducing falls and fall-related injuries. To engage patients, bedside nursing staff must first understand the concept of patient centeredness and then incorporate patient centeredness in clinical practice. Clinicians should move from being experts to being enablers. To conceptualize the knowledge gaps identified, a conceptual model was developed to guide future research and quality improvement efforts in hospital settings. This model could be used as a guide to advance nursing leadership in hospital fall prevention via promoting patient engagement (e.g., developing patient-centered fall prevention interventions with patients' input). PMID:26845821

  7. Designing a falls prevention strategy that works.

    PubMed

    Ireland, Sandra; Lazar, Terry; Mavrak, Caroline; Morgan, Beverly; Pizzacalla, Anne; Reis, Cathy; Fram, Nancy

    2010-01-01

    In implementing an evidence-based falls prevention strategy in acute care, planners are frequently pressed to meet organizational targets while allowing staff flexibility to match interventions with patient population needs and clinical realities. We describe the process of how one hospital creatively used evidence, systems change, staff engagement, expert consultation, policy and protocols, staff and patient education, marketing, and celebration to design and implement a falls prevention strategy on 60 clinical units that reduced annual fall rates by 20%. PMID:20535846

  8. Falls: epidemiology and strategies for prevention.

    PubMed

    Mosenthal, A C; Livingston, D H; Elcavage, J; Merritt, S; Stucker, S

    1995-05-01

    Injury secondary to falls is a largely preventable public health problem. The records of 356 patients admitted following a fall to a level I trauma center over a 32-month period were reviewed to determine the epidemiology and to define possible prevention strategies. Falls constituted 9% of total trauma admissions during this time period and had a mortality of 11% (38 of 356). Two hundred ninety-seven falls were accidental, 36 were due to violent criminal behavior, 16 were from suicide attempts, and 7 were from house fires. Sixty-one children under the age of 13 fell; only one died. Falls out of windows accounted for 36% of these falls with over three-quarters of children falling from three stories or less. Elderly patients (age more than 64 years) accounted for only 44 (14%) of falls but over 50% of the deaths. This mortality rate occurred despite the fact that the majority of these falls were from relatively low heights. There were 224 adult falls (ages 18 to 64 years); 36% were occupation-related, and most were by construction workers, roofers, or painters. The remaining adult fall victims had a high rate of unemployment and alcohol and drug use. This study identified several groups where risk factors for falling permit targeted prevention strategies. A large percentage of children who fell were preschool males who fell from windows and this may be related to the lack of window guard legislation in our area.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7760404

  9. Orthopedic Injuries: Protocols to Prevent and Manage Patient Falls.

    PubMed

    Parsons, Lynn C; Revell, Maria A

    2015-12-01

    Health care organizations must adopt a culture of safety and implement effective fall prevention protocols. The teach-back method is a useful strategy for health providers to determine patient understanding of information taught to maintain a safe environment and prevent falls. Purposeful rounding is a proactive approach to ensure that patient assessments are accurate and research supports that patients use the call light less when nurses participate in hourly rounding. This article provides the reader with evidence-based fall prevention interventions, tips for using the teach-back method, and fall prevention tools to safely care for patients of all ages. PMID:26596654

  10. Research on fall prevention and protection from heights in Japan.

    PubMed

    Ohdo, Katsutoshi; Hino, Yasumichi; Takahashi, Hiroki

    2014-01-01

    The high frequency of fall accidents is a serious problem in Japan. Thus, more stringent countermeasures for preventing falls from scaffolds were developed and incorporated into institutional guidelines. These countermeasures aim to decrease deaths caused by falls from scaffolds. Despite the improvements in such measures, however, the rate of accidental fall deaths remains high in Japan's construction industries. To improve the rigor of the countermeasures, a committee was established in our institute by the Japan Ministry of Health, Labour, and Welfare. This committee investigated the regulations applied in other countries and evaluated construction industry compliance with existing fall prevention guidelines. After considerable research and discussion, the Occupational Safety and Health Regulations and Guidelines were amended in 2009. The effects of the amended regulations have recently been investigated on the basis of accident reports. This paper describes the investigation and its results. The paper also discusses other research and workplace safety countermeasures for preventing falls and ensuring fall protection from heights. PMID:25098387

  11. Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil)

    PubMed Central

    2013-01-01

    Background Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. Methods/design Multicentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis. Discussion This study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions. Trial registration ClinicalTrials.gov (NCT01698580) PMID:23497000

  12. Exercises to help prevent falls

    MedlinePLUS

    ... can be active You can do the following exercises anytime and almost anywhere. As you get stronger, ... your ankles. This will increase how effective the exercise is. Try to exercise 2 or more days ...

  13. Falls Prevention: Unique to Older Adults

    MedlinePLUS

    ... linked to high risk of falling. Frail older adults must focus on maintaining their weight and eating a robust diet in order to ... you care for is an older, frail diabetic adult, discuss the need for strict glycemic ... Nutrition to Prevent Weight Loss As we get older, it becomes more ...

  14. Management of falls in older persons: a prescription for prevention.

    PubMed

    Moncada, Lainie Van Voast

    2011-12-01

    Although falls are a common cause of injury in older persons, they are not just a normal part of the aging process. The American Geriatrics Society and British Geriatrics Society recommend that all adults older than 65 years be screened annually for a history of falls or balance impairment. An individualized risk assessment should be performed, with corresponding multifactorial intervention, for those who report a single fall and have unsteadiness; who report two or more falls; who report difficulties with gait or balance; or who seek medical attention because of a fall. The following components should be included in multifactorial interventions: exercise, particularly balance, strength, and gait training; modification of the home environment; minimization of medications, especially psychoactive medications; management of postural hypotension; and management of foot problems and footwear. These interventions are effective in decreasing falls and fall-related injuries in the community and nursing home settings, as well as in decreasing the number of persons who fall in the subacute hospital setting. Prevention of falls and, most importantly, of injury and death is possible. An evidence-based fall prevention prescription may be used to efficiently accomplish management. PMID:22150660

  15. Exercise for falls prevention in Parkinson disease

    PubMed Central

    Sherrington, Catherine; Lord, Stephen R.; Close, Jacqueline C.T.; Heritier, Stephane; Heller, Gillian Z.; Howard, Kirsten; Allen, Natalie E.; Latt, Mark D.; Murray, Susan M.; O'Rourke, Sandra D.; Paul, Serene S.; Song, Jooeun; Fung, Victor S.C.

    2015-01-01

    Objective: To determine whether falls can be prevented with minimally supervised exercise targeting potentially remediable fall risk factors, i.e., poor balance, reduced leg muscle strength, and freezing of gait, in people with Parkinson disease. Methods: Two hundred thirty-one people with Parkinson disease were randomized into exercise or usual-care control groups. Exercises were practiced for 40 to 60 minutes, 3 times weekly for 6 months. Primary outcomes were fall rates and proportion of fallers during the intervention period. Secondary outcomes were physical (balance, mobility, freezing of gait, habitual physical activity), psychological (fear of falling, affect), and quality-of-life measures. Results: There was no significant difference between groups in the rate of falls (incidence rate ratio [IRR] = 0.73, 95% confidence interval [CI] 0.45–1.17, p = 0.18) or proportion of fallers (p = 0.45). Preplanned subgroup analysis revealed a significant interaction for disease severity (p < 0.001). In the lower disease severity subgroup, there were fewer falls in the exercise group compared with controls (IRR = 0.31, 95% CI 0.15–0.62, p < 0.001), while in the higher disease severity subgroup, there was a trend toward more falls in the exercise group (IRR = 1.61, 95% CI 0.86–3.03, p = 0.13). Postintervention, the exercise group scored significantly (p < 0.05) better than controls on the Short Physical Performance Battery, sit-to-stand, fear of falling, affect, and quality of life, after adjusting for baseline performance. Conclusions: An exercise program targeting balance, leg strength, and freezing of gait did not reduce falls but improved physical and psychological health. Falls were reduced in people with milder disease but not in those with more severe Parkinson disease. Classification of evidence: This study provides Class III evidence that for patients with Parkinson disease, a minimally supervised exercise program does not reduce fall risk. This study lacked the precision to exclude a moderate reduction or modest increase in fall risk from exercise. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12608000303347). PMID:25552576

  16. Fall Prevention for Older Adults Receiving Home Healthcare.

    PubMed

    Bamgbade, Sarah; Dearmon, Valorie

    2016-02-01

    Falls pose a significant risk for community-dwelling older adults. Fall-related injuries increase healthcare costs related to hospitalization, diagnostic procedures, and/or surgeries. This article describes a quality improvement project to reduce falls in older adults receiving home healthcare services. The fall prevention program incorporated best practices for fall reduction, including fall risk assessment, medication review/management, home hazard and safety assessment, staff and patient fall prevention education, and an individualized home-based exercise program. The program was implemented and evaluated during a 6-month time frame. Fewer falls occurred post implementation of the falls prevention program with no major injuries. PMID:26835805

  17. What Are Ways to Prevent Falls and Related Fractures?

    MedlinePLUS

    ... What Are Ways to Prevent Falls and Related Fractures? Fast Facts: An Easy-to-Read Series of ... 57 KB) Español Related Resources Preventing Falls and Fractures Osteoporosis and Falls Osteoporosis and Falls (çčé«”äž­æ–‡) Partner ...

  18. Falls, falls prevention and the role of physiotherapy and exercise: perceptions and interpretations of Italian-born and Australian-born older persons living in Australia.

    PubMed

    Lam, Julie; Liamputtong, Pranee; Hill, Keith

    2015-06-01

    Exercise programmes are effective in reducing falls but few older people consider doing an exercise programme for falls prevention. This paper examines older people's perceptions and experiences of falls, physiotherapy and exercise. Individual interviews were conducted with Australian-born and Italian-born older persons who had ≄1 fall in the past 12 months and completed a community-based physiotherapy programme. Although preventing further falls was considered important, participants were unsure whether falls were preventable. Few described evidence-based approaches such as exercise or medication reviews as strategies to prevent falls. Most participants thought that physiotherapy and exercise were beneficial in improving physical function. A clear explanation on the role of exercise for falls prevention, that many falls are preventable, and understanding of personal motivating and de-motivating factors for exercise for falls prevention are important for clinicians to consider in engaging this group of older people. PMID:25917600

  19. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial

    PubMed Central

    2011-01-01

    Objective To determine the effectiveness of a multifaceted podiatry intervention in preventing falls in community dwelling older people with disabling foot pain. Design Parallel group randomised controlled trial. Setting University health sciences clinic in Melbourne, Australia. Participants 305 community dwelling men and women (mean age 74 (SD 6) years) with disabling foot pain and an increased risk of falling. 153 were allocated to a multifaceted podiatry intervention and 152 to routine podiatry care, with 12 months’ follow-up. Interventions Multifaceted podiatry intervention consisting of foot orthoses, advice on footwear, subsidy for footwear ($A100 voucher; Ł65; €74), a home based programme of foot and ankle exercises, a falls prevention education booklet, and routine podiatry care for 12 months. The control group received routine podiatry care for 12 months. Main outcome measures Proportion of fallers and multiple fallers, falling rate, and injuries resulting from falls during follow-up. Results Overall, 264 falls occurred during the study. 296 participants returned all 12 calendars: 147 (96%) in the intervention group and 149 (98%) in the control group. Adherence was good, with 52% of the participants completing 75% or more of the requested three exercise sessions weekly, and 55% of those issued orthoses reporting wearing them most of the time. Participants in the intervention group (n=153) experienced 36% fewer falls than participants in the control group (incidence rate ratio 0.64, 95% confidence interval 0.45 to 0.91, P=0.01). The proportion of fallers and multiple fallers did not differ significantly between the groups (relative risk 0.85, 0.66 to 1.08, P=0.19 and 0.63, 0.38 to 1.04, P=0.07). One fracture occurred in the intervention group and seven in the control group (0.14, 0.02 to 1.15, P=0.07). Significant improvements in the intervention group compared with the control group were found for the domains of strength (ankle eversion), range of motion (ankle dorsiflexion and inversion/eversion), and balance (postural sway on the floor when barefoot and maximum balance range wearing shoes). Conclusions A multifaceted podiatry intervention reduced the rate of falls in community dwelling older people with disabling foot pain. The components of the intervention are inexpensive and relatively simple to implement, suggesting that the programme could be incorporated into routine podiatry practice or multidisciplinary falls prevention clinics. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000065392. PMID:21680622

  20. Do sitters prevent falls? A review of the literature.

    PubMed

    Lang, Carrie E

    2014-05-01

    Preventing falls is a primary nursing concern, especially among older adult patients. Employing a sitter is a common but costly intervention. This article is a comprehensive review of the literature on sitter use and its effect on fall rates in acute care. The search was conducted in CINAHL, MEDLINE, PsycINFO, and the Psychology and Behavioral Sciences Collection and included articles published between 1995 and 2013. The articles included reported data on studies increasing or decreasing sitter use. Sitter reduction studies showed no increase in fall rates; studies implementing sitters to reduce falls showed conflicting results. Implications include the impact to staffing and nursing practice that results from sitter use, the need for staff education programs, how sitter use can affect patient satisfaction, and the need for additional, more robust research on this topic to determine whether sitter use is evidence-based practice. PMID:24640963

  1. Preventing Falls | NIH MedlinePlus the Magazine

    MedlinePLUS

    ... people fall are: Poor vision Poor balance Certain diseases that affect how you walk Some types of medicine, such as sleeping pills Some tips to help prevent falls outdoors are: Use a cane or walker ...

  2. Preventing Falls in Older Adults Who Live in Community Settings

    MedlinePLUS

    ... for Patients Preventing Falls in Older Adults Who Live in Community Settings: U.S. Preventive Services Task Force ... in people aged 65 years or older who live in community settings and are at high risk ...

  3. Integration of Fall Prevention into State Policy in Connecticut

    ERIC Educational Resources Information Center

    Murphy, Terrence E.; Baker, Dorothy I.; Leo-Summers, Linda S.; Bianco, Luann; Gottschalk, Margaret; Acampora, Denise; King, Mary B.

    2013-01-01

    Purpose of Study: To describe the ongoing efforts of the Connecticut Collaboration for Fall Prevention (CCFP) to move evidence regarding fall prevention into clinical practice and state policy. Methods: A university-based team developed methods of networking with existing statewide organizations to influence clinical practice and state policy.…

  4. Development of STEADI: A Fall Prevention Resource for Health Care Providers

    PubMed Central

    Stevens, Judy A.; Phelan, Elizabeth A.

    2015-01-01

    Falls among people aged ?65 years are the leading cause of both injury deaths and emergency department visits for trauma. Research shows that many falls are preventable. In the clinical setting, an effective fall intervention involves assessing and addressing an individual’s fall risk factors. This individualized approach is recommended in the American and British Geriatrics Societies’ (AGS/BGS) practice guideline. This article describes the development of STEADI (Stopping Elderly Accidents, Deaths, and Injuries), a fall prevention tool kit that contains an array of health care provider resources for assessing and addressing fall risk in clinical settings. As researchers at the Centers for Disease Control and Prevention’s Injury Center, we reviewed relevant literature and conducted in-depth interviews with health care providers to determine current knowledge and practices related to older adult fall prevention. We developed draft resources based on the AGS/BGS guideline, incorporated provider input, and addressed identified knowledge and practice gaps. Draft resources were reviewed by six focus groups of health care providers and revised. The completed STEADI tool kit, Preventing Falls in Older Patients—A Provider Tool Kit, is designed to help health care providers incorporate fall risk assessment and individualized fall interventions into routine clinical practice and to link clinical care with community-based fall prevention programs. PMID:23159993

  5. [The use of piribedil for the prevention of falls in elderly patients with metabolic syndrome].

    PubMed

    Il'nitski?, A N; Proshchaev, K I; Shvartsman, G I; Bakhmutova, Iu V; Pozdniakova, N M; Krivetski?, V V; Varavina, L Iu

    2014-01-01

    Effects of pirebedil used to prevent falls in elderly patients with metabolic syndrome are discussed. A prospective controlled study showed that therapy with pirebedil significantly decreases the frequency of falls, reduces severity of pro-inflammatory and pro-oxidative activities, improves cognitive abilities. Prevention of falls by virtue of improved cognitive abilities is a new clinical effect of pirebedil and gives reason to recommend it for the treatment of geriatric patients with metabolic syndrome. PMID:25782306

  6. Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis

    PubMed Central

    2014-01-01

    Background Limited attention has been paid in the literature to multiple component fall prevention interventions that comprise two or more fixed combinations of fall prevention interventions that are not individually tailored following a risk assessment. The study objective was to determine the effect of multiple component interventions on fall rates, number of fallers and fall-related injuries among older people and to establish effect sizes of particular intervention combinations. Methods Medline, EMBASE, CINAHL, PsychInfo, Cochrane, AMED, UK Clinical Research Network Study Portfolio, Current Controlled Trials register and Australian and New Zealand Clinical Trials register were systematically searched to August 2013 for randomised controlled trials targeting those aged 60 years and older with any medical condition or in any setting that compared multiple component interventions with no intervention, placebo or usual clinical care on the outcomes reported falls, number that fall or fall-related injuries. Included studies were appraised using the Cochrane risk of bias tool. Estimates of fall rate ratio and risk ratio were pooled across studies using random effects meta-analysis. Data synthesis took place in 2013. Results Eighteen papers reporting 17 trials were included (5034 participants). There was a reduction in the number of people that fell (pooled risk ratio?=?0.85, 95% confidence interval (95% CI) 0.80 to 0.91) and the fall rate (pooled rate ratio?=?0.80, 95% CI 0.72 to 0.89) in favour of multiple component interventions when compared with controls. There was a small amount of statistical heterogeneity (I2?=?20%) across studies for fall rate and no heterogeneity across studies examining number of people that fell. Conclusions This systematic review and meta-analysis of randomised controlled trials found evidence that multiple component interventions that are not tailored to individually assessed risk factors are effective at reducing both the number of people that fall and the fall rate. This approach should be considered as a service delivery option. PMID:24495705

  7. Nursing Staff Develop a Video to Prevent Falls: A Quality Improvement Project.

    PubMed

    Silkworth, Amelia L; Baker, Jennifer; Ferrara, Joseph; Wagner, Molly; Gevaart, Melinda; Morin, Karen

    2016-01-01

    Many fall prevention strategies exist with some degree of effectiveness. Evidence to support 1 unique bundling of strategies is limited. The purpose of this article is to describe a staff-driven quality improvement initiative to develop a video in partnership with patients and families to prevent falls when hospitalized. Since the video's release, the fall rate has decreased by 29.4%. PMID:26121052

  8. Patients who fall: how to predict and prevent injuries.

    PubMed

    Tibbitts, G M

    1996-09-01

    Approximately 30% of persons over age 65 who are independent and living on their own will fall each year. Falls in this age group result in a bone fracture 5% of the time and account for 250,000 hip fractures each year. Risk factors for falls involve both environmental hazards and host issues. Evaluation of the patient, his or her living conditions, and any personal unsafe behaviors can identify those at risk for falling. Efforts to prevent falls in the elderly have involved education, strengthening exercises, medication evaluation, and environmental improvements. Patients in preventive programs have shown a tendency to fall less often and improved confidence in performing normal daily activities. PMID:8814111

  9. Community-based falls prevention: lessons from an Interprofessional Mobility Clinic

    PubMed Central

    Bauman, Craig A.; Milligan, James D.; Patel, Tejal; Pritchard, Sarah; Labreche, Tammy; Dillon-Martin, Sharon; Ilich, Alexandra; Riva, John J.

    2014-01-01

    Falls are a common and serious risk with an aging population. Chiropractors commonly see firsthand the effects of falls and resulting injuries in their senior patients and they can reduce falls risk through active screening. Ongoing research has provided proven approaches for making falls less likely. Screening for falls should be done yearly for all patients 65 years and older or in those with a predisposing medical condition. Additional specific falls prevention professional education would enable the chiropractor to best assist these patients. Collaboration and communication with the patient’s family physician offers an opportunity for improved interprofessional dialogue to enhance patient care related to falls risk. Frequently falls prevention strategies are implemented by an interprofessional team. Chiropractors increasingly contribute within multidisciplinary teams. Collaboration by the chiropractor requires both simple screening and knowledge of health care system navigation. Such awareness can permit optimal participation in the care of their patient and the best outcome. PMID:25202159

  10. Engaging Community-Based Organizations in Fall Prevention Education

    ERIC Educational Resources Information Center

    Kramer, B. Josea; Vivrette, Rebecca L.; Rubenstein, Laurence Z.

    2011-01-01

    Falls are a major public health problem for older adults, and community-based organizations play a key role in educating seniors about falls prevention (FP). We conducted a qualitative process evaluation at six sites to report community-based centers' perspectives on adoption, adaptation, and sustainability of an evidence-based multifactorial FP…

  11. Preventing Death and Serious Injury from Falling Trees and Branches

    ERIC Educational Resources Information Center

    Brookes, Andrew

    2007-01-01

    Of 128 outdoor education related deaths examined since 1960, 14 have been due to falling trees or branches. This article examines the grounds on which death or serious injury due to falling trees or branches can be regarded as an inherent risk in outdoor education, and the extent to which such incidents can be regarded as preventable. It compares…

  12. Preventing Death and Serious Injury from Falling Trees and Branches

    ERIC Educational Resources Information Center

    Brookes, Andrew

    2007-01-01

    Of 128 outdoor education related deaths examined since 1960, 14 have been due to falling trees or branches. This article examines the grounds on which death or serious injury due to falling trees or branches can be regarded as an inherent risk in outdoor education, and the extent to which such incidents can be regarded as preventable. It compares


  13. Falls among Older Adults: Public Health Impact and Prevention Strategies.

    ERIC Educational Resources Information Center

    Stevens, Judy A.

    2003-01-01

    Provides an overview of the epidemiology of falls among older adults, describes current prevention strategies, and highlights key areas that need to be addressed, including risk assessments, exercise, and environmental changes. (Contains 50 references.) (JOW)

  14. Effectiveness of Web-Based Versus Face-To-Face Delivery of Education in Prescription of Falls-Prevention Exercise to Health Professionals: Randomized Trial

    PubMed Central

    Haas, Romi; Keating, Jennifer L; Molloy, Elizabeth; Jolly, Brian; Sims, Jane; Morgan, Prue; Haines, Terry

    2011-01-01

    Background Exercise is an effective intervention for the prevention of falls; however, some forms of exercises have been shown to be more effective than others. There is a need to identify effective and efficient methods for training health professionals in exercise prescription for falls prevention. Objective The objective of our study was to compare two approaches for training clinicians in prescribing exercise to prevent falls. Methods This study was a head-to-head randomized trial design. Participants were physiotherapists, occupational therapists, nurses, and exercise physiologists working in Victoria, Australia. Participants randomly assigned to one group received face-to-face traditional education using a 1-day seminar format with additional video and written support material. The other participants received Web-based delivery of the equivalent educational material over a 4-week period with remote tutor facilitation. Outcomes were measured across levels 1 to 3 of Kirkpatrick’s hierarchy of educational outcomes, including attendance, adherence, satisfaction, knowledge, and self-reported change in practice. Results Of the 166 participants initially recruited, there was gradual attrition from randomization to participation in the trial (n = 67 Web-based, n = 68 face-to-face), to completion of the educational content (n = 44 Web-based, n = 50 face-to-face), to completion of the posteducation examinations (n = 43 Web-based, n = 49 face-to-face). Participant satisfaction was not significantly different between the intervention groups: mean (SD) satisfaction with content and relevance of course material was 25.73 (5.14) in the Web-based and 26.11 (5.41) in the face-to-face group; linear regression P = .75; and mean (SD) satisfaction with course facilitation and support was 11.61 (2.00) in the Web-based and 12.08 (1.54) in the face-to-face group; linear regression P = .25. Knowledge test results were comparable between the Web-based and face-to-face groups: median (interquartile range [IQR]) for the Web-based group was 90.00 (70.89–90.67) and for the face-to-face group was 80.56 (70.67–90.00); rank sum P = .07. The median (IQR) scores for the exercise assignment were also comparable: Web-based, 78.6 (68.5–85.1), and face-to-face, 78.6 (70.8–86.9); rank sum P = .61. No significant difference was identified in Kirkpatrick’s hierarchy domain change in practice: mean (SD) Web-based, 21.75 (4.40), and face-to-face, 21.88 (3.24); linear regression P = .89. Conclusion Web-based and face-to-face approaches to the delivery of education to clinicians on the subject of exercise prescription for falls prevention produced equivalent results in all of the outcome domains. Practical considerations should arguably drive choice of delivery method, which may favor Web-based provision for its ability to overcome access issues for health professionals in regional and remote settings. Trial Registration Australian New Zealand Clinical Trials Registry number: ACTRN12610000135011; http://www.anzctr.org.au/ACTRN12610000135011.aspx (Archived by WebCite at http://www.webcitation.org/63MicDjPV) PMID:22189410

  15. Fall prevention intervention technologies: A conceptual framework and survey of the state of the art.

    PubMed

    Hamm, Julian; Money, Arthur G; Atwal, Anita; Paraskevopoulos, Ioannis

    2016-02-01

    In recent years, an ever increasing range of technology-based applications have been developed with the goal of assisting in the delivery of more effective and efficient fall prevention interventions. Whilst there have been a number of studies that have surveyed technologies for a particular sub-domain of fall prevention, there is no existing research which surveys the full spectrum of falls prevention interventions and characterises the range of technologies that have augmented this landscape. This study presents a conceptual framework and survey of the state of the art of technology-based fall prevention systems which is derived from a systematic template analysis of studies presented in contemporary research literature. The framework proposes four broad categories of fall prevention intervention system: Pre-fall prevention; Post-fall prevention; Fall injury prevention; Cross-fall prevention. Other categories include, Application type, Technology deployment platform, Information sources, Deployment environment, User interface type, and Collaborative function. After presenting the conceptual framework, a detailed survey of the state of the art is presented as a function of the proposed framework. A number of research challenges emerge as a result of surveying the research literature, which include a need for: new systems that focus on overcoming extrinsic falls risk factors; systems that support the environmental risk assessment process; systems that enable patients and practitioners to develop more collaborative relationships and engage in shared decision making during falls risk assessment and prevention activities. In response to these challenges, recommendations and future research directions are proposed to overcome each respective challenge. PMID:26773345

  16. Tailored prevention of inpatient falls: development and usability testing of the fall TIPS toolkit.

    PubMed

    Zuyev, Lyubov; Benoit, Angela N; Chang, Frank Y; Dykes, Patricia C

    2011-02-01

    Patient falls and fall-related injuries are serious problems in hospitals. The Fall TIPS application aims to prevent patient falls by translating routine nursing fall risk assessment into a decision support intervention that communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to the care team, patients, and family members. In our design and implementation of the Fall TIPS toolkit, we used the Spiral Software Development Life Cycle model. Three output tools available to be generated from the toolkit are bed poster, plan of care, and patient education handout. A preliminary design of the application was based on initial requirements defined by project leaders and informed by focus groups with end users. Preliminary design partially simulated the paper version of the Morse Fall Scale currently used in hospitals involved in the research study. Strengths and weaknesses of the first prototype were identified by heuristic evaluation. Usability testing was performed at sites where research study is implemented. Suggestions mentioned by end users participating in usability studies were either directly incorporated into the toolkit and output tools, were slightly modified, or will be addressed during training. The next step is implementation of the fall prevention toolkit on the pilot testing units. PMID:20975543

  17. Falls and Fractures: A systematic approach to screening and prevention.

    PubMed

    Ambrose, Anne Felicia; Cruz, Lisanne; Paul, Geet

    2015-09-01

    Falls are one of the major causes of mortality and morbidity in older adults. Every year, an estimated 30-40% of patients over the age of 65 will fall at least once. Falls lead to moderate to severe injuries, fear of falling, loss of independence and death in a third of those patients. Falls account for 87 % of all fractures in the elderly. These fractures are almost always due to low impact injuries in osteoporotic bones. Several organizations have recommended screening older patients to identify those with a high risk of falling and, or fractures. The present review provides a brief summary and update of the relevant literature, summarizing screening tools and interventions to prevent falls and fractures. The major risk factors identified are impaired balance and gait, polypharmacy, and history of previous falls. Other risk factors include advancing age, female gender, visual impairments, cognitive decline especially attention and executive dysfunction, and environmental factors. Recommendations for the clinician to screen and prevent falls in older patients are also summarized. PMID:26255681

  18. Developing an Evidence-Based Fall Prevention Curriculum for Community Health Workers

    PubMed Central

    St. John, Julie A.; Shubert, Tiffany E.; Smith, Matthew Lee; Rosemond, Cherie A.; Howell, Doris A.; Beaudoin, Christopher E.; Ory, Marcia G.

    2015-01-01

    This perspective paper describes processes in the development of an evidence-based fall prevention curriculum for community health workers/promotores (CHW/P) that highlights the development of the curriculum and addresses: (1) the need and rationale for involving CHW/P in fall prevention; (2) involvement of CHW/P and content experts in the curriculum development; (3) best practices utilized in the curriculum development and training implementation; and (4) next steps for dissemination and utilization of the CHW/P fall prevention curriculum. The project team of CHW/P and content experts developed, pilot tested, and revised bilingual in-person training modules about fall prevention among older adults. The curriculum incorporated the following major themes: (1) fall risk factors and strategies to reduce/prevent falls; (2) communication strategies to reduce risk of falling and strategies for developing fall prevention plans; and (3) health behavior change theories utilized to prevent and reduce falls. Three separate fall prevention modules were developed for CHW/P and CHW/P Instructors to be used during in-person trainings. Module development incorporated a five-step process: (1) conduct informal focus groups with CHW/P to inform content development; (2) develop three in-person modules in English and Spanish with input from content experts; (3) pilot-test the modules with CHW/P; (4) refine and finalize modules based on pilot-test feedback; and (5) submit modules for approval of continuing education units. This project contributes to the existing evidence-based literature by examining the role of CHW/P in fall prevention among older adults. By including evidence-based communication strategies such as message tailoring, the curriculum design allows CHW/P to personalize the information for individuals, which can result in an effective dissemination of a curriculum that is evidence-based and culturally appropriate. PMID:25964920

  19. Fall prevention modulates decisional saccadic behavior in aging

    PubMed Central

    Coubard, Olivier A.

    2012-01-01

    As society ages and frequency of falls increases in older adults, counteracting motor decline is a challenging issue for developed countries. Physical activity based on aerobic and strength training as well as motor activity based on skill learning both help benefit balance and reduce the risk of falls, as assessed by clinical or laboratory measures. However, how such programs influence motor control is a neglected issue. This study examined the effects of fall prevention (FP) training on saccadic control in older adults. Saccades were recorded in 12 participants aged 64–91 years before and after 2.5 months training in FP. Traditional analysis of saccade timing and dynamics was performed together with a quantitative analysis using the LATER model, enabling us to examine the underlying motor control processes. Results indicated that FP reduced the rate of anticipatory and express saccades in inappropriate directions and enhanced that of express saccades in the appropriate direction, resulting in decreased latency and higher left-right symmetry of motor responses. FP reduced within-participant variability of saccade duration, amplitude, and peak velocity. LATER analysis suggested that FP modulates decisional thresholds, extending our knowledge of motor training influence on central motor control. We introduce the Threshold Interval Modulation with Early Release-Rate of rIse Deviation with Early Release (TIMER-RIDER) model to account for the results. PMID:22807914

  20. Integration of Fall Prevention into State Policy in Connecticut

    PubMed Central

    Murphy, Terrence E.

    2013-01-01

    Purpose of Study: To describe the ongoing efforts of the Connecticut Collaboration for Fall Prevention (CCFP) to move evidence regarding fall prevention into clinical practice and state policy. Methods: A university-based team developed methods of networking with existing statewide organizations to influence clinical practice and state policy. Results: We describe steps taken that led to funding and legislation of fall prevention efforts in the state of Connecticut. We summarize CCFP’s direct outreach by tabulating the educational sessions delivered and the numbers and types of clinical care providers that were trained. Community organizations that had sustained clinical practices incorporating evidence-based fall prevention were subsequently funded through mini-grants to develop innovative interventional activities. These mini-grants targeted specific subpopulations of older persons at high risk for falls. Implications: Building collaborative relationships with existing stakeholders and care providers throughout the state, CCFP continues to facilitate the integration of evidence-based fall prevention into clinical practice and state-funded policy using strategies that may be useful to others. PMID:23042690

  1. An interdisciplinary intervention to prevent falls in community-dwelling elderly persons: protocol of a cluster-randomized trial [PreFalls

    PubMed Central

    2011-01-01

    Background Prevention of falls in the elderly is a public health target in many countries around the world. While a large number of trials have investigated the effectiveness of fall prevention programs, few focussed on interventions embedded in the general practice setting and its related network. In the Prevent Falls (PreFalls) trial we aim to investigate the effectiveness of a pre-tested multi-modal intervention compared to usual care in this setting. Methods/Design PreFalls is a controlled multicenter prospective study with cluster-randomized allocation of about 40 general practices to an experimental or a control group. We aim to include 382 community dwelling persons aged 65 and older with an increased risk of falling. All participating general practitioners are trained to systematically assess the risk of falls using a set of validated tests. Patients from intervention practices are invited to participate in a 16-weeks exercise program with focus on fall prevention delivered by specifically trained local physiotherapists. Patients from practices allocated to the control group receive usual care. Main outcome measure is the number of falls per individual in the first 12 months (analysis by negative binomial regression). Secondary outcomes include falls in the second year, the proportion of participants falling in the first and the second year, falls associated with injury, risk of falls, fear of falling, physical activity and quality of life. Discussion Reducing falls in the elderly remains a major challenge. We believe that with its strong focus on a both systematic and realistic fall prevention strategy adapted to primary care setting PreFalls will be a valuable addition to the scientific literature in the field. Trial registration NCT01032252 PMID:21329525

  2. Falls prevention in the elderly: translating evidence into practice.

    PubMed

    Luk, James K H; Chan, T Y; Chan, Daniel K Y

    2015-04-01

    Falls are a common problem in the elderly. A common error in their management is that injury from the fall is treated, without finding its cause. Thus a proactive approach is important to screen for the likelihood of fall in the elderly. Fall assessment usually includes a focused history and a targeted examination. Timed up-and-go test can be performed quickly and is able to predict the likelihood of fall. Evidence-based fall prevention interventions include multi-component group or home-based exercises, participation in Tai Chi, environmental modifications, medication review, management of foot and footwear problems, vitamin D supplementation, and management of cardiovascular problems. If possible, these are best implemented in the form of multifactorial intervention. Bone health enhancement for residential care home residents and appropriate community patients, and prescription of hip protectors for residential care home residents are also recommended. Multifactorial intervention may also be useful in a hospital and residential care home setting. Use of physical restraints is not recommended for fall prevention. PMID:25722468

  3. Survey on Fall Detection and Fall Prevention Using Wearable and External Sensors

    PubMed Central

    Delahoz, Yueng Santiago; Labrador, Miguel Angel

    2014-01-01

    According to nihseniorhealth.gov (a website for older adults), falling represents a great threat as people get older, and providing mechanisms to detect and prevent falls is critical to improve people's lives. Over 1.6 million U.S. adults are treated for fall-related injuries in emergency rooms every year suffering fractures, loss of independence, and even death. It is clear then, that this problem must be addressed in a prompt manner, and the use of pervasive computing plays a key role to achieve this. Fall detection (FD) and fall prevention (FP) are research areas that have been active for over a decade, and they both strive for improving people's lives through the use of pervasive computing. This paper surveys the state of the art in FD and FP systems, including qualitative comparisons among various studies. It aims to serve as a point of reference for future research on the mentioned systems. A general description of FD and FP systems is provided, including the different types of sensors used in both approaches. Challenges and current solutions are presented and described in great detail. A 3-level taxonomy associated with the risk factors of a fall is proposed. Finally, cutting edge FD and FP systems are thoroughly reviewed and qualitatively compared, in terms of design issues and other parameters. PMID:25340452

  4. Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossébo randomised controlled trial

    PubMed Central

    El-Khoury, Fabienne; Cassou, Bernard; Latouche, Aurélien; Aegerter, Philippe; Charles, Marie-Aline

    2015-01-01

    Objective To assess the effectiveness of a two year exercise programme of progressive balance retraining in reducing injurious falls among women aged 75-85 at increased risk of falls and injuries and living in the community. Design Pragmatic multicentre, two arm, parallel group, randomised controlled trial. Setting 20 study sites in 16 medium to large cities throughout France. Participants 706 women aged 75-85, living in their own home, and with diminished balance and gait capacities, randomly allocated to the experimental intervention group (exercise programme, n=352) or the control group (no intervention, n=354). Intervention Weekly supervised group sessions of progressive balance training offered in community based premises for two years, supplemented by individually prescribed home exercises. Outcome measures A geriatrician blinded to group assignment classified falls into one of three categories (no consequence, moderate, severe) based on physical damage and medical care. The primary outcome was the rate of injurious falls (moderate and severe). The two groups were compared for rates of injurious falls with a “shared frailty” model. Other outcomes included the rates of all falls, physical functional capacities (balance and motor function test results), fear of falling (FES-I), physical activity level, and perceived health related quality of life (SF-36). Analysis was by intention to treat. Results There were 305 injurious falls in the intervention group and 397 in the control group (hazard ratio 0.81, 95% confidence interval 0.67 to 0.99). The difference in severe injuries (68 in intervention group v 87 in control group) was of the same order of magnitude (0.83, 0.60 to 1.16). At two years, women in the intervention group performed significantly better on all physical tests and had significantly better perception of their overall physical function than women in the control group. Among women who started the intervention (n=294), the median number of group sessions attended was 53 (interquartile range 16-71). Five injurious falls related to the intervention were recorded. Conclusion A two year progressive balance retraining programme combining weekly group and individual sessions was effective in reducing injurious falls and in improving measured and perceived physical function in women aged 75-85 at risk of falling. Trial registration ClinicalTrials.gov (NCT00545350). PMID:26201510

  5. Protecting hospice patients: a new look at falls prevention.

    PubMed

    Gray, Jullie

    2007-01-01

    Falls prevention is a critical priority in hospice and palliative care settings. To keep patients safe and comply with national standards, hospice professionals must have available appropriate assessment, prevention, and intervention tools. Existing procedures engaging patients in strengthening exercises and reducing or eliminating medications that cause dizziness, imbalance and confusion are fitting and useful in environments where first-line fall reduction efforts are possible. These current tools are based on research in facilities for nonhospice patients and run counter to the goals of palliative care. By definition, hospice patients have a terminal illness and are, or will become, too weak to manage strengthening exercises. Without their medications, many would experience intolerable pain and unmanageable anxiety and depression. This article proposes assessment guidelines and pragmatic interventions to reduce the risk of falling that are consistent with the hospice philosophy of comfort. PMID:17601851

  6. Engaging community-based organizations in fall prevention education.

    PubMed

    Kramer, B Josea; Vivrette, Rebecca L; Rubenstein, Laurence Z

    2011-01-01

    Falls are a major public health problem for older adults, and community-based organizations play a key role in educating seniors about falls prevention (FP). We conducted a qualitative process evaluation at six sites to report community-based centers' perspectives on adoption, adaptation, and sustainability of an evidence-based multifactorial FP model. Wide dissemination of new health-oriented programs requires marketing to center directors, who must consider sustainability options. The diversity and independence of community-based organizations, together with current staffing and funding limitations, suggest that fidelity to multifactorial evidence-based interventions will be difficult to achieve. PMID:21598150

  7. Evaluating the effectiveness of a home-based exercise programme delivered through a tablet computer for preventing falls in older community-dwelling people over 2 years: study protocol for the Standing Tall randomised controlled trial

    PubMed Central

    Delbaere, K; Valenzuela, T; Woodbury, A; Davies, T; Yeong, J; Steffens, D; Miles, L; Pickett, L; Zijlstra, G A R; Clemson, L; Close, J C T; Howard, K; Lord, S R

    2015-01-01

    Introduction In order to prevent falls, older people should exercise for at least 2 h per week for 6 months, with a strong focus on balance exercises. This article describes the design of a randomised controlled trial to evaluate the effectiveness of a home-based exercise programme delivered through a tablet computer to prevent falls in older people. Methods and analysis Participants aged 70 years or older, living in the community in Sydney will be recruited and randomly allocated to an intervention or control group. The intervention consists of a tailored, home-based balance training delivered through a tablet computer. Intervention participants will be asked to complete 2 h of exercises per week for 2 years. Both groups will receive an education programme focused on health-related information relevant to older adults, delivered through the tablet computer via weekly fact sheets. Primary outcome measures include number of fallers and falls rate recorded in weekly fall diaries at 12 months. A sample size of 500 will be necessary to see an effect on falls rate. Secondary outcome measures include concern about falling, depressive symptoms, health-related quality of life and physical activity levels (in all 500 participants); and physiological fall risk, balance, functional mobility, gait, stepping and cognitive performance (in a subsample of 200 participants). Adherence, acceptability, usability and enjoyment will be recorded in intervention group participants over 2 years. Data will be analysed using the intention-to-treat principle. Secondary analyses are planned in people with greater adherence. Economic analyses will be assessed from a health and community care provider perspective. Ethics and dissemination Ethical approval was obtained from UNSW Ethics Committee in December 2014 (ref number HC#14/266). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conferences. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN)12615000138583. PMID:26493461

  8. Assessing the Quality of a Nonrandomized Pragmatic Trial for Primary Prevention of Falls among Older Adults

    PubMed Central

    Albert, Steven M.; Edelstein, Offer; King, Jennifer; Flatt, Jason; Lin, Chyongchiou J.; Boudreau, Robert; Newman, Anne B.

    2014-01-01

    Background Current approaches to falls prevention mostly rely on secondary and tertiary prevention and target individuals at high risk of falls. An alternative is primary prevention, in which all seniors are screened, referred as appropriate, and educated regarding falls risk. Little information is available on research designs that allow investigation of this approach in the setting of aging services delivery, where randomization may not be possible. Methods Healthy Steps for Older Adults, a statewide program of the Pennsylvania (PA) Department of Aging, involves a combination of education about falls and screening for balance problems, with referral to personal physicians and home safety assessments. We developed a nonrandomized statewide trial, Falls Free PA, to assess its effectiveness in reducing falls incidence over 12 months. We recruited 814 seniors who completed the program (503 first time participants, 311 people repeating the program) and 1020 who did not participate in the program, from the same sites. We assessed the quality of this nonrandomized design by examining recruitment, follow-up across study groups, and comparability at baseline. Results Of older adults approached in senior centers, 90.5% (n=2219) signed informed consent, and 1834 (82.4%) completed baseline assessments and were eligible for follow-up. Attrition in the three groups over 12 months was low and non-differential (<10% for withdrawal and <2% for other loss to follow-up). Median follow-up, which involved standardized monthly assessment of falls, was 10 months in all study groups. At baseline the groups did not differ in measures of health or falls risk factors. Conclusions Comparable status at baseline, recruitment from common sites, and similar experience with retention suggest that the nonrandomized design will be effective for assessment of this approach to primary prevention of falls. PMID:24488533

  9. Is there a role for neck manipulation in elderly falls prevention? – An overview

    PubMed Central

    Kendall, Julie C.; Hartvigsen, Jan; French, Simon D.; Azari, Michael F.

    2015-01-01

    Many risk factors exist for falls in the elderly. Dizziness is an important risk factor for such falls. Spinal pain has also been identified as a risk factor for these falls. In this overview of the literature, we examine studies, including trials, of neck manipulation for neck pain, unsteadiness and falls risk relevant to the elderly. We also examine two related, but not mutually exclusive, mechanisms through which a putative beneficial effect may be mediated. These are the effects of neck manipulation on neck pain and on non-specific dizziness. We focus on the available evidence primarily in terms of clinical data rather than laboratory-based measures of balance. We conclude that chiropractors may have a role in falls prevention strategies in the subpopulation of the elderly that suffer from mechanical neck pain or dysfunction and non-specific dizziness. However, this role remains to be rigorously studied and properly defined. PMID:25729086

  10. Falls prevention in persons with intellectual disabilities: development, implementation, and process evaluation of a tailored multifactorial fall risk assessment and intervention strategy.

    PubMed

    Smulders, Ellen; Enkelaar, Lotte; Schoon, Yvonne; Geurts, Alexander C; van Schrojenstein Lantman-de Valk, Henny; Weerdesteyn, Vivian

    2013-09-01

    In the general elderly population, multifactorial screening of fall risks has been shown to be effective. Although persons with intellectual disabilities (ID) fall more often, there appears to be no targeted screening for them. The aim of this study was to develop, implement, and evaluate a falls clinic for persons with ID. Based on guidelines, literature, and expert meetings, a falls clinic for persons with ID was developed. In total, 26 persons with ID and a fall history participated in the study. Process evaluation was conducted with evaluation forms and focus groups. Fifty interventions (0-8 per person) were prescribed. The (para)medical experts, clients, and caregivers described the falls clinic as useful. Advice for improvement included minor changes to clinic content. Logistics were the largest challenge for the falls clinic, for example organizing meetings, completing questionnaires prior to meetings, and ensuring that a personal caregiver accompanied the person with ID. Furthermore, the need for a screening tool to determine whether a person would benefit from the falls clinic was reported. In conclusion, the falls clinic for persons with ID was considered feasible and useful. Some minor content changes are necessary and there is a need for a screening tool. However, logistics concerning the falls clinic need improvement. More attention and time for multifactorial and multidisciplinary treatment of persons with ID is necessary. Implementation on a larger scale would also make it possible to investigate the effectiveness of the falls clinic with regard to the prevention of falls in this population. PMID:23792376

  11. Gust effects on a freely falling plate

    NASA Astrophysics Data System (ADS)

    Wan, Hui; Dong, Haibo; Liang, Zongxian; FSRG Team

    2011-11-01

    Depending on the Reynolds number and the Froude number, a freely falling plate usually performs one of the following four types of motion, flutter, tumble, steady or chaos fall. It is interesting to know that if and how a gust changes the falling status of a plate. In this work, Direct Numerical Simulations (DNS) will be conducted to study the effects of gust on the freely falling plate by varying the gust amplitude, frequency, and phase relative to the falling plate. Especially, for a plate lies in the chaotic (transitional) region, how its motion be affected as a response to the gust will be discussed. NSF CBET-1055949.

  12. Yale FICSIT: risk factor abatement strategy for fall prevention.

    PubMed

    Tinetti, M E; Baker, D I; Garrett, P A; Gottschalk, M; Koch, M L; Horwitz, R I

    1993-03-01

    Based on finding a strong association between number of impairments and risk of falling in earlier studies, Yale FICSIT investigators are conducting an intervention trial comparing the effectiveness of usual care plus social visits (SV) and a targeted risk abatement intervention (TI) strategy in reducing falls among at risk community elderly persons. Subjects include members of a participating HMO who are > or = 70 years of age, cognitively intact, not terminally ill, not too physically active, and possess at least one fall risk factor. The targeted risk factors include postural hypotension; sedative use; at least four targeted medications; upper and lower extremity strength and range of motion impairments; foot problems; and balance, gait, and transfer dysfunctions. The interventions include medication adjustments, behavioral change recommendations, education and training, and home-based exercise regimens targeting the identified risk factors. The interventions are carried out by the study nurse practitioner and physical therapist in TI subjects' homes. The SV subjects receive a comparable number of home visits as the TI subjects during which a structured life review is performed by social work students. The primary outcome is occurrence of falls during the 12-month followup. Secondary outcomes include change in mobility performance and fall-related efficacy. PMID:8440856

  13. Strength or power, which is more important to prevent slip-related falls?

    PubMed

    Han, Longzhu; Yang, Feng

    2015-12-01

    Falls are a serious health and medical concern facing older adults worldwide. Both muscle strength and power have been related to falls among older adults. The primary purpose of this study was to identify which one of these two muscular performances is more important in preventing a slip-related fall. Twenty-six healthy young adults participated in this study. Their muscle strength (torque) and power capacities were assessed at the right knee under maximum voluntary isometric (flexion and extension) and isokinetic (concentric extension and flexion at three different contraction speeds: 60deg/s, 120deg/s, and 180deg/s) contractions, respectively. They were then subjected to an identical and unannounced slip during gait on a treadmill under the protection of a safety harness after walking regularly for five times on the treadmill. Accuracy of predicting slip outcome (fall vs. recovery) was examined for each muscle performance measurement using logistic regression. Results showed that overall the joint power capacity measurements predicted the slip outcome among these subjects with higher accuracy than did the joint torque capacity measurements. Such results suggested that muscle power could be more closely related to a fall initiated by a slip during gait. The findings from the present study could provide guidance to identify individuals at increased risk of falling using the joint power capacity measurement and to design effective fall prevention training paradigms aiming at maximizing muscle power among older adults and others with physical disabilities. PMID:26378820

  14. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials

    PubMed Central

    Chang, John T; Morton, Sally C; Rubenstein, Laurence Z; Mojica, Walter A; Maglione, Margaret; Suttorp, Marika J; Roth, Elizabeth A; Shekelle, Paul G

    2004-01-01

    Objective To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group. Design Systematic review and meta-analyses. Data sources Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews. Data extraction Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education. Results 40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82, 0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01; 2.7). Conclusions Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling. PMID:15031239

  15. ["Jaques-Dalcroze eurhythmics" improves gait and prevents falls in the elderly].

    PubMed

    Trombetti, Andrea; Hars, Mélany; Herrmann, François; Kressig, Reto; Ferrari, Serge; Rizzoli, René

    2011-06-15

    Given the significant health and socioeconomic consequences of falls, to develop and promote effective falls prevention strategies among older adults represents a major issue. Jaques-Dalcroze eurhythmics is a music education program through movement method developed in Geneva, Switzerland, in the early 20th century. This new exercise form, adapted for elderly people, features various multitask exercises performed to the rhythm of improvised piano music and mainly challenge gait and balance, but also memory, attention and coordination. We report here the results of a randomized controlled trial conducted in Geneva showing that Jaques-Dalcroze eurythmics practice can improve gait performance under single and dual-task conditions, and balance, as well as reduce both rate of falls and the risk of falling in at-risk elderly community-dwellers. PMID:21793420

  16. Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial

    PubMed Central

    2013-01-01

    Background Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the ‘holistic’ approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people. Methods/design A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed. Discussion This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612000889853 The trial is now in progress with 12 villages already have been randomised. PMID:23675705

  17. Falls prevention training for community health workers: strategies and actions for independent living (SAIL).

    PubMed

    Scott, Victoria J; Votova, Kristine; Gallagher, Elaine

    2006-10-01

    This article describes a quasi-experimental study on falls prevention for clients of home support services in British Columbia, Canada. The study tested a nurse-designed multifactorial intervention, delivered by community health workers. The intervention consisted of 1 day of falls surveillance and prevention training for 51 community health workers, followed by 6 months of evidence-based interventions with their clients (n = 70) using a pretested Checklist and Action Plan. Study findings showed a 43% reduction (chi2 = 8.742, p < .01) in falls and a 44% reduction (chi2 = 5.739, p < .05) for fallers (those who fell once or more) from the 6-month preintervention period to postintervention. The proportion of falls resulting in any injury did not decrease; however, fractures were reduced from seven in the 6-month preintervention period to one following the intervention. The results indicate this intervention is an effective and inexpensive falls prevention strategy for frail recipients of home support services. PMID:17048756

  18. Fall Prevention Research and Practice: A Total Worker Safety Approach

    PubMed Central

    HSIAO, Hongwei

    2014-01-01

    Slips, trips, and falls (STF) represent a serious hazard to workers and occupants in many industries, homes, and communities. Often, the cause of a STF incident is multifactorial, encompassing human, environmental, and task risk factors. A STF-related disability can greatly diminish the occupational capability and quality of life of individuals in both the workplace and the home. Countering STF hazards and risks both on and off the job and on all aspects of control measures is a “total worker safety” matter, a challenging yet tangible undertaking. As the federal organization responsible for conducting research for the prevention of work-related injuries in the United States, the National Institute for Occupational Safety and Health (NIOSH) has been conducting research on STF controls for some decades. Many NIOSH research outcomes have been utilized for STF prevention in workplaces, with potential for prevention in homes as well. This paper summarizes the concept of total worker safety for STF control, NIOSH priority research goals, major activities, and accomplishments, and some emerging issues on STF. The strategic planning process for the NIOSH research goals and some identified research focuses are applicable to the development and implementation of global STF research goals. PMID:25345424

  19. Fall prevention research and practice: a total worker safety approach.

    PubMed

    Hsiao, Hongwei

    2014-01-01

    Slips, trips, and falls (STF) represent a serious hazard to workers and occupants in many industries, homes, and communities. Often, the cause of a STF incident is multifactorial, encompassing human, environmental, and task risk factors. A STF-related disability can greatly diminish the occupational capability and quality of life of individuals in both the workplace and the home. Countering STF hazards and risks both on and off the job and on all aspects of control measures is a "total worker safety" matter, a challenging yet tangible undertaking. As the federal organization responsible for conducting research for the prevention of work-related injuries in the United States, the National Institute for Occupational Safety and Health (NIOSH) has been conducting research on STF controls for some decades. Many NIOSH research outcomes have been utilized for STF prevention in workplaces, with potential for prevention in homes as well. This paper summarizes the concept of total worker safety for STF control, NIOSH priority research goals, major activities, and accomplishments, and some emerging issues on STF. The strategic planning process for the NIOSH research goals and some identified research focuses are applicable to the development and implementation of global STF research goals. PMID:25345424

  20. Laboratory review: the role of gait analysis in seniors' mobility and fall prevention.

    PubMed

    Bridenbaugh, Stephanie A; Kressig, Reto W

    2011-01-01

    Walking is a complex motor task generally performed automatically by healthy adults. Yet, by the elderly, walking is often no longer performed automatically. Older adults require more attention for motor control while walking than younger adults. Falls, often with serious consequences, can be the result. Gait impairments are one of the biggest risk factors for falls. Several studies have identified changes in certain gait parameters as independent predictors of fall risk. Such gait changes are often too discrete to be detected by clinical observation alone. At the Basel Mobility Center, we employ the GAITRite electronic walkway system for spatial-temporal gait analysis. Although we have a large range of indications for gait analyses and several areas of clinical research, our focus is on the association between gait and cognition. Gait analysis with walking as a single-task condition alone is often insufficient to reveal underlying gait disorders present during normal, everyday activities. We use a dual-task paradigm, walking while simultaneously performing a second cognitive task, to assess the effects of divided attention on motor performance and gait control. Objective quantification of such clinically relevant gait changes is necessary to determine fall risk. Early detection of gait disorders and fall risk permits early intervention and, in the best-case scenario, fall prevention. We and others have shown that rhythmic movement training such as Jaques-Dalcroze eurhythmics, tai chi and social dancing can improve gait regularity and automaticity, thus increasing gait safety and reducing fall risk. PMID:20980732

  1. Quantifying Temperature Effects on Fall Chinook Salmon

    SciTech Connect

    Jager, Yetta

    2011-11-01

    The motivation for this study was to recommend relationships for use in a model of San Joaquin fall Chinook salmon. This report reviews literature pertaining to relationships between water temperature and fall Chinook salmon. The report is organized into three sections that deal with temperature effects on development and timing of freshwater life stages, temperature effects on incubation survival for eggs and alevin, and temperature effects on juvenile survival. Recommendations are made for modeling temperature influences for all three life stages.

  2. Older People's Views of Advice about Falls Prevention: A Qualitative Study

    ERIC Educational Resources Information Center

    Yardley, L.; Donovan-Hall, M.; Francis, K.; Todd, C.

    2006-01-01

    The aim of this study was to gain an understanding of older people's perceptions of falls prevention advice, and how best to design communications that will encourage older people to take action to prevent falls. Focus groups and interviews were carried out with 66 people aged 61-94 years recruited from a variety of settings, using falls…

  3. Prevention strategies to reduce falls in psychiatric settings.

    PubMed

    Al-Khatib, Yasser; Arnold, Paul; Brautigam, Lois; Chan-Domingo, Letty; Gennello, Barbara; Jaminola, Edgardo; Meehan, Kate; Modrzynski, John; Nicolardi, Carolyn K; Rasi, L J; Stockton, David

    2013-05-01

    A Fall Committee was developed in response to an increase in the rate of falls by patients at a primarily behavioral health, urban teaching hospital in the mid-Atlantic region of the United States. The Fall Committee identified interventions to potentially lessen the number of patient falls and areas where documentation could be improved to better describe an incident in the medical record. The Fall Committee developed paperwork to be completed after each patient fall and made changes to the low fall risk and high fall risk treatment plans. This article describes the recommendations submitted by the Fall Committee and its subsequent implementation. Although not causational, the fall rate decreased after the recommendations of the Fall Committee were implemented; however, a recent rise in the fall rate was noted and attributed to higher patient acuity on the unit. The committee investigation into this issue highlighted the paucity of research in this field and the need for a streamlined, easy-to-use, behavioral health fall scale to more accurately judge the fall risk of patients in this specialized subset. PMID:23557088

  4. Effect of free fall on higher plants.

    NASA Technical Reports Server (NTRS)

    Gordon, S. A.

    1973-01-01

    The influence of exposure to the free-fall state on the orientation, morphogenesis, physiology, and radiation response of higher plants is briefly summarized. It is proposed that the duration of the space-flight experiments has been to brief to permit meaningful effects of free fall on general biochemistry, growth, and development to appear. However, two types of significant effect did occur. The first is on differential growth - i.e., tropism and epinasty - resulting from the absence of a normal geostimulus. For these phenomena it is suggested that ground-based experiments with the clinostat would suffice to mimic the effect of the free-fall state. The second is an apparent interaction between the radiation response and some flight condition, yielding an enhanced microspore abortion, a disturbed spindle function, and a stunting of stamen hairs. It is suggested that this apparent interaction may be derived from a shift in the rhythm of the cell cycle, induced by the free fall.

  5. Preventing Falls | NIH MedlinePlus the Magazine

    MedlinePLUS

    ... But many cannot and need long-term care. Fear of Falling Fear of falling becomes more common with age, even ... and restore your walking confidence. Getting over your fear can help you to stay active, maintain your ...

  6. Educators’ perspectives about how older hospital patients can engage in a falls prevention education programme: a qualitative process evaluation

    PubMed Central

    Hill, Anne-Marie; McPhail, Steven M; Francis-Coad, Jacqueline; Waldron, Nicholas; Etherton-Beer, Christopher; Flicker, Leon; Ingram, Katharine; Haines, Terry P

    2015-01-01

    Objectives Falls are the most frequent adverse event reported in hospitals. Patient and staff education delivered by trained educators significantly reduced falls and injurious falls in an older rehabilitation population. The purpose of the study was to explore the educators’ perspectives of delivering the education and to conceptualise how the programme worked to prevent falls among older patients who received the education. Design A qualitative exploratory study. Methods Data were gathered from three sources: conducting a focus group and an interview (n=10 educators), written educator notes and reflective researcher field notes based on interactions with the educators during the primary study. The educators delivered the programme on eight rehabilitation wards for periods of between 10 and 40 weeks. They provided older patients with individualised education to engage in falls prevention and provided staff with education to support patient actions. Data were thematically analysed and presented using a conceptual framework. Results Falls prevention education led to mutual understanding between staff and patients which assisted patients to engage in falls prevention behaviours. Mutual understanding was derived from the following observations: the educators perceived that they could facilitate an effective three-way interaction between staff actions, patient actions and the ward environment which led to behaviour change on the wards. This included engaging with staff and patients, and assisting them to reconcile differing perspectives about falls prevention behaviours. Conclusions Individualised falls prevention education effectively provides patients who receive it with the capability and motivation to develop and undertake behavioural strategies that reduce their falls, if supported by staff and the ward environment. PMID:26656027

  7. ICT-based system to predict and prevent falls (iStoppFalls): study protocol for an international multicenter randomized controlled trial

    PubMed Central

    2014-01-01

    Background Falls are very common, especially in adults aged 65 years and older. Within the current international European Commission’s Seventh Framework Program (FP7) project ‘iStoppFalls’ an Information and Communication Technology (ICT) based system has been developed to regularly assess a person’s risk of falling in their own home and to deliver an individual and tailored home-based exercise and education program for fall prevention. The primary aims of iStoppFalls are to assess the feasibility and acceptability of the intervention program, and its effectiveness to improve balance, muscle strength and quality of life in older people. Methods/Design This international, multicenter study is designed as a single-blinded, two-group randomized controlled trial. A total of 160 community-dwelling older people aged 65 years and older will be recruited in Germany (n = 60), Spain (n = 40), and Australia (n = 60) between November 2013 and May 2014. Participants in the intervention group will conduct a 16-week exercise program using the iStoppFalls system through their television set at home. Participants are encouraged to exercise for a total duration of 180 minutes per week. The training program consists of a variety of balance and strength exercises in the form of video games using exergame technology. Educational material about a healthy lifestyle will be provided to each participant. Final reassessments will be conducted after 16 weeks. The assessments include physical and cognitive tests as well as questionnaires assessing health, fear of falling, quality of life and psychosocial determinants. Falls will be followed up for six months by monthly falls calendars. Discussion We hypothesize that the regular use of this newly developed ICT-based system for fall prevention at home is feasible for older people. By using the iStoppFalls sensor-based exercise program, older people are expected to improve in balance and strength outcomes. In addition, the exercise training may have a positive impact on quality of life by reducing the risk of falls. Taken together with expected cognitive improvements, the individual approach of the iStoppFalls program may provide an effective model for fall prevention in older people who prefer to exercise at home. Trial registration Australian New Zealand Clinical Trials Registry Trial ID: ACTRN12614000096651. International Standard Randomised Controlled Trial Number: ISRCTN15932647. PMID:25141850

  8. Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study)

    PubMed Central

    Pahor, Marco; Guralnik, Jack M; McDermott, Mary M; King, Abby C; Buford, Thomas W; Strotmeyer, Elsa S; Nelson, Miriam E; Sink, Kaycee M; Demons, Jamehl L; Kashaf, Susan S; Walkup, Michael P; Miller, Michael E

    2016-01-01

    Objective To test whether a long term, structured physical activity program compared with a health education program reduces the risk of serious fall injuries among sedentary older people with functional limitations. Design Multicenter, single blinded randomized trial (Lifestyle Interventions and Independence for Elders (LIFE) study). Setting Eight centers across the United States, February 2010 to December 2011. Participants 1635 sedentary adults aged 70-89 years with functional limitations, defined as a short physical performance battery score ≀9, but who were able to walk 400 m. Interventions A permuted block algorithm stratified by field center and sex was used to allocate interventions. Participants were randomized to a structured, moderate intensity physical activity program (n=818) conducted in a center (twice a week) and at home (3-4 times a week) that included aerobic, strength, flexibility, and balance training activities, or to a health education program (n=817) consisting of workshops on topics relevant to older people and upper extremity stretching exercises. Main outcome measures Serious fall injuries, defined as a fall that resulted in a clinical, non-vertebral fracture or that led to a hospital admission for another serious injury, was a prespecified secondary outcome in the LIFE Study. Outcomes were assessed every six months for up to 42 months by staff masked to intervention assignment. All participants were included in the analysis. Results Over a median follow-up of 2.6 years, a serious fall injury was experienced by 75 (9.2%) participants in the physical activity group and 84 (10.3%) in the health education group (hazard ratio 0.90, 95% confidence interval 0.66 to 1.23; P=0.52). These results were consistent across several subgroups, including sex. However, in analyses that were not prespecified, sex specific differences were observed for rates of all serious fall injuries (rate ratio 0.54, 95% confidence interval 0.31 to 0.95 in men; 1.07, 0.75 to 1.53 in women; P=0.043 for interaction), fall related fractures (0.47, 0.25 to 0.86 in men; 1.12, 0.77 to 1.64 in women; P=0.017 for interaction), and fall related hospital admissions (0.41, 0.19 to 0.89 in men; 1.10, 0.65 to 1.88 in women; P=0.039 for interaction). Conclusions In this trial, which was underpowered to detect small, but possibly important reductions in serious fall injuries, a structured physical activity program compared with a health education program did not reduce the risk of serious fall injuries among sedentary older people with functional limitations. These null results were accompanied by suggestive evidence that the physical activity program may reduce the rate of fall related fractures and hospital admissions in men. Trial registration ClinicalsTrials.gov NCT01072500. PMID:26842425

  9. Implementation of a home-based interactive training system for fall prevention: requirements and challenges.

    PubMed

    Kiselev, Jörn; Haesner, Marten; Gövercin, Mehmet; Steinhagen-Thiessen, Elisabeth

    2015-01-01

    A critical need exists for rehabilitation for improving older adults' physical abilities, especially in the field of fall prevention. Although virtual reality and ambient-assistive technology-based approaches are promising, they are cost intensive and frequently face significant obstacles during the developmental process. The authors of the current article developed a motivational interactive training system for fall prevention and stroke rehabilitation and planned a pilot study to measure its usability, user acceptance, and effect on physical abilities and quality of life. Usability results from a field trial are presented. The purpose of the current article is to describe the technological and organizational problems during the development process and field trial. Recommendations for overcoming these barriers are described. These experiences should be taken into account when planning further field trials with assistive technology and older adults. PMID:25486114

  10. What factors influence community-dwelling older people’s intent to undertake multifactorial fall prevention programs?

    PubMed Central

    Hill, Keith D; Day, Lesley; Haines, Terry P

    2014-01-01

    Purpose To investigate previous, current, or planned participation in, and perceptions toward, multifactorial fall prevention programs such as those delivered through a falls clinic in the community setting, and to identify factors influencing older people’s intent to undertake these interventions. Design and methods Community-dwelling people aged >70 years completed a telephone survey. Participants were randomly selected from an electronic residential telephone listing, but purposeful sampling was used to include equal numbers with and without common chronic health conditions associated with fall-related hospitalization. The survey included scenarios for fall prevention interventions, including assessment/multifactorial interventions, such as those delivered through a falls clinic. Participants were asked about previous exposure to, or intent to participate in, the interventions. A path model analysis was used to identify factors associated with intent to participate in assessment/multifactorial interventions. Results Thirty of 376 participants (8.0%) reported exposure to a multifactorial falls clinic-type intervention in the past 5 years, and 16.0% expressed intention to undertake this intervention. Of the 132 participants who reported one or more falls in the past 12 months, over one-third were undecided or disagreed that a falls clinic type of intervention would be of benefit to them. Four elements from the theoretical model positively influenced intention to participate in the intervention: personal perception of intervention effectiveness, self-perceived risk of falls, self-perceived risk of injury, and inability to walk up/down steps without a handrail (P<0.05). Conclusion Multifactorial falls clinic-type interventions are not commonly accessed or considered as intended fall prevention approaches among community-dwelling older people, even among those with falls in the past 12 months. Factors identified as influencing intention to undertake these interventions may be useful in promoting or targeting these interventions. PMID:25473276

  11. Falling towards Forgetfulness: Synaptic Decay Prevents Spontaneous Recovery of Memory

    PubMed Central

    Stone, James V.; Jupp, Peter E.

    2008-01-01

    Long after a new language has been learned and forgotten, relearning a few words seems to trigger the recall of other words. This “free-lunch learning” (FLL) effect has been demonstrated both in humans and in neural network models. Specifically, previous work proved that linear networks that learn a set of associations, then partially forget them all, and finally relearn some of the associations, show improved performance on the remaining (i.e., nonrelearned) associations. Here, we prove that relearning forgotten associations decreases performance on nonrelearned associations; an effect we call negative free-lunch learning. The difference between free-lunch learning and the negative free-lunch learning presented here is due to the particular method used to induce forgetting. Specifically, if forgetting is induced by isotropic drifting of weight vectors (i.e., by adding isotropic noise), then free-lunch learning is observed. However, as proved here, if forgetting is induced by weight values that simply decay or fall towards zero, then negative free-lunch learning is observed. From a biological perspective, and assuming that nervous systems are analogous to the networks used here, this suggests that evolution may have selected physiological mechanisms that involve forgetting using a form of synaptic drift rather than synaptic decay, because synaptic drift, but not synaptic decay, yields free-lunch learning. PMID:18725945

  12. [Current evidence based interventions for preventing fall and fall-related hip fracture of the older people].

    PubMed

    Kanzaki, Hideto; Ikezoe, Tome; Nagase, Tokiko

    2014-10-01

    For older people, the consequences of falling include injury, fear of falling, decreased activity, functional deterioration, reduced quality of life, and death. According to reliable systematic reviews and guidelines, exercise programs including balance and strength training, multifactorial interventions, and home safety assessment and modification interventions are effective at reducing the rates of falls and risks of falling among community-dwelling elderly people. Taking vitamin D supplements might be effective for reducing falls in older people who exhibit lower vitamin D levels in the blood. Hip protectors apparently reduce the risk of hip fractures in frail older residents of care facilities. Taking vitamin D with calcium supplements might reduce the risk of hip fractures. PMID:25509810

  13. Factors influencing the implementation of fall-prevention programmes: a systematic review and synthesis of qualitative studies

    PubMed Central

    2012-01-01

    Background More than a third of people over the age of 65?years fall each year. Falling can lead to a reduction in quality of life, mortality, and a risk of prolonged hospitalisation. Reducing and preventing falls has become an international health priority. To help understand why research evidence has often not been translated into changes in clinical practice, we undertook a systematic review and synthesis of qualitative research in order to identify what factors serve as barriers and facilitators to the successful implementation of fall-prevention programmes. Methods We conducted a review of literature published between 1980 and January 2012 for qualitative research studies that examined barriers and facilitators to the effective implementation of fall-prevention interventions among community-dwelling older people and healthcare professionals. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality according to predefined criteria. Findings were synthesised using meta-ethnography. Results Of the 5010 articles identified through database searching, 19 were included in the review. Analysis of the 19 studies revealed limited information about the mechanisms by which barriers to implementation of fall-prevention interventions had been overcome. Data synthesis produced three overarching concepts: (1) practical considerations, (2) adapting for community, and (3) psychosocial. A line of argument synthesis describes the barriers and facilitators to the successful implementation of fall-prevention programmes. These concepts show that the implementation of fall-prevention programmes is complex and multifactorial. This is the first systematic review and synthesis of qualitative studies to examine factors influencing the implementation of fall-prevention programmes from the perspectives of both the healthcare professional and the community-dwelling older person. Conclusions The current literature on barriers and facilitators to the implementation of fall-prevention programmes examines a variety of interventions. However, the ways in which the interventions are reported suggests there are substantial methodological challenges that often inhibit implementation into practice. We recommend that successful implementation requires individuals, professionals, and organisations to modify established behaviours, thoughts, and practice. The issues identified through this synthesis need to be fully considered and addressed if fall-prevention programmes are to be successfully implemented into clinical practice. PMID:22978693

  14. Falls among hemodialysis patients: potential opportunities for prevention?

    PubMed Central

    Kutner, Nancy G.; Zhang, Rebecca; Huang, Yijian; Wasse, Haimanot

    2014-01-01

    Background Falls among patients undergoing maintenance hemodialysis (HD) have significant consequences for quality of life and functional independence, morbidity, healthcare utilization and even mortality, but studies on the etiology of falls within large HD cohorts are limited. Methods Falls during the past 12 months were ascertained for a prevalent multi-center HD cohort (n = 762) aged 20–92 years, and associations with demographic and treatment characteristics, comorbidities, cognitive function, prescribed medications, balance tests, frailty and depressive symptoms were assessed. Results Falls were sustained by 28.4% of participants. In multivariable-adjusted analyses, participants classified as frail were over two times more likely to report falls [odds ratio (OR): 2.39, 95% confidence interval (CI): 1.22–4.71, P = 0.01], and participants with a CES-D score 18+ and/or prescribed antidepressants were over 80% more likely to be fallers (OR: 1.83, 95% CI: 1.23–2.74, P = 0.003) than were participants with a CES-D score <18 and no prescribed antidepressants. Conclusions Frailty and depressed mood, factors that are potentially modifiable, are prominently associated with falls. PMID:25852886

  15. Vibration Therapy to Prevent Bone Loss and Falls: Mechanisms and Efficacy.

    PubMed

    Beck, Belinda R

    2015-12-01

    A considerable volume of evidence has accumulated to suggest that whole-body vibration (WBV) may have a therapeutic role to play in the prevention of osteoporotic fracture, particularly for individuals who are unable to tolerate vigorous exercise interventions. There is moderate to strong evidence that WBV will prevent falls (likely due to enhanced neuromuscular function), but also some indication that the effects of WBV do not outstrip those of targeted exercise. Animal data indicates that WBV will also improve bone mass, including preventing loss due to hormone withdrawal, disuse and glucocorticoid exposure. Human trials, however, have produced equivocal outcomes for bone. Positive trends are apparent at the hip and spine, but shortcomings in study designs have limited statistical power. The mechanism of the vibration effect on bone tissue is likely to be mechanical coupling between an oscillating cell nucleus and the cytoskeleton. More robust dose-response human data are required before therapeutic guidelines can be developed. PMID:26456496

  16. The role of podiatry in the prevention of falls in older people: a JAPMA special issue.

    PubMed

    Najafi, Bijan; de Bruin, Eling D; Reeves, Neil D; Armstrong, David G; Menz, Hylton B

    2013-01-01

    Given the age-related decline in foot strength and flexibility, and the emerging evidence that foot problems increase the risk of falls, established guidelines for falls prevention recommend that older adults have their feet examined by a podiatrist as a precautionary measure. However, these guidelines do not specify which intervention activities might be performed. Published in this special issue of JAPMA are nine high-quality articles, including seven original studies and two basic science reviews, focusing on the benefit and impact of footwear and foot and ankle interventions in reducing the risk of falling. The selected studies discuss various relevant questions related to podiatric intervention, including adherence to intervention; preference and perception of older adults in selecting footwear; benefit of insoles, footwear, and nonslip socks in preventing falls; fear of falling related to foot problems; benefit of podiatric surgical intervention; and benefit of foot and ankle exercise in preventing falls. PMID:24297980

  17. Falls risk factors: assessment and management to prevent falls and fractures.

    PubMed

    Martin, Finbarr C

    2011-03-01

    Falls and fragility fractures are common, dangerous, and important public health challenges. They are best understood as geriatric syndromes with close relation to frailty and other aging-related health problems. They are associated with many risk factors, in all health domains - physical, psychological, social, and environmental. At a population level, the challenge is to improve the health and well-being of all older people to reduce the incidence of falls. At a clinical level, the challenge is to assess the individual risk factors and apply evidence-based individually tailored, multifactorial interventions. The most powerful component is strength-and-balance exercise training. PMID:24650637

  18. Implementing an Evidence-Based Fall Prevention Program in an Outpatient Clinical Setting

    PubMed Central

    Li, Fuzhong; Harmer, Peter; Stock, Ronald; Fitzgerald, Kathleen; Stevens, Judy; Gladieux, Michele; Chou, Li-Shan; Carp, Kenji; Voit, Jan

    2015-01-01

    Objectives Few evidence-based fall prevention programs have been evaluated for adoption in clinical settings. This study investigated the dissemination potential of a Tai Ji Quan-based program, previously shown efficacious for reducing risk of falls in older adults, through outpatient clinical settings. Design A single-group pre-post design in which participants attended a twice weekly Tai Ji Quan training program for 24 weeks. Setting Communities in Lane County, Oregon. Participants Referral patients (N = 379) aged 65 and older living independently. Measurements Using the RE-AIM framework, the primary outcome was the proportion of participating healthcare providers who made referrals. Secondary outcomes were the proportion of referred patients agreeing to participate and enrolling in the program, and measures of program implementation, maintenance, and effectiveness (on measures of falls, balance, gait, physical performance, and balance efficacy). Results Of the 252 providers invited to participate, 157 made referrals (62% adoption rate). Of 564 patients referred, 379 (67% reach) enrolled in the program, which was successfully implemented in senior/community centers with good fidelity. Of the total number of participants, 283 completed the program (75% retention) and 212 of these attended ?75% of the total (48) sessions. Participants reported a reduction in falls with an incidence rate of 0.13 falls per person-month and showed significant improvement from baseline in all outcome measures. A 3-month post-intervention follow-up indicated encouraging levels of program maintenance among providers, patients, and community centers. Conclusion A protocol to refer patients at increased risk of falling to a Tai Ji Quan-based program was successfully implemented among healthcare providers. The evidence-based program appears readily scalable and exportable with potential for substantial clinical and public health impact. PMID:24164465

  19. Does a fall prevention educational programme improve knowledge and change exercise prescribing behaviour in health and exercise professionals? A study protocol for a randomised controlled trial

    PubMed Central

    Tiedemann, A; Sturnieks, D L; Hill, A-M; Lovitt, L; Clemson, L; Lord, S R; Harvey, L; Sherrington, C

    2014-01-01

    Introduction Falling in older age is a serious and costly problem. At least one in three older people fall annually. Although exercise is recognised as an effective fall prevention intervention, low numbers of older people engage in suitable programmes. Health and exercise professionals play a crucial role in addressing fall risk in older adults. This trial aims to evaluate the effect of participation in a fall prevention educational programme, compared with a wait-list control group, on health and exercise professionals’ knowledge about fall prevention and the effect on fall prevention exercise prescription behaviour and confidence to prescribe the exercises to older people. Methods and analysis A randomised controlled trial involving 220 consenting health and exercise professionals will be conducted. Participants will be individually randomised to an intervention group (n=110) to receive an educational workshop plus access to internet-based support resources, or a wait-list control group (n=110). The two primary outcomes, measured 3?months after randomisation, are: (1) knowledge about fall prevention and (2) self-perceived change in fall prevention exercise prescription behaviour. Secondary outcomes include: (1) participants’ confidence to prescribe fall prevention exercises; (2) the proportion of people aged 60+ years seen by trial participants in the past month who were prescribed fall prevention exercise; and (3) the proportion of fall prevention exercises prescribed by participants to older people in the past month that comply with evidence-based guidelines. Outcomes will be measured with a self-report questionnaire designed specifically for the trial. Ethics and dissemination The trial protocol was approved by the Human Research Ethics Committee, The University of Sydney, Australia. Trial results will be disseminated via peer reviewed journals, presentations at international conferences and participants’ newsletters. Trial registration number Trial protocol was registered with the Australian and New Zealand Clinical Trials Registry (Number ACTRN12614000224628) on 3 March 2014. PMID:25410607

  20. Smartphone-Based Solutions for Fall Detection and Prevention: Challenges and Open Issues

    PubMed Central

    Habib, Mohammad Ashfak; Mohktar, Mas S.; Kamaruzzaman, Shahrul Bahyah; Lim, Kheng Seang; Pin, Tan Maw; Ibrahim, Fatimah

    2014-01-01

    This paper presents a state-of-the-art survey of smartphone (SP)-based solutions for fall detection and prevention. Falls are considered as major health hazards for both the elderly and people with neurodegenerative diseases. To mitigate the adverse consequences of falling, a great deal of research has been conducted, mainly focused on two different approaches, namely, fall detection and fall prevention. Required hardware for both fall detection and prevention are also available in SPs. Consequently, researchers' interest in finding SP-based solutions has increased dramatically over recent years. To the best of our knowledge, there has been no published review on SP-based fall detection and prevention. Thus in this paper, we present the taxonomy for SP-based fall detection and prevention solutions and systematic comparisons of existing studies. We have also identified three challenges and three open issues for future research, after reviewing the existing articles. Our time series analysis demonstrates a trend towards the integration of external sensing units with SPs for improvement in usability of the systems. PMID:24759116

  1. Design, delivery, and outcomes from an interprofessional fall prevention course.

    PubMed

    Dauenhauer, Jason A; Glose, Susan; Watt, Celia

    2015-01-01

    This article describes the development, delivery, and outcomes from an interprofessional evidence-based falls management course for undergraduate and graduate students. The 3-credit elective course was developed by a gerontological social work and nursing faculty member in partnership with community-based housing and case management organizations. Creation of the course was in response to a mandate by the Health Resources and Services Administration, funding source for federal Geriatric Education Centers, to train interprofessional students using an evidence-based approach while tying the outcomes to improved health measures in the target population. Therefore, this article describes student competencies pre- and postcourse completion and outcomes of community-dwelling older adults completing a Matter of Balance (MOB) program delivered by these students. A total of 16 students completed the course which included delivery of the MOB program to 41 older adults. Results indicate statistically significant improvements in student outcomes from a pre/post falls knowledge test. For older adult participants, many screened positively for fall risk factors pre-post MOB participation showed statistically significant improvements in falls efficacy, control, management, and overall mobility. Opportunities and challenges associated with course delivery are also described. PMID:25941927

  2. Identifying clusters of falls-related hospital admissions to inform population targets for prioritising falls prevention programmes

    PubMed Central

    Finch, Caroline F; Stephan, Karen; Shee, Anna Wong; Hill, Keith; Haines, Terry P; Clemson, Lindy; Day, Lesley

    2015-01-01

    Background There has been limited research investigating the relationship between injurious falls and hospital resource use. The aims of this study were to identify clusters of community-dwelling older people in the general population who are at increased risk of being admitted to hospital following a fall and how those clusters differed in their use of hospital resources. Methods Analysis of routinely collected hospital admissions data relating to 45?374 fall-related admissions in Victorian community-dwelling older adults aged ?65?years that occurred during 2008/2009 to 2010/2011. Fall-related admission episodes were identified based on being admitted from a private residence to hospital with a principal diagnosis of injury (International Classification of Diseases (ICD)-10-AM codes S00 to T75) and having a first external cause of a fall (ICD-10-AM codes W00 to W19). A cluster analysis was performed to identify homogeneous groups using demographic details of patients and information on the presence of comorbidities. Hospital length of stay (LOS) was compared across clusters using competing risks regression. Results Clusters based on area of residence, demographic factors (age, gender, marital status, country of birth) and the presence of comorbidities were identified. Clusters representing hospitalised fallers with comorbidities were associated with longer LOS compared with other cluster groups. Clusters delineated by demographic factors were also associated with increased LOS. Conclusions All patients with comorbidity, and older women without comorbidities, stay in hospital longer following a fall and hence consume a disproportionate share of hospital resources. These findings have important implications for the targeting of falls prevention interventions for community-dwelling older people. PMID:25618735

  3. Protecting Patient Safety: Can Video Monitoring Prevent Falls in High-Risk Patient Populations?

    PubMed

    Sand-Jecklin, Kari; Johnson, Jennifer Ray; Tylka, Sharon

    2016-01-01

    Despite implementation of many prevention strategies, patient falls in hospitals continue to be a significant safety problem, causing nursing staff and administrators to seek innovative means to further reduce falls among hospitalized patients. This article describes the feasibility and impact of implementing centralized video monitoring on the safety of patients identified as high risk for falls, as well as implications of video monitoring in the acute care setting. PMID:26513398

  4. In response to Dr. Jose AP da Silva: fall prevention with vitamin D clarifications needed

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We agree with Dr. da Silva, and wish to clarify three issues raised by the recent IOM report concerning our 2009 meta-analysis on vitamin D and fall prevention. 1. The IOM questioned the inclusion of Broe et al., which did not pre-specify falls as a primary or secondary outcome. While this did viol...

  5. Steady As You Go (SAYGO): A Falls-Prevention Program for Seniors Living in the Community.

    ERIC Educational Resources Information Center

    Robson, Ellie; Edwards, Joy; Gallagher, Elaine; Baker, Dorothy

    2003-01-01

    In a randomized trial of Steady as You Go, a falls-prevention program for the elderly, the treatment group (n=235) reduced eight of nine risk factors. Over a 4-month follow-up, the treatment group fell less than controls (n=236) and significantly fewer treatment group participants who had fallen before experienced falls (20%) compared to 35% of…

  6. Obstacle Course Training Can Improve Mobility and Prevent Falls in People with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Van Hanegem, E.; Enkelaar, L.; Smulders, E.; Weerdesteyn, V.

    2014-01-01

    Background: Persons with intellectual disabilities (ID) constitute a special-needs population at high risk of falling. This is the first study to evaluate whether obstacle course training can improve mobility and prevent falls in this population. Methods: The intervention was implemented as part of an institution-wide health care improvement plan…

  7. Clinical Decision Support for Nurses: A Fall Risk and Prevention Example.

    PubMed

    Lytle, Kathryn S; Short, Nancy M; Richesson, Rachel L; Horvath, Monica M

    2015-12-01

    Clinical decision support tools in electronic health records have demonstrated improvement with process measures and clinician performance, predominantly for providers. Clinical decision support tools could improve patient fall risk identification and prevention plans, a common concern for nursing. This quality-improvement project used clinical decision support to improve the rate of nurse compliance with documented fall risk assessments and, for patients at high risk, fall prevention plans of care in 16 adult inpatient units. Preintervention and postintervention data were compared using quarterly audits, retrospective chart review, safety reports, and falls and falls-with-injury rates. Documentation of fall risk assessments on the 16 units improved significantly according to quarterly audit data (P = .05), whereas documentation of the plans of care did not. Retrospective chart review on two units indicated improvement for admission fall risk assessment (P = .05) and a decrease in the documentation of the shift plan of care (P = .01); one unit had a statistically significant decrease in documentation of plans of care on admission (P = .00). Examination of safety reports for patients who fell showed all patients before and after clinical decision support had fall risk assessments documented. Falls and falls with injury did not change significantly before and after clinical decision support intervention. PMID:26571334

  8. Heterogeneity of Falls Among Older Adults: Implications for Public Health Prevention

    PubMed Central

    Kelsey, Jennifer L.; Procter-Gray, Elizabeth; Hannan, Marian T.

    2012-01-01

    Objectives. We examined risk factors for falls among older people according to indoor and outdoor activity at the time of the fall and explored risk factors for seriously injurious falls. Methods. Data came from MOBILIZE Boston, a prospective cohort study of 765 community-dwelling women and men, mainly aged 70 years or older. Over 4.3 years, 1737 falls were recorded, along with indoor or outdoor activity at the time of the fall. Results. Participants with poor baseline health characteristics had elevated rates of indoor falls while transitioning, walking, or not moving. Healthy, active people had elevated rates of outdoor falls during walking and vigorous activity. For instance, participants with fast, rather than normal, gait speed, had a rate ratio of 7.36 (95% confidence interval [CI] = 2.54, 21.28) for outdoor falls during vigorous activity. The likelihood of a seriously injurious fall also varied by personal characteristics, activity, and location. For example, the odds ratio for serious injury from an outdoor fall while walking outside compared to inside a participant’s neighborhood was 3.31 (95% CI = 1.33, 8.23). Conclusions. Fall prevention programs should be tailored to personal characteristics, activities, and locations. PMID:22994167

  9. Targeting a High-Risk Group for Fall Prevention: Strategies for Health Plans

    PubMed Central

    Jennings, Lee A.; Reuben, David B.; Kim, Sung-Bou; Keeler, Emmett; Roth, Carol P.; Zingmond, David S.; Wenger, Neil S.; Ganz, David A.

    2015-01-01

    Objectives Although Medicare has implemented incentives for health plans to reduce fall risk, the best way to identify older people at high risk of falling and to use screening results to target fall prevention services remains unknown. We evaluated 4 different strategies using a combination of administrative data and patient-reported information that health plans could easily obtain. Study Design Observational study. Methods We used data from 1776 patients 75 years or older in 4 community-based primary care practices who screened positive for a fear of falling and/or a history of falls. For these patients, we predicted fall-related injuries in the 24 months after the date of screening using claims/encounter data. After controlling for age and gender, we predicted the number of fall-related injuries by adding Elixhauser comorbidity count, any claim for a fall-related injury during the 12 months prior to screening, and falls screening question responses in a sequential fashion using negative binomial regression models. Results Basic patient characteristics, including age and Elixhauser comorbidity count, were strong predictors of fall-related injury. Among falls screening questions, a positive response to, “Have you fallen 2 or more times in the past year?” was the most predictive of a fall-related injury (incidence rate ratio [IRR], 1.56; 95% CI, 1.25–1.94). Prior claim for a fall-related injury also independently predicted this type of injury (IRR, 1.41; 95% CI, 1.05–1.89). The best model for predicting fall-related injuries combined all of these approaches. Conclusions The combination of administrative data and a simple screening item can be used by health plans to target patients at high risk for future fall-related injuries. PMID:26618439

  10. Drawing on Related Knowledge to Advance Multiple Sclerosis Falls-Prevention Research

    PubMed Central

    Deshpande, Nandini; Latimer-Cheung, Amy E.; Finlayson, Marcia

    2014-01-01

    There is much to be learned from falls-related research outside the field of multiple sclerosis (MS), as well as from work within the MS field but not specific to falls or falls prevention. This article describes three examples of such bodies of work that have potential to broaden approaches to falls-prevention research: 1) sensory components of postural control among older adults, 2) lessons learned from physical activity promotion among people with spinal cord injury (SCI), and 3) aging among people with MS. Age-related deterioration in visual, vestibular, and somatosensory systems or in sensory integration can adversely affect postural control and can contribute to falls in older people. Sensory-specific interventions designed for improving balance in older people could be adapted for preventing falls in individuals with MS. Spinal Cord Injury (SCI) Action Canada's strategy for disseminating physical activity promotion interventions for adults with SCI has been successful and widely accepted by community partners. Many of the peer-based interventions developed by SCI Action Canada are potentially relevant and could be adapted to the MS population for both physical activity promotion and falls prevention. Considering that older people with MS constitute a growing proportion of the MS population and over 70% of older people with MS report moderate to extreme balance problems, falls prevention should be one of the key components, particularly for MS management in older or more disabled groups. Overall, given people's different ages, symptoms, strengths, and barriers, a tailored MS falls-prevention intervention that includes peer/caregiver support is critical. PMID:25694774

  11. Drawing on related knowledge to advance multiple sclerosis falls-prevention research.

    PubMed

    Ploughman, Michelle; Deshpande, Nandini; Latimer-Cheung, Amy E; Finlayson, Marcia

    2014-01-01

    There is much to be learned from falls-related research outside the field of multiple sclerosis (MS), as well as from work within the MS field but not specific to falls or falls prevention. This article describes three examples of such bodies of work that have potential to broaden approaches to falls-prevention research: 1) sensory components of postural control among older adults, 2) lessons learned from physical activity promotion among people with spinal cord injury (SCI), and 3) aging among people with MS. Age-related deterioration in visual, vestibular, and somatosensory systems or in sensory integration can adversely affect postural control and can contribute to falls in older people. Sensory-specific interventions designed for improving balance in older people could be adapted for preventing falls in individuals with MS. Spinal Cord Injury (SCI) Action Canada's strategy for disseminating physical activity promotion interventions for adults with SCI has been successful and widely accepted by community partners. Many of the peer-based interventions developed by SCI Action Canada are potentially relevant and could be adapted to the MS population for both physical activity promotion and falls prevention. Considering that older people with MS constitute a growing proportion of the MS population and over 70% of older people with MS report moderate to extreme balance problems, falls prevention should be one of the key components, particularly for MS management in older or more disabled groups. Overall, given people's different ages, symptoms, strengths, and barriers, a tailored MS falls-prevention intervention that includes peer/caregiver support is critical. PMID:25694774

  12. Beyond Socks, Signs, and Alarms: A Reflective Accountability Model for Fall Prevention.

    PubMed

    Hoke, Linda M; Guarracino, Dana

    2016-01-01

    Despite standard fall precautions, including nonskid socks, signs, alarms, and patient instructions, our 48-bed cardiac intermediate care unit (CICU) had a 41% increase in the rate of falls (from 2.2 to 3.1 per 1,000 patient days) and a 65% increase in the rate of falls with injury (from 0.75 to 1.24 per 1,000 patient days) between fiscal years (FY) 2012 and 2013. An evaluation of the falls data conducted by a cohort of four clinical nurses found that the majority of falls occurred when patients were unassisted by nurses, most often during toileting. Supported by the leadership team, the clinical nurses developed an accountability care program that required nurses to use reflective practice to evaluate each fall, including sending an e-mail to all staff members with both the nurse's and the patient's perspective on the fall, as well as the nurse's reflection on what could have been done to prevent the fall. Other program components were a postfall huddle and guidelines for assisting and remaining with fall risk patients for the duration of their toileting. Placing the accountability for falls with the nurse resulted in decreases in the unit's rates of falls and falls with injury of 55% (from 3.1 to 1.39 per 1,000 patient days) and 72% (from 1.24 to 0.35 per 1,000 patient days), respectively, between FY2013 and FY2014. Prompt call bell response (less than 60 seconds) also contributed to the goal of fall prevention. PMID:26710147

  13. Falls Prevention Education for Older Adults during and after Hospitalization: A Systematic Review and Meta-Analysis

    ERIC Educational Resources Information Center

    Lee, Den-Ching A.; Pritchard, Elizabeth; McDermott, Fiona; Haines, Terry P.

    2014-01-01

    Objectives: To assess the effectiveness of patient education in reducing falls, promoting behavioural change and the uptake of prevention activities in older adults during and after hospitalization. Design: Systematic review and meta-analysis. Methods: A systematic search of five health science databases was performed up to November 2012. Studies…

  14. Falls Prevention Education for Older Adults during and after Hospitalization: A Systematic Review and Meta-Analysis

    ERIC Educational Resources Information Center

    Lee, Den-Ching A.; Pritchard, Elizabeth; McDermott, Fiona; Haines, Terry P.

    2014-01-01

    Objectives: To assess the effectiveness of patient education in reducing falls, promoting behavioural change and the uptake of prevention activities in older adults during and after hospitalization. Design: Systematic review and meta-analysis. Methods: A systematic search of five health science databases was performed up to November 2012. Studies


  15. Falls after Discharge from Hospital: Is There a Gap between Older Peoples' Knowledge about Falls Prevention Strategies and the Research Evidence?

    ERIC Educational Resources Information Center

    Hill, Anne-Marie; Hoffmann, Tammy; Beer, Christopher; McPhail, Steven; Hill, Keith D.; Oliver, David; Brauer, Sandra G.; Haines, Terry P.

    2011-01-01

    Purpose: The aim of this study was to examine whether older people are prepared to engage in appropriate falls prevention strategies after discharge from hospital. Design and Methods: We used a semi-structured interview to survey older patients about to be discharged from hospital and examined their knowledge regarding falls prevention strategies…

  16. Fall-induced spinal cord injury: External causes and implications for prevention.

    PubMed

    Chen, Yuying; Tang, Ying; Allen, Victoria; DeVivo, Michael J

    2016-01-01

    Objective To document the demographic and clinical profile of persons who sustained spinal cord injury (SCI) as a result of accidental falls and to determine the usual circumstances surrounding the fall-induced SCI. Design Cohort study. Setting 21 SCI Model Systems centers throughout the United States. Participants 6,408 individuals with traumatic SCI between 2005 and 2014 were recruited from the National SCI Database. 1,877 (29%) of them were injuries caused by falls. Interventions Not applicable. Outcomes Measures External causes of injury documented by the International Classification of Diseases, 10(th) revision, Clinical Modification (ICD-10-CM). Results Falls on the same level from slipping, tripping, and stumbling were the most common cause of fall-induced SCI (20%), followed by falls from building (16%), stairs and steps (16%), and ladder (9%). People who were 61 years of age and older had the highest frequency of falls on the same level, while those aged 16-45 years had a higher percentage of falls from buildings, usually work-related. The mechanisms of falls also varied by sex and race. Associated injury and vertebral injury occurred frequently among falls from buildings and ladders. High falls were more likely to be work-related and result in thoracic and complete injury, while low falls were more commonly associated with cervical and motor functionally incomplete injury. Conclusion The study findings of different mechanisms of falls by age, sex, race and medical consequences provide an insight for future interventions aimed at high risk persons, activities, and environmental factors for preventing or reducing fall-induced SCI. PMID:25832327

  17. Vitamin D Treatment for the Prevention of Falls in Older Adults: Systematic Review and Meta-Analysis

    PubMed Central

    Kalyani, Rita Rastogi; Stein, Brady; Valiyil, Ritu; Manno, Rebecca; Maynard, Janet W.; Crews, Deidra

    2010-01-01

    Objectives To systematically review and quantitatively synthesize the effect of vitamin D therapy on fall prevention in older adults. Design Systematic review and meta-analysis. Setting MEDLINE, CINAHL,Web of Science, EMBASE, Cochrane Library, LILACS, bibliographies of selected articles, and previous systematic reviews through February 2009 were searched for eligible studies. Participants Older adults (aged ?60 years) who participated in randomized controlled trials that investigated the effectiveness of vitamin D therapy in the prevention of falls and used an explicit fall definition. Measurements Two authors independently extracted data including study characteristics, quality assessment, and outcomes. The I2 statistic was used to assess heterogeneity in a randomeffects model. Results Of 1,679 potentially relevant articles, 10 studies met inclusion criteria. In pooled analysis, vitamin D therapy (200-1000IU) reduced falls by 14% (relative risk [RR] 0.86;95% confidence interval 0.79-0.93;I2=7%) compared to calcium or placebo; number needed to treat=15. The following subgroups had significant fall reductions: community-dwelling (age<80 years), adjunctive calcium supplementation, no history of fractures/falls, duration>6 months, cholecalciferol, and dose?800 IU. Meta-regression demonstrated no linear association of vitamin D dose or duration with treatment effect. Post-hoc analysis, including 7 additional studies (17 total) without explicit fall definitions, yielded smaller benefit (RR 0.92,0.87-0.98) and more heterogeneity (I2=36%) but found significant intergroup differences favoring adjunctive calcium versus none (p=0.001). Conclusion Vitamin D treatment effectively reduces the risk of falls in older adults. Future studies should investigate whether particular populations or treatment regimens may have greater benefit. PMID:20579169

  18. Journey to a safe environment: fall prevention in an emergency department at a level I trauma center.

    PubMed

    Alexander, Danette; Kinsley, Terry L; Waszinski, Christine

    2013-07-01

    Predicting which patients will fall is a challenging task, especially in the often unpredictable setting of an emergency department of a Level I Trauma Center. Unfortunately, there is a great potential for falls to occur in this environment. Fall risk assessment tools used in inpatient settings do not adequately capture the risk factors of patients presenting to the emergency department. The ability to accurately identify patients at risk for falling at the point of entry is the first step toward preventing patient harm. Once patients are identified as at risk for a fall, the next challenge is to be sure that they do not fall. We created the KINDER1 Fall Risk Assessment Tool for use in the emergency department. This instrument was specifically designed for the rapid identification of patients at risk for a fall as well as the re-evaluation of patients for fall risk throughout their stay in the emergency department. Once we had an appropriate assessment tool, our next challenge was for staff to consistently apply fall prevention interventions. Performing a mini-root cause analysis on each fall showed trends and in turn led to the design and implementation of specific fall prevention interventions to motivate the nursing staff to focus on fall prevention that the ED nursing leadership used to select change strategies. With improved identification of fall risk patients and consistent application of innovative prevention strategies, we were able to show a trend toward reduction of falls and fall-related injuries in our emergency department. PMID:23380299

  19. Community Delivery of a Comprehensive Fall-Prevention Program in People with Multiple Sclerosis

    PubMed Central

    Frankel, Debra; Tompkins, Sara A.; Cameron, Michelle

    2016-01-01

    Background: People with multiple sclerosis (MS) fall frequently. In 2011, the National Multiple Sclerosis Society launched a multifactorial fall-prevention group exercise and education program, Free From Falls (FFF), to prevent falls in MS. The objective of this study was to assess the impact of participation in the FFF program on balance, mobility, and falls in people with MS. Methods: This was a retrospective evaluation of assessments from community delivery of FFF. Changes in Activities-specific Balance Confidence scale scores, Berg Balance Scale scores, 8-foot Timed Up and Go performance, and falls were assessed. Results: A total of 134 participants completed the measures at the first and last FFF sessions, and 109 completed a 6-month follow-up assessment. Group mean scores on the Activities-specific Balance Confidence scale (F1,66 = 17.14, P < .05, η2 = 0.21), Berg Balance Scale (F1,68 = 23.39, P < .05, η2 = 0.26), and 8-foot Timed Up and Go (F1,79 = 4.83, P < .05, η2 = 0.06) all improved significantly from the first to the last session. At the 6-month follow-up, fewer falls were reported (χ2 [4, N = 239] = 10.56, P < .05, Phi = 0.21). Conclusions: These observational data suggest that the FFF group education and exercise program improves balance confidence, balance performance, and functional mobility and reduces falls in people with MS. PMID:26917997

  20. Prevention Program Lowered The Risk Of Falls And Decreased Claims For Long-Term Services Among Elder Participants.

    PubMed

    Cohen, Marc A; Miller, Jessica; Shi, Xiaomei; Sandhu, Jasbir; Lipsitz, Lewis A

    2015-06-01

    The LIFT (Living Independently and Falls-free Together) Wellness Program is a multifactorial fall-prevention intervention developed for community-dwelling elders. Its effectiveness was tested in a randomized controlled trial of consenting people who were ages seventy-five and older and who held long-term care insurance policies with one of three major insurers. The study was conducted during 2008-12. In the first year following the intervention, participants in the intervention group had an 11 percent reduction in risk of falling and an 18 percent reduction in risk of injurious falls, compared to participants in the active control group. In the three years after the intervention, participants in the intervention group had a significantly (33 percent) lower incidence of claims for long-term services and supports than those in the administrative control group, for an estimated return of $1.68 on every dollar invested in program delivery. The results of this evaluation are unique in demonstrating that a multifactorial fall prevention program can do more than reduce falls in this population; they suggest that the broader availability of LIFT could benefit long-term care insurers and policyholders alike. PMID:26056202

  1. Recommendations for promoting the engagement of older people in activities to prevent falls

    PubMed Central

    Yardley, L; Beyer, N; Hauer, K; McKee, K; Ballinger, C; Todd, C

    2007-01-01

    Objective To develop recommendations for promoting uptake of and adherence to falls‐prevention interventions among older people. Design The recommendations were initially developed from literature review, clinical experience of the core group members, and substantial qualitative and quantitative studies of older people's views. They were refined through a consultation process with members of the falls‐prevention community, drawing on Delphi survey and nominal group techniques. Transparency was enhanced by recording and reporting aspects of the iterative consultation process such as the degree of consensus and critical comments on drafts of the recommendations. Setting The recommendations were developed and refined at three meetings of the core group, and through internet‐based consultation and two meetings involving members of the wider falls‐prevention community. Participants The authors developed the recommendations incorporating the feedback from the researchers and practitioners responding to a broad‐based internet consultation and consulted in the meetings. Results A high degree of consensus was achieved. Recommendations addressed the need for public education, ensuring that interventions were compatible with a positive identity, tailoring interventions to the specific situation and values of the individual, and using validated methods to maintain longer‐term adherence. Conclusion These recommendations represent a consensus based on current knowledge and evidence, but the evidence base from which these recommendations were developed was limited, and not always specific to prevention of falls. To increase the effectiveness of falls‐prevention interventions, further research is needed to identify the features of falls‐prevention programmes that will encourage older people's engagement in them. PMID:17545352

  2. Vitamin D supplementation to prevent falls in the elderly: evidence and practical considerations.

    PubMed

    Fosnight, Susan M; Zafirau, William J; Hazelett, Susan E

    2008-02-01

    Pharmacists in both ambulatory and institutional settings are often in a position to help optimize the drug regimens of patients who are experiencing falls. Supplementation with vitamin D is an important emerging therapy for the prevention of falls. Numerous investigators have recently studied or reviewed the association between vitamin D supplementation and decreased risk of falls in elderly patients, yet little of this information is available in the pharmacy literature. A MEDLINE search was conducted to collect relevant articles about the role of vitamin D in preventing falls among elderly patients; recently published meta-analyses and randomized controlled trials were identified and reviewed. The studies indicated a statistically significant positive relationship between vitamin D supplementation with either cholecalciferol 700 IU/day or greater or ergocalciferol 800 IU/day or greater and decreased risk of falls. Other practical issues, including who should receive vitamin D replacement, what form of vitamin D should be used, and what dosage is required to prevent falls, are discussed. PMID:18225968

  3. A cluster randomised controlled trial of advice, exercise or multifactorial assessment to prevent falls and fractures in community-dwelling older adults: protocol for the prevention of falls injury trial (PreFIT)

    PubMed Central

    Lall, Ranjit; Withers, Emma J; Finnegan, Susanne; Underwood, Martin; Hulme, Claire; Sheridan, Ray; Skelton, Dawn A; Martin, Finbarr; Lamb, Sarah E

    2016-01-01

    Introduction Falls are the leading cause of accident-related mortality in older adults. Injurious falls are associated with functional decline, disability, healthcare utilisation and significant National Health Service (NHS)-related costs. The evidence base for multifactorial or exercise interventions reducing fractures in the general population is weak. This protocol describes a large-scale UK trial investigating the clinical and cost-effectiveness of alternative falls prevention interventions targeted at community dwelling older adults. Methods and analysis A three-arm, pragmatic, cluster randomised controlled trial, conducted within primary care in England, UK. Sixty-three general practices will be randomised to deliver one of three falls prevention interventions: (1) advice only; (2) advice with exercise; or (3) advice with multifactorial falls prevention (MFFP). We aim to recruit over 9000 community-dwelling adults aged 70 and above. Practices randomised to deliver advice will mail out advice booklets. Practices randomised to deliver ‘active’ interventions, either exercise or MFFP, send all trial participants the advice booklet and a screening survey to identify participants with a history of falling or balance problems. Onward referral to ‘active’ intervention will be based on falls risk determined from balance screen. The primary outcome is peripheral fracture; secondary outcomes include number with at least one fracture, falls, mortality, quality of life and health service resource use at 18 months, captured using self-report and routine healthcare activity data. Ethics and dissemination The study protocol has approval from the National Research Ethics Service (REC reference 10/H0401/36; Protocol V.3.1, 21/May/2013). User groups and patient representatives were consulted to inform trial design. Results will be reported at conferences and in peer-reviewed publications. A patient-friendly summary of trial findings will be published on the prevention of falls injury trial (PreFIT) website. This protocol adheres to the recommended SPIRIT Checklist. Amendments will be reported to relevant regulatory parties. Trial registration number ISRCTN 71002650; Pre-results. PMID:26781504

  4. Internet provision of tailored advice on falls prevention activities for older people: a randomized controlled evaluation.

    PubMed

    Yardley, Lucy; Nyman, Samuel R

    2007-06-01

    Falls are very common in older persons and can result in substantial disability and distress. By undertaking strength and balance training (SBT) exercises, older people can reduce their risk of falling. The Internet offers a potentially cost-effective means of disseminating information about SBT to older people and their carers. A particular advantage of using the Internet for this purpose is that the advice given can be 'tailored' to the needs of the individual. This study used a randomized controlled design to evaluate an interactive web-based program that tailored advice about undertaking SBT activities. The participants were 280 people with an age range of 65-97 years recruited by advertising the website by email and the Internet. Those randomized to the tailored advice were presented with advice tailored to their personal self-rated balance capabilities, health problems and activity preferences. Those in the control group were presented with all the advice from which the tailored advice was selected. After reading the advice, those in the tailored advice group (n = 144) had more positive attitudes (p < 0.01) than those in the control group (n = 136), reporting greater perceived relevance of the SBT activities, greater confidence in the ability to carry them out, and hence stronger intentions to undertake the activities. This study provides an initial indication that an interactive website might offer a cost-effective way to provide personalized advice to some older people. Further research is required to determine whether website-based advice on falls prevention changes behavior as well as intentions and whether the advice needs to be supplemented by other forms of support. PMID:17355994

  5. Falls Prevention within the Australian General Practice Data Model: Methodology, Information Model, and Terminology Issues

    PubMed Central

    Liaw, Siaw-Teng; Sulaiman, Nabil; Pearce, Christopher; Sims, Jane; Hill, Keith; Grain, Heather; Tse, Justin; Ng, Choon-Kiat

    2003-01-01

    The iterative development of the Falls Risk Assessment and Management System (FRAMS) drew upon research evidence and early consumer and clinician input through focus groups, interviews, direct observations, and an online questionnaire. Clinical vignettes were used to validate the clinical model and program logic, input, and output. The information model was developed within the Australian General Practice Data Model (GPDM) framework. The online FRAMS implementation used available Internet (TCP/IP), messaging (HL7, XML), knowledge representation (Arden Syntax), and classification (ICD10-AM, ICPC2) standards. Although it could accommodate most of the falls prevention information elements, the GPDM required extension for prevention and prescribing risk management. Existing classifications could not classify all falls prevention concepts. The lack of explicit rules for terminology and data definitions allowed multiple concept representations across the terminology–architecture interface. Patients were more enthusiastic than clinicians. A usable standards-based online-distributed decision support system for falls prevention can be implemented within the GPDM, but a comprehensive terminology is required. The conceptual interface between terminology and architecture requires standardization, preferably within a reference information model. Developments in electronic decision support must be guided by evidence-based clinical and information models and knowledge ontologies. The safety and quality of knowledge-based decision support systems must be monitored. Further examination of falls and other clinical domains within the GPDM is needed. PMID:12807809

  6. Effects of Aging on the Biomechanics of Slips and Falls

    PubMed Central

    Lockhart, Thurmon E.; Smith, James L.; Woldstad, Jeffrey C.

    2010-01-01

    Although much has been learned in recent decades about the deterioration of muscular strength, gait adaptations, and sensory degradation among older adults, little is known about how these intrinsic changes affect biomechanical parameters associated with slip-induced fall accidents. In general, the objective of this laboratory study was to investigate the process of initiation, detection, and recovery of inadvertent slips and falls. We examined the initiation of and recovery from foot slips among three age groups utilizing biomechanical parameters, muscle strength, and sensory measurements. Forty-two young, middle-age, and older participants walked around a walking track at a comfortable pace. Slippery floor surfaces were placed on the track over force platforms at random intervals without the participants’ awareness. Results indicated that younger participants slipped as often as the older participants, suggesting that the likelihood of slip initiation is similar across all age groups; however, older individuals’ recovery process was much slower and less effective. The ability to successfully recover from a slip (thus preventing a fall) is believed to be affected by lower extremity muscle strength and sensory degradation among older individuals. Results from this research can help pinpoint possible intervention strategies for improving dynamic equilibrium among older adults. PMID:16553061

  7. Formative evaluation of the telecare fall prevention project for older veterans

    PubMed Central

    2011-01-01

    Background Fall prevention interventions for community-dwelling older adults have been found to reduce falls in some research studies. However, wider implementation of fall prevention activities in routine care has yielded mixed results. We implemented a theory-driven program to improve care for falls at our Veterans Affairs healthcare facility. The first project arising from this program used a nurse advice telephone line to identify patients' risk factors for falls and to triage patients to appropriate services. Here we report the formative evaluation of this project. Methods To evaluate the intervention we: 1) interviewed patient and employee stakeholders, 2) reviewed participating patients' electronic health record data and 3) abstracted information from meeting minutes. We describe the implementation process, including whether the project was implemented according to plan; identify barriers and facilitators to implementation; and assess the incremental benefit to the quality of health care for fall prevention received by patients in the project. We also estimate the cost of developing the pilot project. Results The project underwent multiple changes over its life span, including the addition of an option to mail patients educational materials about falls. During the project's lifespan, 113 patients were considered for inclusion and 35 participated. Patient and employee interviews suggested support for the project, but revealed that transportation to medical care was a major barrier in following up on fall risks identified by nurse telephone triage. Medical record review showed that the project enhanced usual medical care with respect to home safety counseling. We discontinued the program after 18 months due to staffing limitations and competing priorities. We estimated a cost of $9194 for meeting time to develop the project. Conclusions The project appeared feasible at its outset but could not be sustained past the first cycle of evaluation due to insufficient resources and a waning of local leadership support due to competing national priorities. Future projects will need both front-level staff commitment and prolonged high-level leadership involvement to thrive. PMID:21605438

  8. Measuring fall program outcomes.

    PubMed

    Quigley, Pat; Neily, Julia; Watson, Mary; Wright, Marilyn; Strobe, Karen

    2007-05-01

    Nurses help to ensure patient safety, which includes preventing falls and fall related injuries. The aging Veteran population, like the general population, is at risk for falls and fall related injuries whether at home, in hospitals or in long term care facilities. Nurses are leading practice innovations to systematically assess patients' risk for falls and implement population based prevention interventions. To determine the effectiveness of programs, data can be analyzed using a variety of statistical measures to determine program impacts. Thus, data analysis of fall rates by type of fall and severity of fall related injury can help facilities examine the effectiveness of their interventions and program outcomes. Examples of actual fall prevention programs and their approaches to measurement are showcased in this article. PMID:21848355

  9. The REFORM study protocol: a cohort randomised controlled trial of a multifaceted podiatry intervention for the prevention of falls in older people

    PubMed Central

    Cockayne, Sarah; Adamson, Joy; Corbacho Martin, Belen; Fairhurst, Caroline; Hewitt, Catherine; Hicks, Kate; Hull, Robin; Keenan, Anne Maree; Lamb, Sarah E; Loughrey, Lorraine; McIntosh, Caroline; Menz, Hylton B; Redmond, Anthony C; Rodgers, Sara; Vernon, Wesley; Watson, Judith; Torgerson, David

    2014-01-01

    Introduction Falls and fall-related injuries are a serious cause of morbidity and cost to society. Foot problems and inappropriate footwear may increase the risk of falls; therefore podiatric interventions may play a role in reducing falls. Two Cochrane systematic reviews identified only one study of a podiatry intervention aimed to reduce falls, which was undertaken in Australia. The REFORM trial aims to evaluate the clinical and cost-effectiveness of a multifaceted podiatry intervention in reducing falls in people aged 65 years and over in a UK and Irish setting. Methods and analysis This multicentre, cohort randomised controlled trial will recruit 2600 participants from routine podiatry clinics in the UK and Ireland to the REFORM cohort. In order to detect a 10% point reduction in falls from 50% to 40%, with 80% power 890 participants will be randomised to receive routine podiatry care and a falls prevention leaflet or routine podiatry care, a falls prevention leaflet and a multifaceted podiatry intervention. The primary outcome is rate of falls (falls/person/time) over 12 months assessed by patient self-report falls diary. Secondary self-report outcome measures include: the proportion of single and multiple fallers and time to first fall over a 12-month period; Short Falls Efficacy Scale—International; fear of falling in the past 4 weeks; Frenchay Activities Index; fracture rate; Geriatric Depression Scale; EuroQoL-five dimensional scale 3-L; health service utilisation at 6 and 12 months. A qualitative study will examine the acceptability of the package of care to participants and podiatrists. Ethics and dissemination The trial has received a favourable opinion from the East of England—Cambridge East Research Ethics Committee and Galway Research Ethics Committee. The trial results will be published in peer-reviewed journals and at conference presentations. Trial registration number Current Controlled Trials ISRCTN68240461assigned 01/07/2011. PMID:25518875

  10. Vision and Relevant Risk Factor Interventions for Preventing Falls among Older People: A Network Meta-analysis

    PubMed Central

    Zhang, Xin-Yi; Shuai, Jian; Li, Li-Ping

    2015-01-01

    Our study objective was to determine the effect of vision intervention and combinations of different intervention components on preventing falls and fall-related injuries among older people. Six electronic databases were searched to identify seven articles published before May, 2014. We conducted a systematic review of data from seven randomized controlled trails and identified eight regimens: vision intervention alone (V), vision plus exercise (referred to as physical exercise) interventions (V + E), vision plus home hazard interventions (V + HH), vision plus exercise plus home hazard interventions (V + E + HH), vision plus exercise plus sensation interventions (V + E + S), vision plus hearing interventions (V + H), vision plus various risk factor assessment and interventions (V + VRF), and the control group (C, no intervention group). The main outcome was the incidence of falls during the follow-up period. Seven papers included 2723 participants. Network meta-analysis of seven trials, using pairwise comparisons between each intervention, indicated there was no significant difference. However, there was a trend in which intervention incorporating V + VRF had more advantages than any other combination of interventions. In conclusion, V + VRF proves to be more effective than other V combination interventions in preventing falls in older people (≄65 years of age). V alone appears less effective in our network meta-analysis. PMID:26020415

  11. Development of a Fall Prevention Survey to Determine Educational Needs for Primary Care Providers

    ERIC Educational Resources Information Center

    Kramer, B. Josea; Ganz, David A.; Vivrette, Rebecca L.; Harker, Judith O.; Josephson, Karen R.; Saliba, Debra

    2010-01-01

    Quality indicators are standardized measures of health care quality. We designed a survey to assess how knowledge, attitude, and organizational practices might affect healthcare provider behaviors in meeting quality indicators for fall prevention to plan curricula for a continuing educational intervention. The survey was pilot tested in the…

  12. Psychosocial Issues in Engaging Older People with Physical Activity Interventions for the Prevention of Falls

    ERIC Educational Resources Information Center

    Nyman, Samuel R.

    2011-01-01

    This article presents an overview of the psychosocial factors that influence older people's participation in physical activity interventions to prevent falls. The importance of psychosocial factors is stressed inasmuch as interventions will be rendered useless if they do not successfully gain the active participation of older people. The theory of…

  13. Implementing a Community-Based Falls-Prevention Program: From Drawing Board to Reality

    ERIC Educational Resources Information Center

    Filiatrault, Johanne; Parisien, Manon; Laforest, Sophie; Genest, Carole; Gauvin, Lise; Fournier, Michel; Trickey, Francine; Robitaille, Yvonne

    2007-01-01

    Several studies have demonstrated the efficacy of falls-prevention programs designed for community-dwelling seniors using randomized designs. However, little is known about the feasibility of implementing these programs under natural conditions and about the success of these programs when delivered under such conditions. The objectives of this…

  14. Quality of Austrian and Dutch Falls-Prevention Information: A Comparative Descriptive Study

    ERIC Educational Resources Information Center

    Schoberer, Daniela; Mijnarends, Donja M.; Fliedner, Monica; Halfens, Ruud J. G.; Lohrmann, Christa

    2016-01-01

    Objectives: The aim of this study was to evaluate and compare the quality of written patient information material available in Austrian and Dutch hospitals and nursing homes pertaining to falls prevention. Design: Comparative descriptive study design Setting: Hospitals and nursing homes in Austria and the Netherlands. Method: Written patient


  15. Quality of Austrian and Dutch Falls-Prevention Information: A Comparative Descriptive Study

    ERIC Educational Resources Information Center

    Schoberer, Daniela; Mijnarends, Donja M.; Fliedner, Monica; Halfens, Ruud J. G.; Lohrmann, Christa

    2016-01-01

    Objectives: The aim of this study was to evaluate and compare the quality of written patient information material available in Austrian and Dutch hospitals and nursing homes pertaining to falls prevention. Design: Comparative descriptive study design Setting: Hospitals and nursing homes in Austria and the Netherlands. Method: Written patient…

  16. What works to prevent falls in older adults dwelling in long term care facilities and hospitals? An umbrella review of meta-analyses of randomised controlled trials.

    PubMed

    Stubbs, Brendon; Denkinger, Michael D; Brefka, Simone; Dallmeier, Dhayana

    2015-07-01

    Preventing falls in long term care facilities (LTCF) and hospitals is an international priority. Many interventions have been investigated and summarised in meta-analyses (MA) and there is a need to synthesise the top of the hierarchy of evidence in one place. Therefore we conducted an umbrella review of MA of randomised controlled trials (RCTs) of falls prevention interventions LTCF and hospitals. Two independent reviewers searched major electronic databases from inception till October 2014 for MA containing ?3 RCTs investigating any intervention to prevent falls in LTCF or hospitals in older adults aged ?60 years. Methodological quality was assessed by the AMSTAR tool and data were narratively synthesised. The methodological quality of the MA was moderate to high across the 10 included MA. Nine MA provided data for LTCF and only two considered hospital settings. Only one MA defined a fall and two reported adverse events (although minor). Consistent evidence suggests that multifactorial interventions reduce falls (including the rate, risk and odds of falling) in LTCF and hospitals. Inconsistent evidence exists for exercise and vitamin D as single interventions in LTCF, whilst no MA has investigated this in hospitals. No evidence exists for hip protectors and medication review on falls in LTCF. In conclusion, multifactorial interventions appear to be the most effective interventions to prevent falls in LTCF and hospital settings. This is not without limitations and more high quality RCTs are needed in hospital settings in particular. Future RCTs and MA should clearly report adverse events. PMID:25935294

  17. A randomized controlled trial of a community-based consultation service to prevent falls

    PubMed Central

    Hogan, David B.; MacDonald, Frank A.; Betts, Jennifer; Bricker, Sheila; Ebly, Erika M.; Delarue, Barb; Fung, Tak S.; Harbidge, Cathy; Hunter, Maggie; Maxwell, Colleen J.; Metcalf, Barb

    2001-01-01

    Background Multifaceted programs that combine assessment with interventions have been shown to reduce subsequent falls in some clinical trials. We tested this approach to see whether it would be effective if offered as a consultation service using existing health care resources. Methods The subjects of this randomized controlled trial had to be aged 65 years or more and had to have fallen within the previous 3 months. They were randomly assigned to receive either usual care or the intervention, which consisted of in-home assessment in conjunction with the development of an individualized treatment plan, including an exercise program for those deemed likely to benefit. The primary outcomes were the proportion of participants who fell and the rate of falling during the following year. Visits to the emergency department and admissions to hospital were secondary outcomes. Results One hundred and sixty-three subjects were randomly assigned to either the control or the intervention group, and 152 provided data about their falls. There were no significant differences between the control and intervention groups in the cumulative number of falls (311 v. 241, p = 0.34), having one or more falls (79.2% v. 72.0%, p = 0.30) or in the mean number of falls (4.0 v. 3.2, p = 0.43). Analysis of secondary outcomes (health care use) also showed no significant differences between the intervention group and the control group. In the Cox regression analysis, there was no significant difference between the groups in the proportion of subjects having one or more falls (p = 0.55), but there was a significantly (p < 0.001) longer time between falls in the intervention group. In a post hoc subgroup analysis, subjects with more than 2 falls in the 3 months preceding study entry who had been assigned to the intervention group were less likely to fall (p = 0.046) and had a significantly longer time between falls (p < 0.001), when compared with the group who received usual care. Interpretation The intervention did not decrease significantly the cumulative number of falls, the likelihood of participants having at least one fall over the next year or the mean number of falls. It did increase significantly the time between falls in a survival analysis when age, sex and history of falling were used as covariates. PMID:11563205

  18. Recommendations for assessing and preventing falls in adults of all ages with rheumatoid arthritis.

    PubMed

    Stanmore, Emma K

    2015-11-01

    Rheumatoid arthritis (RA) is a debilitating disease that affects younger as well as older adults. It is associated with a high risk of injurious falls due to problems such as lower-limb muscle weakness, balance impairment, swollen and tender joints, pain, and fatigue. Falls are typically associated with older people; hence, many professionals do not recognise the risks for younger persons with diseases such as RA. Falls can lead to devastating consequences, such as fatalities, hip fractures (with 50% of those affected never regaining their previous level of mobility and 30% dying within 1 year), or loss of independence and confidence. Research has shown that many people are either unaware or deny their risk of falling. Therefore, it is important that health professionals, such as community nurses, are aware of the risk factors, methods of assessment, and evidence-based preventative measures, so that falls can be avoided in this population. This article presents research and practice implications for community nurses to enable them to assess, treat, and appropriately refer adults with RA who are also at risk of falls. PMID:26551381

  19. i Engaging as an innovative approach to engage patients in their own fall prevention care

    PubMed Central

    Tzeng, Huey-Ming; Yin, Chang-Yi

    2014-01-01

    Decreasing patient fall injuries during hospitalization continues to be a challenge at the bedside. Empowering patients to become active participants in their own fall prevention care could be a solution. In a previous study, elderly patients recently discharged from a United States hospital expressed a need for nurses to give and repeat directives about fall prevention; when the nurse left a brochure on the topic, but did not provide any (or limited) verbal explanations about the content or the importance of the information, the patient felt that the information was insufficient. To address patients’ needs, we developed “i Engaging”, a Web-based software application for use at the bedside. i Engaging is an innovative approach that is used to engage patients in their own fall prevention care during hospital stays. The application was designed based on the assumption that patients are the best and most critical sources of information about their health status. i Engaging has not yet been tested in clinical trials. PMID:24868148

  20. Effects of lower extremity muscle fatigue on the outcomes of slip-induced falls

    PubMed Central

    Parijat, Prakriti; Lockhart, Thurmon E.

    2010-01-01

    Slip-induced fall accidents continue to be a significant cause of fatal injuries and economic losses. Identifying the risk factors causing slip-induced falls is key to developing better preventive measures to reduce fall accidents. Although epidemiological studies suggest localised muscle fatigue may be one of the risk factors for slip-induced falls, there has been no documented biomechanical study examining the relationship between fatigue and fall accidents. As such, the overall objective of the current study was to investigate the effects of localised muscle fatigue of the quadriceps on the slip initiation and slip recovery phases of slip-induced falls. Sixteen healthy, young participants were recruited to walk across a vinyl floor surface in two different sessions (fatigue and no fatigue). Kinematic and kinetic data were collected using a 3-D motion analysis system and force plates during both sessions. Results suggest that localised muscle fatigue of the quadriceps affected various kinematic and kinetic gait variables that are linked with a higher risk of slip-induced falls. Additionally, the results indicated that localised muscle fatigue of the knee extensor muscle caused a delayed response in producing an effective joint moment and base of support using the trailing limb to recover from a fall. The findings from this study indicate that localised muscle fatigue is a potential risk factor causing slip-induced falls. PMID:19034783

  1. Prevention of falls and fractures in old people by administration of calcium and vitamin d. randomized clinical trial

    PubMed Central

    2011-01-01

    Background There are many studies that associate vitamin D serum levels in older persons with muscle strength, physical performance and risk of fractures and falls. However, current evidence is insufficient to make a general recommendation for administrating calcium and vitamin D to older persons. The objective of this study is to determine the effectiveness of calcium and vitamin D supplementation in improving musculoskeletal function and decreasing the number of falls in person aged over 65 years. Methods/Design Phase III, randomized, double blind, placebo-controlled trial to evaluate the efficacy of already marketed drugs in a new indication. It will be performed at Primary Care doctor visits at several Healthcare Centers in different Spanish Health Areas. A total of 704 non-institutionalized subjects aged 65 years or older will be studied (sample size calculated for a statistical power of 80%, alpha error 0.05, annual incidence of falls 30% and expected reduction of 30% to 20% and expected loss to follow up of 20%). The test drug containing 800 IU of vitamin D and 1000 mg of calcium will be administered daily. The control group will receive a placebo. The subjects will be followed up over two years. The primary variable will be the incidence of spontaneous falls. The secondary variables will include: consequences of the falls (fractures, need for hospitalization), change in calcidiol plasma levels and other analytical determinations (transaminases, PTH, calcium/phosphorous, albumin, creatinine, etc.), change in bone mass by densitometry, change in muscle strength in the dominant hand and change in musculoskeletal strength, risk factors for falls, treatment compliance, adverse effects and socio-demographic data. Discussion The following principles have been considered in the development of this Project: the product data are sufficient to ensure that the risks assumed by the study participants are acceptable, the study objectives will probably provide further knowledge on the problem studied and the available information justifies the performance of the study and its possible risk for the participants. If calcium and vitamin D supplementation is effective in the prevention of falls and fractures in the elderly population, a recommendation may be issued with the aim of preventing some of the consequences of falls that affect quality of life and the ensuing personal, health and social costs. Trial Registration ClinicalTrials.gov: NCT01452243 Clinical trial authorized by the Spanish Medicines Agency: EudraCT number 2006-001643-63. PMID:22151975

  2. Outdoor pedestrian fall-related injuries among Swedish senior citizens--injuries and preventive strategies.

    PubMed

    Gyllencreutz, Lina; Björnstig, Johanna; Rolfsman, Ewa; Saveman, Britt-Inger

    2015-06-01

    Senior citizens get around, to a large extent, as pedestrians, and safe walking is desirable for senior citizens allowing them to stay mobile, independent and healthy in old age. Senior citizens are over-represented in injury statistics, and fall-related injuries are common. The aim of this study was to investigate fall-related injuries including healthcare costs among senior citizen pedestrians injured when walking in public outdoor environments and to describe their self-reported causes and suggested preventive strategies. The data were based on a combination of information from injury data and a questionnaire. Three hundred senior citizens attended one emergency department after sustaining injuries from pedestrian falls; 60% suffered nonminor injuries, mostly fractures. One-fifth of the pedestrians were hospitalised for an average of 8 days with an indirect hospital cost of 6.2 million EUR (55 million SEK). Environmental factors such as ice were the most commonly described cause of the injury incident. Forty per cent of the respondents indicated that the municipality was responsible for the cause of the injury incident. Fewer respondents mentioned their own responsibility as a preventive strategy. Thirty per cent described a combination of improvements such as better road maintenance, changes in human behaviour and use of safety products as preventive strategies. It is of great importance to highlight general safety, products and preventive strategies to minimise injury risks, so that pedestrians can safely realise the known health benefits of walking and thereby limit healthcare costs. PMID:24913321

  3. Radar walking speed measurements of seniors in their apartments: technology for fall prevention.

    PubMed

    Cuddihy, Paul E; Yardibi, Tarik; Legenzoff, Zachary J; Liu, Liang; Phillips, Calvin E; Abbott, Carmen; Galambos, Colleen; Keller, James; Popescu, Mihail; Back, Jessica; Skubic, Marjorie; Rantz, Marilyn J

    2012-01-01

    Falls are a significant cause of injury and accidental death among persons over the age of 65. Gait velocity is one of the parameters which have been correlated to the risk of falling. We aim to build a system which monitors gait in seniors and reports any changes to caregivers, who can then perform a clinical assessment and perform corrective and preventative actions to reduce the likelihood of falls. In this paper, we deploy a Doppler radar-based gait measurement system into the apartments of thirteen seniors. In scripted walks, we show the system measures gait velocity with a mean error of 14.5% compared to the time recorded by a clinician. With a calibration factor, the mean error is reduced to 10.5%. The radar is a promising sensing technology for gait velocity in a day-to-day senior living environment. PMID:23365880

  4. An educational video to promote multi-factorial approaches for fall and injury prevention in long-term care facilities

    PubMed Central

    2014-01-01

    Background Older adults living in long term care (LTC) settings are vulnerable to fall-related injuries. There is a need to develop and implement evidence-based approaches to address fall injury prevention in LTC. Knowledge translation (KT) interventions to support the uptake of evidence-based approaches to fall injury prevention in LTC need to be responsive to the learning needs of LTC staff and use mediums, such as videos, that are accessible and easy-to-use. This article describes the development of two unique educational videos to promote fall injury prevention in long-term care (LTC) settings. These videos are unique from other fall prevention videos in that they include video footage of real life falls captured in the LTC setting. Methods Two educational videos were developed (2012–2013) to support the uptake of findings from a study exploring the causes of falls based on video footage captured in LTC facilities. The videos were developed by: (1) conducting learning needs assessment in LTC settings via six focus groups (2) liaising with LTC settings to identify learning priorities through unstructured conversations; and (3) aligning the content with principles of adult learning theory. Results The videos included footage of falls, interviews with older adults and fall injury prevention experts. The videos present evidence-based fall injury prevention recommendations aligned to the needs of LTC staff and: (1) highlight recommendations deemed by LTC staff as most urgent (learner-centered learning); (2) highlight negative impacts of falls on older adults (encourage meaning-making); and, (3) prompt LTC staff to reflect on fall injury prevention practices (encourage critical reflection). Conclusions Educational videos are an important tool available to researchers seeking to translate evidence-based recommendations into LTC settings. Additional research is needed to determine their impact on practice. PMID:24884899

  5. Key Factors Influencing Implementation of Falls Prevention Exercise Programs in the Community.

    PubMed

    Day, Lesley; Trotter, Margaret J; Donaldson, Alex; Hill, Keith D; Finch, Caroline F

    2016-01-01

    The study aim was to evaluate the implementation of group- and home-based exercise falls prevention programs delivered through community health agencies to community-dwelling older people. Interviews with program staff were guided by the Diffusion of Innovations theory. Highly consistent themes emerged for the two types of programs. Both had high overall compatibility, high relative advantage, good observability and high inherent trialability-all factors known to strengthen implementation. The level of complexity and low financial compatibility emerged as the strongest potential inhibitors to program implementation in the context examined. The two main factors contributing to complexity were the need to challenge balance safely across a broad range of capability, and practical considerations associated with program delivery. A range of strategies to provide more technical support for exercise program leaders to tailor balance challenge for exercise program leaders may enhance implementation of falls prevention exercise programs. PMID:25838262

  6. The Effects of the A Matter of Balance Program on Falls and Physical Risk of Falls, Tampa, Florida, 2013

    PubMed Central

    Edwards, Jerri D.; Janke, Megan C.

    2015-01-01

    Introduction This study investigated the effects of the A Matter of Balance (MOB) program on falls and physical risk factors of falling among community-dwelling older adults living in Tampa, Florida, in 2013. Methods A total of 110 adults (52 MOB, 58 comparison) were enrolled in this prospective cohort study. Data on falls, physical risk of falling, and other known risk factors of falling were collected at baseline and at the end of the program. Multivariate analysis of covariance with repeated measures and logistic regressions were used to investigate the effects of this program. Results Participants in the MOB group were less likely to have had a fall and had significant improvements in their physical risk of falling compared with adults in the comparison group. No significant effects of the MOB program on recurrent falls or the number of falls reported were found. Conclusion This study contributes to our understanding of the MOB program and its effectiveness in reducing falls and the physical risk of falling among older adults. The findings support extended use of this program to reduce falls and physical risk of falling among older adults. PMID:26402047

  7. Exercise-Based Fall Prevention in the Elderly: What About Agility?

    PubMed

    Donath, Lars; van Dieën, Jaap; Faude, Oliver

    2016-02-01

    Annually, one in three seniors aged over 65 years fall. Balance and strength training can reduce neuromuscular fall risk factors and fall rates. Besides conventional balance and strength training, explosive or high-velocity strength training, eccentric exercises, perturbation-based balance training, trunk strength, and trunk control have also been emphasized. In contrast, aerobic exercise has to date not been included in fall-prevention studies. However, well-developed endurance capacity might attenuate fatigue-induced declines in postural control in sports-related or general activities of daily living. Physical performance indices, such as balance, strength, and endurance, are generally addressed independently in exercise guidelines. This approach seems time consuming and may impede integrative training of sensorimotor, neuromuscular, and cardiocirculatory functions required to deal with balance-threatening situations in the elderly. An agility-based conceptual training framework comprising perception and decision making (e.g., visual scanning, pattern recognition, anticipation) and changes of direction (e.g., sudden starts, stops and turns; reactive control; concentric and eccentric contractions) might enable an integrative neuromuscular, cardiocirculatory, and cognitive training. The present paper aims to provide a scientific sketch of how to build such an integrated modular training approach, allowing adaptation of intensity, complexity, and cognitive challenge of the agility tasks to the participant's capacity. Subsequent research should address the (1) link between agility and fall risk factors as well as fall rates, (2) benefit-risk ratios of the proposed approach, (3) psychosocial aspects of agility training (e.g., motivation), and (4) logistical requirements (e.g., equipment needed). PMID:26395115

  8. Children can't fly: a program to prevent childhood morbidity and mortality from window falls

    PubMed Central

    Spiegel, Charlotte N; Lindaman, Francis C

    1995-01-01

    `Children Can't Fly' is a health education program developed by the New York City Department of Health to combat the high incidence of child mortality and morbidity due to falls from windows. The success of the program, begun in 1972, in drastically reducing death and injury persuaded the New York City Board of Health to amend the Health Code in 1976 to require that landlords provide window guards in apartments where children 10 years old and younger reside. The law is the first and only one of its kind in the nation. The program has four major components: (1) reporting of falls by hospital emergency rooms and police precincts, followed up by counseling, referral and data collecting by public health nurses; (2) a media campaign to inform the public and elevate their awareness of the hazards; (3) community education for prevention through door-to-door hazard identification, counseling by outreach workers, community organization efforts with schools, tenant groups, clinics, churches, health care providers, etc; (4) provision of free, easily installed window guards to families with young children living in high-risk areas. Significant reduction in falls resulted, particularly in the Bronx, where reported falls declined 50% from 1973 to 1975. The program is one solution to an urgent urban problem which other cities might consider to avert the loss of life and limb, and the corollary financial burden for hospitalization, rehabilitation and maintenance of the injured and permanently disabled. PMID:9346026

  9. A gait analysis method based on a depth camera for fall prevention.

    PubMed

    Dubois, Amandine; Charpillet, Francois

    2014-01-01

    This paper proposes a markerless system whose purpose is to help preventing falls of elderly people at home. To track human movements, the Microsoft Kinect camera is used which allows to acquire at the same time a RGB image and a depth image. Several articles show that the analysis of some gait parameters could allow fall risk assessment. We developed a system which extracts three gait parameters (the length and the duration of steps and the speed of the gait) by tracking the center of mass of the person. To check the validity of our system, the accuracy of the gait parameters obtained with the camera is evaluated. In an experiment, eleven subjects walked on an actimetric carpet, perpendicularly to the camera which filmed the scene. The three gait parameters obtained by the carpet are compared with those of the camera. In this study, four situations were tested to evaluate the robustness of our model. The subjects walked normally, making small steps, wearing a skirt and in front of the camera. The results showed that the system is accurate when there is one camera fixed perpendicularly. Thus we believe that the presented method is accurate enough to be used in real fall prevention applications. PMID:25570995

  10. Mobility is a key predictor of changes in wellbeing among older fallers: Evidence from the Vancouver Falls Prevention Cohort

    PubMed Central

    Davis, Jennifer C.; Bryan, Stirling; Best, John R.; Li, Linda C; Hsu, Chun Liang; Gomez, Caitlin; Vertes, Kelly; Liu-Ambrose, Teresa

    2015-01-01

    Introduction Falls and injuries resulting from falls in older adults represent a significant public health, personal and societal burden worldwide. Valuing wellbeing or quality of life more broadly may be a more appropriate method of measuring the full impact of falls prevention interventions. Our primary objective was to identify key factors relating to mobility and cognitive function explaining variation in wellbeing among community dwelling older fallers. Methods We conducted a longitudinal analysis of a 12-month prospective cohort study at the Vancouver Falls Prevention Clinic (Available Case Set: n=244/245). We constructed linear mixed models where assessment month (0, 6, 12) was entered as a within-subjects repeated measure, the intercept was specified as a random effect, and predictors and covariates were entered as between-subjects fixed effects. We included the predictors (i.e., Short Performance Physical Battery (SPPB) or Timed Up and Go (TUG) or Montreal Cognitive Assessment (MoCA)) to investigate sex differences over time in the relations between the predictor variable and the outcome variable, the ICECAP-O, a measure of wellbeing/quality of life. Results The SPPB and TUG were associated with wellbeing at baseline (p<0.05). Further a SPPB and TUG by time by sex interaction (p<0.05) was observed. Conclusion This study highlights a significant interaction of balance and mobility with wellbeing by time and sex. This study demonstrates that sex differences exist in the relationship between mobility and wellbeing with all men declining over time regardless of baseline mobility status and with women’s trajectories being dependent on their baseline function. PMID:25862255

  11. Health Promotion Board-Ministry of Health Clinical Practice Guidelines: Falls Prevention among Older Adults Living in the Community.

    PubMed

    Shyamala, Thilagaratnam; Wong, Sweet Fun; Andiappan, Akila; Au Eong, Kah Guan; Bakshi, Anu Birla; Boey, Debbie; Chong, Tsung Wei; Eng, Hui Ping; Ismail, Noor Hafizah; Lau, Tang Ching; Lim, Wei-Yen; Lim, Hsin Wei Wendy; Seong, Lydia; Wong, Wei Chin; Yap, Kai Zhen; Yudah, Sri

    2015-05-01

    The Health Promotion Board (HPB) has developed the Clinical Practice Guidelines (CPG) on Falls Prevention among Older Adults Living in the Community to provide health professionals in Singapore with recommendations for evidence-based assessments and interventions for falls prevention. This article reproduces the introduction and executive summary of the key recommendations from the HPB-MOH CPG on Falls Prevention among Older Adults Living in the Community for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website: http://www.hpb.gov. sg/cpg-falls-prevention. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:26034320

  12. Health Promotion Board–Ministry of Health Clinical Practice Guidelines: Falls Prevention among Older Adults Living in the Community

    PubMed Central

    Shyamala, Thilagaratnam; Wong, Sweet Fun; Andiappan, Akila; Eong, Kah Guan Au; Bakshi, Anu Birla; Boey, Debbie; Chong, Tsung Wei; Eng, Hui Ping; Ismail, Noor Hafizah; Lau, Tang Ching; Lim, Wei-Yen; Lim, Hsin Wei Wendy; Seong, Lydia; Wong, Wei Chin; Yap, Kai Zhen; Yudah, Sri

    2015-01-01

    The Health Promotion Board (HPB) has developed the Clinical Practice Guidelines (CPG) on Falls Prevention among Older Adults Living in the Community to provide health professionals in Singapore with recommendations for evidence-based assessments and interventions for falls prevention. This article reproduces the introduction and executive summary of the key recommendations from the HPB-MOH CPG on Falls Prevention among Older Adults Living in the Community for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website: http://www.hpb.gov. sg/cpg-falls-prevention. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:26034320

  13. Engaging home health care providers in a fall prevention best practice initiative.

    PubMed

    Shaw, Jay; Sidhu, Katharina; Kearney, Colleen; Keeber, Mary; McKay, Sandra

    2013-01-01

    This article reports key findings regarding the engagement of home health care providers in the implementation of a fall prevention best practice initiative. Participants were 29 home health care providers from physiotherapy, occupational therapy, and nursing. Each participant completed a self-efficacy for evidence-based practice survey, and a smaller subgroup of volunteers participated in focus groups for each discipline individually. Findings suggest home health care providers value the implementation of best practice in everyday care, but may need to be highly involved in the development of best practice initiatives and implementation strategies to foster engagement with the initiative in everyday practice. PMID:23438506

  14. Reporting of complex interventions in clinical trials: development of a taxonomy to classify and describe fall-prevention interventions

    PubMed Central

    2011-01-01

    Background Interventions for preventing falls in older people often involve several components, multidisciplinary teams, and implementation in a variety of settings. We have developed a classification system (taxonomy) to describe interventions used to prevent falls in older people, with the aim of improving the design and reporting of clinical trials of fall-prevention interventions, and synthesis of evidence from these trials. Methods Thirty three international experts in falls prevention and health services research participated in a series of meetings to develop consensus. Robust techniques were used including literature reviews, expert presentations, and structured consensus workshops moderated by experienced facilitators. The taxonomy was refined using an international test panel of five health care practitioners. We assessed the chance corrected agreement of the final version by comparing taxonomy completion for 10 randomly selected published papers describing a variety of fall-prevention interventions. Results The taxonomy consists of four domains, summarized as the "Approach", "Base", "Components" and "Descriptors" of an intervention. Sub-domains include; where participants are identified; the theoretical approach of the intervention; clinical targeting criteria; details on assessments; descriptions of the nature and intensity of interventions. Chance corrected agreement of the final version of the taxonomy was good to excellent for all items. Further independent evaluation of the taxonomy is required. Conclusions The taxonomy is a useful instrument for characterizing a broad range of interventions used in falls prevention. Investigators are encouraged to use the taxonomy to report their interventions. PMID:21586143

  15. Rapid demountable platform (RDP)--a device for preventing fall from height accidents.

    PubMed

    Cheung, Esther; Chan, Albert P C

    2012-09-01

    The prevention of fall from height accidents has long been a popular topic in the field of construction safety. Previous research has indicated one of the potential hazards was induced by the use of steel bracket as scaffold support. While researchers are focusing to improve the existing scaffolding system, this research introduces a newly developed device to minimize fall accidents. The working platform, namely Rapid Demountable Platform (RDP) can be applied across window frames without fixing anchor bolts. Emphasizing on the rapid installation/dismantling, the RDP provides another safer option for working at height. The development of the RDP has incorporated modular concept and aesthetic factor into the design, achieving a more user-friendly platform. Although the RDP is not intended to totally replace the traditional bamboo truss-out scaffold, it is designed to act as an alternative or a supplement to the existing bamboo truss-out scaffold. The RDP is the first of this kind to minimize fall from height accidents especially in cities similar to Hong Kong where external working at height is frequently encountered. PMID:22664686

  16. Efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people: study protocol for a randomised trial

    PubMed Central

    Spink, Martin J; Menz, Hylton B; Lord, Stephen R

    2008-01-01

    Background Falls in older people are a major public health problem, with at least one in three people aged over 65 years falling each year. There is increasing evidence that foot problems and inappropriate footwear increase the risk of falls, however no studies have been undertaken to determine whether modifying these risk factors decreases the risk of falling. This article describes the design of a randomised trial to evaluate the efficacy of a multifaceted podiatry intervention to reduce foot pain, improve balance, and reduce falls in older people. Methods Three hundred community-dwelling men and women aged 65 years and over with current foot pain and an increased risk of falling will be randomly allocated to a control or intervention group. The "usual cae" control group will receive routine podiatry (i.e. nail care and callus debridement). The intervention group will receive usual care plus a multifaceted podiatry intervention consisting of: (i) prefabricated insoles customised to accommodate plantar lesions; (ii) footwear advice and assistance with the purchase of new footwear if current footwear is inappropriate; (iii) a home-based exercise program to strengthen foot and ankle muscles; and (iv) a falls prevention education booklet. Primary outcome measures will be the number of fallers, number of multiple fallers and the falls rate recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the Medical Outcomes Study Short Form 12 (SF-12), the Manchester Foot Pain and Disability Index, the Falls Efficacy Scale International, and a series of balance and functional tests. Data will be analysed using the intention to treat principle. Discussion This study is the first randomised trial to evaluate the efficacy of podiatry in improving balance and preventing falls. The trial has been pragmatically designed to ensure that the findings can be generalised to clinical practice. If found to be effective, the multifaceted podiatry intervention will be a unique addition to common falls prevention strategies already in use. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12608000065392 PMID:19025668

  17. Fall Prevention in Community Settings: Results from Implementing Tai Chi: Moving for Better Balance in Three States

    PubMed Central

    Ory, Marcia G.; Smith, Matthew Lee; Parker, Erin M.; Jiang, Luohua; Chen, Shuai; Wilson, Ashley D.; Stevens, Judy A.; Ehrenreich, Heidi; Lee, Robin

    2015-01-01

    Tai Chi: Moving for Better Balance (TCMBB) is an evidence-based fall prevention exercise program being disseminated in selected communities through state injury prevention programs. This study: (1) describes the personal characteristics of TCMBB participants; (2) quantifies participants’ functional and self-reported health status at enrollment; and (3) measures changes in participants’ functional and self-reported health status post-intervention. There were 421 participants enrolled in 36 TCMBB programs delivered in Colorado, New York, and Oregon. Of the 209 participants who completed both baseline enrollment and post-intervention surveys, the average age of participants was 75.3 (SD?±?8.2) years. Most participants were female (81.3%), non-Hispanic (96.1%), White (94.1%), and described themselves as in excellent or very good health (52.2%). Paired t-test and general estimating equation models assessed changes over the 3-month program period. Pre- and post-assessment self-reported surveys and objective functional data [Timed Up and Go (TUG) test] were collected. On average, TUG test scores decreased (p?falling was five times greater after completing the program. TCMBB, which addresses gait and balance problems, can be an effective way to reduce falls among the older adult population. By helping older adults maintain their functional abilities, TCMBB can help community-dwelling older adults continue to live independently. PMID:25964934

  18. A Population-Based Intervention for the Prevention of Falls and Fractures in Home Dwelling People 65 Years and Older in South Germany: Protocol

    PubMed Central

    Rapp, Kilian; Küpper, Michaela; Becker, Clemens; Fischer, Torben; Büchele, Gisela; Benzinger, Petra

    2014-01-01

    Background Falls and fall-related injuries pose a major threat to older peoples’ health, and are associated with increased morbidity and mortality. In the course of demographic changes, development and implementation of fall prevention strategies have been recognized as an urgent public health challenge. Various risk factors for falls and a number of effective interventions have been recognized. A substantial proportion of falls occur for people who are neither frail nor at high risk. Therefore, population-based approaches reaching the entire older population are needed. Objective The objective of the study presented is the development, implementation, and evaluation of a population-based intervention for the prevention of falls and fall-related injuries in a medium sized city in Germany. Methods The study is designed as a population-based approach. The intervention community is a mid sized city named Reutlingen in southern Germany with a population of 112,700 people. All community dwelling inhabitants 65 years and older are addressed. There are two main measures that are defined: (1) increase of overall physical activity, and (2) reduction of modifiable risk factors for falls such as deficits in strength and balance, home and environmental hazards, impaired vision, unsafe footwear, and improper use of assistive devices. The implementation strategies are developed in a participatory community planning process. These might include, for example, training of professionals and volunteers, improved availability of exercise classes, and education and raising awareness via newspaper, radio, or lectures. Results The study starts in September 2010 and ends in December 2013. It is evaluated primarily by process evaluation as well as by telephone survey. Conclusions Physical activity as a key message entails multiple positive effects with benefits on a range of geriatric symptoms. The strength of the design is the development of implementation strategies in a participatory community planning. The problems that we anticipate are the dependency on the stakeholders’ willingness to participate, and the difficulty of evaluating population-based programs by hard end points. PMID:24686959

  19. Effect of Preexisting Musculoskeletal Diseases on the 1-Year Incidence of Fall-related Injuries

    PubMed Central

    Lee, Won Kyung; Kong, Kyoung Ae

    2012-01-01

    Objectives People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea. Methods We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group. Results The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08). Conclusions One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases. PMID:23091653

  20. Robot-assisted home hazard assessment for fall prevention: a feasibility study.

    PubMed

    Sadasivam, Rajani S; Luger, Tana M; Coley, Heather L; Taylor, Benjamin B; Padir, Taskin; Ritchie, Christine S; Houston, Thomas K

    2014-01-01

    We examined the feasibility of using a remotely manoeuverable robot to make home hazard assessments for fall prevention. We employed use-case simulations to compare robot assessments with in-person assessments. We screened the homes of nine elderly patients (aged 65 years or more) for fall risks using the HEROS screening assessment. We also assessed the participants' perspectives of the remotely-operated robot in a survey. The nine patients had a median Short Blessed Test score of 8 (interquartile range, IQR 2-20) and a median Life-Space Assessment score of 46 (IQR 27-75). Compared to the in-person assessment (mean?=?4.2 hazards identified per participant), significantly more home hazards were perceived in the robot video assessment (mean?=?7.0). Only two checklist items (adequate bedroom lighting and a clear path from bed to bathroom) had more than 60% agreement between in-person and robot video assessment. Participants were enthusiastic about the robot and did not think it violated their privacy. The study found little agreement between the in-person and robot video hazard assessments. However, it identified several research questions about how to best use remotely-operated robots. PMID:24352900

  1. Repeated-Slip Training: An Emerging Paradigm for Prevention of Slip-Related Falls Among Older Adults

    PubMed Central

    Pai, YC; Bhatt, TS

    2009-01-01

    Falls frequently cause injury-related hospitalization or death among older adults. This article reviews a new conceptual framework on dynamic stability and weight support in reducing the risk for falls resulting from a forward slip, based on the principles of motor control and learning, in the context of adaptation and longer-term retention induced by repeated-slip training. Although an unexpected slip is severely destabilizing, a recovery step often is adequate for regaining stability, regardless of age. Consequently, poor weight support (quantified by reduction in hip height), rather than instability, is the major determinant of slip-related fall risk. Promisingly, a single session of repeated-slip training can enhance neuromechanical control of dynamic stability and weight support to prevent falls, which can be retained for several months or longer. These principles provide the theoretical basis for establishing task-specific adaptive training that facilitates the development of protective strategies to reduce falls among older adults. PMID:17712033

  2. Vision and agility training in community dwelling older adults: incorporating visual training into programs for fall prevention.

    PubMed

    Reed-Jones, Rebecca J; Dorgo, Sandor; Hitchings, Maija K; Bader, Julia O

    2012-04-01

    This study aimed to examine the effect of visual training on obstacle course performance of independent community dwelling older adults. Agility is the ability to rapidly alter ongoing motor patterns, an important aspect of mobility which is required in obstacle avoidance. However, visual information is also a critical factor in successful obstacle avoidance. We compared obstacle course performance of a group that trained in visually driven body movements and agility drills, to a group that trained only in agility drills. We also included a control group that followed the American College of Sports Medicine exercise recommendations for older adults. Significant gains in fitness, mobility and power were observed across all training groups. Obstacle course performance results revealed that visual training had the greatest improvement on obstacle course performance (22%) following a 12 week training program. These results suggest that visual training may be an important consideration for fall prevention programs. PMID:22206782

  3. The Patient Who Falls

    PubMed Central

    Tinetti, Mary E.; Kumar, Chandrika

    2013-01-01

    Falls are common health events that cause discomfort and disability for older adults and stress for caregivers. Using the case of an older man who has experienced multiple falls and a hip fracture, this article, which focuses on community-living older adults, addresses the consequences and etiology of falls; summarizes the evidence on predisposing factors and effective interventions; and discusses how to translate this evidence into patient care. Previous falls; strength, gait, and balance impairments; and medications are the strongest risk factors for falling. Effective single interventions include exercise and physical therapy, cataract surgery, and medication reduction. Evidence suggests that the most effective strategy for reducing the rate of falling in community-living older adults may be intervening on multiple risk factors. Vitamin D has the strongest clinical trial evidence of benefit for preventing fractures among older men at risk. Issues involved in incorporating these evidence-based fall prevention interventions into outpatient practice are discussed, as are the trade-offs inherent in managing older patients at risk of falling. While challenges and barriers exist, fall prevention strategies can be incorporated into clinical practice. PMID:20085954

  4. Children’s perceptions about falls and their prevention: a qualitative study from a rural setting in Bangladesh

    PubMed Central

    2013-01-01

    Background Childhood falls is a major public health problem in Bangladesh. In-depth understanding of the situation by the target groups and their families is necessary for successful development, implementation and evaluation of any intervention. The study aimed at knowing the views of Bangladeshi rural children about childhood falls and their suggestions for prevention. Methods Children of 10–17 were selected purposely from 4 villages of Sherpur Sadar upazila (sub-district), Sherpur district of Bangladesh. Six focus group discussions and ten in-depth interviews were conducted during July-August 2010 for this study. Gender and education of the participants were considered. Major themes were identified, coded and categorized from content analysis. Results Participants stated that young children (<5 years of age) and boys appeared to be the main victims of falls and majority of these injuries occurred in and around the households. Boys commonly fall from the tree around their premises and high places. Girls usually fall when they remain busy in household chores and playing with friends around their premises. Participants also mentioned that children mostly sustained injury when they are unsupervised. Supervision, public awareness and putting barriers (e.g. door barrier, putting pillow and use net around the bed etc.) were suggested as the preventive measures. Conclusion Findings of this study could be considered as part of knowledge-base in designing interventions to address childhood falls. PMID:24168265

  5. Fall prevention and safety communication training for foremen:Report of a pilot project designed to improve residential construction safety

    PubMed Central

    Kaskutas, Vicki; Dale, Ann Marie; Lipscomb, Hester; Evanoff, Brad

    2013-01-01

    Problem Falls from heights account for 64% of residential construction worker fatalities and 20% of missed work days. We hypothesized that worker safety would improve with foremen training in fall prevention and safety communication. Method Training priorities identified through foreman and apprentice focus groups and surveys were integrated into an 8-hour training. We piloted the training with ten foremen employed by a residential builder. Carpenter trainers contrasted proper methods to protect workers from falls with methods observed at the foremen’s worksites. Trainers presented methods to deliver toolbox talks and safety messages. Results from worksite observational audits (n=29) and foremen/crewmember surveys (n=97) administered before and after training were compared. Results We found that inexperienced workers are exposed to many fall hazards that they are often not prepared to negotiate. Fall protection is used inconsistently and worksite mentorship is often inadequate. Foremen feel pressured to meet productivity demands and some are unsure of the fall protection requirements. After the training, the frequency of daily mentoring and toolbox talks increased, and these talks became more interactive and focused on hazardous daily work tasks. Foremen observed their worksites for fall hazards more often. We observed increased compliance with fall protection and decreased unsafe behaviors during worksite audits. Discussion Designing the training to meet both foremen’s and crewmembers’ needs ensured the training was learner-centered and contextually-relevant. This pilot suggests that training residential foremen can increase use of fall protection, improve safety behaviors, and enhance on-the-job training and safety communication at their worksites. Impact on Industry Construction workers’ training should target safety communication and mentoring skills with workers who will lead work crews. Interventions at multiple levels are necessary to increase safety compliance in residential construction and decrease falls from heights. PMID:23398712

  6. CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes

    PubMed Central

    2012-01-01

    Background Quality improvement (QI) programs focused on mastery of content by individual staff members are the current standard to improve resident outcomes in nursing homes. However, complexity science suggests that learning is a social process that occurs within the context of relationships and interactions among individuals. Thus, QI programs will not result in optimal changes in staff behavior unless the context for social learning is present. Accordingly, we developed CONNECT, an intervention to foster systematic use of management practices, which we propose will enhance effectiveness of a nursing home Falls QI program by strengthening the staff-to-staff interactions necessary for clinical problem-solving about complex problems such as falls. The study aims are to compare the impact of the CONNECT intervention, plus a falls reduction QI intervention (CONNECT + FALLS), to the falls reduction QI intervention alone (FALLS), on fall-related process measures, fall rates, and staff interaction measures. Methods/design Sixteen nursing homes will be randomized to one of two study arms, CONNECT + FALLS or FALLS alone. Subjects (staff and residents) are clustered within nursing homes because the intervention addresses social processes and thus must be delivered within the social context, rather than to individuals. Nursing homes randomized to CONNECT + FALLS will receive three months of CONNECT first, followed by three months of FALLS. Nursing homes randomized to FALLS alone receive three months of FALLs QI and are offered CONNECT after data collection is completed. Complexity science measures, which reflect staff perceptions of communication, safety climate, and care quality, will be collected from staff at baseline, three months after, and six months after baseline to evaluate immediate and sustained impacts. FALLS measures including quality indicators (process measures) and fall rates will be collected for the six months prior to baseline and the six months after the end of the intervention. Analysis will use a three-level mixed model. Discussion By focusing on improving local interactions, CONNECT is expected to maximize staff's ability to implement content learned in a falls QI program and integrate it into knowledge and action. Our previous pilot work shows that CONNECT is feasible, acceptable and appropriate. Trial Registration ClinicalTrials.gov: NCT00636675 PMID:22376375

  7. The Effect of Personalization on Smartphone-Based Fall Detectors.

    PubMed

    Medrano, Carlos; Plaza, Inmaculada; Igual, Raúl; Sánchez, Ángel; Castro, Manuel

    2016-01-01

    The risk of falling is high among different groups of people, such as older people, individuals with Parkinson's disease or patients in neuro-rehabilitation units. Developing robust fall detectors is important for acting promptly in case of a fall. Therefore, in this study we propose to personalize smartphone-based detectors to boost their performance as compared to a non-personalized system. Four algorithms were investigated using a public dataset: three novelty detection algorithms-Nearest Neighbor (NN), Local Outlier Factor (LOF) and One-Class Support Vector Machine (OneClass-SVM)-and a traditional supervised algorithm, Support Vector Machine (SVM). The effect of personalization was studied for each subject by considering two different training conditions: data coming only from that subject or data coming from the remaining subjects. The area under the receiver operating characteristic curve (AUC) was selected as the primary figure of merit. The results show that there is a general trend towards the increase in performance by personalizing the detector, but the effect depends on the individual being considered. A personalized NN can reach the performance of a non-personalized SVM (average AUC of 0.9861 and 0.9795, respectively), which is remarkable since NN only uses activities of daily living for training. PMID:26797614

  8. The Effect of Personalization on Smartphone-Based Fall Detectors

    PubMed Central

    Medrano, Carlos; Plaza, Inmaculada; Igual, RaĂșl; SĂĄnchez, Ángel; Castro, Manuel

    2016-01-01

    The risk of falling is high among different groups of people, such as older people, individuals with Parkinson's disease or patients in neuro-rehabilitation units. Developing robust fall detectors is important for acting promptly in case of a fall. Therefore, in this study we propose to personalize smartphone-based detectors to boost their performance as compared to a non-personalized system. Four algorithms were investigated using a public dataset: three novelty detection algorithms—Nearest Neighbor (NN), Local Outlier Factor (LOF) and One-Class Support Vector Machine (OneClass-SVM)—and a traditional supervised algorithm, Support Vector Machine (SVM). The effect of personalization was studied for each subject by considering two different training conditions: data coming only from that subject or data coming from the remaining subjects. The area under the receiver operating characteristic curve (AUC) was selected as the primary figure of merit. The results show that there is a general trend towards the increase in performance by personalizing the detector, but the effect depends on the individual being considered. A personalized NN can reach the performance of a non-personalized SVM (average AUC of 0.9861 and 0.9795, respectively), which is remarkable since NN only uses activities of daily living for training. PMID:26797614

  9. Fall prevention with supplemental and alpha-hydroxylated vitamin D: a meta-analysis of randomized controlled trials

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Results from fall prevention trials with supplemental vitamin D have been mixed and a possible differential benefit of supplemental versus alpha-hydroxylated vitamin D (activeD) has not been established. We performed a meta-analysis on the efficacy of supplemental vitamin D and activeD with or witho...

  10. Older People's Views of Falls-Prevention Interventions in Six European Countries

    ERIC Educational Resources Information Center

    Yardley, Lucy; Bishop, Felicity L.; Beyer, Nina; Hauer, Klaus; Kempen, Gertrudis I. J. M.; Piot-Ziegler, Chantal; Todd, Chris J.; Cuttelod, Therese; Horne, Maria; Lanta, Kyriaki; Holt, Anne Rosell

    2006-01-01

    Purpose: Our study identified factors common to a variety of populations and settings that may promote or inhibit uptake and adherence to falls-related interventions. Design and Methods: Semistructured interviews to assess perceived advantages and barriers to taking part in falls-related interventions were carried out in six European countries…

  11. Difficulties Experienced in Setting and Achieving Goals by Participants of a Falls Prevention Programme: A Mixed-Methods Evaluation

    PubMed Central

    Mason, Wendy; Haines, Terry P.

    2014-01-01

    ABSTRACT Purpose: To evaluate the ability of participants of a falls prevention programme to set and achieve goals. Methods: The study used a prospective longitudinal design and a mixed-methods approach to data collection. Study participants were (1) 220 older adults participating in a 15-week combined exercise and education falls prevention programme and (2) 9 practitioners (3 home-care nurses, 5 community workers, and an exercise physiologist) involved in delivering the programme. Data from goal-setting forms were analyzed, and descriptive statistics were used to determine the number of appropriate goals set and achieved. Data were analyzed according to programme setting (home- or group-based) and whether or not participants were classified as being from a Culturally and Linguistically Diverse (CALD) background in the Australian context. Semi-structured interviews with programme practitioners were thematically analyzed. Results: A total of 144 respondents (n=75 CALD group, n=41 non-CALD group, n=6 CALD home, n=22 non-CALD home) set 178 goals. Only 101 (57%) goals could be evaluated according to achievement, because participants set goals that focused on health state instead of behaviour, set goals not relevant to falls prevention, used inappropriate constructs to measure goal achievement, and either did not review their goals or dropped out of the programme before goal review. Of these 101 goals, 64 were achieved. Practitioners described their own difficulties in understanding the process of setting health behaviour goals along with communication, cultural, and logistic difficulties. Conclusions: Both CALD and non-CALD participants and those participating in both group- and home-based programmes experienced difficulty in setting and achieving goals to facilitate behaviour change for falls prevention. Data suggest that home-based participants had more difficulty in setting goals than their group-based counterparts and, to a lesser extent, that CALD participants experienced more difficulty in setting goals than their non-CALD counterparts. The use of a guided approach to goal setting and the need for more specific practitioner training and follow-up support regarding goal setting in the context of a falls prevention programme should be considered. PMID:25922563

  12. Legionnaires` disease: Seeking effective prevention

    SciTech Connect

    Millar, J.D.; Morris, G.K.; Shelton, B.G.

    1997-01-01

    During the Bicentennial summer of 1976, American Legion Conventioneers in Philadelphia suffered a dramatic epidemic that left 34 dead. Near the end of 1976, scientists at the Centers for Disease Control (CDC) in Atlanta discovered the bacterium that caused Legionnaires` disease and named it Legionella. Nearly two decades later, a wealth of scientific information exists about the organism, its health effects, epidemiology, microbiology, aquatic ecology, molecular biology, immunology, pathophysiology, etc. Fortunately, for the engineer seeking to prevent Legionnaires` disease, it is unnecessary to master this complexity; the practice of prevention requires understanding a few, straightforward facts. The purpose of this paper is to present four messages about Legionnaires` disease that provide a conceptual framework to guide the crucial role of practical prevention. Those messages are: Legionnaires` disease is important; Legionnaires` disease is an environmental disease; Legionnaires` disease is preventable; and Legionnaires` disease prevention requires the right strategy.

  13. Planting date effects on the nutritive value of fall-grown oat cultivars

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Fall-grown oat (Avena sativa L.) shows potential to fill an important niche as emergency fall forage throughout central Wisconsin. Our objectives were to assess the effects of planting date on the nutritive value of fall-grown oat from four cultivars exhibiting diverse maturation characteristics. Du...

  14. Stochastic analysis of motor-control stability, polymer based force sensing, and optical stimulation as a preventive measure for falls

    NASA Astrophysics Data System (ADS)

    Landrock, Clinton K.

    Falls are the leading cause of all external injuries. Outcomes of falls include the leading cause of traumatic brain injury and bone fractures, and high direct medical costs in the billions of dollars. This work focused on developing three areas of enabling component technology to be used in postural control monitoring tools targeting the mitigation of falls. The first was an analysis tool based on stochastic fractal analysis to reliably measure levels of motor control. The second focus was on thin film wearable pressure sensors capable of relaying data for the first tool. The third was new thin film advanced optics for improving phototherapy devices targeting postural control disorders. Two populations, athletes and elderly, were studied against control groups. The results of these studies clearly show that monitoring postural stability in at-risk groups can be achieved reliably, and an integrated wearable system can be envisioned for both monitoring and treatment purposes. Keywords: electro-active polymer, ionic polymer-metal composite, postural control, motor control, fall prevention, sports medicine, fractal analysis, physiological signals, wearable sensors, phototherapy, photobiomodulation, nano-optics.

  15. A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background With increasing age neuromuscular deficits (e.g., sarcopenia) may result in impaired physical performance and an increased risk for falls. Prominent intrinsic fall-risk factors are age-related decreases in balance and strength / power performance as well as cognitive decline. Additional studies are needed to develop specifically tailored exercise programs for older adults that can easily be implemented into clinical practice. Thus, the objective of the present trial is to assess the effects of a fall prevention program that was developed by an interdisciplinary expert panel on measures of balance, strength / power, body composition, cognition, psychosocial well-being, and falls self-efficacy in healthy older adults. Additionally, the time-related effects of detraining are tested. Methods/Design Healthy old people (n?=?54) between the age of 65 to 80 years will participate in this trial. The testing protocol comprises tests for the assessment of static / dynamic steady-state balance (i.e., Sharpened Romberg Test, instrumented gait analysis), proactive balance (i.e., Functional Reach Test; Timed Up and Go Test), reactive balance (i.e., perturbation test during bipedal stance; Push and Release Test), strength (i.e., hand grip strength test; Chair Stand Test), and power (i.e., Stair Climb Power Test; countermovement jump). Further, body composition will be analysed using a bioelectrical impedance analysis system. In addition, questionnaires for the assessment of psychosocial (i.e., World Health Organisation Quality of Life Assessment-Bref), cognitive (i.e., Mini Mental State Examination), and fall risk determinants (i.e., Fall Efficacy Scale – International) will be included in the study protocol. Participants will be randomized into two intervention groups or the control / waiting group. After baseline measures, participants in the intervention groups will conduct a 12-week balance and strength / power exercise intervention 3 times per week, with each training session lasting 30 min. (actual training time). One intervention group will complete an extensive supervised training program, while the other intervention group will complete a short version ('3 times 3’) that is home-based and controlled by weekly phone calls. Post-tests will be conducted right after the intervention period. Additionally, detraining effects will be measured 12 weeks after program cessation. The control group / waiting group will not participate in any specific intervention during the experimental period, but will receive the extensive supervised program after the experimental period. Discussion It is expected that particularly the supervised combination of balance and strength / power training will improve performance in variables of balance, strength / power, body composition, cognitive function, psychosocial well-being, and falls self-efficacy of older adults. In addition, information regarding fall risk assessment, dose–response-relations, detraining effects, and supervision of training will be provided. Further, training-induced health-relevant changes, such as improved performance in activities of daily living, cognitive function, and quality of life, as well as a reduced risk for falls may help to lower costs in the health care system. Finally, practitioners, therapists, and instructors will be provided with a scientifically evaluated feasible, safe, and easy-to-administer exercise program for fall prevention. Trial registration ClinicalTrials.gov Identifier: NCT01906034 PMID:24106864

  16. Preventing Slips and Falls through Leisure-Time Physical Activity: Findings from a Study of Limited-Service Restaurants

    PubMed Central

    Caban-Martinez, Alberto J.; Courtney, Theodore K.; Chang, Wen-Ruey; Lombardi, David A.; Huang, Yueng-Hsiang; Brennan, Melanye J.; Perry, Melissa J.; Katz, Jeffrey N.; Verma, Santosh K.

    2014-01-01

    Background/Objective Physical activity has been shown to be beneficial at improving health in some medical conditions and in preventing injury. Epidemiologic studies suggest that physical activity is one factor associated with a decreased risk for slips and falls in the older (≄65 years) adult population. While the risk of slips and falls is generally lower in younger than in older adults; little is known of the relative contribution of physical activity in preventing slips and falls in younger adults. We examined whether engagement in leisure-time physical activity (LTPA) was protective of slips and falls among a younger/middle-aged (≀50 years old) working population. Methods 475 workers from 36 limited-service restaurants in six states in the U.S. were recruited to participate in a prospective cohort study of workplace slipping. Information on LTPA was collected at the time of enrollment. Participants reported their slip experience and work hours weekly for up to 12 weeks. We investigated the association between the rate of slipping and the rate of major slipping (i.e., slips that resulted in a fall and/or injury) and LTPA for workers 50 years of age and younger (n = 433, range 18–50 years old) using a multivariable negative binomial generalized estimating equation model. Results The rate of major slips among workers who engaged in moderate (Adjusted Rate Ratio (RR)  = 0.65; 95% Confidence Interval (CI)  =  [0.18–2.44]) and vigorous (RR = 0.64; 95%CI  =  [0.18–2.26]) LTPA, while non-significant, were approximately one-third lower than the rate of major slips among less active workers. Conclusion While not statistically significant, the results suggest a potential association between engagement in moderate and vigorous LTPA and the rate of major slips in younger adults. Additional studies that examine the role of occupational and non-occupational physical activity on the risk of slips, trips and falls among younger and middle aged adults appear warranted. PMID:25329816

  17. How Can Older Adults Prevent Falls? | NIH MedlinePlus the Magazine

    MedlinePLUS

    ... html Eldercare Locator 1-800-677-1116 (toll-free) www.eldercare.gov National Center for Injury Prevention ... Control and Prevention 1-800-232-4636 (toll-free) 1-888-232-6348 (TTY/toll-free) www. ...

  18. Middle College. National Dropout Prevention Center/Network Newsletter. Volume 17, Number 4, Fall 2005

    ERIC Educational Resources Information Center

    Duckenfield, Marty, Ed.

    2005-01-01

    The "National Dropout Prevention Newsletter" is published quarterly by the National Dropout Prevention Center/Network. This issue contains the following articles: (1) College As A Bridge to High School Graduation (Terry Cash); (2) 2005 NDPN Crystal Star Awards of Excellence; (3) Mott Middle College (Chery S. Wagonlander); (4) Gateway to College: A


  19. Towards falls prevention: a wearable wireless and battery-less sensing and automatic identification tag for real time monitoring of human movements.

    PubMed

    Ranasinghe, Damith C; Shinmoto Torres, Roberto L; Sample, Alanson P; Smith, Joshua R; Hill, Keith; Visvanathan, Renuka

    2012-01-01

    Falls related injuries among elderly patients in hospitals or residents in residential care facilities is a significant problem that causes emotional and physical trauma to those involved while presenting a rising healthcare expense in countries such as Australia where the population is ageing. Novel approaches using low cost and privacy preserving sensor enabled Radio Frequency Identification (RFID) technology may have the potential to provide a low cost and effective technological intervention to prevent falls in hospitals. We outline the details of a wearable sensor enabled RFID tag that is battery free, low cost, lightweight, maintenance free and can be worn continuously for automatic and unsupervised remote monitoring of activities of frail patients at acute hospitals or residents in residential care. The technological developments outlined in the paper forms part of an overall technological intervention developed to reduce falls at acute hospitals or in residential care facilities. This paper outlines the details of the technology, underlying algorithms and the results (where an accuracy of 94-100% was achieved) of a successful pilot trial. PMID:23367394

  20. Fall rice straw management and winter flooding treatment effects on a subsequent soybean crop

    USGS Publications Warehouse

    Anders, M.M.; Windham, T.E.; McNew, R.W.; Reinecke, K.J.

    2005-01-01

    The effects of fall rice (Oryza sativa L.) straw management and winter flooding on the yield and profitability of subsequent irrigated and dryland soybean [Glycine max (L.) Merr.] crops were studied for 3 years. Rice straw treatments consisted of disking, rolling, or standing stubble. Winter flooding treatments consisted of maintaining a minimum water depth of 10 cm by pumping water when necessary, impounding available rainfall, and draining fields to prevent flooding. The following soybean crop was managed as a conventional-tillage system or no-till system. Tillage system treatments were further divided into irrigated or dryland. Results indicated that there were no significant effects from either fall rice straw management or winter flooding treatments on soybean seed yields. Soybean seed yields for, the conventional tillage system were significantly greater than those for the no-till system for the first 2 yrs and not different in the third year. Irrigated soybean seed yields were significantly greater than those from dryland plots for all years. Net economic returns averaged over the 3 yrs were greatest ($390.00 ha-1) from the irrigated no-till system.

  1. Evaluation of the Frails' Fall Efficacy by Comparing Treatments (EFFECT) on reducing fall and fear of fall in moderately frail older adults: study protocol for a randomised control trial

    PubMed Central

    2011-01-01

    Background Falls are common in frail older adults and often result in injuries and hospitalisation. The Nintendo¼ Wiiℱ is an easily available exercise modality in the community which has been shown to improve lower limb strength and balance. However, not much is known on the effectiveness of the Nintendo¼ Wiiℱ to improve fall efficacy and reduce falls in a moderately frail older adult. Fall efficacy is the measure of fear of falling in performing various daily activities. Fear contributes to avoidance of activities and functional decline. Methods This randomised active-control trial is a comparison between the Nintendo WiiActive programme against standard gym-based rehabilitation of the older population. Eighty subjects aged above 60, fallers and non-fallers, will be recruited from the hospital outpatient clinic. The primary outcome measure is the Modified Falls Efficacy Scale and the secondary outcome measures are self-reported falls, quadriceps strength, walking agility, dynamic balance and quality of life assessments. Discussions The study is the first randomised control trial using the Nintendo Wii as a rehabilitation modality investigating a change in fall efficacy and self-reported falls. Longitudinally, the study will investigate if the interventions can successfully reduce falls and analyse the cost-effectiveness of the programme. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000576022 PMID:21682909

  2. Obesity and falls in older people: mediating effects of disease, sedentary behavior, mood, pain and medication use.

    PubMed

    Mitchell, Rebecca J; Lord, Stephen R; Harvey, Lara A; Close, Jacqueline C T

    2015-01-01

    Obesity has been associated with an increased risk of falls among older people. However, it is not certain whether factors commonly associated with falls and/or obesity mediate this risk. This research examines whether specific diseases, sedentary behavior, mood, pain, and medication use mediate the association between obesity and falls. A representative sample of community-living individuals aged 65+ years in New South Wales (NSW), Australia were surveyed regarding their experience of falls, height, weight, lifestyle and general health within a 12 month period. Intervening variable effects were examined using Freedman and Schatzkin's difference in coefficients tests and regression analyses were used to estimate relative risks. Obesity was associated with a 25% higher risk (95%confidence interval (CI) 1.11-1.41; p<0.0003) of having fallen in the previous 12 months compared to non-obese individuals. The strongest mediators of the association between obesity and falls were sleeping tablets (t=-5.452; p<0.0001), sitting for more than 8h per day on weekdays (t=5.178; p<0.0001), heart disease/angina (t=3.526; p<0.0001), anti-depressant use (t=3.102; p=0.002), moderate/extreme anxiety or depression (t=3.038; p=0.002), and diabetes (t=3.032; p=0.002). Sedentary behavior, chronic health conditions and medication use were identified as mediators for the association between obesity and falls in community living older people. Interventions aimed at weight reduction and increased activity may have benefits not only for fall prevention, but also for the mediating health, mood and lifestyle factors identified here. PMID:25307955

  3. Prophylactic Fresh Frozen Plasma Infusion is Ineffective in Reversing Warfarin Anticoagulation and Preventing Delayed Intracranial Hemorrhage After Falls

    PubMed Central

    Reddy, Subhash; Sharma, Rohit; Grotts, Jonathan; Ferrigno, Lisa

    2015-01-01

    Background: Elderly patients, with considerable fall risk, are increasingly anticoagulated to prevent thromboembolic disease. We hypothesized that a policy of prophylactic fresh frozen plasma (FFP) infusion in patients having falls would reverse vitamin K antagonists (VKAs) and that reversal would decrease delayed intracranial hemorrhage (ICH). Methods: A retrospective review of patients with trauma admitted to a level 2 community trauma center was performed from January 2010 until November 2012. Inclusion criteria were: ground level fall (GLF) with suspected head trauma, on VKA, an international normalized ratio (INR) of >1.5, and a negative head computed tomography (CT). Patients were transfused with FFP to a goal INR of <1.5 while observed. Patients were classified as reversed (REV) if the lowest INR achieved within 4 to 24 hours after initial INR was <1.5 or unreversed (NREV) if lowest INR achieved was >1.5. Chi-square and logistic regression were performed. Results: A total of 194 patients met the criteria. In all, 43 (22%) patients were able to be REV, and 151 (78%) patients remained NREV. Unreversed patients were male and younger (P < .05). There was no difference in mean FFP received. Unreversed patients had a higher initial INR of 3.0 compared to REV patients (2.5; P = .018). One patient developed a delayed ICH and belonged to the REV group. Conclusion: The incidence of delayed hemorrhage was 0.5%. A strategy of prophylactic FFP infusion was ineffective in VKA reversal. We recommend against prophylactic infusion of FFP during a period of observation for patients on VKA with suspected head trauma and a negative initial CT. PMID:26425246

  4. The effects of a walking exercise program on fall-related fitness, bone metabolism, and fall-related psychological factors in elderly women.

    PubMed

    Yoo, Eun Jung; Jun, Tae Won; Hawkins, Steven A

    2010-10-01

    The purpose of this study was to determine the effects of a 3-month walking exercise program with ankle weights on fall-related fitness, bone metabolism, and fall-related psychological factors. Fall-related fitness was determined from strength, balance, agility, aerobic endurance, muscle mass, and fat mass measures. Bone metabolism was measured using bone density, hormones, and biochemical markers. Fall-related psychological factors included fear of falling and falls efficacy. A 2 × 2 factorial with repeated measures design was used. All subjects were community-dwelling elderly women who volunteered to participate, and randomly were assigned to either an exercise group (n = 11) or a control group (n = 10). Results revealed significant changes in upper body strength, leg strength, aerobic endurance, and body composition. Additionally, hormones and biochemical markers changed significantly over time. Trunk fat and fear of falling changed differently among the two groups. In conclusion, this study suggests that a 3-month walking exercise program with ankle weights may have positive effects on fall-related fitness, bone metabolism, and fall-related psychological factors. PMID:21058209

  5. The effect of physical restraints on fall rates in older adults who are institutionalized.

    PubMed

    Dunn, K S

    2001-10-01

    Since the Omnibus Budget Reconciliation Act (OBRA) of 1987, there has been a significant reduction in the use of physical restraints to prevent falls in older adults who are institutionalized because of the developing awareness of the physical and psychological problems associated with them. The purpose of this ex post facto descriptive study was to determine if there is a difference in falls when physical restraints are allowed or prohibited in one older adult population. Data from incident reports from a purposive sample of 97 older adults in one long-term care facility were analyzed before and after the implementation of a restraint-free policy. The results indicated no significant difference in the number of falls before and after the policy change. However, there was a significantly lower number of falls with injuries and a significantly higher number of falls without injuries. These findings suggest older adults will continue to fall with or without the use of physical restraints because of changes associated with the aging process and risk factors. Removing physical barriers from older adults and allowing freedom of movement may decrease the severity of injury sustained in a fall. PMID:11820377

  6. Tunguska meteor fall of 1908: effects on stratospheric ozone.

    PubMed

    Turco, R P; Toon, O B; Park, C; Whitten, R C; Pollack, J B; Noerdlinger, P

    1981-10-01

    In 1908, when the giant Tunguska meteor disintegrated in the earth's atmosphere over Siberia, it may have generated as much as 30 million metric tons of nitric oxide (NO) in the stratosphere and mesosphere. The photochemical aftereffects of the event have been simulated using a comprehensive model of atmospheric trace composition. Calculations indicate that up to 45 percent of the ozone in the Northern Hemisphere may have been depleted by Tunguska's nitric oxide cloud early in 1909 and large ozone reductions may have persisted until 1912. Measurements of atmospheric transparentiy by the Smithsonian Astrophysical Observatory for the years 1909 to 1911 show evidence of a steady ozone recovery from unusually low levels in early 1909, implying a total ozone deficit of 30 +/- 15 percent. The coincidence in time between the observed ozone recovery and the Tunguska meteor fall indicates that the event may provide a test of current ozone depletion theories. PMID:17802551

  7. Tunguska meteor fall of 1908 - Effects on stratospheric ozone

    NASA Technical Reports Server (NTRS)

    Turco, R. P.; Toon, O. B.; Park, C.; Whitten, R. C.; Pollack, J. B.; Noerdlinger, P.

    1981-01-01

    The Tunguska meteor, whose disintegration over Siberia in 1908 may have generated as much as 30 million metric tons of nitric oxide (NO) in the stratosphere and mesosphere, is discussed. The photochemical aftereffects of the event are simulated using a comprehensive model of atmospheric trace composition. Calculations are made which indicate that up to 45% of the ozone in the Northern Hemisphere may have been depleted by the meteor's nitric oxide cloud early in 1909 and that large ozone reductions may have persisted until 1912. Measurements of atmospheric transparency by the Smithsonian Astrophysical Observatory for the years 1909-1911 reveal evidence of a steady ozone recovery from unusually low levels in early 1909, implying a total ozone deficit of 30 + or - 15%. The coincidence in time between the observed ozone recovery and the Tunguska meteor fall suggests that the event may provide a test of current ozone depletion theories.

  8. Tunguska meteor fall of 1908: effects on stratospheric ozone

    SciTech Connect

    Turco, R.P.; Toon, O.B.; Park, C.; Whitten, R.C.; Pollack, J.B.; Noerdlinger, P.

    1981-10-02

    In 1908, when the giant Tunguska meteor disintegrated in the earth's atmosphere over Siberia, it may have generated as much as 30 million metric tons of nitric oxide (NO) in the stratosphere and mesosphere. The photochemical aftereffects of the event have been simulated using a comprehensive model of atmospheric trace composition. Calculations indicate that up to 45 percent of the ozone in the Northern Hemisphere may have been depleted by Tunguska's nitric oxide cloud early in 1909 and large ozone reductions may have persisted until 1912. Measurements of atmospheric transparency by the Smithsonian Astrophysical Observatory for the years 1909 to 1911 show evidence of a steady ozone recovery from unusually low levels in early 1909, implying a total ozone deficit of 30 +- 15 percent. The coincidence in time between the observed ozone recovery and the Tungska meteor fall indicates that the event may provide a test of current ozone depletion theories.

  9. Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients

    PubMed Central

    Chen, Ying; Zhu, Ling-Ling; Zhou, Quan

    2014-01-01

    Background Falls among the elderly are an issue internationally and a public health problem that brings substantial economic and quality-of-life burdens to individuals and society. Falls prevention is an important measure of nursing quality and patient safety. Numerous studies have evaluated the association of medication use with fall risk in elderly patients. However, an up-to-date review has not been available to summarize the multifaceted pharmaceutical concerns in the prevention of medication-related falls. Materials and methods Relevant literature was identified by performing searches in PubMed, Web of Science, and the Cochrane Library, covering the period until February 2014. We included studies that described an association between medications and falls, and effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and pharmacological interventions on fall risk in elderly patients. The full text of each included article was critically reviewed, and data interpretation was performed. Results Fall-risk-increasing drugs (FRIDs) include central nervous system-acting agents, cough preparations, nonsteroidal anti-inflammatory drugs, anti-Alzheimer’s agents, antiplatelet agents, calcium antagonists, diuretics, ?-blockers, digoxin, hypoglycemic drugs, neurotoxic chemotherapeutic agents, nasal preparations, and antiglaucoma ophthalmic preparations. The degree of medication-related fall risk was dependent on one or some of the following factors: drug pharmacokinetic/pharmacodynamic properties (eg, elimination half-life, metabolic pathway, genetic polymorphism, risk rating of medications despite belonging to the same therapeutic class) and/or characteristics of medication use (eg, number of medications and drug–drug interactions, dose strength, duration of medication use and time since stopping, medication change, prescribing appropriateness, and medication adherence). Pharmacological interventions, including withdrawal of FRIDs, pharmacist-conducted clinical medication review, and computerized drug alerts, were effective in reducing fall risk. Conclusion Based on the literature review, clear practical recommendations for clinicians to prevent falls in the elderly included making a list of FRIDs, establishing a computerized alert system for when to e-prescribe FRIDs, seeking an alternative drug with lower fall risk, withdrawing FRIDs if clinically indicated, taking pertinent cautions when the use of FRIDs cannot be avoidable, paying attention to prescribing appropriateness, simplifying the medication regimen, strengthening pharmacist-conducted clinical medication review, ensuring the label of each FRID dispensed contains a corresponding warning sign, being careful when medication change occurs, enhancing medication adherence, and mandating for periodic reassessment of potential risk associated with the patient’s medication regimen. Further studies should be conducted in this area, such as investigating whether medication reconciliation and improving medication adherence could decrease the rate of falls. PMID:24966681

  10. Moving Forward in Fall Prevention: An Intervention to Improve Balance Among Older Adults in Real-World Settings

    PubMed Central

    Robitaille, Yvonne; Laforest, Sophie; Fournier, Michel; Gauvin, Lise; Parisien, Manon; Corriveau, Hélène; Trickey, Francine; Damestoy, Nicole

    2005-01-01

    Objectives. We investigated the effectiveness of a group-based exercise intervention to improve balancing ability among older adults delivered in natural settings by staff in local community organizations. Methods. The main component of the intervention consisted of biweekly group-based exercise sessions conducted over 12 weeks by a professional, coupled with home-based exercises. In a quasiexperimental design, 10 community organizations working with older adults offered the intervention to groups of 5 to 15 persons concerned about falls, while 7 organizations recruited similar groups to participate in the control arm of the study. Participants (98 experimental and 102 control) underwent balance assessments by a physiotherapist at registration and 3 months later. Results. Eighty-nine percent of participants attended the 3-month measurement session (n=177). A linear regression analysis showed that after adjusting for baseline levels of balance and demographic and health characteristics, the intervention significantly improved static balance and mobility. Conclusion. Structured, group-based exercise programs offered by community organizations in natural settings can successfully increase balancing ability among community-dwelling older adults concerned about falls. PMID:16195514

  11. Older Adults' Participation in a Community-Based Falls Prevention Exercise Program: Relationships between the Easy Tool, Program Attendance, and Health Outcomes

    ERIC Educational Resources Information Center

    Smith, Matthew Lee; Ory, Marcia G.; Ahn, SangNam; Bazzarre, Terry L.; Resnick, Barbara

    2011-01-01

    Purpose of the Study: The Exercise Assessment Screening for You (EASY) tool was developed to encourage older adults at every functional level to be more physically active. The purposes of this study were to examine characteristics of older adults who participated in an evidence-based falls prevention program by their entry to EASY tool scores,…

  12. Older Adults' Participation in a Community-Based Falls Prevention Exercise Program: Relationships between the Easy Tool, Program Attendance, and Health Outcomes

    ERIC Educational Resources Information Center

    Smith, Matthew Lee; Ory, Marcia G.; Ahn, SangNam; Bazzarre, Terry L.; Resnick, Barbara

    2011-01-01

    Purpose of the Study: The Exercise Assessment Screening for You (EASY) tool was developed to encourage older adults at every functional level to be more physically active. The purposes of this study were to examine characteristics of older adults who participated in an evidence-based falls prevention program by their entry to EASY tool scores,


  13. Musculoskeletal Strength, Balance Performance, and Self-Efficacy in Elderly Ving Tsun Chinese Martial Art Practitioners: Implications for Fall Prevention

    PubMed Central

    Fong, Shirley S. M.; Ng, Shamay S. M.; Liu, Karen P. Y.; Pang, Marco Y. C.; Lee, H. W.; Chung, Joanne W. Y.; Lam, Priscillia L.; Guo, X.

    2014-01-01

    Objectives. To (1) compare the bone strength, lower limb muscular strength, functional balance performance, and balance self-efficacy between Ving Tsun (VT) martial art practitioners and nonpractitioners and (2) identify the associations between lower limb muscular strength, functional balance performance, and balance self-efficacy among the VT-trained participants. Methods. Thirty-five VT practitioners (mean age ± SD = 62.7 ± 13.3 years) and 49 nonpractitioners (mean age ± SD = 65.9 ± 10.5 years) participated in the study. The bone strength of the distal radius, lower limb muscular strength, functional balance performance, and balance self-efficacy were assessed using an ultrasound bone sonometer, the five times sit-to-stand test (FTSTS), the Berg balance scale (BBS), and the Chinese version of the activities-specific balance confidence scale, respectively. A multivariate analysis of covariance was performed to compare all the outcome variables between the two groups. Results. Elderly VT practitioners had higher radial bone strength on the dominant side (P < 0.05), greater lower limb muscular strength (P = 0.001), better functional balance performance (P = 0.003), and greater balance confidence (P < 0.001) than the nonpractitioners. Additionally, only the FTSTS time revealed a significant association with the BBS score (r = ?0.575, ?P = 0.013). Conclusions. VT may be a suitable health-maintenance exercise for the elderly. Our findings may inspire the development of VT fall-prevention exercises for the community-dwelling healthy elderly. PMID:25530782

  14. [Nursing care of elderly persons: reactions to the use of a security blanket to prevent falling out of bed].

    PubMed

    Ntetu, A L; Courville, F; Chouinard, M C; Tremblay, H

    2001-03-01

    This article presents the results of the first part of a survey aiming at assessing the chances for adoption and use of the safety blanket, a new device preventing the falls from the beds. In this part, the resarchers wanted to know how the caretakers reacted to the use of this material. Thirty four people with five beneficiaries among them, nine family members, fifteen contributors and five managers, interacting in the context of a care unit for elderly people of a hospital centre were interviewed. The data of the interviews were analysed according to a six step procedure: listening to the interviews and reading the descriptions; deriving the significant statements, analysing and reformulating the meaning of the statements; regrouping the signification units under more global themes; gathering the analysis results and describing exhaustively the studied phenomenon; validating the exhaustive description. As a whole, the reactions recorded were positive and indicate that the safety blanket has big chances to be adopted by the healthcare units. PMID:12037882

  15. Fall fertilization timing effects on nitrate leaching and turfgrass color and growth.

    PubMed

    Mangiafico, Salvatore S; Guillard, Karl

    2006-01-01

    Fall season fertilization is a widely recommended practice for turfgrass. Fertilizer applied in the fall, however, may be subject to substantial leaching losses. A field study was conducted in Connecticut to determine the timing effects of fall fertilization on nitrate N (NO3-N) leaching, turf color, shoot density, and root mass of a 90% Kentucky bluegrass (Poa pratensis L.), 10% creeping red fescue (Festuca rubra L.) lawn. Treatments consisted of the date of fall fertilization: 15 September, 15 October, 15 November, 15 December, or control which received no fall fertilizer. Percolate water was collected weekly with soil monolith lysimeters. Mean log(10) NO3-N concentrations in percolate were higher for fall fertilized treatments than for the control. Mean NO3-N mass collected in percolate water was linearly related to the date of fertilizer application, with higher NO3-N loss for later application dates. Applying fall fertilizer improved turf color and density but there were no differences in color or density among applications made between 15 October and 15 December. These findings suggest that the current recommendation of applying N in mid- to late November in southern New England may not be compatible with water quality goals. PMID:16391287

  16. The effect of modified trampoline training on balance, gait, and falls efficacy of stroke patients

    PubMed Central

    Hahn, Joohee; Shin, Seonhae; Lee, Wanhee

    2015-01-01

    [Purpose] This research was conducted to investigate the effects of modified trampoline training on the balance, gait, and falls efficacy of stroke patients. [Subjects] Twenty-four stroke patients participated in this study. The subjects were randomly allocated to one of two groups: the trampoline group (n=12) or the control group (n=12). [Methods] Both groups participated in conventional physical therapy for thirty minutes per day, three times a week for six weeks. The trampoline group also took part in trampoline training for thirty minutes per day, three times a week for six weeks. We evaluated balance (Berg balance scale, timed up and go test), gait (dynamic gait index), and falls efficacy (falls efficacy scale-K) to confirm the effects of the intervention. [Results] Both the trampoline and the control group showed significant improvements in balance, gait, and falls efficacy compared to before the intervention, and the improvements were significantly greater in the trampoline group than in the control group. [Conclusion] Modified trampoline training resulted in significantly improved balance, dynamic gait, and falls efficacy of stroke patients compared to the control group. These results suggest that modified trampoline training is feasible and effective at improving balance, dynamic gait, and falls efficacy after stroke. PMID:26696696

  17. Fall Proofing Your Home

    MedlinePLUS

    ... Aging at NIH www.nia.nih.gov/Go4Life Fall Proofing Your Home Six out of every 10 falls happen at home, where we spend much of ... without thinking about our safety. Many of these falls could be prevented by making simple changes. Go4Life ...

  18. Comparison of tai chi vs. strength training for fall prevention among female cancer survivors: study protocol for the GET FIT trial

    PubMed Central

    2012-01-01

    Background Women with cancer are significantly more likely to fall than women without cancer placing them at higher risk of fall-related fractures, other injuries and disability. Currently, no evidence-based fall prevention strategies exist that specifically target female cancer survivors. The purpose of the GET FIT (Group Exercise Training for Functional Improvement after Treatment) trial is to compare the efficacy of two distinct types of exercise, tai chi versus strength training, to prevent falls in women who have completed treatment for cancer. The specific aims of this study are to: 1) Determine and compare the efficacy of both tai chi training and strength training to reduce falls in older female cancer survivors, 2) Determine the mechanism(s) by which tai chi and strength training each reduces falls and, 3) Determine whether or not the benefits of each intervention last after structured training stops. Methods/Design We will conduct a three-group, single-blind, parallel design, randomized controlled trial in women, aged 50–75 years old, who have completed chemotherapy for cancer comparing 1) tai chi 2) strength training and 3) a placebo control group of seated stretching exercise. Women will participate in supervised study programs twice per week for six months and will be followed for an additional six months after formal training stops. The primary outcome in this study is falls, which will be prospectively tracked by monthly self-report. Secondary outcomes are maximal leg strength measured by isokinetic dynamometry, postural stability measured by computerized dynamic posturography and physical function measured by the Physical Performance Battery, all measured at baseline, 3, 6 and 12 months. The sample for this trial (N=429, assuming 25% attrition) will provide adequate statistical power to detect at least a 47% reduction in the fall rate over 1 year by being in either of the 2 exercise groups versus the control group. Discussion The GET FIT trial will provide important new knowledge about preventing falls using accessible and implementable exercise interventions for women following chemotherapy for cancer. ClinicalTrials.gov NCT01635413 PMID:23217054

  19. GENERALIZATION OF TREADMILL-SLIP TRAINING TO PREVENT A FALL FOLLLOWING A SUDDEN (NOVEL) SLIP IN OVER-GROUND WALKING

    PubMed Central

    Yang, Feng; Bhatt, Tanvi; Pai, Yi-Chung

    2012-01-01

    The purposes of the study were to determine 1) whether treadmill-slip training could reduce the likelihood of falls during a novel slip in over-ground walking, and 2) to what extent such (indirect) training would be comparable to (direct) over-ground-slip training. A treadmill-slip training group (Group A, n=17) initially experienced repeated perturbations on treadmill intended to simulate forward-slip in over-ground walking. Perturbation continued and its intensity reduced when necessary to ensure subjects’ successful adaptation (i.e., when they could land their trailing foot ahead of the slipping foot in at least 3 of 5 consecutive trials). They then experienced a novel slip during over-ground walking. Another 17 young adults in Group B experienced an identical novel slip that served as the controls. They then underwent more slip trials during over-ground walking. Their 16th slip trial was analyzed to represent the over-ground-slip training effect. Eight subjects (47%) in Group A fell upon their first treadmill slip, while all adapted successfully after a minimum of 15 slip trials. Upon the novel slip during over-ground walking, none of them fell in comparison to four subjects (23.5%) fell in Group B upon the same trial (p<0.05). Group A’s control of stability, both proactive and reactive, was significantly better than that of Group B’s on their first over-ground slip, while the level of improvement derived from indirect treadmill training was not as strong as that from direct over-ground-slip training, as demonstrated in Group B’s 16th slip trial (p<0.001). These results clearly demonstrated the feasibility of fall reduction through treadmill-slip training. PMID:23141636

  20. Mt. Hood Community College Institutional Effectiveness (IE) Report Fall 2001.

    ERIC Educational Resources Information Center

    Walleri, R. Dan

    This report examines the indicators of institutional effectiveness for Mount Hood Community College (MHCC) (Oregon). The document reports on five institutional goals: (1) knowledge-based workforce education and services; (2) access for members of the community and development of an environment in which diversity thrives; (3) economic development,…

  1. The effects of multidirectional stepping training on balance, gait ability, and falls efficacy following stroke

    PubMed Central

    Park, Gi-Deok; Choi, Jin-Uk; Kim, Young-Min

    2016-01-01

    [Purpose] The purpose of this study was to determine whether a multidirectional stepping training improves balance, gait ability, and falls efficacy in stroke patients. [Subjects] Firty patients who met the selection criteria and agreed to participate in research at hospital N were randomly allocated and enrolled in this study. Twenty of the subjects were assigned to an experimental group that participated in combined stepping exercise, and the other twenty subjects were assigned to a control group that received general physical therapy. [Methods] In the two groups, balance was measured using the Berg Balance Scale, gait ability was measured using the 10-m Walk Test, and falls efficacy was measured using the Falls Efficacy Scale before training and after 6 weeks of training. [Results] Comparative analysis of the experimental group’s pretest and post-test results showed statistically significant differences in the Berg Balance Scale, 10-m Walk Test, and Falls Efficacy Scale scores. There were significant between-group differences in the Berg Balance Scale, 10-m Walk Test, and Falls Efficacy Scale scores. [Conclusion] The results suggest that a combined stepping exercise can be an effective intervention to improve the balance, gait ability, and falls efficacy in stroke patients.

  2. Cause or Effect? Selective Serotonin Reuptake Inhibitors and Falls in Older Adults: A Systematic Review.

    PubMed

    Gebara, Marie Anne; Lipsey, Kim L; Karp, Jordan F; Nash, Maureen C; Iaboni, Andrea; Lenze, Eric J

    2015-10-01

    A 2012 update of the Beers criteria categorizes selective serotonin reuptake inhibitors (SSRIs) as potentially inappropriate medications in all older adults based on fall risk. The application of these recommendations, not only to frail nursing home residents, but to all older adults, may lead to changes in health policy or clinical practice with harmful consequences. A systematic review of studies on the association between SSRIs and falls in older adults was conducted to examine the evidence for causation. Twenty-six studies met the inclusion criteria. The majority of studies were observational and suggest an association between SSRIs and falls. The direction of the relationship--causation or effect--cannot be discerned from this type of study. Standardized techniques for determining likely causation were then used to see if there was support for the hypothesis that SSRIs lead to falls. This analysis did not suggest causation was likely. There is no Level 1 evidence that SSRIs cause falls. Therefore, changes in the current treatment guidelines or policies on the use of SSRIs in older adults based on fall risk may not be justified at this time given the lack of an established evidence base. Given its significance to public health, well-designed experimental studies are required to address this question definitively. PMID:25586602

  3. The Fall of Oil Prices and the Effects on Biofuels.

    PubMed

    Reboredo, Fernando H; Lidon, Fernando; Pessoa, Fernanda; Ramalho, José C

    2016-01-01

    This analysis is focused on the effect of the abrupt decline of oil prices on biofuels, particularly second-generation ethanol. The efforts to decrease the production costs of biofuels, especially cellulosic ethanol (CE), will be greatly threatened if current oil prices remain low, especially since production is not slowing. Only huge state subsidies could alleviate this threat, but the challenge is to persuade citizens that this sacrifice is worthwhile. PMID:26723755

  4. Dynamics of a falling film with solutal Marangoni effect

    NASA Astrophysics Data System (ADS)

    Pereira, Antonio; Kalliadasis, Serafim

    2008-09-01

    We investigate the dynamics of a thin liquid film on an inclined planar substrate in the presence of an insoluble surfactant on its free surface. We consider both the linear and nonlinear regimes. The linear regime is examined through the Orr-Sommerfeld eigenvalue problem of the full Navier-Stokes and concentration equations and wall and free-surface boundary conditions. The nonlinear regime is investigated through two different models. The first one is obtained from the classical long-wave expansion and the second one through an integral-boundary-layer approximation combined with a simple Galerkin projection. Although accurate close to the instability threshold, the first model fails to describe the dynamics of the system far from criticality. On the other hand, the second model not only captures accurately the behavior close to the instability threshold, but is also valid far from criticality. Analytical and numerical results on the role of the surfactant on the free-surface dynamics are presented. In the linear regime, the Marangoni stresses induced by the surfactant reduce the domain of instability for the base flow. In the nonlinear regime, the system evolves into solitary pulses for both the free surface and surfactant concentration. The amplitude and velocity of these pulses decrease as the Marangoni effect becomes stronger.

  5. Cost-effectiveness and budget impact of Empirical vitamin D therapy on unintentional falls in older adults in the UK

    PubMed Central

    Poole, C D; Smith, J; Davies, J S

    2015-01-01

    Objectives To evaluate the health outcomes and economics associated with the current guidance relating to the prevention of falls in the elderly through vitamin D supplementation. Setting UK. Participants UK population aged 60 years and above. Interventions A Markov health state transition model simulated patient transitions between key fall-related outcomes using a 5-year horizon and annual cycles to assess the costs and benefits of empirical treatment with colecalciferol 800 iu daily. Primary and secondary outcome measures Costs and health outcomes attributable to fall prevention following vitamin D supplementation. Results Our model shows that treating the UK population aged 60 years and above with 800 iu colecalciferol would, over a 5-year period: (1) prevent in excess of 430 000 minor falls; (2) avoid 190 000 major falls; (3) prevent 1579 acute deaths; (4) avoid 84 000 person-years of long-term care and (5) prevent 8300 deaths associated with increased mortality in long-term care. The greatest gains are seen among those 75 years and older. Based on reduction in falls alone, the intervention in all adults aged 65+ is cost-saving and leads to increased quality adjusted life years. Treating all adults aged 60+ incurs an intervention cost of £2.70bn over 5 years, yet produces a −£3.12bn reduction in fall-related costs; a net saving of £420M. Increasing the lower bound age limit by 5-year increments increases budget impact to −£1.17bn, −£1.75bn, and −£2.06bn for adults 65+, 70+ and 75+, respectively. Conclusions This study shows that treatment of the elderly UK population with colecalciferol 800 iu daily would be associated with reductions in mortality and substantial cost-savings through fall prevention. PMID:26419680

  6. Effects of CG location on the launch behavior of free-fall lifeboats

    SciTech Connect

    Nelson, J.K.; Fallon, D.J.; Hirsch, T.J.

    1995-05-01

    The free-fall lifeboat was developed to reduce the risk of injury during evacuation in a maritime emergency. It is a generally accepted concept for lifesaving appliances that currently is in use on many ships and offshore platforms. Three concerns during launch of these lifeboats are the attitude of the boat at water entry, the headway immediately after water entry, and the acceleration forces to which the occupants are subjected. Limited quantitative data is available about the behavior of the boats during launch and, in particular, on the effects of mass distribution on the launch behavior of free-fall lifeboats. The purpose of this paper is to discuss quantitatively the launch behavior of free-fall lifeboats, with particular emphasis on the effects of changes in the location of the CG.

  7. Exercise and Fall Prevention: Narrowing the Research-to-Practice Gap and Enhancing Integration of Clinical and Community Practice.

    PubMed

    Li, Fuzhong; Eckstrom, Elizabeth; Harmer, Peter; Fitzgerald, Kathleen; Voit, Jan; Cameron, Kathleen A

    2016-02-01

    Falls in older adults are a global public health crisis, but mounting evidence from randomized controlled trials shows that falls can be reduced through exercise. Public health authorities and healthcare professionals endorse the use of evidence-based, exercise-focused fall interventions, but there are major obstacles to translating and disseminating research findings into healthcare practice, including lack of evidence of the transferability of efficacy trial results to clinical and community settings, insufficient local expertise to roll out community exercise programs, and inadequate infrastructure to integrate evidence-based programs into clinical and community practice. The practical solutions highlighted in this article can be used to address these evidence-to-practice challenges. Falls and their associated healthcare costs can be reduced by better integrating research on exercise intervention into clinical practice and community programs. PMID:26825429

  8. Data acquisition system using six degree-of-freedom inertia sensor and ZigBee wireless link for fall detection and prevention.

    PubMed

    Dinh, A; Teng, D; Chen, L; Ko, S B; Shi, Y; Basran, J; Del Bello-Hass, V

    2008-01-01

    Fall detection and prevention require logged physiological activity data of a patient for a long period of time. This work develops a data acquisition system to collect motion data from multiple patients and store in a data base. A wireless sensor network is built using high precision inertia sensors and low power Zigbee wireless transceivers. Testing results prove the system function properly. Researchers and physicians can now retrieve and analyze the accurate data of the patient movement with ease. PMID:19163174

  9. Fall-Risk Evaluation and Management: Challenges in Adopting Geriatric Care Practices

    ERIC Educational Resources Information Center

    Tinetti, Mary E.; Gordon, Catherine; Sogolow, Ellen; Lapin, Pauline; Bradley, Elizabeth H.

    2006-01-01

    One third of older adults fall each year, placing them at risk for serious injury, functional decline, and health care utilization. Despite the availability of effective preventive approaches, policy and clinical efforts at preventing falls among older adults have been limited. In this article we present the burden of falls, review evidence…

  10. Effectiveness of blast-mitigation for rock fall endangered critical infrastructure using terrestrial laser scanning (LIDAR).

    NASA Astrophysics Data System (ADS)

    Kos, A.; Lunghi, A.; Naenni, C.; Conforti, D.; Tompkinson, W.

    2009-04-01

    Following a national rock fall risk assessment undertaken by the Swiss Federal Roads Office (FEDRO) a potential rock fall area located above the San Bernardino highway (A13) at Brusei, Canton Graubünden was identified. The rockslope at Brusei was characterized by a previous record of rock fall, large overhanging outcrops and open tension cracks up to 2 metres. Combined with the fact that the A13 is a critical north-south traffic corridor in Switzerland and the geological situation, the Public Works Department of the Canton Graubünden made the decision to mitigate the rock fall risk with the use of explosives. We report on the use of terrestrial laser scanning for evaluating the effectiveness of mitigation using explosives for the protection of critical infrastructure. Although modern blast mitigation methods allow for accurate control on removed volumes of rock, it is important to calculate how much was actually removed particularly when protection structures, such as rock fall galleries are located in the transit/deposition zone of the blasted area. High resolution laser scanning is an appropriate technology for monitoring the pre- and post blast situation and provides the basis for: 1) Geological investigations for understanding the initial cause of instabilities; 2) Monitoring the formation of potential new instabilities following blast mitigation; and 3) Integration with other spatial monitoring technologies, such as ground-based radar interferometry.

  11. Effect of magnetic field profile on the anode fall in a Hall-effect thruster discharge

    SciTech Connect

    Dorf, L.; Raitses, Y.; Fisch, N.J.

    2006-05-15

    The effect of the magnetic field configuration on the anode fall in an E-vectorxB-vector discharge of a Hall thruster is studied both experimentally and theoretically. Plasma potential, electron temperature, and plasma density in the near-anode region are measured with a biased probe in three configurations of the magnetic field. It is observed that the anode fall in a Hall thruster can be changed from negative to positive by creating a magnetic field configuration with a zero magnetic field region. Similar configurations are utilized in some advanced Hall thrusters, like an ATON thruster. Results of the measurements are employed to model a Hall thruster with different magnetic field configurations, including the one with a zero-field region. Different anode sheath regimes observed experimentally are used to set the boundary conditions for the quasineutral plasma. Numerical solutions obtained with a hydrodynamic quasi-one-dimensional model suggest that varying the magnetic field configuration affects the electron mobility both inside and outside the channel, as well as the plasma density distribution along the axis.

  12. 75 FR 27625 - Announcement of the Fall 2010 Annual Grant Competition Effective October 1, 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-17

    ... PEACE Announcement of the Fall 2010 Annual Grant Competition Effective October 1, 2010 AGENCY: United States Institute of Peace. ACTION: Notice. SUMMARY: The Agency announces its Annual Grant Competition... international peace and conflict resolution. The Annual Grant Competition is open to any project that...

  13. Effects of age-related gait changes on the biomechanics of slips and falls

    PubMed Central

    Lockhart, Thurmon E.; Woldstad, Jeffrey C.; Smith, James L.

    2010-01-01

    A laboratory study was conducted to examine gait changes associated with aging and the effect of these changes on initiation of slips and frequency of falls utilizing newly defined biomechanical parameters of slips and falls. Twenty-eight participants from two age groups (young and old) walked around a circular track at a comfortable pace wearing a safety harness. A slippery floor surface was placed on the walking track over the force plate at random time intervals without the participants' awareness. Synchronized kinetic and kinematic measurements were obtained on both slippery and non-slippery walking surfaces. The results indicated that older participants' horizontal heel contact velocity was significantly faster, step length was significantly shorter, and transitional acceleration of the whole body centre-of-mass (COM) was significantly slower than younger participants. Older participants' initial friction demand, as measured by required coefficient of friction (RCOF), was not significantly different than their younger counterparts. Additionally, older participants slipped longer and faster, and fell more often than younger participants. A comparison of horizontal heel contact velocity for participants who fell with participants who did not fall indicated that, in general, fallers' horizontal heel contact velocity was faster than non-fallers. However, a comparison of RCOF for participants who fell with participants who did not fall suggested that RCOF was not a totally deterministic factor influencing actual fall events. These findings suggest that gait changes associated with aging (especially higher horizontal heel contact velocity and slower transition of the whole body COM) affect initiation of slip-induced falls. PMID:12933077

  14. Effect of Pre-Impact Movement Strategies on the Impact Forces Resulting From a Lateral Fall

    PubMed Central

    Lo, J.; Ashton-Miller, J. A.

    2008-01-01

    Approximately 90% of hip fractures in older adults result from falls, mostly from landing on or near the hip. A three-dimensional, 11-segment, forward dynamic biomechanical model was developed to investigate whether segment movement strategies prior to impact can affect the impact forces resulting from a lateral fall. Four different pre-impact movement strategies, with and without using the ipsilateral arm to break the fall, were implemented using paired actuators representing the agonist and antagonist muscles acting about each joint. Proportional-derivative feedback controller controlled joint angles and velocities so as to minimize risk of fracture at any of the impact sites. It was hypothesized that (a) use of active knee, hip and arm joint torques during the pre-contact phase neither affects the whole body kinetic energy at impact nor the peak impact forces on the knee, hip, or shoulder; and (b) muscle strength and reaction time do not considerably affect peak impact forces. The results demonstrate that, compared with falling laterally as a rigid body, an arrest strategy that combines flexion of the lower extremities, combined with an axial rotation to progressively present the posterolateral aspects of the thigh, pelvis and then torso, can reduce the peak hip impact force by up to 56%. A 30% decline in muscle strength did not markedly affect the effectiveness of that fall strategy. However, a 300 ms delay in implementing the movement strategy inevitably caused hip impact forces consistent with fracture unless the arm was used to break the fall prior to the hip impact. PMID:18513728

  15. Unobtrusive monitoring and identification of fall accidents.

    PubMed

    van de Ven, Pepijn; O'Brien, Hugh; Nelson, John; Clifford, Amanda

    2015-05-01

    Falls are a societal and economic problem of great concern with large parts of the population, in particular older citizens, at significant risk and the result of a fall often being grave. It has long been established that it is of importance to provide help to a faller soon after the event to prevent complications and this can be achieved with a fall monitor. Yet, the practical use of currently available fall monitoring solutions is limited due to accuracy, usability, cost, and, not in the least, the stigmatising effect of many solutions. This paper proposes a fall sensor concept that can be embedded in the user's footwear and discusses algorithms, software and hardware developed. Sensor performance is illustrated using results of a series of functional tests. These show that the developed sensor can be used for the accurate measurement of various mobility and gait parameters and that falls are detected accurately. PMID:25769224

  16. A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia

    PubMed Central

    2013-01-01

    Background People with dementia have a disproportionately high rate of falls and fractures and poorer outcomes, yet there is currently no evidence to guide falls prevention in this population. Methods A randomised trial design was used to test feasibility of study components and acceptability of a home hazard reduction and balance and strength exercise fall prevention program. The program was tailored to participant’s individual cognitive levels and implemented as a carer-supported intervention. Feasibility of recruitment, retention and implementation of intervention were recorded through observation and documented in field notes. Adherence, carer burden and use of task simplification strategies were also monitored. Outcome measures, collected at 12 weeks included physiological, fear of falling, cognitive and functional measures. Results Recruitment was achievable but may be more challenging in a multisite trial. Twenty two dyads of persons with mild dementia and their carers were randomised to intervention or usual care control group. Of 38 dyads referred to the study, there was a high rate of willingness to participate, with 6 (16%) declining and 10 (26%) not meeting inclusion criteria. The intervention was well received by participants and carers and adherence to both program components was very good. All participants implemented some home safety recommendations (range 19-80%) with half implementing 50% or more. At the end of 12 weeks, 72% of the intervention group were exercising. Both the rate of falling and the risk of a fall were lower in the intervention group but these findings were not significant (RR= 0.50 (95% CI 0.11-2.19). There were no differences in physiological outcome measures between the control and intervention groups. However results were influenced by the small study size and incomplete data primarily in the intervention group at follow up. Conclusions The pilot study was feasible and acceptable to people with mild dementia and their carers. The lessons learnt included: recruitment for a larger trial will require multiple approaches; home safety recommendations should provide a greater emphasis on environmental use compared with behavioural change; strategies to ensure an adequate dosage of exercise should be further explored. We recommend that intervention delivery incorporate an integrated occupational therapy and physiotherapy approach and that carers be provided with an individualised session to enhance dementia-specific skills in management and communication. A refined intervention should be tested in a randomised trial with an adequately powered sample size. Trial registration Australia and New Zealand Clinical Trials Registry 126100001049066 PMID:24004682

  17. The geomorphological effect of cornice fall avalanches in the Longyeardalen valley, Svalbard

    NASA Astrophysics Data System (ADS)

    Eckerstorfer, M.; Christiansen, H. H.; Rubensdotter, L.; Vogel, S.

    2013-09-01

    The study of snow avalanches and their geomorphological effect in the periglacial parts of the cryosphere is important for enhanced geomorphological process understanding as well as hazard-related studies. Only a few field studies, and particularly few in the High Arctic, have quantified avalanche sedimentation. Snow avalanches are traditionally ranked behind rockfall in terms of their significance for mass-wasting processes of rockslopes. Cornice fall avalanches are at present the most dominant snow avalanche type at two slope systems, called Nybyen and Larsbreen, in the valley Longyeardalen in central Svalbard. Both slope systems are on northwest-facing lee slopes underneath a large summit plateau, with annual cornices forming on the top. High-frequency and magnitude cornice fall avalanching is observed by daily automatic time-lapse photography. In addition, rock debris sedimentation by cornice fall avalanches was measured directly in permanent sediment traps or by snow inventories. The results from a maximum of seven years of measurements in a total of 13 catchments show maximum mean rock debris sedimentation rates ranging from 8.2 to 38.7 kg m-2 at Nybyen, and from 0.8 to 55.4 kg m-2 at Larsbreen. Correspondingly, avalanche fan surfaces accreted from 2.6 to 8.8 mm yr-1 at Nybyen, and from 0.2 to 13.9 mm yr-1 at Larsbreen. This comparably efficient rockslope mass wasting is due to collapsing cornices producing cornice fall avalanches containing large amounts of rock debris throughout the entire winter. The rock debris of different origin stems from the plateau crests, the adjacent free rock face and the transport pathway, accumulating distinct avalanche fans at both slope systems. Cornice fall avalanche sedimentation also contributed to the development of a rock glacier at the Larsbreen site during the Holocene. We have recorded present maximum rockwall retreat rates of 0.9 mm yr-1 at Nybyen, but as much as 6.7 mm yr-1 at Larsbreen, while average Holocene rockwall retreat rates of 1.1 mm yr-1 at Nybyen have been determined earlier. As cornice fall avalanches are the dominant type of avalanche in central Svalbard, the related geomorphological effect is assumed to be of significance at periglacial landscape scale. A climate-induced shift in prevailing winter wind direction could change the rockslope sedimentation effectively by changing the snow avalanche activity.

  18. Effects of strength and balance training on the mobility, fear of falling and grip strength of elderly female fallers.

    PubMed

    Prata, Melina Galleti; Scheicher, Marcos Eduardo

    2015-10-01

    The aim of this study was to evaluate the effects of virtual reality and strength training on the balance, fear of falling and handgrip strength of older women with a history of falls. The fear of falling, mobility and grip strength were evaluated in 11 elderly fallers (72.4 ± 5.2 years). The faller group was submitted to 12 weeks of virtual reality and muscle strength training. The results showed improvement in mobility (p = 0.0004) and in the fear of falling (p = 0.002). No significant difference was observed for hand grip strength. It can be concluded that virtual reality and muscle strength interventions are beneficial for mobility and fear of falling in older women with a history of falls. PMID:26592222

  19. Falls and Fractures

    MedlinePLUS

    ... Disease Also of Interest Exercise to Improve Your Balance - Go4Life Tip Sheet (PDF, 113K) Preventing Falls - Go4Life Tip Sheet (PDF, 397K) Falls and Older Adults - NIHSeniorHealth Other Non-English Bone Health Publications Spanish ...

  20. A feasibility study of a randomised controlled trial comparing fall prevention using exercise with or without the support of motivational interviewing

    PubMed Central

    Arkkukangas, Marina; Johnson, Susanna Tuvemo; Hellström, Karin; Söderlund, Anne; Eriksson, Staffan; Johansson, Ann-Christin

    2015-01-01

    Objective The aim of this investigation was to study the feasibility of a randomised controlled trial (RCT) based on a multicentre fall prevention intervention including exercise with or without motivational interviewing compared to standard care in community-living people 75 years and older. Method The feasibility of a three-armed, randomised controlled trial was evaluated according to the following: process, resources, management by questionnaire, and treatment outcomes. The outcome measures were fall frequency, physical performance and falls self-efficacy evaluated after three months. Twelve physiotherapists conducted the measurements and treatments and responded to the questionnaire. The first 45 participants recruited to the ongoing RCT were included: 16 individuals in the Otago Exercise Program group (OEP), 16 individuals in the OEP combined with motivational interviewing group (MI), and 13 individuals in the control group. The study was conducted from November 2012 to December 2013. Results The feasibility of the study process, resources and management reached the set goals in most aspects; however, the set goal regarding the MI guide and planned exercise for the participating older people was not completely reached. No significant differences were found between the groups regarding the outcome measures. Conclusion This study confirmed the acceptable feasibility for the study protocol in the ongoing RCT. PMID:26844061

  1. Effect of Alpine ski boot cuff release on knee joint force during the backward fall.

    PubMed

    Benoit, D L; Lamontagne, M; Greaves, C; Liti, A; Cerulli, G

    2005-01-01

    The modern rigid alpine ski boot has been associated with an increase in severe knee joint injuries. A new design that allows the rear portion of the upper cuff of the boot (rear spoiler) to open when a posterior directed force is applied to it (similar to when a skier falls back on the ski) is investigated. Motion analysis was combined with kinetic measures to estimate the shear and compressive forces at the knee joint using a link-segment model while subjects fell backward to provoke ski boot cuff release. The rear spoiler opening was found to reduce anterior cruciate ligament directed shear force while increasing compressive force at the joint. We conclude that both compressive force and reduced anterior cruciate directed shear force have been associated with protective mechanisms at the knee joint. This occurred over a very brief period of time, however, and the influence this may have on knee injury prevention is discussed. PMID:16440506

  2. Effectiveness of riboflavin in pediatric migraine prevention

    PubMed Central

    Sherwood, Michelle; Goldman, Ran D.

    2014-01-01

    Abstract Question The rate of migraine diagnosed among children is increasing. Is riboflavin, an alternative to traditional pharmacologic agents, effective and safe for prevention of migraine in children? Answer Because migraine is a very common condition in childhood and adolescence, often contributing to substantial burden of illness, there is increased interest in alternatives to traditional pharmacologic prevention. The expectation is that over-the-counter alternative medication will be less toxic, better tolerated, and have fewer side effects. A few studies in adults show that riboflavin (vitamin B2) might decrease frequency of migraine headaches. It has become common practice to recommend that children try riboflavin to prevent migraine; however, research on riboflavin use in children is inconclusive. PMID:24627379

  3. Effects of obesity on slip-induced fall risks among young male adults

    PubMed Central

    Wu, Xuefang; Lockhart, Thurmon E.; Yeoh, Han T.

    2012-01-01

    Obesity is associated with structural and functional limitations with impairment of normal gait. Although falls have been identified as the most common cause of injuries in the obese, the mechanisms associated with increased fall risk among the obese population are still unknown. The purpose of this study was to investigate the influence of gait adaptations of the obese individuals and its implication on risk of slip initiations as measured by friction demand characteristics. To exclude the aging and gender effects, a total of ten healthy young male adults participated in the study. Kinematic and kinetic data were collected using a three-dimensional motion analysis system and force plates while subjects were walking at their self-selected walking pace. Results indicated that young obese adults walked similarly as their lean counterparts except for exhibiting greater step width and higher transversal friction demand, suggesting that slip-induced fall risks are similar along the horizontal direction, but increased along the transversal direction under certain floor conditions. PMID:22304846

  4. The medical effects of radioactive fall-out: role of stable end-products?

    PubMed Central

    Burrows, B. A.; Cardarelli, J. C.; Boling, E. A.; Sinex, F. M.

    1981-01-01

    To summarize, from preliminary observations on the possible effects of radioactive fall-out, it may be inferred that in addition to the secondary products of ionizing irradiation per se, the stable end-products of the transmutation of certain radionuclides may adversely influence cellular metabolism, including mutagenesis. The discussion of the possible role of intracellular barium as an end-product of 137Cs decay is offered as an example of an unpredictable number of broad ecological, as well as the more limited medical, effects that may be of both clinical and climatological significance. Images Fig. 1 Fig. 2 PMID:7281411

  5. The cancer preventive effects of edible mushrooms.

    PubMed

    Xu, Tongtong; Beelman, Robert B; Lambert, Joshua D

    2012-12-01

    An increasing body of scientific literature suggests that dietary components may exert cancer preventive effects. Tea, soy, cruciferous vegetables and other foods have been investigated for their cancer preventive potential. Some non-edible mushrooms like Reishi (Ganoderma lucidum) have a history use, both alone and in conjunction with standard therapies, for the treatment of various diseases including cancer in some cultures. They have shown efficacy in a number of scientific studies. By comparison, the potential cancer preventive effects of edible mushrooms have been less well-studied. With similar content of putative effective anticancer compounds such as polysaccharides, proteoglycans, steroids, etc., one might predict that edible mushrooms would also demonstrate anticancer and cancer preventive activity. In this review, available data for five commonly-consumed edible mushrooms: button mushrooms (Agaricus bisporus), A. blazei, oyster mushrooms (Pleurotus ostreatus), shiitake mushrooms (Lentinus edodes), and maitake (Grifola frondosa) mushrooms is discussed. The results of animal model and human intervention studies, as well as supporting in vitro mechanistic studies are critically evaluated. Weaknesses in the current data and topics for future work are highlighted. PMID:22583406

  6. The effect of enhanced trunk control on balance and falls through bilateral upper extremity exercises among chronic stroke patients in a standing position

    PubMed Central

    Shin, Ji Won; Don Kim, Kyoung

    2016-01-01

    [Purpose] This study examined the effects of bilateral upper extremity exercises on trunk control, balance, and risk of falls in stroke patients. [Subjects and Methods] A total of 30 study subjects were selected and randomly divided into experimental and control groups containing 15 subjects each, who received bilateral upper extremity activities and conventional rehabilitation treatment, respectively. [Results] There were statistically significant differences between groups in all sub-items and total trunk impairment and Berg Balance scale scores. Significant differences between groups were also observed in all sub-items of the trunk impairment scale, except for static sitting balance. [Conclusion] Bilateral upper extremity exercises are effective for trunk control and balance as well as for fall prevention. PMID:26957756

  7. Moving forward in fall prevention: an intervention to improve balance among patients in a quasi-experimental study of hospitalized patients.

    PubMed

    Villafańe, Jorge H; Pirali, Caterina; Buraschi, Riccardo; Arienti, Chiara; Corbellini, Camilo; Negrini, Stefano

    2015-12-01

    We investigated the effectiveness of three different rehabilitative programs: group exercise, individual core stability or balance training intervention with a stabilometric platform to improve balance ability in elderly hospitalized patients. We used a prospective quasi-experimental study design. Twenty-eight patients, 39.3% women [age (mean±SD) 72.4±6.5 years], known to have had at least a fall in the last 12 months, were consecutively assigned to one of the following three groups: group exercise intervention, individual core stability or balance training with a stabilometric platform (five sessions a week for 3 weeks in each group). Outcomes were collected at baseline and immediately following the intervention period. In each intervention group, patients showed improvement in balance and mobility, shown as an improvement in the three functional tests score (the Tinetti scale, the Berg Balance Scale, and the Time Up and Go test) (all, P<0.05), whereas, generally, the changes in the score of the test of the stabilometric platform (Postural Stability Test and Fall Risk Test) were not significant for all the interventions. No significant group-by-time interaction was detected for any of the intervention groups, which suggests that the groups improved in the same way. These findings indicate that participation in an exercise program can improve balance and functional mobility, which might contribute toward the reductions of the falls of elderly hospitalized patients and the subsequent fall-related costs. Functional scales might be more appropriate than an instrumental test (Postural Stability Test and Fall Risk Test of the Biodex Balance System) in detecting the functional improvement because of a rehabilitative intervention. PMID:26230947

  8. Physiological and Psychological Effects of a Walk in Urban Parks in Fall

    PubMed Central

    Song, Chorong; Ikei, Harumi; Igarashi, Miho; Takagaki, Michiko; Miyazaki, Yoshifumi

    2015-01-01

    In recent times, attention has been focused on the role of urban green spaces in promoting human health and well-being. However, there is a lack of evidence-based research on the physiological effects of walking in urban green areas. This study aimed to clarify the physiological and psychological effects of walking in urban parks during fall. Twenty-three males (mean age 22.3 ± 1.2 years) were instructed to walk predetermined 15-min courses in an urban park and in a nearby city area (control). Heart rate and heart rate variability were measured to assess physiological responses, and the semantic differential method, Profile of Mood States, and State-Trait Anxiety Inventory were used to measure psychological responses. We observed that walking in an urban park resulted in a significantly lower heart rate, higher parasympathetic nerve activity, and lower sympathetic nerve activity than walking through the city area. In subjective evaluations, participants were more “comfortable,” “natural,” “relaxed,” and “vigorous” after a walk in the urban park. Furthermore, they exhibited significantly lower levels of negative emotions and anxiety. These findings provide scientific evidence for the physiological and psychological relaxation effects of walking in urban parks during fall. PMID:26569271

  9. Common factors in effective HIV prevention programs.

    PubMed

    Rotheram-Borus, Mary Jane; Swendeman, Dallas; Flannery, Diane; Rice, Eric; Adamson, David M; Ingram, Barbara

    2009-06-01

    We propose a set of common factors in evidence-based interventions (EBI) for HIV prevention, which cut across theoretical models of behavior change. Three existing literatures support this agenda: (1) Common factors in psychotherapy; (2) core elements from the Centers for Disease Control and Prevention EBIs; and (3) component analyses of EBI. To stimulate discussion among prevention researchers, we propose a set of common factors at the highest level of abstraction that describe what all effective programs do: (1) establish a framework to understand behavior change; (2) convey issue-specific and population-specific information necessary for healthy actions; (3) build cognitive, affective, and behavioral self-management skills; (4) address environmental barriers to implementing health behaviors; and (5) provide tools to develop ongoing social and community support for healthy actions. A focus on common factors will enhance research on new HIV prevention interventions, encourage collaboration among researchers, provide guidelines for adapting EBI, and simplify and speed the adoption of EBI for providers. PMID:18830813

  10. Lasers effects on enamel for caries prevention

    NASA Astrophysics Data System (ADS)

    Ana, P. A.; Bachmann, L.; Zezell, D. M.

    2006-05-01

    The aim of this study was to ascertain whether laser irradiation is able to reduce caries incidence. For this purpose, the effects of laser on enamel and on fluoride uptake were discussed. Current literature regarding the preventive effect of laser irradiation on dental hard tissue has been reviewed. An evaluation of the results of the available in vitro and in vivo studies on the efficacy of anticaries and induced changes on enamel by laser irradiation were also performed. Articles were selected using the Medline, Web of Science, Embase, and Cochrane databases, and the results of these studies were described. The most common lasers employed for caries prevention on enamel are Nd:YAG; CO2; Er:YAG; Er,Cr:YSGG; and argon. The percentage of inhibition of dental caries varied from 30 to 97.2%, and the association with fluoride has demonstrated the best results on inhibition of caries development. Laser irradiation under specific conditions can change the crystallographic properties of apatite crystals, increasing the acid resistance of lased enamel. The combined treatment of laser irradiation with fluoride propitiates an expressive fluoride uptake, reducing the progression of carieslike lesions, and this treatment is more effective than laser or fluoride alone. Available data suggest that lasers combined with fluoride is a promising treatment in caries prevention.

  11. A translational research evaluation of the Stay Active and Independent for Life (SAIL) community-based fall prevention exercise and education program.

    PubMed

    York, Sally C; Shumway-Cook, Anne; Silver, Ilene F; Morrison, A Clare

    2011-11-01

    Falls in older adults are the leading cause of injury hospitalizations and fatalities in the United States; primary risk factors are muscle weakness, impaired mobility, and balance deficits. This article describes the 12-month translational research evaluation of the Stay Active and Independent for Life (SAIL) community-based public health, public domain fall prevention exercise and education program. Recruitment reached the target goal by 154%; 331 adults (mean age = 74.6) attended more than one class (mean classes attended = 24.8, SD = 26.6, range = 1-120) at nine community sites in one county in the 12-month period; 173 completed health and demographic forms, 132 completed program surveys, and 91 completed baseline and follow-up physical function tests. Physical function test results showed significant improvements in strength, balance, and mobility in those who were below normal limits at baseline, and in those who attended classes twice a week or more for more than 2 months. Survey results found that 93% of respondents reported improved performance of daily activities; 92% reported improved strength, balance, fitness, or flexibility; and 80% found the SAIL information guide education component helpful. PMID:21191079

  12. Selection effects and prevention program outcomes.

    PubMed

    Hill, Laura G; Rosenman, Robert; Tennekoon, Vidhura; Mandal, Bidisha

    2013-12-01

    A primary goal of the paper is to provide an example of an evaluation design and analytic method that can be used to strengthen causal inference in nonexperimental prevention research. We used this method in a nonexperimental multisite study to evaluate short-term outcomes of a preventive intervention, and we accounted for effects of two types of selection bias: self-selection into the program and differential dropout. To provide context for our analytic approach, we present an overview of the counterfactual model (also known as Rubin's causal model or the potential outcomes model) and several methods derived from that model, including propensity score matching, the Heckman two-step approach, and full information maximum likelihood based on a bivariate probit model and its trivariate generalization. We provide an example using evaluation data from a community-based family intervention and a nonexperimental control group constructed from the Washington State biennial Healthy Youth Survey (HYS) risk behavior data (HYS n = 68,846; intervention n = 1,502). We identified significant effects of participant, program, and community attributes in self-selection into the program and program completion. Identification of specific selection effects is useful for developing recruitment and retention strategies, and failure to identify selection may lead to inaccurate estimation of outcomes and their public health impact. Counterfactual models allow us to evaluate interventions in uncontrolled settings and still maintain some confidence in the internal validity of our inferences; their application holds great promise for the field of prevention science as we scale up to community dissemination of preventive interventions. PMID:23417667

  13. Eleven Components of Effective Drug Abuse Prevention Curricula.

    ERIC Educational Resources Information Center

    Dusenbury, Linda; Falco, Mathea

    1995-01-01

    This review examined school-based drug abuse prevention programs for 1989-94. From a literature review and interviews with a panel of experts in prevention research, 11 key components of effective prevention curricula were identified. These components are listed and discussed briefly. Dissemination of effective prevention programs is discussed.…

  14. Analyzing the problem of falls among older people

    PubMed Central

    Dionyssiotis, Yannis

    2012-01-01

    Falls are a serious problem facing the elderly. The prevention of falls that contribute to disability, mainly in elderly people, is an important issue. Ensuring the greatest possible functionality for elderly people is an important element in the prevention of disability. This paper analyzes the importance of falls, risk factors for falls, and interventions to prevent falls. Recent publications as well as research regarding the prevention and rehabilitation for falls are reviewed. PMID:23055770

  15. Strategies for Success: New Pathways to Drug Abuse Prevention. Volume 1, Issue 1, Fall/Winter 2006

    ERIC Educational Resources Information Center

    Office of National Drug Control Policy, 2006

    2006-01-01

    Published twice a year and distributed nationwide, "Strategies for Success" keeps readers informed about events and developments in the field of drug testing. It reports the latest research findings on the effectiveness of drug testing as a tool for reducing substance abuse. Each issue also provides a wealth of guidance and resources on student


  16. Vitamin D: A Review on Its Effects on Muscle Strength, the Risk of Fall, and Frailty

    PubMed Central

    Halfon, Matthieu; Phan, Olivier; Teta, Daniel

    2015-01-01

    Vitamin D is the main hormone of bone metabolism. However, the ubiquitary nature of vitamin D receptor (VDR) suggests potential for widespread effects, which has led to new research exploring the effects of vitamin D on a variety of tissues, especially in the skeletal muscle. In vitro studies have shown that the active form of vitamin D, calcitriol, acts in myocytes through genomic effects involving VDR activation in the cell nucleus to drive cellular differentiation and proliferation. A putative transmembrane receptor may be responsible for nongenomic effects leading to rapid influx of calcium within muscle cells. Hypovitaminosis D is consistently associated with decrease in muscle function and performance and increase in disability. On the contrary, vitamin D supplementation has been shown to improve muscle strength and gait in different settings, especially in elderly patients. Despite some controversies in the interpretation of meta-analysis, a reduced risk of falls has been attributed to vitamin D supplementation due to direct effects on muscle cells. Finally, a low vitamin D status is consistently associated with the frail phenotype. This is why many authorities recommend vitamin D supplementation in the frail patient. PMID:26000306

  17. Planting date effects on the yield and nutritive value of fall-grown oat cultivars

    Technology Transfer Automated Retrieval System (TEKTRAN)

    For the dairy industry within the north-central U.S., options for producing emergency forage are limited when late-summer or fall inventories are inadequate, primarily because of the relatively short growing season. Fall-grown cereal crops can fill this niche, but knowing what to plant and when to p...

  18. Quantum Incompressibility of a Falling Rydberg Atom, and a Gravitationally-Induced Charge Separation Effect in Superconducting Systems

    NASA Astrophysics Data System (ADS)

    Chiao, R. Y.; Minter, S. J.; Wegter-McNelly, K.; Martinez, L. A.

    2012-01-01

    Freely falling point-like objects converge toward the center of the Earth. Hence the gravitational field of the Earth is inhomogeneous, and possesses a tidal component. The free fall of an extended quantum mechanical object such as a hydrogen atom prepared in a high principal-quantum-number state, i.e. a circular Rydberg atom, is predicted to fall more slowly than a classical point-like object, when both objects are dropped from the same height above the Earth's surface. This indicates that, apart from transitions between quantum states, the atom exhibits a kind of quantum mechanical incompressibility during free fall in inhomogeneous, tidal gravitational fields like those of the Earth. A superconducting ring-like system with a persistent current circulating around it behaves like the circular Rydberg atom during free fall. Like the electronic wavefunction of the freely falling atom, the Cooper-pair wavefunction is quantum mechanically incompressible. The ions in the lattice of the superconductor, however, are not incompressible, since they do not possess a globally coherent quantum phase. The resulting difference during free fall in the response of the nonlocalizable Cooper pairs of electrons and the localizable ions to inhomogeneous gravitational fields is predicted to lead to a charge separation effect, which in turn leads to a large Coulomb force that opposes the convergence caused by the tidal gravitational force on the superconducting system. A "Cavendish-like" experiment is proposed for observing the charge separation effect induced by inhomogeneous gravitational fields in a superconducting circuit. The charge separation effect is determined to be limited by a pair-breaking process that occurs when low frequency gravitational perturbations are present.

  19. Pedestrians' behaviour in cross walks: the effects of fear of falling and age.

    PubMed

    Avineri, Erel; Shinar, David; Susilo, Yusak O

    2012-01-01

    Pedestrians are exposed to risks when crossing roads in urban areas. The crossing behaviour of pedestrians was studied as a factor contributing to their exposure to risks on the road and to their involvement in road accidents. This work explores two specific aspects of crossing behaviour: crossing speed and head pitches-the proportion of time pedestrians point their heads down (rather than towards the traffic) when crossing a road. The last one is used as an indicator of the (lack of) attention to cross-traffic. We also explored the possible effect of fear of falling (FOF) among pedestrians, as it might be associated with slow walking, less attention to cross traffic, and more attention to the pavement and their footsteps. This paper reports on a field study that combined an observatory technique with short survey. 203 pedestrians in two sites (signalised and unsignalised crosswalks) were video recorded while crossing the road. The FOF of pedestrians and other measures of pedestrian behaviour at crosswalks were revealed by means of questionnaire. Age and gender had the most significant effects on crossing speed, and FOF had a significant effect on the proportion of downward head pitches during crossing. PMID:22062333

  20. Fall- and spring-applied poultry litter effectiveness as corn fertilizer in the mid-southern United States

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The effectiveness of fall- or winter-applied poultry litter, relative to spring-applied litter, as row crop fertilizer in the southern and southeastern US has not been well researched. A 3-yr field research was conducted in northern Mississippi to determine the effectiveness of litter as corn fertil...

  1. Glucose prevents the fall in ventromedial hypothalamic GABA that is required for full activation of glucose counterregulatory responses during hypoglycemia.

    PubMed

    Zhu, Wanling; Czyzyk, Daniel; Paranjape, Sachin A; Zhou, Ligang; Horblitt, Adam; Szabó, Gábor; Seashore, Margretta R; Sherwin, Robert S; Chan, Owen

    2010-05-01

    Local delivery of glucose into a critical glucose-sensing region within the brain, the ventromedial hypothalamus (VMH), can suppress glucose counterregulatory responses to systemic hypoglycemia. Here, we investigated whether this suppression was accomplished through changes in GABA output in the VMH. Sprague-Dawley rats had catheters and guide cannulas implanted. Eight to ten days later, microdialysis-microinjection probes were inserted into the VMH, and they were dialyzed with varying concentrations of glucose from 0 to 100 mM. Two groups of rats were microdialyzed with 100 mM glucose and microinjected with either the K(ATP) channel opener diazoxide or a GABA(A) receptor antagonist. These animals were then subjected to a hyperinsulinemic-hypoglycemic glucose clamp. As expected, perfusion of glucose into the VMH suppressed the counterregulatory responses. Extracellular VMH GABA levels positively correlated with the concentration of glucose in the perfusate. In turn, extracellular GABA concentrations in the VMH were inversely related to the degree of counterregulatory hormone release. Of note, microinjection of either diazoxide or the GABA(A) receptor antagonist reversed the suppressive effects of VMH glucose delivery on counterregulatory responses. Some GABAergic neurons in the VMH respond to changes in local glucose concentration. Glucose in the VMH dose-dependently stimulates GABA release, and this in turn dose-dependently suppresses the glucagon and epinephrine responses to hypoglycemia. These data suggest that during hypoglycemia a decrease in glucose concentration within the VMH may provide an important signal that rapidly inactivates VMH GABAergic neurons, reducing inhibitory GABAergic tone, which in turn enhances the counterregulatory responses to hypoglycemia. PMID:20304763

  2. Glucose prevents the fall in ventromedial hypothalamic GABA that is required for full activation of glucose counterregulatory responses during hypoglycemia

    PubMed Central

    Zhu, Wanling; Czyzyk, Daniel; Paranjape, Sachin A.; Zhou, Ligang; Horblitt, Adam; Szabó, Gábor; Seashore, Margretta R.; Sherwin, Robert S.

    2010-01-01

    Local delivery of glucose into a critical glucose-sensing region within the brain, the ventromedial hypothalamus (VMH), can suppress glucose counterregulatory responses to systemic hypoglycemia. Here, we investigated whether this suppression was accomplished through changes in GABA output in the VMH. Sprague-Dawley rats had catheters and guide cannulas implanted. Eight to ten days later, microdialysis-microinjection probes were inserted into the VMH, and they were dialyzed with varying concentrations of glucose from 0 to 100 mM. Two groups of rats were microdialyzed with 100 mM glucose and microinjected with either the KATP channel opener diazoxide or a GABAA receptor antagonist. These animals were then subjected to a hyperinsulinemic-hypoglycemic glucose clamp. As expected, perfusion of glucose into the VMH suppressed the counterregulatory responses. Extracellular VMH GABA levels positively correlated with the concentration of glucose in the perfusate. In turn, extracellular GABA concentrations in the VMH were inversely related to the degree of counterregulatory hormone release. Of note, microinjection of either diazoxide or the GABAA receptor antagonist reversed the suppressive effects of VMH glucose delivery on counterregulatory responses. Some GABAergic neurons in the VMH respond to changes in local glucose concentration. Glucose in the VMH dose-dependently stimulates GABA release, and this in turn dose-dependently suppresses the glucagon and epinephrine responses to hypoglycemia. These data suggest that during hypoglycemia a decrease in glucose concentration within the VMH may provide an important signal that rapidly inactivates VMH GABAergic neurons, reducing inhibitory GABAergic tone, which in turn enhances the counterregulatory responses to hypoglycemia. PMID:20304763

  3. Long-run effects of falling cellulosic ethanol production costs on the US agricultural economy

    NASA Astrophysics Data System (ADS)

    Campiche, Jody L.; Bryant, Henry L.; Richardson, James W.

    2010-01-01

    Renewable energy production has been expanding at a rapid pace. New advances in cellulosic ethanol technologies have the potential to displace the use of petroleum as a transportation fuel, and could have significant effects on both the agricultural economy and the environment. In this letter, the effects of falling cellulosic ethanol production costs on the mix of ethanol feedstocks employed and on the US agricultural economy are examined. Results indicate that, as expected, cellulosic ethanol production increases by a substantial amount as conversion technology improves. Corn production increases initially following the introduction of cellulosic technology, because producers enjoy new revenue from sales of corn stover. After cellulosic ethanol production becomes substantially cheaper, however, acres are shifted from corn production to all other agricultural commodities. Essentially, this new technology could facilitate the exploitation of a previously under-employed resource (corn stover), resulting in an improvement in overall welfare. In the most optimistic scenario considered, 68% of US ethanol is derived from cellulosic sources, coarse grain production is reduced by about 2%, and the prices of all food commodities are reduced modestly.

  4. Long-run effects of falling cellulosic ethanol production costs on the US agricultural economy

    SciTech Connect

    Bryant, Henry L.; Campiche, Jody L.; Richardson, James W.

    2010-03-09

    Renewable energy production has been expanding at a rapid pace. New advances in cellulosic ethanol technologies have the potential to displace the use of petroleum as a transportation fuel, and could have significant effects on both the agricultural economy and the environment. In this letter, the effects of falling cellulosic ethanol production costs on the mix of ethanol feedstocks employed and on the US agricultural economy are examined. Results indicate that, as expected, cellulosic ethanol production increases by a substantial amount as conversion technology improves. Corn production increases initially following the introduction of cellulosic technology, because producers enjoy new revenue from sales of corn stover. After cellulosic ethanol production becomes substantially cheaper, however, acres are shifted from corn production to all other agricultural commodities. Essentially, this new technology could facilitate the exploitation of a previously under-employed resource (corn stover), resulting in an improvement in overall welfare. Thus in the most optimistic scenario considered, 68% of US ethanol is derived from cellulosic sources, coarse grain production is reduced by about 2%, and the prices of all food commodities are reduced modestly.

  5. Long-run effects of falling cellulosic ethanol production costs on the US agricultural economy

    DOE PAGESBeta

    Bryant, Henry L.; Campiche, Jody L.; Richardson, James W.

    2010-03-09

    Renewable energy production has been expanding at a rapid pace. New advances in cellulosic ethanol technologies have the potential to displace the use of petroleum as a transportation fuel, and could have significant effects on both the agricultural economy and the environment. In this letter, the effects of falling cellulosic ethanol production costs on the mix of ethanol feedstocks employed and on the US agricultural economy are examined. Results indicate that, as expected, cellulosic ethanol production increases by a substantial amount as conversion technology improves. Corn production increases initially following the introduction of cellulosic technology, because producers enjoy new revenuemore » from sales of corn stover. After cellulosic ethanol production becomes substantially cheaper, however, acres are shifted from corn production to all other agricultural commodities. Essentially, this new technology could facilitate the exploitation of a previously under-employed resource (corn stover), resulting in an improvement in overall welfare. Thus in the most optimistic scenario considered, 68% of US ethanol is derived from cellulosic sources, coarse grain production is reduced by about 2%, and the prices of all food commodities are reduced modestly.« less

  6. Experiments in Free Fall

    ERIC Educational Resources Information Center

    Art, Albert

    2006-01-01

    A model lift containing a figure of Albert Einstein is released from the side of a tall building and its free fall is arrested by elastic ropes. This arrangement allows four simple experiments to be conducted in the lift to demonstrate the effects of free fall and show how they can lead to the concept of the equivalence of inertial and


  7. Experiments in Free Fall

    ERIC Educational Resources Information Center

    Art, Albert

    2006-01-01

    A model lift containing a figure of Albert Einstein is released from the side of a tall building and its free fall is arrested by elastic ropes. This arrangement allows four simple experiments to be conducted in the lift to demonstrate the effects of free fall and show how they can lead to the concept of the equivalence of inertial and…

  8. Functional levels of floor surface roughness for the prevention of slips and falls: clean-and-dry and soapsuds-covered wet surfaces.

    PubMed

    Kim, In-Ju; Hsiao, Hongwei; Simeonov, Peter

    2013-01-01

    Literature has shown a general trend that slip resistance performance improves with floor surface roughness. However, whether slip resistance properties are linearly correlated with surface topographies of the floors or what roughness levels are required for effective slip resistance performance still remain to be answered. This pilot study aimed to investigate slip resistance properties and identify functional levels of floor surface roughness for practical design applications in reducing the risk of slip and fall incidents. A theory model was proposed to characterize functional levels of surface roughness of floor surfaces by introducing a new concept of three distinctive zones. A series of dynamic friction tests were conducted using 3 shoes and 9 floor specimens under clean-and-dry as well as soapsuds-covered slippery wet environments. The results showed that all the tested floor-shoe combinations provided sufficient slip resistances performance under the clean-and-dry condition. A significant effect of floor type (surface roughness) on dynamic friction coefficient (DFC) was found in the soapsuds-covered wet condition. As compared to the surface roughness effects, the shoe-type effects were relatively small. Under the soapsuds-covered wet condition, floors with 50 ÎŒm in Ra roughness scale seemed to represent an upper bound in the functional range of floor surface roughness for slip resistance because further increase of surface roughness provided no additional benefit. A lower bound of the functional range for slip resistance under the soapsuds-covered wet condition was estimated from the requirement of DFC > 0.4 at Ra ≅ 17 ÎŒm. Findings from this study may have potential safety implications in the floor surface design for reducing slip and fall hazards. PMID:22641153

  9. Bridalveil Fall

    USGS Multimedia Gallery

    In this image, Bridalveil Fall can be seen from Tunnel View in Yosemite National Park. The waterfall is 617 ft (188 m) in height and is one of the most well-known of Yosemite National Park's waterfalls....

  10. Falls in Nursing Homes

    MedlinePLUS

    ... grab bars, adding raised toilet seats, lowering bed heights, and installing handrails in the hallways. 10 Providing patients with hip pads that may prevent a hip fracture if a fall occurs. 19 Exercise programs can improve balance, strength, walking ability, and physical functioning among nursing ...

  11. Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis

    PubMed Central

    Burton, Elissa; Cavalheri, Vinicius; Adams, Richard; Oakley Browne, Colleen; Bovery-Spencer, Petra; Fenton, Audra M; Campbell, Bruce W; Hill, Keith D

    2015-01-01

    Objective The objective of this systematic review and meta-analysis is to evaluate the effectiveness of exercise programs to reduce falls in older people with dementia who are living in the community. Method Peer-reviewed articles (randomized controlled trials [RCTs] and quasi-experimental trials) published in English between January 2000 and February 2014, retrieved from six electronic databases – Medline (ProQuest), CINAHL, PubMed, PsycInfo, EMBASE and Scopus – according to predefined inclusion criteria were included. Where possible, results were pooled and meta-analysis was conducted. Results Four articles (three RCT and one single-group pre- and post-test pilot study) were included. The study quality of the three RCTs was high; however, measurement outcomes, interventions, and follow-up time periods differed across studies. On completion of the intervention period, the mean number of falls was lower in the exercise group compared to the control group (mean difference [MD] [95% confidence interval {CI}] =−1.06 [−1.67 to −0.46] falls). Importantly, the exercise intervention reduced the risk of being a faller by 32% (risk ratio [95% CI] =0.68 [0.55–0.85]). Only two other outcomes were reported in two or more of the studies (step test and physiological profile assessment). No between-group differences were observed in the results of the step test (number of steps) (MD [95% CI] =0.51 [−1.77 to 2.78]) or the physiological profile assessment (MD [95% CI] =−0.10 [−0.62 to 0.42]). Conclusion Findings from this review suggest that an exercise program may potentially assist in preventing falls of older people with dementia living in the community. However, further research is needed with studies using larger sample sizes, standardized measurement outcomes, and longer follow-up periods, to inform evidence-based recommendations. PMID:25709416

  12. EFFECTS OF CROP ROTATIONS AND A FALL COVER CROP ON RHIZOCTONIA CANKER, BLACK SCURF, AND COMMON SCAB OF POTATO, 2004

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Six different rotation crops (barley/clover, canola, green bean, rapeseed, soybean, and sweet corn) planted in 2-yr rotations with potato (and a continuous potato nonrotation control) were evaluated both with and without a fall cover crop of winter rye for their effects on the development of soilbor...

  13. Host effects on fitness in two strains of the fall armyworm (Noctuidae) and a parasitoid of the family Eulophidae

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The fall armyworm is known to be a pest of many species of the family Poaceae. In this study we compared the effects of two host plants (Zea mays and Cynodon nlemfuensis var. nlemfuensis) on survivorship of two strains of the FAW and the parasitoid Euplectrus platyhypenae....

  14. Developmental approach to prevent adolescent suicides: research pathways to effective upstream preventive interventions.

    PubMed

    Wyman, Peter A

    2014-09-01

    The 2012 National Strategy for Suicide Prevention expands the current suicide prevention paradigm by including a strategic direction aimed at promoting healthy populations. Childhood and adolescence are key suicide prevention window periods, yet knowledge of suicide prevention pathways through universal interventions is limited (Aspirational Goal 11). Epidemiologic evidence suggests that prevention programs in normative social systems such as schools are needed for broad suicide prevention impact. Prevention trial results show that current universal prevention programs for children and young adolescents are effective in reducing adolescent emotional and behavioral problems that are risk factors for suicidal behavior, and in the case of the Good Behavior Game, suicide attempts. A developmentally sequenced upstream suicide prevention approach is proposed: (1) childhood programs to strengthen a broad set of self-regulation skills through family and school-based programs, followed by (2) adolescent programs that leverage social influences to prevent emerging risk behaviors such as substance abuse and strengthen relationships and skills. Key knowledge breakthroughs needed are evidence linking specific intervention strategies to reduced suicidal behaviors and mortality and their mechanisms of action. Short- and long-term objectives to achieve these breakthroughs include combining evidence from completed prevention trials, increasing motivators for prevention researchers to assess suicide-related outcome, and conducting new trials of upstream interventions in populations using efficient designs acceptable to communities. In conclusion, effective upstream prevention programs have been identified that modify risk and protective factors for adolescent suicide, and key knowledge breakthroughs can jump-start progress in realizing the suicide prevention potential of specific strategies. PMID:25145747

  15. Inpatient falls in freestanding children's hospitals.

    PubMed

    Jamerson, Patricia A; Graf, Elaine; Messmer, Patricia R; Fields, Heidi W; Barton, Sharon; Berger, Anne; Daraiseh, Nancy M; Fix, Michele; Huth, Myra; Latta, Linda; Smith, Andrea B; Lunbeck, Michelle

    2014-01-01

    Patient falls are considered a significant safety risk, but little evidence regarding the significance of falls in children is available. A multisite, observational study of fall events occurring in pediatric inpatients (younger than 18 years of age) from Child Health Corporation of America member hospitals was conducted to determine the prevalence and significance of falls. Fall prevalence was 0.84 per 1,000 patient days with 48% classified as preventable. Injuries occurred in 32%, but only two falls resulted in an increased length of stay; none resulted in permanent disability or death. Only 47% of the children who fell were identified to be at risk for fall. Alert mechanisms were used in 60% and preventive measures in 23%. These findings suggest that while inpatient pediatric fall rates are lower than those of adults, greater diligence in identification and risk reduction may further reduce the prevalence of falls and the proportion of fall-related injuries. PMID:25134226

  16. [The effectiveness of suicide prevention centers].

    PubMed

    Lester, D

    1994-01-01

    The basic services provided by suicide prevention services as well as research on the evaluation of these services are reviewed whether there is evidence that the services prevent suicide and also how the services might evaluate their internal activities. A plea is made for much greater involvement both by scholars and by counselors in the evaluation of these services, for only by formulating clear goals or hypotheses and examining whether they have been achieved or confirmed can we expect to improve the quality and range of suicide prevention services offered. PMID:7795011

  17. Effect of Concentration on Evaporation Rate for Lithium Bromide Aqueous Solution in a Falling Film Heater

    NASA Astrophysics Data System (ADS)

    Matsuda, Akira; Ide, Tetsuo

    Experiments on evaporation for lithium bromide aqueous solution (0-55 wt% LiBr) were made in Summary a externally heated wetted-wall column under reduced pressures. The evaporation rates of 5 and 8 wt% LiBr-water solutions were similar to those of water. The evaporation rates, however, owered with further increase of the concentration of LiBr, and at low feed rates the evaporation rates lowered with decrease of the feed rate because the temperature of the falling film rose. On the other hand, at high feed rates the evaporation rates lowered with increase of feed rates because the heat transfer coefficients of the falling film decreased. Therefore, a maximum evaporation rate existed and it was supposed that there is the optimum feed rate. The experimental data agreed with the values that were calculated numerically based on the unidirectional model that lithium bromide didn't move through falling film.

  18. Perchlorate in dust fall and indoor dust in Malta: An effect of fireworks.

    PubMed

    Vella, Alfred J; Chircop, Cynthia; Micallef, Tamara; Pace, Colette

    2015-07-15

    We report on the presence of perchlorate in the settleable dust of Malta, a small central Mediterranean island. Both dust fall collected directly as it precipitated from atmosphere over a period of one month and deposited indoor dust from domestic residences were studied. Perchlorate was determined by ion chromatography of water extracts of the collected dusts. Dust fall was collected from 43 towns during 2011 to 2013 and indoor dust was sampled from homes in the same localities. Perchlorate was detected in 108 of 153 samples of dust fall (71%) and in 28 of 37 indoor dust samples (76%). Detectable perchlorate in dust fall ranged from 0.52ÎŒgg(-1) to 561ÎŒgg(-1) with a median value of 6.2ÎŒgg(-1); in indoor dust, levels were from 0.79ÎŒgg(-1) to 53ÎŒgg(-1) with a median value of 7.8ÎŒgg(-1), the highest recorded anywhere to date. Statistical analysis suggested that there was no significant difference in perchlorate content of indoor dust and dust fall. Perchlorate levels in dust fall escalate during the summer in response to numerous religious feasts celebrated with fireworks and perchlorate persists at low ÎŒgg(-1) concentrations for several months beyond the summer festive period. In Malta, perchlorate derives exclusively from KClO4, imported for fireworks manufacture. Its residue in dust presents an exposure risk to the population, especially via ingestion by hand to mouth transfer. Our results suggest that wherever intensive burning of fireworks takes place, the environmental impact may be much longer lived than realised, mainly due to re-suspension and deposition of contaminated settled dust in the urban environment. PMID:25828411

  19. Effects of cultivar and grazing initiation date on fall-grown oat for replacement dairy heifers.

    PubMed

    Coblentz, W K; Brink, G E; Esser, N M; Cavadini, J S

    2015-09-01

    Fall-grown oat has shown promise for extending the grazing season in Wisconsin, but the optimum date for initiating grazing has not been evaluated. Our objectives for this project were (1) to assess the pasture productivity and nutritive value of 2 oat cultivars [Ogle and ForagePlus (OG and FP, respectively)] with late-September (EG) or mid-October (LG) grazing initiation dates; and (2) to evaluate growth performance by heifers grazing these oat forages compared with heifers reared in confinement (CON). A total of 160 gravid Holstein heifers (80 heifers/yr) were assigned to 10 research groups (8 heifers/group). Mean initial body weight was 509±40.5 kg in 2013 and 517±30.2 kg in 2014. Heifer groups were assigned to specific pastures arranged as a 2×2 factorial of oat cultivars and grazing initiation dates. Grazing heifer groups were allowed to strip-graze oat pastures for 6 h daily before returning to the barn, where they were offered a forage-based basal total mixed ration. Main effects of oat cultivar and sampling date interacted for forage characteristics in 2013, but not in 2014. During 2013, oat forage mass increased until early November before declining in response to freezing weather conditions, thereby exhibiting linear and quadratic effects of sampling date, regardless of oat cultivar. Similar trends over time were observed in 2014. For 2013, the maximum forage mass was 5,329 and 5,046 kg/ha for FP and OG, respectively, whereas the mean maximum forage mass for 2014 was 4,806 kg/ha. ForagePlus did not reach the boot stage of growth during either year of the trial; OG matured more rapidly, reaching the late-heading stage during 2013, but exhibited only minor maturity differences from FP in 2014. For 2013, average daily gain for CON did not differ from grazing heifer groups (overall mean=0.63 kg/d); however, average daily gain from FP was greater than OG (0.68 vs. 0.57 kg/d), and greater from EG compared with LG (0.82 vs. 0.43 kg/d). For 2013, advantages in average daily gain for heifers grazing FP pastures were likely related to the greater energy density of FP oat throughout the fall that reached a maximum of 68.8% total digestible nutrients on November 27 compared with only 63.7% for OG on October 10. During 2014, average daily gain from CON exceeded all grazing heifer groups (0.81 vs. 0.57 kg/d), and average daily gain from EG again exceeded LG (0.70 vs. 0.44 kg/d). These results suggest that delaying grazing until mid-October will consistently suppress heifer growth performance, particularly if rapidly maturing cultivars are used. PMID:26142852

  20. The relationship between specific cognitive functions and falls in aging.

    PubMed

    Holtzer, Roee; Friedman, Rachel; Lipton, Richard B; Katz, Mindy; Xue, Xiaonan; Verghese, Joe

    2007-09-01

    The current study examined the relationship between cognitive function and falls in older people who did not meet criteria for dementia or mild cognitive impairment (N = 172). To address limitations of previous research, the authors controlled for the confounding effects of gait measures and other risk factors by means of associations between cognitive function and falls. A neuropsychological test battery was submitted to factor analysis, yielding 3 orthogonal factors (Verbal IQ, Speed/Executive Attention, Memory). Single and recurrent falls within the last 12 months were evaluated. The authors hypothesized that Speed/Executive Attention would be associated with falls. Additionally, the authors assessed whether associations between different cognitive functions and falls varied depending on whether single or recurrent falls were examined. Multivariate logistic regressions showed that lower scores on Speed/Executive Attention were associated with increased risk of single and recurrent falls. Lower scores on Verbal IQ were related only to increased risk of recurrent falls. Memory was not associated with either single or recurrent falls. These findings are relevant to risk assessment and prevention of falls and point to possible shared neural substrates of cognitive and motor function. PMID:17784802

  1. Preventing Challenging Behaviors in Preschool: Effective Strategies for Classroom Teachers

    ERIC Educational Resources Information Center

    Coleman, Janelle C.; Crosby, Megan G.; Irwin, Heather K.; Dennis, Lindsay R.; Simpson, Cynthia G.; Rose, Chad A.

    2013-01-01

    This article provides practical strategies and techniques that early childhood educators can implement in their classrooms to effectively manage challenging behaviors. The specific strategies addressed fall under the following categories: (a) classroom management, (b) reinforcement, and (c) communication. Suggestions are made for how parents can


  2. Preventing Challenging Behaviors in Preschool: Effective Strategies for Classroom Teachers

    ERIC Educational Resources Information Center

    Coleman, Janelle C.; Crosby, Megan G.; Irwin, Heather K.; Dennis, Lindsay R.; Simpson, Cynthia G.; Rose, Chad A.

    2013-01-01

    This article provides practical strategies and techniques that early childhood educators can implement in their classrooms to effectively manage challenging behaviors. The specific strategies addressed fall under the following categories: (a) classroom management, (b) reinforcement, and (c) communication. Suggestions are made for how parents can…

  3. [Less need for prevention through better care? Towards an effective deployment of preventive and curative care].

    PubMed

    van Baal, Pieter

    2015-01-01

    Scientists and politicians repeatedly call for more investment in prevention. Besides improving public health, this would reduce health care spending. This article discusses two mechanisms that are relevant to the debate regarding the efficiency of prevention. The first mechanism concerns the additional demand for health care as a result of increased life expectancy. The second mechanism concerns the impact that improvements in curative care have on the consequences of prevention. Both mechanisms show that prevention and curative care cannot be considered separately. Consequently, decisions on investments in preventive and curative care should ideally be based on the same decision-making framework. An effective deployment of prevention and care will benefit from economic evaluations that give as full a picture as possible of both the costs and benefits of new interventions. PMID:25923498

  4. Nutrient losses from fall- and winter-applied manure: effects of timing and soil temperature

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Soil temperature is a major environmental factor that affects meltwater and precipitation infiltration and nutrient cycling. The objective of this study was to determine nutrient losses in runoff and leachate from fall- and winter-applied dairy manure as affected by soil temperature at the time of a...

  5. Nutrient losses from Fall and Winter-applied manure: Effects of timing and soil temperature

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Soil temperature is a major environmental factor that affects both the infiltration of meltwater and precipitation, and nutrient cycling. The objectives of this study were to determine nutrient losses in runoff and leachate from fall and winter-applied dairy manure based on the soil temperature at t...

  6. Effects of cyanogenic plants on fitness in two host strains of the fall armyworm (Spodoptera frugiperda)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The generalist species fall armyworm, Spodoptera frugiperda (J. E. Smith) is actually composed of two genetic subgroups (host strains) that infest a wide range of host plants, including several of agricultural significance. Currently, little is known about the physiological factors that drive host p...

  7. EFFECT OF PLUGGING DATE ON FALL FLOWERING AND FRUITING IN SOME SHORT-DAY STRAWBERRY

    Technology Transfer Automated Retrieval System (TEKTRAN)

    From 2002 to 2005, we conducted studies to force June-bearing strawberry plants to flower in the fall and early winter under the mid-Atlantic coast region growing conditions in attempt to crop them twice in one season. Mother plants were grown in a soilless system under protected cultivation and ru...

  8. Students fall for Fall Meeting

    NASA Astrophysics Data System (ADS)

    Smedley, Kara

    2012-02-01

    From Boston to Beijing, thousands of students traveled to San Francisco for the 2011 AGU Fall Meeting. Of those who participated, 183 students were able to attend thanks to AGU's student travel grant program, which assists students with travel costs and seeks to enrich the meeting through ethnic and gender diversity. Students at Fall Meeting enjoyed a variety of programs and activities designed to help them better network with their peers, learn about new fields, and disseminate their research to the interested public. More than 800 students attended AGU's first annual student mixer, sharing drinks and ideas with fellow student members and future colleagues as well as forging new friendships and intellectual relationships.

  9. Disseminating Effective Community Prevention Practices: Opportunities for Social Work Education

    PubMed Central

    Hawkins, J. David; Shapiro, Valerie B.; Fagan, Abigail A.

    2009-01-01

    In the United States about 17% of adolescents meet diagnostic criteria for mental, emotional, and behavioral disorders. Six million young people receive treatment services annually for mental, emotional, or behavioral problems. These problems affect 1 in 5 families and cost $247 million annually (O'Connell, Boat, & Warner, 2009). Some strategies for preventing mental, emotional, and behavioral disorders in young people have been developed, tested, and found to be effective in preventing the onset, persistence, and severity of psychological disorders, drug abuse, and delinquency. Unfortunately, tested and effective prevention policies, programs, and practices are not widely used (O'Connell, Boat, & Warner, 2009). This paper highlights recent advances in prevention science and describes some opportunities and challenges in advancing the use of science-based prevention in communities. The chapter concludes by exploring the potential role of social work education in developing a workforce ready to increase community access to effective prevention strategies. PMID:21072250

  10. The Moderating Effects of School Climate on Bullying Prevention Efforts

    ERIC Educational Resources Information Center

    Low, Sabina; Van Ryzin, Mark

    2014-01-01

    Bullying prevention efforts have yielded mixed effects over the last 20 years. Program effectiveness is driven by a number of factors (e.g., program elements and implementation), but there remains a dearth of understanding regarding the role of school climate on the impact of bullying prevention programs. This gap is surprising, given research


  11. Vitamin D and Sarcopenia/Falls.

    PubMed

    Lappe, Joan M; Binkley, Neil

    2015-01-01

    Maintenance of adequate vitamin D status is a stratagem to consider for sarcopenia prevention and treatment. Vitamin D deficiency is common and involves all ages of most racial/ethnic groups and both sexes. Evidence suggests that vitamin D is important for muscle strength and function, and prospective studies are underway to further define these effects. This article summarizes the potential effects of vitamin D on skeletal muscle structure and function and provides guidance for vitamin D supplementation in prevention and treatment of sarcopenia and falls. PMID:26059567

  12. Effect of the ash Fall on the Human Health at Colima Volcano During 2005-2006.

    NASA Astrophysics Data System (ADS)

    Nieto, A.; Martin, A. L.; Fonseca, R.; Garcia, M.

    2007-05-01

    Colima Volcano in western Mexico had several small ash emitting eruptions during 2005-2006. In this time period we studied the impact of the ash fall on human health through field observations, interviews and health data processing. The volcano was most active in May-June 2005. Data from 15.000 medical records of the Colima and Jalisco State Health Departments show two main health problems in humans during this time: Conjunctivitis was detected in 1,933 people and respiratory disease in 12,630 people in an area of 1,841,283 km2 which was affected by small amounts of ash fall near the volcano in 2005. Ash emissions from Colima Volcano correlate well with increased affections. When emissions increased so did the frequency of these health problems in the population.

  13. Falls - Multiple Languages: MedlinePlus

    MedlinePLUS

    ... Chinese - Traditional (????) French (français) Hindi (??????) Japanese (???) Korean (???) Russian (???????) Somali (af Soomaali) ... ?????? (Hindi) Bilingual PDF Health Information Translations Japanese (???) Preventing Falls in the Hospital ???????????? - ??? ( ...

  14. Sleep in fall/winter seasonal affective disorder: effects of light and changing seasons.

    PubMed

    Anderson, J L; Rosen, L N; Mendelson, W B; Jacobsen, F M; Skwerer, R G; Joseph-Vanderpool, J R; Duncan, C C; Wehr, T A; Rosenthal, N E

    1994-05-01

    Disturbances of sleep are a hallmark of seasonal affective disorders (SAD), as they are of other mood disorders. Fall/winter SAD patients most often report hypersomnia. Among responses of 293 SAD patients on a symptom questionnaire, complaints of winter hypersomnia (80%) greatly exceeded insomnia (10%), hypersomnia plus insomnia (5%), or no sleep difficulty (5%). Increased sleep length in fall/winter is not unique to SAD. Among 1571 individuals across four latitudes surveyed at random from the general population, winter sleep increases of < or = 2 hr/day relative to summer were reported by nearly half. However, hypersomnia had a low correlation (r = 0.29) with the total number of other SAD symptoms that were reported in this sample. Ten SAD patients kept daily sleep logs across 1 yr that showed increases in fall and winter (sleeping most in October; least in May) whose maximum averaged 2.7 hr per day more weekend sleep than in spring and summer. These winter increases might have been somewhat attenuated since most received light therapy during part of the winter. Nocturnal EEG recordings of depressed SAD patients in winter showed decreased sleep efficiency, decreased delta sleep percentage, and increased REM density (but normal REM latency) in comparison with recordings: (1) from themselves in summer; (2) from themselves after > or = 9 days of light therapy; or (3) from age- and gender-matched healthy controls. Thus, the extent of fall/winter oversleeping recorded by our SAD patients did not differ dramatically from that reported by the general population, but sleep complaints of our SAD patients have been accompanied by features of sleep architecture that are different from healthy controls and are reversed by summer or by bright-light therapy. PMID:8064650

  15. Lava Falls Rapid in Grand Canyon; effects of late Holocene debris flows on the Colorado River

    USGS Publications Warehouse

    Webb, Robert H.; Melis, Theodore S.; Griffiths, Peter G.; Elliott, John G.; Cerling, Thure E.; Poreda, Robert J.; Wise, Thomas W.; Pizzuto, James E.

    1999-01-01

    Lava Falls Rapid is the most formidable reach of whitewater on the Colorado River in Grand Canyon and is one of the most famous rapids in the world. Debris flows in 1939, 1954, 1955, 1966, and 1995, as well as prehistoric events, completely changed flow through the rapid. Floods cleared out much of the increased constrictions, but releases from Glen Canyon Dam, including the 1996 controlled flood, are now required to remove the boulders deposited by the debris flows.

  16. Radiation Therapy: Preventing and Managing Side Effects

    MedlinePLUS

    ... who share your problems and concerns. Will side effects limit my activity? Side effects might limit your ... that might irritate the area being treated. Side effects can vary. Your cancer care team can tell ...

  17. Exercise for Fall Risk Reduction in Community-Dwelling Older Adults: A Systematic Review

    PubMed Central

    Arnold, Catherine M.; Sran, Meena M.; Harrison, Elizabeth L.

    2008-01-01

    Purpose: To evaluate the influence of exercise on falls and fall risk reduction in community-dwelling older adults and to present an updated synthesis of outcome measures for the assessment of fall risk in community-dwelling older adults. Method: A systematic review was performed, considering English-language articles published from 2000 to 2006 and accessible through MEDLINE, CINAHL, PEDro, EMBASE, and/or AMED. Included were randomized controlled clinical trials (RCTs) that used an exercise or physical activity intervention and involved participants over age 50. Screening and methodological quality for internal validity were conducted by two independent reviewers. Results: The search retrieved 156 abstracts; 22 articles met the internal validity criteria. Both individualized and group exercise programmes were found to be effective in reducing falls and fall risk. The optimal type, frequency, and dose of exercise to achieve a positive effect have not been determined. A variety of outcome measures have been used to measure fall risk, especially for balance. Conclusions: Falls and fall risk can be reduced with exercise interventions in the community-dwelling elderly, although the most effective exercise variables are unknown. Future studies in populations with comorbidities known to increase fall risk will help determine optimal, condition-specific fall-prevention programmes. Poor balance is a key risk factor for falls; therefore, the best measure of this variable should be selected when evaluating patients at risk of falling. PMID:20145768

  18. Effects of a Multicomponent Exercise Program on Spatiotemporal Gait Parameters, Risk of Falling and Physical Activity in Dementia Patients

    PubMed Central

    Perrochon, Anaïck; Tchalla, Achille E.; Bonis, Joelle; Perucaud, Florian; Mandigout, Stéphane

    2015-01-01

    Background Exercise programs are presumed to rehabilitate gait disorders and to reduce the risk of falling in dementia patients. This study aimed to analyze the specific effects of multicomponent exercise on gait disorders and to determine the association between gait impairments and the risk of falling in dementia patients before and after intervention. Methods We conducted an 8-week multicomponent exercise program in 16 dementia patients (age 86.7 ± 5.4 years). All participants were assessed several times for gait analysis (Locométrixź), Tinetti score and physical activity (Body Media SenseWearź Pro armband). Results After 8 weeks of the exercise program, the mean gait speed was 0.12 m/s faster than before the intervention (0.55 ± 0.17 vs. 0.67 ± 0.14 m/s). The multicomponent exercise program improved gait performance and Tinetti score (p < 0.05). Gait performance (gait speed, stride length) was correlated with the Tinetti score (p < 0.05). Conclusion Analysis of spatiotemporal gait parameters using an accelerometer method provided a quick and easy tool to estimate the benefits of an exercise program and the risk of falling. PMID:26557134

  19. Effects of the Otago exercise program on fall efficacy, activities of daily living and quality of life in elderly stroke patients

    PubMed Central

    Park, Youngju; Chang, Moonyoung

    2016-01-01

    [Purpose] The purpose of this study was to determine the effects of the Otago exercise program on fall efficacy, activities of daily living, and quality of life in elderly stroke patients. [Subjects and Methods] Eight subjects performed the Otago exercise program three times per week, for 8 weeks. The outcome measures were the Fall Efficacy Scale score for fall efficacy, modified Barthel index for activities of daily living, and EQ-5D for quality of life. [Results] In our comparison of the results before and after the intervention, we found that the Otago exercise program improved fall efficacy significantly as well as the score for activities of daily living and quality of life, though not significantly. [Conclusion] We consider that the Otago exercise program is an effective method for improving fall efficacy in elderly stroke patients. PMID:26957755

  20. A randomized controlled trial on Stroke telerehabilitation: The effects on falls self-efficacy and satisfaction with care

    PubMed Central

    Chumbler, Neale R; Li, Xinli; Quigley, Patricia; Morey, Miriam C; Rose, Dorian; Griffiths, Patricia; Sanford, Jon; Hoenig, Helen

    2015-01-01

    Summary We determined the effect of a multifaceted stroke telerehabilitation (STeleR) intervention on falls-related self-efficacy and satisfaction with care. We conducted a prospective, randomized, multisite, single-blinded trial in 52 veterans from three Veterans Affairs Medical Centers. Participants who experienced a stroke in the past 24 months were randomized to the STeleR intervention or usual care. Participants in the intervention arm were administered an exit interview to gather specific patient satisfaction data three months after their final outcome measure. The STeleR intervention consisted of three home visits, five telephone calls, and an in-home messaging device provided over three months to instruct patients in functionally based exercises and adaptive strategies. The outcome measures included Falls Efficacy Scale to measure fall-related self-efficacy and a Stroke-Specific Patient Satisfaction with Care (SSPSC) scale, a measure separated into two subscales (satisfaction with home care and satisfaction with hospital care) was employed to measure the participants’ satisfaction. At six months, compared with the usual care group, the STeleR group showed statistically significant improvements in one of the two SSPSC scales (satisfaction with hospital care, p =.029) and approached significance in the second SSPSC scale (satisfaction with home care, p =.077). There were no improvements in fall-related self-efficacy. Core concepts identified were: (a) beneficial impact of the trained assistant; (b) exercises helpful; (c) home use of technology. The STeleR intervention improved satisfaction with care, especially as it relates to care following their experience from the hospital. With the limited resources available for in-home rehabilitation for stroke survivors, STeleR (and especially its exercise components) can be a useful complement to traditional post-stroke rehabilitation. PMID:25680390

  1. [Effective interventions to prevent child injuries: a review of the literature].

    PubMed

    Nguyen Thanh, Viêt; Clément, Juliette; Thélot, Bertrand; Richard, Jean-Baptiste; Lamboy, Béatrice; Arwidson, Pierre

    2015-01-01

    Child injuries represent an important public health problem. The aim of this paper is to review the current scientific knowledge on interventions designed to prevent child injuries. The current state of knowledge in this area was assessed by means of a specific method involving a review of literature reviews and a classification of health promotion interventions identified in these reviews (rapid reviews). We found a large number of effective or promising programmes devoted to the prevention of the most common child injuries: drowning, burns, falls, poisoning, electrocution, sports and leisure injuries. Some interventions are based on environmental measures, while others are educational or use law and regulatory processes. Some are primary prevention measures, others are secondary prevention measures, while others are multidimensional and can effectively reduce several types of injuries. For example, home safety education and provision of safety equipment, or home-based parenting interventions, can have an impact on injury rates. These findings present a number of limitations due to the marked diversity of the quality of the documents reviewed. It should also be stressed that interventions that are not listed in this article are not necessarily ineffective: they may simply lack a rigorous evaluation enabling them to be identified in our review. PMID:26751923

  2. Reducing Falls and Fall-Related Injuries in Medical-Surgical Units: One-Year Multihospital Falls Collaborative.

    PubMed

    Quigley, Patricia A; Barnett, Scott D; Bulat, Tatjana; Friedman, Yvonne

    2016-01-01

    On the basis of fall injury program characteristics across multiple inpatient medical-surgical units from 6 medical centers, we developed and implemented an operational strategic plan to address fall and injury prevention program attributes and enhance program infrastructure and capacity. Expert faculty provided lectures and served as coaches and mentors through triweekly conference calls and collaborative e-mail exchange. Statistically significant findings support improved fall and injury prevention program components and processes at the organizational and unit levels. PMID:26323049

  3. Counterintuitive effect of fall mixed layer deepening on eukaryotic new production in the Sargasso Sea

    NASA Astrophysics Data System (ADS)

    Fawcett, S. E.; Lomas, M. W.; Ward, B. B.; Sigman, D. M.

    2012-12-01

    The Sargasso Sea is characterized by a short period of deep vertical mixing in the late winter and early spring, followed by strong thermal stratification during the summer. Stratification persists into the fall, impeding the upward flux of nitrate from depth so that recycled forms of nitrogen (N) such as ammonium are thought to support most primary production. We collected particles from surface waters during March, July, October, and December, used flow cytometry to separate the prokaryotic and eukaryotic phytoplankton, and analyzed their respective 15N/14N. In all months, the 15N/14N of the prokaryotic genera, Prochlorococcus and Synechococcus, was low, indicative of reliance on recycled N throughout the year. In July, the 15N/14N of eukaryotic phytoplankton was variable but consistently higher than that of the prokaryotes, reflecting eukaryotic consumption of subsurface nitrate. Two eukaryotic profiles from October and December were similar to those from July. In three other fall profiles, the eukaryotes had a 15N/14N similar to that of the prokaryotes, suggesting a switch toward greater reliance on recycled N. This change in the dominant N source supporting eukaryotic production appears to be driven by the density structure of the upper water column. The very shallow low-density surface "mixed layer" (?20 m) that develops in early-to-mid summer does not contribute to stratification at the base of the euphotic zone, and subsurface nitrate can mix up into the lower euphotic zone, facilitating continued production. The deepening of the mixed layer into the fall, typically taken as an indication of weaker overall stratification, actually strengthens the isolation of the euphotic zone as a whole, reducing the upward supply of nitrate to the photosynthetically active layer. The same counterintuitive dynamic explains the latitudinal patterns in a set of three October depth profiles. Two northern stations (32°N and 27°N) were characterized by a thick, low-density surface layer, and the 15N/14N of all phytoplankton was low, consistent with assimilation of recycled N. The southernmost station (23°N) had a shallower mixed layer, and eukaryote 15N/14N reflects growth on nitrate. In the subtropics, evidence for the direct supply of nitrate into surface waters in the face of the strong upper ocean stratification has long been sought. Our N isotope results suggest a mechanism by which subsurface nitrate is imported into shallow waters. This interpretation offers a new perspective on the relationship between euphotic zone stratification and nitrate assimilation, implying that significant new production occurs under conditions previously assumed to drive oligotrophy.

  4. Treatment Prevents Chemotherapy Side Effects for Children with Cancer

    Cancer.gov

    Final results from a phase III randomized clinical trial show that addition of aprepitant to the anti-nausea drug ondansetron, with or without dexamethasone, effectively prevents chemotherapy-induced nausea and vomiting in pediatric patients.

  5. Effective HIV prevention: the indispensable role of social science

    PubMed Central

    Kippax, Susan

    2012-01-01

    This paper examines the ways in which HIV prevention is understood including “biomedical”, “behavioural”, “structural”, and “combination” prevention. In it I argue that effective prevention entails developing community capacity and requires that public health addresses people not only as individuals but also as connected members of groups, networks and collectives who interact (talk, negotiate, have sex, use drugs, etc.) together. I also examine the evaluation of prevention programmes or interventions and argue that the distinction between efficacy and effectiveness is often glossed and that, while efficacy can be evaluated by randomized controlled trials, the evaluation of effectiveness requires long-term descriptive strategies and/or modelling. Using examples from a number of countries, including a detailed account of the Australian HIV prevention response, effectiveness is shown to be dependent not only on the efficacy of the prevention technology or tool but also on the responses of people – individuals, communities and governments – to those technologies. Whether a particular HIV prevention technology is adopted and its use sustained depends on a range of social, cultural and political factors. The paper concludes by calling on biomedical and social scientists to work together and describes a “social public health”. PMID:22713254

  6. Large ozone perturbations caused by the 1908 Tunguska meteor fall - Were there related weather effects

    NASA Technical Reports Server (NTRS)

    Turco, R. P.; Toon, O. B.; Park, C.; Whitten, R. C.; Noerdlinger, P.

    1981-01-01

    The magnitude of the ozone depletion due to the 1908 Tunguska meteor fall is estimated and observational evidence of such a depletion is presented. Calculated stratospheric ozone and NO(x) perturbations caused by the meteor are shown, with the hemispherically averaged model giving total stratospheric ozone reductions as large as 45 percent in the first year, with significant reductions persisting for at least three more years. Ozone depletion above 10 km altitude is found to be about 85 percent for several months, and higher yet at 20, 30, and 40 km. Data from the early 1900s to calculate the variability of the solar constant is used to calculate the ozone column concentration for 1909-11. The results are in close agreement with the model prediction. Weather records of the early 1900s show a cooling trend in the Northern Hemisphere for almost a decade after Tunguska.

  7. The effects of cranberries on preventing urinary tract infections.

    PubMed

    Shin, Cha-Nam

    2014-02-01

    Despite considerable controversy about their effects, cranberries in various forms have been used widely for several decades to prevent as well as treat urinary tract infections (UTIs). The purpose of this article is to present a review of research-based information regarding the ability of cranberries to prevent UTIs in adults at risk for UTIs. Current evidence suggests that cranberries decrease bacterial adherence to uroepithelial cells and thus decrease the incidence of UTIs without adverse effects in most individuals. Thus clinicians may safely advise patients that cranberries are helpful in preventing UTIs. Cranberries may be a viable adjunct to antibiotics for patients with repeated UTIs. PMID:23396043

  8. Will it rise or will it fall? Managing the complex effects of urbanization on base flow

    USGS Publications Warehouse

    Bhaskar, Aditi; Beesley, Leah; Burns, Matthew J.; Fletcher, T. D.; Hamel, Perrine; Oldham, Carolyn; Roy, Allison

    2016-01-01

    Sustaining natural levels of base flow is critical to maintaining ecological function as stream catchments are urbanized. Research shows a variable response of stream base flow to urbanization, with base flow or water tables rising in some locations, falling in others, or elsewhere remaining constant. The variable baseflow response is due to the array of natural (e.g., physiographic setting and climate) and anthropogenic (e.g., urban development and infrastructure) factors that influence hydrology. Perhaps as a consequence of this complexity, few simple tools exist to assist managers to predict baseflow change in their local urban area. This paper addresses this management need by presenting a decision support tool. The tool considers the natural vulnerability of the landscape, together with aspects of urban development in predicting the likelihood and direction of baseflow change. Where the tool identifies a likely increase or decrease it guides managers toward strategies that can reduce or increase groundwater recharge, respectively. Where the tool finds an equivocal result, it suggests a detailed water balance be performed. The decision support tool is embedded within an adaptive-management framework that encourages managers to define their ecological objectives, assess the vulnerability of their ecological objectives to changes in water table height, and monitor baseflow responses to urbanization. We trial our framework using two very different case studies: Perth, Western Australia, and Baltimore, Maryland, USA. Together, these studies show how pre-development water table height, climate and geology together with aspects of urban infrastructure (e.g., stormwater practices, leaky pipes) interact such that urbanization has overall led to rising base flow (Perth) and falling base flow (Baltimore). Greater consideration of subsurface components of the water cycle will help to protect and restore the ecology of urban freshwaters.

  9. Automatic Fall Monitoring: A Review

    PubMed Central

    Pannurat, Natthapon; Thiemjarus, Surapa; Nantajeewarawat, Ekawit

    2014-01-01

    Falls and fall-related injuries are major incidents, especially for elderly people, which often mark the onset of major deterioration of health. More than one-third of home-dwelling people aged 65 or above and two-thirds of those in residential care fall once or more each year. Reliable fall detection, as well as prevention, is an important research topic for monitoring elderly living alone in residential or hospital units. The aim of this study is to review the existing fall detection systems and some of the key research challenges faced by the research community in this field. We categorize the existing platforms into two groups: wearable and ambient devices; the classification methods are divided into rule-based and machine learning techniques. The relative merit and potential drawbacks are discussed, and we also outline some of the outstanding research challenges that emerging new platforms need to address. PMID:25046016

  10. Reducing Aversion to Side Effects in Preventive Medical Treatment Decisions

    ERIC Educational Resources Information Center

    Waters, Erika A.; Weinstein, Neil D.; Colditz, Graham A.; Emmons, Karen M.

    2007-01-01

    Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by…

  11. Prevention

    MedlinePLUS

    ... provides helpful advice and information. Get Started Heart Attack Risk Calculator Discover your 10-year risk of ... and activities near you. Learn more > Home Tools & Protocols Data & Reports Partners & Progress Learn & Prevent News & Media ...

  12. Effects of a Potash Mine Roof Fall Observed in Nearby Monitoring Wells

    NASA Astrophysics Data System (ADS)

    Kuhlman, K. L.

    2012-12-01

    At approximately 5 AM on March 18, 2012, a significant collapse occurred in a potash mine near the Department of Energy's Waste Isolation Pilot Plant (WIPP). The US Geological Survey estimated the event to be magnitude 2.9. Two wells in the WIPP regional groundwater monitoring network experienced oscillatory water level fluctuations greater than 5 feet in response to the event. The changes in water level decayed slowly over several weeks following the event. The potash mine is located in the McNutt Potash zone of the Salado Formation, which is 1000-1400 feet below ground surface (BGS) near the location of the roof fall. The monitoring wells are completed in the semi-confined Culebra Dolomite member of the Rustler Formation, which is 375 feet BGS. The observed response is compared to published well responses to earthquakes and other seismic events. We explore the potential for using the event to characterize aquifer parameters. This research is funded by WIPP programs administered by the Office of Environmental Management (EM) of the U.S Department of Energy. Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000

  13. [Preventive effects of fortified pollen on diphenylhydantoin teratogenesis].

    PubMed

    Zhang, C; Zhou, S S

    1989-12-01

    This paper reports the preventive effects of fortified pollen and folic acid on diphenylhydantoin (DPH) teratogenesis in pregnant SD rats. The experiment showed that i.p. injection of DPH 75mg/kg per day to pregnant rats on gestational days 7 through 11, and feeding of fortified pollen (pollen 10g/kg per day plus folic acid 20mg/kg per day) or folic acid (20mg/kg per day) on gestational days 0 through 20 may partly prevent the embryotoxicity and fetal toxicity produced by DPH. However, the preventive effects of fortified pollen is better than those of folic acid on the following: decrease of fetal body weight; retarded ossification of metacarpus, proximal phalanx, metatarsus, and supraoccipital bone; sternebrae ossification agenesis; subcutaneous hemorrhage; single eye defect; hydronephrosis and the widening of subarachnoid space. This paper also discusses the possible mechanism of prevention of fortified pollen and folic acid against DPH teratogenesis. PMID:2630422

  14. Effects of Hyporheic Exchange Flows on Egg Pocket Water Temperature in Snake River Fall Chinook Salmon Spawning Areas

    SciTech Connect

    Hanrahan, Timothy P.; Geist, David R.; Arntzen, Evan V.; Abernethy, Cary S.

    2004-09-24

    The development of the Snake River hydroelectric system has affected fall chinook salmon smolts by shifting their migration timing to a period when downstream reservoir conditions are unfavorable for survival. Subsequent to the Snake River chinook salmon fall-run Evolutionary Significant Unit being listed as Threatened under the Endangered Species Act, recovery planning has included changes in hydrosystem operations to improve water temperature and flow conditions during the juvenile chinook salmon summer migration period. In light of the limited water supplies from the Dworshak reservoir for summer flow augmentation, and the associated uncertainties regarding benefits to migrating fall chinook salmon smolts, additional approaches for improved smolt survival need to be evaluated. This report describes research conducted by PNNL that evaluated relationships among river discharge, hyporheic zone characteristics, and egg pocket water temperature in Snake River fall chinook salmon spawning areas. The potential for improved survival would be gained by increasing the rate at which early life history events proceed (i.e., incubation and emergence), thereby allowing smolts to migrate through downstream reservoirs during early- to mid-summer when river conditions are more favorable for survival. PNNL implemented this research project throughout 160 km of the Hells Canyon Reach (HCR) of the Snake River. The hydrologic regime during the 2002?2003 sampling period exhibited one of the lowest, most stable daily discharge patterns of any of the previous 12 water years. The vertical hydraulic gradients (VHG) between the river and the riverbed suggested the potential for predominantly small magnitude vertical exchange. The VHG also showed little relationship to changes in river discharge at most sites. Despite the relatively small vertical hydraulic gradients at most sites, the results from the numerical modeling of riverbed pore water velocity and hyporheic zone temperatures suggested that there was significant vertical hydrologic exchange during all time periods. The combined results of temperature monitoring and numerical modeling indicate that only two sites were significantly affected by short-term (hourly to daily) large magnitude changes in discharge. Although the two sites exhibited acute flux reversals between river water and hyporheic water resulting from short-term large magnitude changes in discharge, these flux reversals had minimal effect on emergence timing estimates. Indeed, the emergence timing estimates at all sites was largely unaffected by the changes in river stage resulting from hydropower operations at Hells Canyon Dam. Our results indicate that the range of emergence timing estimates due to differences among the eggs from different females can be as large as or larger than the emergence timing estimates due to site differences (i.e., bed temperatures within and among sites). We conclude that during the 2002-2003 fall chinook salmon incubation period, hydropower operations of Hells Canyon Dam had an insignificant effect on fry emergence timing at the study sites. It appears that short-term (i.e., hourly to daily) manipulations of discharge from the Hells Canyon Complex during the incubation period would not substantially alter egg pocket incubation temperatures, and thus would not affect fry emergence timing at the study sites. However, the use of hydropower operational manipulations at the Hells Canyon Complex to accelerate egg incubation and fry emergence should not be ruled out on the basis of only one water year's worth of study. Further investigation of the incubation environment of Snake River fall chinook salmon is warranted based on the complexity of hyporheic zone characteristics and the variability of surface/subsurface interactions among dry, normal, and wet water years.

  15. Effects of perturbation-based slip training using a virtual reality environment on slip-induced falls.

    PubMed

    Parijat, Prakriti; Lockhart, Thurmon E; Liu, Jian

    2015-04-01

    The purpose of the current study was to design and evaluate the effectiveness of virtual reality training in improving recovery reactions and reducing fall frequency in older adults. Twenty-four older adults were recruited and randomly assigned to two groups (virtual reality training and control). Both groups underwent three sessions including baseline slip, training and transfer of training on slippery surface. Both groups experienced two slips, one during baseline and the other during the transfer of training trial. The training group underwent 12 simulated slips using a visual perturbation induced by tilting a virtual reality scene while walking on the treadmill and the control group performed normal walking during the training session. Kinematic and kinetic data were collected during all the sessions. Results demonstrated a reduced incidence of falls in the training group during the transfer of training trial as compared to the control group. The training group was able to transfer reactive control strategies learned during training to the second slip trial. The reactive adjustments included reduced slip distance. Additionally, gait parameters reflective of gait instability (stride length, step width, variability in stride velocity) reduced after walking in the VR environment for 15-20 min. The results indicated a beneficial effect of the virtual reality training in reducing slip severity and recovery kinematics in healthy older adults. PMID:25245221

  16. A model of the effects of flow fluctuations on fall Chinook salmon spawning habitat availability in the Columbia River

    SciTech Connect

    Geist, David R.; Murray, Christopher J.; Hanrahan, Timothy P.; Xie, YuLong

    2008-12-01

    Previously we reported that about 30% to 60% of the area predicted to be used by fall Chinook salmon (Oncorhynchus tshawytscha) for spawning in the Hanford Reach of the Columbia River did not contain redds. One explanation for the overprediction of habitat was that our model did not incorporate streamflow fluctuation. Daily fluctuation in flow caused by load-following operations (power generation to meet short-term electrical demand) at Priest Rapids Dam, situated at the upper end of the Hanford Reach, changes the hydraulic characteristics to which fish respond in selecting redd sites. The purpose of the study described here was to examine the effect of flow changes on spawning habitat modeling and, in particular, to look at the connection between spawning and the variability and persistence of habitat variables caused by rapid changes in flow resulting from load-following operations at Priest Rapids Dam. We found that spawning habitat use by fall Chinook salmon was consistent with previous fall Chinook salmon studies in the Reach. Dynamic variables that were based on hourly time series were used to account for the variability in habitat as a result of flow fluctuations. The analysis showed that the proportion of velocities that fell within the range of 1.0 to 2.5 m/s differed significantly between locations that were predicted to be spawning by the logistic regression model where spawning actually occurred and locations that were predicted to be spawning where spawning did not occur. However, the resulting sequential logistic regression model that incorporated the dynamic variables did not provide significant improvement in the percentage of errors for areas predicted to be spawning; the model’s overprediction errors still ranged from 63% to 78%. We suggest that while flow fluctuation may affect spawning habitat and individual fish behavior, the high correlation between time-averaged velocities and the proportion of hourly velocities that fell within the most favorable range negated any improvements in model predictions.

  17. The Effects of 10% Front Load Carriage on the Likelihood of Slips and Falls

    PubMed Central

    KIM, Sukwon

    2010-01-01

    The objective of the present study was to evaluate if anterior load carriage would increase the likelihood of slips or falls while walking over a slippery floor surface. The study hypothesized that anterior load carriage may alter spatial-temporal characteristics, such as heel contact velocity, walking velocity (i.e., the whole body center-of-mass velocity), and step length, as well as friction demand characteristics at shoe-floor interface. Additionally, the study hypothesized that alterations in these gait parameters may influence slip initiation characteristics while ambulating over a slippery floor surface. Total of 10 subjects participated in the study: 5 younger (18–28 yr old) and 5 older adults (65 and older). A mixture was used to manipulate the coefficient of friction (COF) of the floor surface. All participants were unexpectedly introduced to a slippery surface while walking with and without a load. To evaluate slip severity, slip distance I and II were evaluated to assess whether a subject fell or not. Three-way repeated measure ANOVA (mix-factor design) was performed: Age factor: between-subject, Load and Floor factors: within-subject. Overall, older adults’ heel contact velocity was slower while carrying a load. Additionally, all participants exhibited shorter SL while carrying a load. No significant friction demand characteristic differences were observed for all subjects while carrying a 10% front load. The results from the present study suggest that carrying 10% of the body weight in front should not intensify the slip propensity and severity although appears to influence spatial-temporal gait characteristics. PMID:18270448

  18. The effects of 10% front load carriage on the likelihood of slips and falls.

    PubMed

    Kim, Sukwon; Lockhart, Thurmon E

    2008-01-01

    The objective of the present study was to evaluate if anterior load carriage would increase the likelihood of slips or falls while walking over a slippery floor surface. The study hypothesized that anterior load carriage may alter spatial-temporal characteristics, such as heel contact velocity, walking velocity (i.e., the whole body center-of-mass velocity), and step length, as well as friction demand characteristics at shoe-floor interface. Additionally, the study hypothesized that alterations in these gait parameters may influence slip initiation characteristics while ambulating over a slippery floor surface. Total of 10 subjects participated in the study: 5 younger (18-28 yr old) and 5 older adults (65 and older). A mixture was used to manipulate the coefficient of friction (COF) of the floor surface. All participants were unexpectedly introduced to a slippery surface while walking with and without a load. To evaluate slip severity, slip distance I and II were evaluated to assess whether a subject fell or not. Three-way repeated measure ANOVA (mix-factor design) was performed: Age factor: between-subject, Load and Floor factors: within-subject. Overall, older adults' heel contact velocity was slower while carrying a load. Additionally, all participants exhibited shorter SL while carrying a load. No significant friction demand characteristic differences were observed for all subjects while carrying a 10% front load. The results from the present study suggest that carrying 10% of the body weight in front should not intensify the slip propensity and severity although appears to influence spatial-temporal gait characteristics. PMID:18270448

  19. The potential effects of floor impact surfaces on infant head injury outcome during a short fall.

    PubMed

    Jones, M D; Theobald, P S

    2011-10-01

    When considering cases of infant head injury as a result of a short fall, investigators often have to base their opinions on the potential severity of a head injury on a scene description and/or photographic evidence of the potential impact surfaces. While variation in the attenuation properties of typical domestic surfaces and underlying support structures have been reported in the literature, this study investigates whether there is a need to consider the nature and composition of specific potential impact floor surfaces/sites, within a scene, prior to providing an opinion about the likely head impact injury outcome. An instrumented headform was impacted within a suspected crime scene to determine whether different potential impact sites posed different risks of producing head injury. The impact acceleration-time waveform, for the headform, was shown to vary considerably across the floor. By applying recognized head impact injury risk measures (peak g and head injury criterion), it was illustrated that the risk of an infant sustaining a significant head injury could vary considerably, depending upon the exact point of impact with the floor. This study highlights the potential for variation in impact force across a scene and illustrates the need to consider surface composition at specific sites across the entire potential impact area, since the risk of head injury can vary significantly. Caution should therefore be exercised when expressing opinions based solely on verbal, written or photographic evidence of head impact surfaces, without due consideration of the specific area onto which a head might have impacted. PMID:22021589

  20. Factors associated with falls among older adults living in institutions

    PubMed Central

    2013-01-01

    Background Falls have enormous impact in older adults. Yet, there is insufficient evidence regarding the effectiveness of preventive interventions in this setting. The objectives were to measure the frequency of falls and associated factors among older people living institutions. Methods Data were obtained from a survey on a probabilistic sample of residents aged ≄65 years, drawn in 1998-99 from institutions of Madrid (Spain). Residents, their caregivers, and facility physicians were interviewed. Fall rates were computed based on the number of physician-reported falls in the preceding 30 days. Adjusted rate ratios were computed using negative binomial regression models, including age, sex, cognitive status, functional dependence, number of diseases, and polypharmacy. Results The final sample comprised 733 residents. The fall rate was 2.4 falls per person-year (95% confidence interval [CI], 2.04-2.82). The strongest risk factor was number of diseases, with an adjusted rate ratio (RR) of 1.32 (95% CI, 1.17-1.50) for each additional diagnosis. Other variables associated with falls were: urinary incontinence (RR = 2.56 [95% CI, 1.32-4.94]); antidepressant use (RR = 2.32 [95% CI, 1.22-4.40]); arrhythmias (RR = 2.00 [95% CI, 1.05-3.81]); and polypharmacy (RR = 1.07 [95% CI, 0.95-1.21], for each additional medication). The attributable fraction for number of diseases (with reference to those with ≀ 1 condition) was 84% (95% CI, 45-95%). Conclusions Number of diseases was the main risk factor for falls in this population of institutionalized older adults. Other variables associated with falls, probably more amenable to preventive action, were urinary incontinence, antidepressants, arrhythmias, and polypharmacy. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3916151157277337 PMID:23320746

  1. Effects of Correspondence Training in an Abduction Prevention Training Program.

    ERIC Educational Resources Information Center

    Olsen-Woods, Laurie A.; Miltenberger, Raymond G.; Foreman, Greg

    1998-01-01

    Examines the effects of adding correspondence training to a behavioral skills training package that taught abduction prevention skills to 31 children, ages 4-5 years. Results indicate that correspondence training did not improve correspondence between saying and doing target behaviors. However, both training approaches were equally effective in…

  2. The effect of Pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults.

    PubMed

    Pata, Rachel W; Lord, Katrina; Lamb, Jamie

    2014-07-01

    Falls are a common problem in older adults. Impaired balance, mobility and postural stability are risk factors for falling. Limited research has been performed on Pilates exercise and the ability to decrease fall risk. In this quasi-experimental study, 35 adults (61-87 years old) participated in an 8-week Pilates based exercise program. Blind examiners conducted the Timed Up and Go (TUG), Forward Reach Test, and Turn 180 Test before and after the intervention. Number of falls, perception of Pilates, and fear of falling was also recorded. Thirty-two (91.4%) participants completed post-test measures. Significant improvements were seen in the TUG (p <0.001) and Turn 180 Test (p = 0.002). Improvements were also demonstrated in the Forward Reach Test (p = 0.049). A positive perception of the Pilates program and decreased fear of falling was shown. Results suggest a Pilates based exercise program may be effective in improving balance, mobility and postural stability to decrease fall risk. PMID:25042305

  3. A Randomized Controlled Trial to Examine the Effect of 2-Year Vitamin B12 and Folic Acid Supplementation on Physical Performance, Strength, and Falling: Additional Findings from the B-PROOF Study.

    PubMed

    Swart, Karin M A; Ham, Annelies C; van Wijngaarden, Janneke P; Enneman, Anke W; van Dijk, Suzanne C; Sohl, Evelien; Brouwer-Brolsma, Elske M; van der Zwaluw, Nikita L; Zillikens, M Carola; Dhonukshe-Rutten, Rosalie A M; van der Velde, Nathalie; Brug, Johannes; Uitterlinden, André G; de Groot, Lisette C P G M; Lips, Paul; van Schoor, Natasja M

    2016-01-01

    Elevated homocysteine concentrations are associated with a decline in physical function in elderly persons. Homocysteine-lowering therapy may slow down this decline. This study aimed to examine the effect of a 2-year intervention of vitamin B12 and folic acid supplementation on physical performance, handgrip strength, and risk of falling in elderly subjects in a double-blind, randomized placebo-controlled trial. Participants aged ?65 years with elevated plasma homocysteine concentrations [12-50 ”mol/L (n = 2919)] were randomly assigned to daily supplementation of 500 ”g vitamin B12, 400 ”g folic acid, and 600 IU vitamin D3, or to placebo with 600 IU vitamin D3. Physical performance (range 0-12) and handgrip strength (kg) were measured at baseline and after 2 years. Falls were reported prospectively on a research calendar. Intention-to-treat (primary) and per-protocol (secondary) analyses were performed. Physical performance level and handgrip strength significantly decreased during the follow-up period, but this decline did not differ between groups. Moreover, time to first fall was not significantly different (HR: 1.0, 95 % CI 0.9-1.2). Secondary analyses on a per-protocol base identified an interaction effect with age on physical performance. In addition, the treatment was associated with higher follow-up scores on the walking test (cumulative OR: 1.3, 95 % CI 1.1-1.5). Two-year supplementation of vitamin B12 and folic acid was neither effective in reducing the age-related decline in physical performance and handgrip strength, nor in the prevention of falling in elderly persons. Despite the overall null-effect, the results provide indications for a positive effect of the intervention on gait, as well as on physical performance among compliant persons >80 years. These effects should be further tested in future studies. PMID:26412463

  4. Could Fire and Rescue Services identify older people at risk of falls?

    PubMed

    Laybourne, Anne H; Martin, Finbarr C; Whiting, David G; Lowton, Karen

    2011-10-01

    Protecting or improving the efficiency and effectiveness of services while reducing costs in response to public sector funding reductions is a significant challenge for all public service organisations. Preventing falls in older people is a major public health objective. We propose here an innovative model of community partnership with Fire and Rescue Services assisting falls prevention services to enhance the safety and well-being of older people in local communities through early identification of those who are at risk of injury from a fall or accidental domestic fire. PMID:22284951

  5. Possible effects of elk harvest on fall distribution of grizzly bears in the Greater Yellowstone Ecosystem

    USGS Publications Warehouse

    Haroldson, M.A.; Schwartz, C.C.; Cherry, S.; Moody, D.

    2004-01-01

     The tradition of early elk (Cervus elaphus) hunting seasons adjacent to Yellowstone National Park (YNP), USA, provides grizzly bears (Ursus arctos horribilis) with ungulate remains left by hunters. We investigated the fall (Aug–Oct) distribution of grizzly bears relative to the boundaries of YNP and the opening of September elk hunting seasons. Based on results from exact tests of conditional independence, we estimated the odds of radiomarked bears being outside YNP during the elk hunt versus before the hunt. Along the northern boundary, bears were 2.40 times more likely to be outside YNP during the hunt in good whitebark pine (Pinus albicaulis) seed-crop years and 2.72 times more likely in poor seed-crop years. The level of confidence associated with 1-sided confidence intervals with a lower endpoint of 1 was approximately 94% in good seed-crop years and 61% in poor years. Along the southern boundary of YNP, radiomarked bears were 2.32 times more likely to be outside the park during the hunt in good whitebark pine seed-crop years and 4.35 times more likely in poor seed-crop years. The level of confidence associated with 1-sided confidence intervals with a lower endpoint of 1 was approximately 93% in both cases. Increased seasonal bear densities and human presence in early hunt units increases potential for conflicts between bears and hunters. Numbers of reported hunting-related grizzly bear mortalities have increased in the Greater Yellowstone Ecosystem (GYE) during the last decade, and nearly half of this increase is due to bear deaths occurring in early hunt units during September. Human-caused grizzly bear mortality thresholds established by the U.S. Fish and Wildlife Service (USFWS) have not been exceeded in recent years. This is because agency actions have reduced other sources of human-caused mortalities, and because population parameters that mortality thresholds are based on have increased. Agencies must continue to monitor and manage hunter-caused grizzly bear mortality at sustainable levels to ensure the long-term health of the GYE population.

  6. Automatic fall detection using wearable biomedical signal measurement terminal.

    PubMed

    Nguyen, Thuy-Trang; Cho, Myeong-Chan; Lee, Tae-Soo

    2009-01-01

    In our study, we developed a mobile waist-mounted device which can monitor the subject's acceleration signal and detect the fall events in real-time with high accuracy and automatically send an emergency message to a remote server via CDMA module. When fall event happens, the system also generates an alarm sound at 50Hz to alarm other people until a subject can sit up or stand up. A Kionix KXM52-1050 tri-axial accelerometer and a Bellwave BSM856 CDMA standalone modem were used to detect and manage fall events. We used not only a simple threshold algorithm but also some supporting methods to increase an accuracy of our system (nearly 100% in laboratory environment). Timely fall detection can prevent regrettable death due to long-lie effect; therefore increase the independence of elderly people in an unsupervised living environment. PMID:19964661

  7. Resource Effective Strategies to Prevent and Treat Cardiovascular Disease.

    PubMed

    Schwalm, J D; McKee, Martin; Huffman, Mark D; Yusuf, Salim

    2016-02-23

    Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries. The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in low- and middle-income countries. Barriers at the patient, healthcare provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD, will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including (1) effective measures for tobacco control, (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of healthcare through task-sharing (nonphysician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above will lead to substantial reductions in CVD and related mortality. PMID:26903017

  8. Alteration of the phenology of leaf senescence and fall in winter deciduous species by climate change: effects on nutrient proficiency.

    PubMed

    Estiarte, Marc; Peńuelas, Josep

    2015-03-01

    Leaf senescence in winter deciduous species signals the transition from the active to the dormant stage. The purpose of leaf senescence is the recovery of nutrients before the leaves fall. Photoperiod and temperature are the main cues controlling leaf senescence in winter deciduous species, with water stress imposing an additional influence. Photoperiod exerts a strict control on leaf senescence at latitudes where winters are severe and temperature gains importance in the regulation as winters become less severe. On average, climatic warming will delay and drought will advance leaf senescence, but at varying degrees depending on the species. Warming and drought thus have opposite effects on the phenology of leaf senescence, and the impact of climate change will therefore depend on the relative importance of each factor in specific regions. Warming is not expected to have a strong impact on nutrient proficiency although a slower speed of leaf senescence induced by warming could facilitate a more efficient nutrient resorption. Nutrient resorption is less efficient when the leaves senesce prematurely as a consequence of water stress. The overall effects of climate change on nutrient resorption will depend on the contrasting effects of warming and drought. Changes in nutrient resorption and proficiency will impact production in the following year, at least in early spring, because the construction of new foliage relies almost exclusively on nutrients resorbed from foliage during the preceding leaf fall. Changes in the phenology of leaf senescence will thus impact carbon uptake, but also ecosystem nutrient cycling, especially if the changes are consequence of water stress. PMID:25384459

  9. Performance of High Strength Rock Fall Meshes: Effect of Block Size and Mesh Geometry

    NASA Astrophysics Data System (ADS)

    Buzzi, Olivier; Leonarduzzi, E.; Krummenacher, B.; Volkwein, A.; Giacomini, A.

    2015-05-01

    In rockfall science, the bullet effect refers to the perforation of a rockfall mesh by a small block traveling at high speed. To date, there is still no comprehensive experimental data set investigating the underlying mechanisms of such effect. The bullet effect illustrates the fact that the capacity of a rockfall mesh depends on the size and speed of the impacting block. This paper presents the results of an experimental study on the effect of block size and mesh geometry (aperture and wire diameter) on the mesh performance. The results clearly show that the amount of energy required to perforate the mesh drops as the blocks get smaller. They also suggest that the mesh performance reaches a maximum and reduces to zero when the mesh cannot sustain the static load imposed by very large blocks. The outcome of the first series validates an analytical model for mesh perforation, making it the first simple model capturing the bullet effect. A second series of tests focused on the effect of mesh geometry and it was found that decreasing the mesh aperture by 19 % improves the performance by 50 % while only an extra 30 % could be gained by increasing the wire diameter by 33 %. The outcomes of the second series were used to discuss and redefine a dimensionless geometrical parameter G* and to validate a simple power type equation relating the mesh characteristics and the mesh performance.

  10. Anger and Violence Prevention: Enhancing Treatment Effects through Booster Sessions

    ERIC Educational Resources Information Center

    Bundy, Alysha; McWhirter, Paula T.; McWhirter, J. Jeffries

    2011-01-01

    This study was designed to evaluate the effectiveness of booster sessions on the maintenance of intervention gains following an anger management prevention program: "Student Created Aggression Replacement Education Program" ("SCARE"). Participants who had completed the "SCARE" program a year earlier were randomly assigned into either a booster…

  11. Effective Dropout Prevention and College Attendance Programs for Latino Students.

    ERIC Educational Resources Information Center

    Fashola, Olatokunbo S.; Slavin, Robert E.

    This paper reviews research related to effective secondary school programs aimed at dropout prevention and increasing college enrollment rates for at-risk Latino youth. The review identifies programs that have demonstrated a significant impact on dropout rates, college attendance, school performance, or related outcomes in rigorous evaluations;…

  12. Effective Instruction: The Forgotten Component in Preventing School Violence.

    ERIC Educational Resources Information Center

    Scott, Terrance M.; Nelson, C. Michael; Liaupsin, Carl J.

    2001-01-01

    Discussion of school violence and student misbehavior reviews research showing that violent and unsafe student behaviors are the outcome of a predictable chain of events that begins with academic failure. The paper urges a greater emphasis on effective academic instruction in any efforts to prevent school violence and improve school safety.


  13. Anger and Violence Prevention: Enhancing Treatment Effects through Booster Sessions

    ERIC Educational Resources Information Center

    Bundy, Alysha; McWhirter, Paula T.; McWhirter, J. Jeffries

    2011-01-01

    This study was designed to evaluate the effectiveness of booster sessions on the maintenance of intervention gains following an anger management prevention program: "Student Created Aggression Replacement Education Program" ("SCARE"). Participants who had completed the "SCARE" program a year earlier were randomly assigned into either a booster


  14. Perceived Cause, Environmental Factors, and Consequences of Falls in Adults with Cerebral Palsy: A Preliminary Mixed Methods Study

    PubMed Central

    McDonald, Rachael; McGinley, Jennifer

    2015-01-01

    Objective. Describe perceived cause, environmental influences, and consequences of falls or near-falls in ambulant adults with cerebral palsy (CP). Methods. Adults with CP completed postal surveys and follow-up semistructured interviews. Surveys sought information on demographic data, self-nominated Gross Motor Function Classification Score (GMFCS-E&R), falls, and near-falls. Interviews gathered additional information on falls experiences, near-falls, and physical and psychosocial consequences. Results. Thirty-four adults with CP participated. Thirty-three participants reported at least one fall in the previous year. Twenty-six participants reported near-falls. Most commonly, falls occurred indoors, at home, and whilst engaged in nonhazardous ambulation. Adults with CP experienced adverse falls consequences, lower limb injuries predominant (37%), and descriptions of fear, embarrassment, powerlessness, and isolation. Discussion. Adults with CP may experience injurious falls. Further investigation into the impact of falls on health-related quality of life and effective remediation strategies is warranted to provide comprehensive falls prevention programs for this population. PMID:25802759

  15. The Fort McMurray Demonstration Project in Social Marketing: no demonstrable effect on already falling injury rates following intensive community and workplace intervention.

    PubMed

    Guidotti, Tee L; Deb, Pooja; Bertera, Robert; Ford, Lynda

    2009-10-01

    The Fort McMurray Demonstration Project in Social Marketing attempted to achieve mutually reinforcing effects from thematically coordinated educational and awareness efforts in the community as a whole and in the workplace and the inclusion of occupational safety within the framework of a community health promotion project. The study community was Fort McMurray, a small, industrial city in northern Alberta. The Mistahiai Health Region, several hundred kilometers to the west and also dominated by one city, Grande Prairie, served as the reference community. The intervention was based on media and events staged at public events, with supporting educational activities in schools and the community. It relied heavily on community-based partners and volunteers. Data on healthcare utilization of selected preventable injuries were obtained from Alberta Health for the time period 1990-1996 for the Regional Health Authorities of Northern Lights, where the only large population centre is Fort McMurray, and Mistahia. Age-adjusted aggregate injury rates were analyzed for evidence of an effect of the intervention. Severity was measured by proxy, using the number of diagnostic claims submitted for reimbursement for medical services in a given year. The communities differed in age-specific injury rates, with Fort McMurray showing higher rates for residents aged less than 55. Young adults and older adolescents showed higher levels of severity. Injury rates fell substantially and at similar rates in both communities over the five-year period. However, in both communities injury rates were already falling before the intervention in Fort McMurray began and continued to fall at about the same rate, slowing toward the end of the period. No evidence was found for an effect of the Project or for acceleration of the reduction in injury frequency in the intervention area. Over the period, fewer medical services were delivered in office settings and more in emergency rooms, in both communities. The Fort McMurray Demonstration Project in Social Marketing achieved an intensity of intervention and community participation that is unlikely to be sustainable in other communities. Despite this level of effort, the study did not achieve an unequivocal, demonstrable reduction in injury frequency above what was already occurring. This may have been due to a more powerful trend manifested as injury reduction across the province. PMID:19521753

  16. Moving from Efficacy to Effectiveness Trials in Prevention Research

    PubMed Central

    Marchand, Erica; Stice, Eric; Rohde, Paul; Becker, Carolyn Black

    2013-01-01

    Efficacy trials test whether interventions work under optimal, highly controlled conditions whereas effectiveness trials test whether interventions work with typical clients and providers in real-world settings. Researchers, providers, and funding bodies have called for more effectiveness trials to understand whether interventions produce effects under ecologically valid conditions, which factors predict program effectiveness, and what strategies are needed to successfully implement programs in practice settings. The transition from efficacy to effectiveness with preventive interventions involves unique considerations, some of which are not shared by treatment research. The purpose of this article is to discuss conceptual and methodological issues that arise when making the transition from efficacy to effectiveness research in primary, secondary, and tertiary prevention, drawing on the experiences of two complimentary research groups as well as the existing literature. We address (a) program of research, (b) intervention design and conceptualization, (c) participant selection and characteristics, (d) providers, (e) context, (f) measurement and methodology, (g) outcomes, (h) cost, and (i) sustainability. We present examples of research in eating disorder prevention that demonstrate the progression from efficacy to effectiveness trials. PMID:21092935

  17. Falls and Older Adults

    MedlinePLUS

    ... rises with age. Click for more information Falls Lead to Fractures, Trauma Each year, more than 1. ... and injury deaths. Fractures caused by falls can lead to hospital stays and disability. Most often, fall- ...

  18. How Effective Homelessness Prevention Impacts the Length of Shelter Spells

    PubMed Central

    Goodman, Sarena; Messeri, Peter; O’Flaherty, Brendan

    2014-01-01

    Homelessness prevention programs intervene with households apparently in imminent danger of becoming homeless, and try to keep them housed. If they are at least partially successful, how do they change the average shelter spell of households actually becoming homeless? We use data from 2003 to 2008 for Homebase, a New York City homelessness prevention program that studies have found to be effective in reducing shelter entries. Homebase made no difference in average shelter spells at the community level. This result, like many results about shelter spell length, is not easy to reconcile with the idea that shelter spell length is a reflection of the seriousness of underlying problems. PMID:24610995

  19. Preventive Interventions for Preterm Children: Effectiveness and Developmental Mechanisms

    PubMed Central

    Guralnick, Michael J.

    2012-01-01

    This article provides an integrative review of the effectiveness of and possible developmental mechanisms associated with preventive interventions for preterm children. An analysis of randomized clinical trials carried out within the last 15 years was framed within a contemporary developmental model emphasizing the role of parental adjustments to preterm children’s characteristics. Evidence suggested positive outcomes could be understood in terms of improvements in developmental pathways associated with parental sensitive-responsiveness and child participation in intensive intervention-oriented child care. Implications for the critical role of the Medical Home model for preventive interventions for preterm children were discussed. PMID:22426651

  20. Improving Institutional Effectiveness through Programmatic Assessment. Professional File Number 109, Fall 2008

    ERIC Educational Resources Information Center

    Brown, Dina

    2008-01-01

    This article identifies concrete steps used at Argosy University/Orange County (Argosy or AUOC) to integrate assessment in daily institutional operations and utilize assessment data for educational and organizational improvements. Additionally, the article addresses the role of an institutional effectiveness committee in facilitating the


  1. Circumstances and outcomes of falls among high risk community-dwelling older adults

    PubMed Central

    Stevens, Judy A.; Mahoney, Jane E.; Ehrenreich, Heidi

    2015-01-01

    Background For older adults, falls threaten their health, independence, and quality of life. Knowing the circumstances surrounding falls is essential for understanding how behavioral and environmental factors interact in fall events. It is also important for developing and implementing interventions that are effective and acceptable to older adults. This study investigated the circumstances and injury outcomes of falls among community-dwelling older adults at high risk of falling. Methods In this secondary analysis, we examined the circumstances and outcomes of falls experienced by 328 participants in the Dane County (Wisconsin) Safety Assessment for Elders (SAFE) Research Study. SAFE was a randomized controlled trial of a community-based multifactorial falls intervention for older adults at high risk for falls, conducted from October 2002 to December 2007. Participants were community-dwelling adults aged ≄65 years who reported at least one fall during the year after study enrollment. Falls were collected prospectively using monthly calendars. Everyone who reported a fall was contacted by telephone to determine the circumstances surrounding the event. Injury outcomes were defined as none, mild (injury reported but no treatment sought), moderate (treatment for any injury except head injury or fracture), and severe (treatment for head injury or fracture). Results Data were available for 1,172 falls. A generalized linear mixed model analysis showed that being age ≄85 (OR = 2.1, 95% confidence interval [CI] = 1.2–3.9), female (OR = 2.1, 95% CI = 1.3–3.4), falling backward and landing flat (OR = 5.6, 95% CI = 2.9–10.5), sideways (OR = 4.6, 95% CI = 2.6–8.0) and forward (OR = 3.3, 95% CI = 2.0–5.7) were significantly associated with the likelihood of injury. Of 783 falls inside the home, falls in the bathroom were more than twice as likely to result in an injury compared to falls in the living room (OR = 2.4, 95% CI = 1.2–4.9). Conclusions Most falls among these high risk older adults occurred inside the home. The likelihood of injury in the bathroom supports the need for safety modifications such as grab bars, and may indicate a need for assistance with bathing. These findings will help clinicians tailor fall prevention for their patients and have practical implications for retirement and assisted living communities and community-based fall prevention programs. PMID:26744637

  2. Preventing Neurocognitive Late Effects in Childhood Cancer Survivors

    PubMed Central

    Askins, Martha A.; Moore, Bartlett D.

    2013-01-01

    Neurocognitive late effects are common sequelae of cancer in children, especially in those who have undergone treatment for brain tumors or in those receiving prophylactic cranial radiation therapy to treat leukemia. Neurocognitive morbidity in attention, executive functioning, processing speed, working memory, and memory frequently occurs and contributes to declines in intellectual and academic abilities. Oncologists are faced with the challenge of using the most effective, often the most intense, therapy to achieve the primary goal of medical success, balanced with the desire to prevent adverse late effects. Not all children with similar diagnoses and treatment have identical neurocognitive outcomes; some do very poorly and some do well. Attention now turns to the reliable prediction of risk for poor outcomes and then, using risk-adapted therapy, to preserve neurocognitive function. Prevention of late effects through rehabilitative strategies, continuation of school, and pharmacotherapy will be explored. PMID:18952582

  3. Effects of Fall Applications of Chemical Defoliants, Urea, and Gibberellic Acid on Defoliation in the Fall and Performance of Hydrangeas during Forcing

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In two separate experiments, Hydrangea macrophylla (Thunb.) Ser. ‘Merritt’s Supreme’ plants were used to study the effects of foliar sprays of Def 6 (tributyl phosphorotrithioate, 2500, 5000, 7500 and 10000 mg·L-1), gibberellic acid, (GA, 50 mg·L-1), copper-EDTA (CuEDTA, 0.5% and 1.0%), Florel (2000...

  4. [The new German prevention act: an effective strategy?].

    PubMed

    Garlichs, Dietrich

    2015-10-01

    The new German prevention act attempts to deal with the influx of obesity and chronic diseases by educating and informing. It seeks to change individual behaviour and supress lifestyle-related risk factors. In the past, however this behavioural prevention strategy has proved ineffective. A structural prevention strategy, as requested by the WHO, should additionally be put into effect with measures that reach all walks of life, not just the health-conscious people in society. It proposes the following: · At least one hour of daily physical activity or sport at school and kindergarten. · A differential food tax that makes unhealthy foods more expensive and healthy foods cheaper (taxing sugary / fatty foods). · Mandatory quality standards for kindergarten and school meals. · Banning food advertising targeted at children. PMID:26445263

  5. Rise and fall of endrin usage in Washington state fruit orchards: Effects on wildlife

    USGS Publications Warehouse

    Blus, L.J.; Henny, C.J.; Grove, R.A.

    1989-01-01

    A study of the effects of endrin on wildlife was conducted from 1981 to 1983 in fruit orchards in central Washington state. The single post-harvest application of endrin as a rodenticide resulted in both acute and chronic toxicity to a variety of avian species. Most mortality occurred soon after application, but several raptors died during the spring and summer. Most wildlife sampled in the orchard system contained residues of endrin. There was on evidence that endrin depressed reproductive success.

  6. Preventing Diabetes

    MedlinePLUS

    ... of this page please turn Javascript on. Preventing Diabetes Past Issues / Fall 2006 Table of Contents The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) suggests these ...

  7. Preventing Influenza

    MedlinePLUS

    ... Navigation Bar Home Current Issue Past Issues Preventing Influenza Past Issues / Fall 2006 Table of Contents For ... page please turn Javascript on. Photo: PhotoDisc Because flu viruses spread in respiratory droplets distributed by coughing ...

  8. A computerized tool for evaluating the effectiveness of preventive interventions.

    PubMed Central

    Daumit, G.; Boulware, L. E.; Powe, N. R.; Minkovitz, C. S.; Frick, K. D.; Anderson, L. A.; Janes, G. R.; Lawrence, R. S.

    2001-01-01

    In identifying appropriate strategies for effective use of preventive services for particular settings or populations, public health practitioners employ a systematic approach to evaluating the literature. Behavioral intervention studies that focus on prevention, however, pose special challenges for these traditional methods. Tools for synthesizing evidence on preventive interventions can improve public health practice. The authors developed a literature abstraction tool and a classification for preventive interventions. They incorporated the tool into a PC-based relational database and user-friendly evidence reporting system, then tested the system by reviewing behavioral interventions for hypertension management. They performed a structured literature search and reviewed 100 studies on behavioral interventions for hypertension management. They abstracted information using the abstraction tool and classified important elements of interventions for comparison across studies. The authors found that many studies in their pilot project did not report sufficient information to allow for complete evaluation, comparison across studies, or replication of the intervention. They propose that studies reporting on preventive interventions should (a) categorize interventions into discrete components; (b) report sufficient participant information; and (c) report characteristics such as intervention leaders, timing, and setting so that public health professionals can compare and select the most appropriate interventions. Images Figure 2 Figure 3 PMID:11889289

  9. Prevalence of falls in elderly women

    PubMed Central

    Vitor, Priscila Regina Rorato; de Oliveira, Ana Carolina Kovaleski; Kohler, Renan; Winter, Gabriele Regiane; Rodacki, Cintia; Krause, Maressa Priscila

    2015-01-01

    OBJECTIVE: To verify prevalence of falls and fear of falling, and to compare functional fitness among elderly women fallers and non-fallers. METHODS: Seventy-eight elderly women participated in this study. Cases of falls and the fear of falling were self-reported by the elderly women, while the functional fitness was measured by a set of functional tests. Mean and standard deviation were used to describe the sample. Independent t-test was used to compare functional fitness between groups. RESULTS: The prevalence of falls in this sample was 32.4%. Among women fallers, 40% self-reported a high fear of falling. CONCLUSION: It is recommended that functional and resistance exercises are included in the preventive strategies for reducing risk factors for falls and its determinants in elderly women. Level of Evidence II, Prognostic-Prospective Study. PMID:26207095

  10. Cost-Effectiveness of a School-Based Obesity Prevention Program

    ERIC Educational Resources Information Center

    Wang, Li Yan; Gutin, Bernard; Barbeau, Paule; Moore, Justin B.; Hanes, John, Jr.; Johnson, Maribeth H.; Cavnar, Marlo; Thornburg, Janet; Yin, Zenong

    2008-01-01

    Background: A school-based obesity prevention study (Medical College of Georgia FitKid Project) started in the fall of 2003 in 18 elementary schools. Half of the schools were randomized to an after-school program that included moderate-to-vigorous physical activity, healthy snacks, homework assistance, and academic enrichment. All third graders


  11. Cost-Effectiveness of a School-Based Obesity Prevention Program

    ERIC Educational Resources Information Center

    Wang, Li Yan; Gutin, Bernard; Barbeau, Paule; Moore, Justin B.; Hanes, John, Jr.; Johnson, Maribeth H.; Cavnar, Marlo; Thornburg, Janet; Yin, Zenong

    2008-01-01

    Background: A school-based obesity prevention study (Medical College of Georgia FitKid Project) started in the fall of 2003 in 18 elementary schools. Half of the schools were randomized to an after-school program that included moderate-to-vigorous physical activity, healthy snacks, homework assistance, and academic enrichment. All third graders…

  12. Rise and fall of endrin usage in Washington state fruit orchards: Effects on wildlife

    USGS Publications Warehouse

    Blus, L.J.; Henny, Charles J.; Grove, Robert A.

    1989-01-01

    A study of the effects of endrin on wildlife was conducted from 1981 to 1983 in fruit orchards in central Washington State. The single post-harvest application of endrin as a rodenticide resulted in both acute and chronic toxicity to a variety of avian species. Of 194 birds found dead, brains of 125 were analysed; endrin toxicosis accounted for >24% of the total and 37% of those analysed. Most mortality occurred soon after application, but several raptors died during the spring and summer. Most wildlife sampled in the orchard system contained residues of endrin. There was no evidence that endrin depressed reproductive success. Use of endrin abruptly declined during this study and its use is currently limited to emergency situations. Wildlife mortality from endrin also decreased; only six endrin-related mortalities were detected the last year of the study and there have been no reports of die-offs since the study ended.

  13. An Ounce of Prevention, a Pound of Uncertainty: The Cost-Effectiveness of School-Based Drug Prevention Programs.

    ERIC Educational Resources Information Center

    Caulkins, Jonathan P.; Rydell, C. Peter; Everingham, Susan S.; Chiesa, James; Bushway, Shawn

    This book describes an analysis of the cost-effectiveness of model school-based drug prevention programs at reducing cocaine consumption. It compares prevention's cost-effectiveness with that of several enforcement programs and with that of treating heavy cocaine users. It also assesses the cost of nationwide implementation of model prevention


  14. Effect of fall-grazed sericea lespedeza (Lespedeza cuneata) on gastrointestinal nematode infections of growing goats.

    PubMed

    Mechineni, A; Kommuru, D S; Gujja, S; Mosjidis, J A; Miller, J E; Burke, J M; Ramsay, A; Mueller-Harvey, I; Kannan, G; Lee, J H; Kouakou, B; Terrill, T H

    2014-08-29

    High prevalence of anthelmintic-resistant gastrointestinal nematodes (GIN) in goats has increased pressure to find effective, alternative non-synthetic control methods, one of which is adding forage of the high condensed tannin (CT) legume sericea lespedeza (SL; Lespedeza cuneata) to the animal's diet. Previous work has demonstrated good efficacy of dried SL (hay, pellets) against small ruminant GIN, but information is lacking on consumption of fresh SL, particularly during the late summer-autumn period in the southern USA when perennial warm-season grass pastures are often low in quality. A study was designed to determine the effects of autumn (September-November) consumption of fresh SL forage, grass pasture (predominantly bermudagrass, BG; Cynodon dactylon), or a combination of SL+BG forage by young goats [intact male Spanish kids, 9 months old (20.7 ± 1.1 kg), n = 10/treatment group] on their GIN infection status. Three forage paddocks (0.40 ha) were set up at the Fort Valley State University Agricultural Research Station (Fort Valley, GA) for an 8-week trial. The goats in each paddock were supplemented with a commercial feed pellet at 0.45 kg/head/d for the first 4 weeks of the trial, and 0.27 kg/head/d for the final 4 weeks. Forage samples taken at the start of the trial were analyzed for crude protein (CP), neutral detergent fiber (NDF), and acid detergent fiber (ADF) content, and a separate set of SL samples was analyzed for CT in leaves, stems, and whole plant using the benzyl mercaptan thiolysis method. Animal weights were taken at the start and end of the trial, and fecal and blood samples were collected weekly for determination of fecal egg counts (FEC) and packed cell volume (PCV), respectively. Adult GIN was recovered from the abomasum and small intestines of all goats at the end of the experiment for counting and speciation. The CP levels were highest for SL forage, intermediate for SL+BG, and lowest for BG forage samples, while NDF and ADF values were the opposite, with highest levels in BG and lowest in SL forage samples. Sericea lespedeza leaves had more CT than stems (16.0 g vs. 3.3g/100g dry weight), a slightly higher percentage of PDs (98% vs. 94%, respectively) and polymers of larger mean degrees of polymerization (42 vs. 18, respectively). There were no differences in average daily gain or blood PCV between the treatment groups, but SL goats had lower FEC (P < 0.05) than the BG or SL+BG forage goats throughout most of the trial. The SL+BG goats had lower FEC than the BG forage animals by the end of the trial (week 8, P < 0.05). The SL goats had lower numbers (P < 0.05) of male Haemonchus contortus and tended to have fewer female (P < 0.10) and total (P < 0.07) H. contortus compared with the BG goats. The predominant GIN in all the goats was Trichostrongylus colubriformis (73% of total GIN). As a low-input forage with activity against pathogenic GIN (H. contortus), SL has a potential to reduce producers' dependence upon synthetic anthelmintics and also to fill the autumn 'window' in good-quality fresh forages for goat grazing in the southern USA. PMID:24996964

  15. Challenges in Defining and Categorizing Falls on Diverse Unit Types

    PubMed Central

    Davidson, Jan; Dunton, Nancy; Crosser, Brandon

    2015-01-01

    In 2012, the National Database of Nursing Quality Indicators launched a project to expand its falls indicator for use on pediatric, neonatal, and psychiatric units. We discuss challenges encountered, argue that schemes for categorizing falls by cause or supposed preventability are not suitable for large-scale efforts to track and prevent falls, express concern about the growing burden of collecting increasingly granular quality data, and discuss limitations of total and injurious fall rates as quality measures. PMID:25188525

  16. Analysis of Core Stability Exercise Effect on the Physical and Psychological Function of Elderly Women Vulnerable to Falls during Obstacle Negotiation

    PubMed Central

    Ko, Dae-Sik; Jung, Dae-In; Jeong, Mi-Ae

    2014-01-01

    [Purpose] The aim of the present study was to investigate the effects of core stability exercise (CSE) on the physical and psychological functions of elderly women while negotiating general obstacles. [Subjects and Methods] After allocating 10 elderly women each to the core stability training group and the control group, we carried out Performance-Oriented Mobility Assessment (POMA) and measured crossing velocity (CV), maximum vertical heel clearance (MVHC), and knee flexion angle for assessing physical performances. We evaluated depression and fear of falling for assessing psychological functions. [Results] Relative to the control group, the core stability training group showed statistically significant overall changes after the training session: an increase in POMA scores, faster CV, lower MVHC, and a decrease in knee flexion angle. Furthermore, depression and fear of falling decreased significantly. [Conclusion] CSE can have a positive effect on the improvement of physical and psychological performances of older women who are vulnerable to falls as they negotiate everyday obstacles. PMID:25435680

  17. Results of research to develop cost effective biomonitoring at oil shale lease tracts. Phase I. Fall sampling report

    SciTech Connect

    Skalski, J.R.; Fitzner, R.E.; Gano, K.A.

    1982-05-01

    This report presents the results of censuses conducted during October 1981 to estimate the fall abundance of small mammals and avifauna on replicate plots in the vicinity of Federal Tract C-a (Rio Blanco Oil Shale Company). The objectives of the fall censuses were to evaluate alternative census techniques, test assumptions vital to the use of indices and abundance estimators, determine cost-functions associated with monitoring efforts, and estimate variance components needed to devise optimal monitoring designs. Analyses of the fall census data on small mammal abundance were performed.

  18. Differentiating fall-prone and healthy adults using local dynamic stability

    PubMed Central

    Lockhart, Thurmon E.; Liu, Jian

    2010-01-01

    Variability in kinematic and spatio-temporal gait parameters has long been equated with stability and used to differentiate fallers from non-fallers. Recently, a mathematically rigorous measure of local dynamic stability has been proposed based on the non-linear dynamics theory to differentiate fallers from non-fallers. This study investigated whether the assessment of local dynamic stability can identify fall-prone elderly individuals who were unable to successfully avoid slip-induced falls. Five healthy young, four healthy elderly and four fall-prone elderly individuals participated in a walking experiment. Local dynamic stability was quantified by the maximum Lyapunov exponent. The fall-prone elderly were found to exhibit significantly lower local dynamic stability (i.e. greater sensitivity to local perturbations), as compared to their healthy counterparts. In addition to providing evidence that the increased falls of the elderly may be due to the inability to attenuate/control stride-to-stride disturbances during locomotion, the current study proposed the opportunity of using local dynamic stability as a potential indicator of risk of falling. Early identification of individuals with a higher risk of falling is important for effective fall prevention. The findings from this study suggest that local dynamic stability may be used as a potential fall predictor to differentiate fall-prone adults. PMID:19034782

  19. Child Sexual Abuse Prevention Programs: What Makes them Effective in Protecting Children?

    ERIC Educational Resources Information Center

    Kraizer, Sherryll; And Others

    1989-01-01

    Describes a school-based child abuse prevention program. The program's effectiveness is evaluated in terms of prevention of sexual abuse, the age of maximum receptivity to prevention education, and implications of the evaluation for early childhood educators. (RJC)

  20. Fall Enrollment Report. 2014

    ERIC Educational Resources Information Center

    Iowa Department of Education, 2014

    2014-01-01

    This report summarizes and analyzes fall enrollment in Iowa's community colleges. Each year, Iowa's 15 community colleges submit data on enrollment on the 10th business day of the fall semester. Some highlights from this report include: (1) Fall 2014 enrollment was 93,772 students--a decline of 0.49 percent from last fall; (2) Enrollment continues…

  1. Upper Yosemite Falls

    USGS Multimedia Gallery

    In this image, Upper Yosemite Falls may be seen from the Yosemite Falls Trail. Upper Yosemite Falls has a total plunge of 1,430 ft (440 m). Yosemite Falls is one of the most famous waterfalls within Yosemite National Park....

  2. Upper Yosemite Falls Detail

    USGS Multimedia Gallery

    In this image, a detailed view Upper Yosemite Falls may be seen from the Yosemite Falls Trail. Upper Yosemite Falls has a total plunge of 1,430 ft (440 m). Yosemite Falls is one of the most famous waterfalls within Yosemite National Park....

  3. Lower Yosemite Falls

    USGS Multimedia Gallery

    In this image, Lower Yosemite Falls may be seen. Lower Yosemite Falls is the lowest of the three sectiosn of Yosemite Falls. It is about 320 ft (98 m) high. Yosemite Falls is one of the most famous waterfalls within Yosemite National Park....

  4. Upper Yosemite Falls

    USGS Multimedia Gallery

    In this image, Upper Yosemite Falls may be seen. Upper Yosemite Falls is the highest of the three sectiosn of Yosemite Falls. It is about 1,430 ft (440 m) high. Yosemite Falls is one of the most famous waterfalls within Yosemite National Park....

  5. The moderating effects of school climate on bullying prevention efforts.

    PubMed

    Low, Sabina; Van Ryzin, Mark

    2014-09-01

    Bullying prevention efforts have yielded mixed effects over the last 20 years. Program effectiveness is driven by a number of factors (e.g., program elements and implementation), but there remains a dearth of understanding regarding the role of school climate on the impact of bullying prevention programs. This gap is surprising, given research suggesting that bullying problems and climate are strongly related. The current study examines the moderating role of school climate on the impacts of a stand-alone bullying prevention curriculum. In addition, the current study examined 2 different dimensions of school climate across both student and staff perceptions. Data for this study were derived from a Steps to Respect (STR) randomized efficacy trial that was conducted in 33 elementary schools over a 1-year period. Schools were randomly assigned to intervention or wait-listed control condition. Outcome measures (pre-to-post) were obtained from (a) all school staff, (b) a randomly selected subset of 3rd-5th grade teachers in each school, and (c) all students in classrooms of selected teachers. Multilevel analyses revealed that psychosocial climate was strongly related to reductions in bullying-related attitudes and behaviors. Intervention status yielded only 1 significant main effect, although, STR schools with positive psychosocial climate at baseline had less victimization at posttest. Policies/administrative commitment to bullying were related to reduced perpetration among all schools. Findings suggest positive psychosocial climate (from both staff and student perspective) plays a foundational role in bullying prevention, and can optimize effects of stand-alone programs. PMID:25089333

  6. Antialdosterones: incidence and prevention of sexual side effects.

    PubMed

    de Gasparo, M; Whitebread, S E; Preiswerk, G; Jeunemaître, X; Corvol, P; Ménard, J

    1989-01-01

    The use of spironolactone in the treatment of hypertension has been limited by the occurrence of sexual side effects, mainly menstrual disturbances in women and gynaecomastia in men. In order to minimize this limitation on the use of an effective potassium-sparing antihypertensive agent, two strategies can be proposed: (1) A decrease in the daily dose of spironolactone. In 182 patients with essential hypertension treated with spironolactone alone for a mean follow-up period of 23 months, daily doses of 75-100 mg were as effective on blood pressure as doses of 150-300 mg. In contrast, the development of gynaecomastia--91 cases among 699 men--was dose-related in 6.9% (50 mg/day) to 52.2% (150 mg or more/day) of the cases. (2) An improvement in the receptor-binding specificity of spironolactone. Three 9 alpha, 11 alpha-epoxy derivatives have been characterized in vitro in rats and in rabbits. They exhibited a 3- to 10-fold decrease of the antiandrogenic and progestagenic effect, compared with spironolactone. In humans, one of these derivatives counteracted the fall in urinary Na/K ratio induced by 9 alpha-fluorohydrocortisone at a 25 mg dose. PMID:2913412

  7. Effect of quality of care on preventable perinatal mortality.

    PubMed

    Salinas, A M; Coria, I; Reyes, H; Zambrana, M

    1997-04-01

    This study assessed and quantified the effect of quality of care on death preventability, independent of social and biological variables. One hundred and eighty-one avoidable perinatal deaths (cases) were compared to 341 non-avoidable ones (controls). Judgement criteria on death preventability were based predominantly on compliance with explicit hospital medical care standards, determined by peer review. The overall perinatal mortality rate was 24.8 per 1000 births and could be reduced by 35% if all avoidable perinatal deaths were prevented. Sixteen per cent of the deaths presented structural and 31.2% process deficiencies; both predominated among avoidable perinatal deaths (35.4% vs 5.3%, p < 0.000; and 79.3% vs 5.9%, p < 0.000, respectively). Structural deficiencies increased the risk of an avoidable perinatal death eleven-fold (95% confidence interval (CI) 4.1, 26.9; p < 0.001) and process deficiencies eighty-eightfold (95% CI 37.2, 204.5, p < 0.001), after controlling for confounders. The strength of the association between quality of care and preventable perinatal mortality was estimated. PMID:9154495

  8. Effectiveness of HIV prevention for women: what is working?

    PubMed

    Gil-Llario, María Dolores; Ballester-Arnal, Rafael; Giménez-García, Cristina; Salmerón-Sånchez, Pedro

    2014-10-01

    The HIV-AIDS remains a public health problem which disproportionally affects women. However, prevention strategies have rarely considered their specific efficacy for them. For this reason, this study examines the differential effectiveness of six intervention elements based on socio-cognitive theories addressing young women. A controlled between-groups design examined the change in risk profile among 167 young Spanish women (mean age 21.3 years old) involved in five sexual risk prevention interventions (informative talk, attitudinal discussion, role-play, fear induction and informative website) and one control non-intervening group (waiting list). Our findings support the differential efficacy of some HIV preventive intervention elements comparing others for women. In particular, the attitudinal discussion stands out followed by the informative talk and the role play. Contrarily, the fear induction component did not reveal relevant improvements. This study provides new evidence related to HIV prevention. Particularly, the higher efficacy of motivational components for these young Spanish women is revealed. PMID:24452498

  9. EFFECTS OF WASTE DISCHARGES ON WATER QUALITY OF THE SNAKE RIVER AND ROCK CREEK, TWIN FALLS AREA, IDAHO. 1971

    EPA Science Inventory

    Comprehensive water quality investigations in the Snake River Basin, Twin Falls Area (17040212) were conducted from November 2 to 17, 1971. Studies included an evaluation of municipal and industrial wastewater treatment facilities. Subsequently, stream surveys were conducted on...

  10. False fame prevented: avoiding fluency effects without judgmental correction.

    PubMed

    Topolinski, Sascha; Strack, Fritz

    2010-05-01

    Three studies show a way to prevent fluency effects independently of judgmental correction strategies by identifying and procedurally blocking the sources of fluency variations, which are assumed to be embodied in nature. For verbal stimuli, covert pronunciations are assumed to be the crucial source of fluency gains. As a consequence, blocking such pronunciation simulations through a secondary oral motor task decreased the false-fame effect for repeatedly presented names of actors (Experiment 1) as well as prevented increases in trust due to repetition for brand names and names of shares in the stock market (Experiment 2). Extending this evidence beyond repeated exposure, we demonstrated that blocking oral motor simulations also prevented fluency effects of word pronunciation on judgments of hazardousness (Experiment 3). Concerning the realm of judgment correction, this procedural blocking of (biasing) associative processes is a decontamination method not considered before in the literature, because it is independent of exposure control, mood, motivation, and post hoc correction strategies. The present results also have implications for applied issues, such as advertising and investment decisions. PMID:20438220

  11. Maternal epigenetic dietary effects on early breast cancer prevention | Division of Cancer Prevention

    Cancer.gov

    Skip to main content Division of Cancer Prevention Search form Search Main menu Home Major Programs Research Networks Map Alliance of Glycobiologists for Detection of Cancer Barrett's Esophagus Translational Research Network (BETRNet) Cancer Prevention

  12. Identifying Balance and Fall Risk in Community-Dwelling Older Women: The Effect of Executive Function on Postural Control

    PubMed Central

    Clark, Jennifer; McLean, Stephanie; Pedlow, Sam; Van Hemmen, Alysia; Montero Odasso, Manuel; Overend, Tom

    2014-01-01

    ABSTRACT Purpose: The mechanisms linking cognition, balance function, and fall risk among older adults are not fully understood. An evaluation of the effect of cognition on balance tests commonly used in clinical practice to assess community-dwelling older adults could enhance the identification of at-risk individuals. The study aimed to determine (1) the association between cognition and clinical tests of balance and (2) the relationship between executive function (EF) and balance under single- and dual-task testing. Methods: Participants (24 women, mean age of 76.18 [SD 16.45] years) completed six clinical balance tests, four cognitive tests, and two measures of physical function. Results: Poor balance function was associated with poor performance on cognitive testing of EF. In addition, the association with EF was strongest under the dual-task timed up-and-go (TUG) test and the Fullerton Advanced Balance Scale. Measures of global cognition were associated only with the dual-task performance of the TUG. Postural sway measured with the Standing Balance Test, under single- or dual-task test conditions, was not associated with cognition. Conclusions: Decreased EF was associated with worse performance on functional measures of balance. The relationship between EF and balance was more pronounced with dual-task testing using a complex cognitive task combined with the TUG. PMID:24799756

  13. Cost-Effectiveness of Fiscal Policies to Prevent Obesity.

    PubMed

    Moodie, Marj; Sheppard, Lauren; Sacks, Gary; Keating, Catherine; Flego, Anna

    2013-01-01

    Cost-effective, sustainable strategies are urgently required to curb the global obesity epidemic. To date, fiscal policies such as taxes and subsidies have been driven largely by imperatives to raise revenue or increase supply, rather than to change population behaviours. This paper reviews the economic evaluation literature around the use of fiscal policies to prevent obesity. The cost-effectiveness literature is limited, and more robust economic evaluation studies are required. However, uncertainty and gaps in the effectiveness evidence base need to be addressed first: more studies are needed that collect 'real-world' empirical data, and larger studies with more robust designs and longer follow-up timeframes are required. Reliability of cross-price elasticity data needs to be investigated, and greater consideration given to moderators of intervention effects and the sustainability of outcomes. Economic evaluations should adopt a societal perspective, incorporate a broader spectrum of economic costs and consider other factors likely to affect the implementation of fiscal measures. The paucity of recent cost-effectiveness studies means that definitive conclusions about the value for money of fiscal policies for obesity prevention cannot yet be drawn. However, as in other public health areas such as alcohol and tobacco, early indications are that population-level fiscal policies are likely to be potentially effective and cost-saving. PMID:23914317

  14. An integrated approach towards identifying age-related mechanisms of slip initiated falls

    PubMed Central

    Lockhart, Thurmon E.

    2008-01-01

    The causes of slip and fall accidents, both in terms of extrinsic and intrinsic factors and their associations are not yet fully understood. Successful intervention solutions for reducing slip and fall accidents require a more complete understanding of the mechanisms involved. Before effective fall prevention strategies can be put into practice, it is central to examine the chain of events in an accident, comprising the exposure to hazards, initiation of events and the final outcome leading to injury and disability. These events can be effectively identified and analyzed by applying epidemiological, psychophysical, biomechanical and tribological research principles and methodologies. In this manuscript, various methods available to examine fall accidents and their underlying mechanisms are presented to provide a comprehensive array of information to help pinpoint the needs and requirements of new interventions aimed at reducing the risk of falls among the growing elderly population. PMID:17768070

  15. Effects of Low-Impact Dance on Blood Biochemistry, Bone Mineral Density, the Joint Range of Motion of Lower Extremities, Knee Extension Torque, and Fall in Females.

    PubMed

    Wu, Hui Ying; Tu, Jui Hung; Hsu, Chin Hsing; Tsao, Te Hung

    2016-01-01

    The effect of low-impact dance on blood metabolites, the joint range of motion (ROM) of the lower extremities, knee extension torque, bone mass density (BMD), the number of falls, and the confidence to perform daily activities (Modified Falls Efficacy Scale [MFES]) was examined in older sedentary women (age: 59 ± 4 years) before and after a 16-week intervention. Results showed that the average score for the MFES, some parameters of blood chemistry, and joint ROM were significantly improved after low-impact intervention. In addition to improvements in blood lipids and body fat percentages, the increases shown in the parameters regarding the lower extremities may contribute to confidence in performing common daily activities in older women, although the number of falls did not significantly differ between the two groups during the 16-week period. PMID:25642949

  16. The effects of aquatic walking and jogging program on physical function and fall efficacy in patients with degenerative lumbar spinal stenosis

    PubMed Central

    Lee, Jae-Hyun; Sung, Eunsook

    2015-01-01

    The purpose of this study was to evaluate the effects of 12-week aqua walking and jogging program on muscle function, ankle range of motion (ROM), balance and fell efficacy in degenerative lumbar spinal stenosis (DLSS) patients. Six patients (2 males, 4 females) with DLSS participated in aquatic exercise program 3 times per week with each session of 60 min (warming-up, aqua walking, aqua jogging and cool down) at 1 m 20 cm–1 m 30 cm deep pool. Janda’s muscle function test, ankle ROM, Berg balance scale (BBS) and fall efficacy scale (FES) were analyzed before and after the training intervention. We found significant increases in balance, muscle function, ankle ROM and fall efficacy after training intervention. In conclusion, aquatic exercise seems to affect physical function and fall efficacy positively in elderly DLSS patients. PMID:26535218

  17. Determining a Cost Effective Sampling Technique Which Will Provide Estimates of the Number of Patrons Utilizing the Purdue General Library During the Fall Semester of 1973.

    ERIC Educational Resources Information Center

    Tolliver, Don L.; Lied, Terry R.

    A study examined the feasibility of developing a cost effective sampling technique which would estimate the mean number of patrons using the Purdue University General Library during one semester. The technique employed, called random sampling without replacement, meant that, from the total population of days in the Fall Semester, particular days…

  18. Estimating intervention effects of prevention programs: Accounting for noncompliance

    PubMed Central

    Stuart, Elizabeth A.; Perry, Deborah F.; Le, Huynh-Nhu; Ialongo, Nicholas S.

    2010-01-01

    Individuals not fully complying with their assigned treatments is a common problem encountered in randomized evaluations of behavioral interventions. Treatment group members rarely attend all sessions or do all “required” activities; control group members sometimes find ways to participate in aspects of the intervention. As a result, there is often interest in estimating both the effect of being assigned to participate in the intervention, as well as the impact of actually participating and doing all of the required activities. Methods known broadly as “complier average causal effects” (CACE) or “instrumental variables” (IV) methods have been developed to estimate this latter effect, but they are more commonly applied in medical and treatment research. Since the use of these statistical techniques in prevention trials has been less widespread, many prevention scientists may not be familiar with the underlying assumptions and limitations of CACE and IV approaches. This paper provides an introduction to these methods, described in the context of randomized controlled trials of two preventive interventions: one for perinatal depression among at-risk women and the other for aggressive disruptive behavior in children. Through these case studies, the underlying assumptions and limitations of these methods are highlighted. PMID:18843535

  19. Design an effective storm water pollution prevention plan

    SciTech Connect

    Vivona, M.A.

    1995-08-01

    A case history shows ``how`` to plan and organize a storm water pollution prevention program (SWPPP). Using easy-to-use worksheets and guidelines, hydrocarbon processing industry (HPI) operators can build upon existing best management practices (i.e., housekeeping procedures, visual inspections, spill prevention programs, etc.) to meet tighter restrictions set by National Pollutant Discharge Elimination system (NPDES) permits. Especially in high rainfall areas, storm water poses an intermittent, but large volume problem. The facility`s site size is another factor that impacts the scope and cost for SWPPP. The five steps to implementing a SWPPP are: Planning and organization; Assessment; Best management practice (BMP) identification; Implementation; Evaluation and monitoring. Initially, HPI operators must identify all potential contamination sources and past spills and leak areas. Following the SWPP guidelines, operators can map out a cost-effective storm water program that meets all NPDES requirements.

  20. "The Great Cataract" - Effects of Late Holocene Debris Flows on Lava Falls Rapid, Grand Canyon National National Park, Arizona

    USGS Publications Warehouse

    Webb, Robert H.; Melis, Theodore S.; Wise, Thomas W.; Elliott, John G.

    1996-01-01

    Lava Falls Rapid is the most formidable reach of whitewater on the Colorado River in Grand Canyon and is one of the most famous rapids in the world. Although the rapid was once thought to be controlled by the remnants of lava dams of Pleistocene age, Lava Falls was created and is maintained by frequent debris flows from Prospect Canyon. We used 232 historical photographs, of which 121 were replicated, and 14C and 3He dating methods to reconstruct the ages and, in some cases, the magnitudes of late Holocene debris flows. We quantified the interaction between Prospect Canyon debris flows and the Colorado River using image processing of the historical photographs. The highest and oldest debris-flow deposits on the debris fan yielded a 3He date of 2.9?0.6 ka (950 BC), which indicates predominately late Holocene aggradation of one of the largest debris fans in Grand Canyon. The deposit, which has a 25-m escarpment caused by river reworking, crossed the Colorado River and raised its base level by 30 m for an indeterminate, although probably short, period. We mapped depositional surfaces of 6 debris flows that occurred after 950 BC. The most recent prehistoric debris flow occurred no more than 500 years ago (AD 1434). From April 1872 to July 1939, no debris flows occurred in Prospect Canyon. Debris flows in 1939, 1954, 1955, 1963, 1966, and 1995 constricted the Colorado River between 35 and 80 percent and completely changed the pattern of flow through the rapid. The debris flows had discharges estimated between about 290 and 1,000 m3/s and transported boulders as heavy as 30 Mg. The recurrence interval of these debris flows, calculated from the volume of the aggraded debris fan, ranged from 35 to 200 yrs. The 1939 debris flow in Prospect Canyon appears to have been the largest debris flow in Grand Canyon during the last 125 years. Debris flows in Prospect Canyon are initiated by streamflow pouring over a 325-m waterfall onto unconsolidated colluvium, a process called the firehose effect. Floods in Prospect Valley above the waterfall are generated during regional winter storms, localized summer thunderstorms, and occasional tropical cyclones. Winter precipitation has increased in the Grand Canyon region since the early 1960s, and the most recent debris flows have occurred during winter storms. Summer rainfall has declined in the same period, decreasing the potential for debris flows in the summer months. The history of river reworking of the Prospect Canyon debris fan illustrates the interrelation between tributary debris fans and mainstem floods in bedrock canyons. Lava Falls Rapid did not change despite Colorado River floods of 8,500 m3/s in 1884 and 6,230 m3/s in 1921. Floods up to 3,540 m3/s that occurred after the historical, pre-dam debris flows removed most of the deposits within 3 years. Releases in 1965 from Glen Canyon Dam that were above powerplant capacity but less than 1,640 m3/s removed most of the debris fan deposited in 1963, and the combination of dam releases and a 1973 flood on the Little Colorado River removed the 1966 aggradation. About 4,800 m3 of the 1995 deposit was reworked on the day of the 1995 debris flow, dam releases of less than 570 m3/s had not reworked the remainder of the aggraded debris fan. Lava Falls Rapid has been the most unstable reach of whitewater in Grand Canyon during the late Holocene and particularly during the last 120 years. Rapids in bedrock canyons controlled by tributary deposition in the main channel are aggradational features that reflect the net effect of tributary-mainstem interactions. Boulders that form the core of rapids in Grand Canyon are essentially immobile by both regulated and unregulated Colorado River flows. Historical operation of Glen Canyon Dam, which was completed in 1963, has reduced the potential for reworking of debris fans, and has accelerated the rate of net aggradation at the mouths of tributary canyons. Because debris fans that formed after 196

  1. IDENTIFYING ROOF FALL PREDICTORS USING FUZZY CLASSIFICATION

    SciTech Connect

    Bertoncini, C. A.; Hinders, M. K.

    2010-02-22

    Microseismic monitoring involves placing geophones on the rock surfaces of a mine to record seismic activity. Classification of microseismic mine data can be used to predict seismic events in a mine to mitigate mining hazards, such as roof falls, where properly bolting and bracing the roof is often an insufficient method of preventing weak roofs from destabilizing. In this study, six months of recorded acoustic waveforms from microseismic monitoring in a Pennsylvania limestone mine were analyzed using classification techniques to predict roof falls. Fuzzy classification using features selected for computational ease was applied on the mine data. Both large roof fall events could be predicted using a Roof Fall Index (RFI) metric calculated from the results of the fuzzy classification. RFI was successfully used to resolve the two significant roof fall events and predicted both events by at least 15 hours before visual signs of the roof falls were evident.

  2. The counterintuitive effect of summer-to-fall mixed layer deepening on eukaryotic new production in the Sargasso Sea

    NASA Astrophysics Data System (ADS)

    Fawcett, Sarah E.; Lomas, Michael W.; Ward, Bess B.; Sigman, Daniel M.

    2014-02-01

    The Sargasso Sea is characterized by strong summertime stratification that is thought to drive oligotrophy, but export production is surprisingly similar to that of high-latitude regions with ample major nutrient supply. Here we use the summer-to-fall progression in the northwestern Sargasso Sea to investigate the relationship between upper ocean stratification and phytoplankton nitrogen (N) uptake. Euphotic zone particles collected in July, October, and December were sorted by flow cytometry, and the 15N/14N of separated prokaryotic and eukaryotic phytoplankton was analyzed. The 15N/14N of Prochlorococcus and Synechococcus was always low, indicating uniform reliance on recycled N. In July and in two fall profiles, the 15N/14N of eukaryotic phytoplankton was high, reflecting consumption of subsurface nitrate. In three other fall profiles, eukaryotic 15N/14N was similar to prokaryote 15N/14N, suggesting a shift toward more complete reliance on recycled N. The progressive deepening of the mixed layer from summer to fall, although reducing the surface-to-deep density contrast, increases the density difference of the euphotic zone as a whole from underlying nutrient-rich waters, which may play a role in the observed decline in euphotic zone nitrate supply into the fall. The apparent summertime nitrate supply to the euphotic zone, when the mixed layer is shallowest, may help to explain the surprisingly high export production of the subtropical and tropical ocean.

  3. Enhanced Estimates of the Influenza Vaccination Effect in Preventing Mortality

    PubMed Central

    Castilla, Jesús; Guevara, Marcela; Martínez-Baz, Iván; Ezpeleta, Carmen; Delfrade, Josu; Irisarri, Fátima; Moreno-Iribas, Conchi

    2015-01-01

    Abstract Mortality is a major end-point in the evaluation of influenza vaccine effectiveness. However, this effect is not well known, since most previous studies failed to show good control of biases. We aimed to estimate the effectiveness of influenza vaccination in preventing all-cause mortality in community-dwelling seniors. Since 2009, a population-based cohort study using healthcare databases has been conducted in Navarra, Spain. In 2 late influenza seasons, 2011/2012 and 2012/2013, all-cause mortality in the period January to May was compared between seniors (65 years or over) who received the trivalent influenza vaccine and those who were unvaccinated, adjusting for demographics, major chronic conditions, dependence, previous hospitalization, and pneumococcal vaccination. The cohort included 103,156 seniors in the 2011/2012 season and 105,140 in the 2012/2013 season (58% vaccinated). Seniors vaccinated in the previous season who discontinued vaccination (6% of the total) had excess mortality and were excluded to prevent frailty bias. The final analysis included 80,730 person-years and 2778 deaths. Vaccinated seniors had 16% less all-cause mortality than those unvaccinated (adjusted rate ratio [RR]?=?0.84; 95% confidence interval 0.76–0.93). This association disappeared in the post-influenza period (adjusted RR?=?0.96; 95% confidence interval 0.85–1.09). A similar comparison did not find an association in January to May of the 2009/2010 pandemic season (adjusted RR?=?0.98; 95% confidence interval 0.84–1.14), when no effect of the seasonal vaccine was expected. On average, 1 death was prevented for every 328 seniors vaccinated: 1 for every 649 in the 65 to 74 year age group and 1 for every 251 among those aged 75 and over. These results suggest a moderate preventive effect and a high potential impact of the seasonal influenza vaccine against all-cause mortality. This reinforces the recommendation of annual influenza vaccination in seniors. PMID:26222861

  4. Prevention of periprosthetic joint infection: what are the effective strategies?

    PubMed

    Alijanipour, Pouya; Heller, Snir; Parvizi, Javad

    2014-08-01

    Periprosthetic joint infection (PJI) following total knee arthroplasty is a major burden for patients and health systems. Prevention of this challenging complication through implementation of effective strategies should be a priority. These strategies should encompass various levels of patient care. Multiple modifiable risk factors such as uncontrolled hyperglycemia, obesity, smoking, substance abuse, and nasal colonization with Staphylococcus aureus have been described for PJI. Preoperative recognition and mitigation of these risk factors along with optimization of nonmodifiable risk factors such as kidney, liver, or immune system insufficiency can considerably decrease the risk of PJI. A comprehensive perioperative protocol should involve optimization of the operative environment to reduce the number of bacteria and particulates in the air. Several surgical and nonsurgical details of intraoperative care such as maintenance of normothermia, skin preparation, surgical field irrigation, wound closure, and duration of surgical and anesthetic procedure can influence the occurrence of PJI. Prophylactic perioperative antibiotic administration is probably one of the most important strategies in preventing PJI. Implementation of surgical safety checklist can diminish the risk of perioperative complications, particularly surgical site infection. Controversy regarding efficacy, efficiency, and optimization of some preventive measures continues to exist due to inconsistency or inadequacy of available evidence. Novel research has focused on designing PJI-resistant implants and developing vaccines that target molecule components with major role in the process of bacterial adhesion to the implant or periprosthetic tissues. PMID:24792971

  5. Assessment of channel changes, model of historical floods, and effects of backwater on flood stage, and flood mitigation alternatives for the Wichita River at Wichita Falls, Texas

    USGS Publications Warehouse

    Winters, Karl E.; Baldys, Stanley

    2011-01-01

    In cooperation with the City of Wichita Falls, the U.S. Geological Survey assessed channel changes on the Wichita River at Wichita Falls, Texas, and modeled historical floods to investigate possible causes and potential mitigation alternatives to higher flood stages in recent (2007 and 2008) floods. Extreme flooding occurred on the Wichita River on June 30, 2007, inundating 167 homes in Wichita Falls. Although a record flood stage was reached in June 2007, the peak discharge was much less than some historical floods at Wichita Falls. Streamflow and stage data from two gages on the Wichita River and one on Holliday Creek were used to assess the interaction of the two streams. Changes in the Wichita River channel were evaluated using historical aerial and ground photography, comparison of recent and historical cross sections, and comparison of channel roughness coefficients with those from earlier studies. The floods of 2007 and 2008 were modeled using a one-dimensional step-backwater model. Calibrated channel roughness was larger for the 2007 flood compared to the 2008 flood, and the 2007 flood peaked about 4 feet higher than the 2008 flood. Calibration of the 1941 flood yielded a channel roughness coefficient (Manning's n) of 0.030, which represents a fairly clean natural channel. The step-backwater model was also used to evaluate the following potential mitigation alternatives: (1) increasing the capacity of the bypass channel near River Road in Wichita Falls, Texas; (2) removal of obstructions near the Scott Avenue and Martin Luther King Junior Boulevard bridges in Wichita Falls, Texas; (3) widening of aggraded channel banks in the reach between Martin Luther King Junior Boulevard and River Road; and (4) reducing channel bank and overbank roughness. Reductions in water-surface elevations ranged from 0.1 foot to as much as 3.0 feet for the different mitigation alternatives. The effects of implementing a combination of different flood-mitigation alternatives were not investigated.

  6. Effects of fall-to-winter changes in habitat and frazil ice on the movements and habitat use of juvenile rainbow trout in a Wyoming tailwater

    USGS Publications Warehouse

    Simpkins, D.G.; Hubert, W.A.; Wesche, T.A.

    2000-01-01

    Overwinter declines in the abundance of small rainbow trout Oncorhynchus mykiss have been observed in a section of the Big Horn River that lies downstream from Boysen Reservoir, where reservoir releases prevent surface ice formation. To provide insight into the possible causes of these declines in abundance, radiotelemetry was used to determine movement and microhabitat use of juvenile (20-25 cm total length) rainbow trout during the fall and winter of 1995-1996. Throughout the fall and winter, both stocked (hatchery) and naturally spawned (wild) fish were generally found in main-channel pools with cover that reduced current velocities to less than 2 cm/s near the bottom and with nearby (<2 m) water velocities that were greater than 15 cm/s. These locations provided refuges from the current, with adjacent flowing water that could deliver drifting aquatic invertebrates. The fish were generally associated with cover that was formed by aquatic vegetation early in the fall, but they shifted to cobble and boulder cover (in deeper water) as the aquatic vegetation decomposed and as winter progressed. Episodes of frazil ice in January and early February were associated with movements of wild fish in the upstream portion of the study area - from normal activity areas to refuges at the bottom of deep pools or under shelf ice in shallow water near shore. Frazil-ice episodes often initiated long-term movements among fish. Our results suggest that changing habitat features from fall to winter and frazil-ice episodes can cause juvenile rainbow trout to move and to modify their habitat use, depending on their location in a tailwater.

  7. Lives saved from malaria prevention in Africa--evidence to sustain cost-effective gains.

    PubMed

    Korenromp, Eline L

    2012-01-01

    Lives saved have become a standard metric to express health benefits across interventions and diseases. Recent estimates of malaria-attributable under-five deaths prevented using the Lives Saved tool (LiST), extrapolating effectiveness estimates from community-randomized trials of scale-up of insecticide-treated nets (ITNs) in the 1990s, confirm the substantial impact and good cost-effectiveness that ITNs have achieved in high-endemic sub-Saharan Africa. An even higher cost-effectiveness would likely have been found if the modelling had included the additional indirect mortality impact of ITNs on preventing deaths from other common child illnesses, to which malaria contributes as a risk factor. As conventional ITNs are being replaced by long-lasting insecticidal nets and scale-up is expanded to target universal coverage for full, all-age populations at risk, enhanced transmission reduction may--above certain thresholds--enhance the mortality impact beyond that observed in the trials of the 1990s. On the other hand, lives saved by ITNs might fall if improved malaria case management with artemisinin-based combination therapy averts the deaths that ITNs would otherwise prevent.Validation and updating of LiST's simple assumption of a universal, fixed coverage-to-mortality-reduction ratio will require enhanced national programme and impact monitoring and evaluation. Key indicators for time trend analysis include malaria-related mortality from population-based surveys and vital registration, vector control and treatment coverage from surveys, and parasitologically-confirmed malaria cases and deaths recorded in health facilities. Indispensable is triangulation with dynamic transmission models, fitted to long-term trend data on vector, parasite and human populations over successive phases of malaria control and elimination.Sound, locally optimized budget allocation including on monitoring and evaluation priorities will benefit much if policy makers and programme planners use planning tools such as LiST - even when predictions are less certain than often understood. The ultimate success of LiST for supporting malaria prevention may be to prove its linear predictions less and less relevant. PMID:22455309

  8. Reviewing the evidence on effectiveness and cost-effectiveness of HIV prevention strategies in Thailand

    PubMed Central

    2010-01-01

    Background Following universal access to antiretroviral therapy in Thailand, evidence from National AIDS Spending Assessment indicates a decreasing proportion of expenditure on prevention interventions. To prompt policymakers to revitalize HIV prevention, this study identifies a comprehensive list of HIV/AIDs preventive interventions that are likely to be effective and cost-effective in Thailand. Methods A systematic review of the national and international literature on HIV prevention strategies from 1997 to 2008 was undertaken. The outcomes used to consider the effectiveness of HIV prevention interventions were changes in HIV risk behaviour and HIV incidence. Economic evaluations that presented their results in terms of cost per HIV infection averted or cost per quality-adjusted life year (QALY) gained were also included. All studies were assessed against quality criteria. Results The findings demonstrated that school based-sex education plus life-skill programs, voluntary and routine HIV counselling and testing, male condoms, street outreach programs, needle and syringe programs, programs for the prevention of mother-to-child HIV transmission, male circumcision, screening blood products and donated organs for HIV, and increased alcohol tax were all effective in reducing HIV infection among target populations in a cost-effective manner. Conclusion We found very limited local evidence regarding the effectiveness of HIV interventions amongst specific high risk populations. This underlines the urgent need to prioritise health research resources to assess the effectiveness and cost-effectiveness of HIV interventions aimed at reducing HIV infection among high risk groups in Thailand. PMID:20604975

  9. Economic Evaluation of a Tai Ji Quan Intervention to Reduce Falls in People With Parkinson Disease, Oregon, 2008–2011

    PubMed Central

    Harmer, Peter

    2015-01-01

    Introduction Exercise is effective in reducing falls in people with Parkinson disease. However, information on the cost effectiveness of this approach is lacking. We conducted a cost-effectiveness analysis of Tai Ji Quan for reducing falls among patients with mild-to-moderate Parkinson disease. Methods We used data from a previous intervention trial to analyze resource use costs related to intervention delivery and number of falls observed during a 9-month study period. Cost effectiveness was estimated via incremental cost-effectiveness ratio (ICER) in which Tai Ji Quan was compared with 2 alternative interventions (Resistance training and Stretching) on the primary outcome of per fall prevented and the secondary outcome of per participant quality-adjusted life years (QALY) gained. We also conducted subgroup and sensitivity analyses. Results Tai Ji Quan was more effective than either Resistance training or Stretching; it had the lowest cost and was the most effective in improving primary and secondary outcomes. Compared with Stretching, Tai Ji Quan cost an average of $175 less for each additional fall prevented and produced a substantial improvement in QALY gained at a lower cost. Results from subgroup and sensitivity analyses showed no variation in cost-effectiveness estimates. However, sensitivity analyses demonstrated a much lower ICER ($27) when only intervention costs were considered. Conclusion Tai Ji Quan represents a cost-effective strategy for optimizing spending to prevent falls and maximize health gains in people with Parkinson disease. While these results are promising, they warrant further validation. PMID:26226067

  10. Peralta Facts: Fall 1983.

    ERIC Educational Resources Information Center

    Peralta Community Coll. District, Oakland, CA. Office of Research, Planning and Development.

    Data were collected in fall 1983 to provide a profile of the student population of the Peralta Community College District (PCCD). The data revealed: (1) total student enrollment declined by 12% from fall 1982 (N=38,976) to fall 1983 (N=34,183); (2) 57% of the students whose sex was identified were women; (3) minorities constituted 58% of the…

  11. Base of Yosemite Falls

    USGS Multimedia Gallery

    In this image, Yosemite Falls may be seen from its base. Yosemite Falls is the tallest waterfall in North America. It is about 2,425 ft (739 m) high. Yosemite Falls is one of the most famous waterfalls within Yosemite National Park....

  12. Snow Falls - Maine

    USGS Multimedia Gallery

    As the Little Androscoggin River flows through western Maine it eventually reaches Snow Falls, a 25 ft cascading waterfall in the town of West Paris.  This photo was taken during a high flow event at the falls. The USGS monitors the Little Androscoggin River upstream of the falls at station 01...

  13. Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have?

    PubMed

    Morris, Brian J; Bailis, Stefan A; Wiswell, Thomas E

    2014-05-01

    The objective of this review was to assess the trend in the US male circumcision rate and the impact that the affirmative 2012 American Academy of Pediatrics policy statement might have on neonatal circumcision practice. We searched PubMed for the term circumcision to retrieve relevant articles. This review was prompted by a recent report by the Centers for Disease Control and Prevention that found a slight increase, from 79% to 81%, in the prevalence of circumcision in males aged 14 to 59 years during the past decade. There were racial and ethnic disparities, with prevalence rising to 91% in white, 76% in black, and 44% in Hispanic males. Because data on neonatal circumcision are equivocal, we undertook a critical analysis of hospital discharge data. After correction for underreporting, we found that the percentage had declined from 83% in the 1960s to 77% by 2010. A risk-benefit analysis of conditions that neonatal circumcision protects against revealed that benefits exceed risks by at least 100 to 1 and that over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin. Other analyses show that neonatal male circumcision is cost-effective for disease prevention. The benefits of circumcision begin in the neonatal period by protection against infections that can damage the pediatric kidney. Given the substantial risk of adverse conditions and disease, some argue that failure to circumcise a baby boy may be unethical because it diminishes his right to good health. There is no long-term adverse effect of neonatal circumcision on sexual function or pleasure. The affirmative 2012 American Academy of Pediatrics policy supports parental education about, access to, and insurance and Medicaid coverage for elective infant circumcision. As with vaccination, circumcision of newborn boys should be part of public health policies. Campaigns should prioritize population subgroups with lower circumcision prevalence and a higher burden of diseases that can be ameliorated by circumcision. PMID:24702735

  14. Effects of hyporheic exchange flows on egg pocket water temperature in Snake River fall Chinook salmon spawning areas

    SciTech Connect

    Hanrahan, T. P.; Geist, D. R.; Arntzen, E. V.; Abernethy, C. S.

    2004-09-01

    The development of the Snake River hydroelectric system has affected fall Chinook salmon smolts by shifting their migration timing to a period (mid- to late-summer) when downstream reservoir conditions are unfavorable for survival. Subsequent to the Snake River Chinook salmon fall-run Evolutionary Significant Unit being listed as Threatened under the Endangered Species Act, recovery planning has included changes in hydrosystem operations (e.g., summer flow augmentation) to improve water temperature and flow conditions during the juvenile Chinook salmon summer migration period. In light of the limited water supplies from the Dworshak reservoir for summer flow augmentation, and the associated uncertainties regarding benefits to migrating fall Chinook salmon smolts, additional approaches for improved smolt survival need to be evaluated. This report describes research conducted by the Pacific Northwest National Laboratory (PNNL) that evaluated relationships among river discharge, hyporheic zone characteristics, and egg pocket water temperature in Snake River fall Chinook salmon spawning areas. This was a pilot-scale study to evaluate these relationships under existing operations of Hells Canyon Dam (i.e., without any prescribed manipulations of river discharge) during the 2002–2003 water year.

  15. Kinematic effect of Nintendo WiiTM sports program exercise on obstacle gait in elderly women with falling risk

    PubMed Central

    Jung, Dae-In; Ko, Dae-Sik; Jeong, Mi-Ae

    2015-01-01

    [Purpose] This study evaluated the changes in balance ability and obstacle gait after lumbar stabilization exercise and Nintendo WiiTM Sports in elderly at risk for falls. [Subjects and Methods] Twenty-four elderly women with at risk for falls were randomly divided into the control, lumbar stabilization exercise, and Nintendo Wii Sports groups. Static balance was measured by the Berg Balance Scale and functional reach test, dynamic balance by the timed up-and-go test, and obstacle negotiation function by crossing velocity and maximum vertical heel clearance. [Results] Both the lumbar stabilization exercise and Nintendo Wii Sports groups showed significant improvements in obstacle negotiation function after the exercise compared to the control group. Berg Balance Scale and functional reach test scores were greater in the lumbar stabilization exercise group, while the timed up-and-go test time was significantly better in the Nintendo Wii Sports groups. [Conclusion] Lumbar stabilization exercises and Nintendo Wii Sports improve falling related balance and obstacle negotiation function in elderly women at risk for falls. PMID:26157228

  16. Kinematic effect of Nintendo Wii(TM) sports program exercise on obstacle gait in elderly women with falling risk.

    PubMed

    Jung, Dae-In; Ko, Dae-Sik; Jeong, Mi-Ae

    2015-05-01

    [Purpose] This study evaluated the changes in balance ability and obstacle gait after lumbar stabilization exercise and Nintendo Wii(TM) Sports in elderly at risk for falls. [Subjects and Methods] Twenty-four elderly women with at risk for falls were randomly divided into the control, lumbar stabilization exercise, and Nintendo Wii Sports groups. Static balance was measured by the Berg Balance Scale and functional reach test, dynamic balance by the timed up-and-go test, and obstacle negotiation function by crossing velocity and maximum vertical heel clearance. [Results] Both the lumbar stabilization exercise and Nintendo Wii Sports groups showed significant improvements in obstacle negotiation function after the exercise compared to the control group. Berg Balance Scale and functional reach test scores were greater in the lumbar stabilization exercise group, while the timed up-and-go test time was significantly better in the Nintendo Wii Sports groups. [Conclusion] Lumbar stabilization exercises and Nintendo Wii Sports improve falling related balance and obstacle negotiation function in elderly women at risk for falls. PMID:26157228

  17. EFFECTS OF PEARLING ON FALLING NUMBER AND ALPHA AMYLASE ACTIVITY OF PRE-HARVEST SPROUTED SPRING WHEAT.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Pre-harvest sprouted wheat is often characterized by the falling number (FN) test. FN decreases in pre-harvest sprouted wheat as enzymatic degradation of the starchy endosperm increases. Wheat with FN values below 250-275 is often discounted at the time of sale. The intent of this investigation w...

  18. Commentary: eight ways to prevent cancer: a framework for effective prevention messages for the public.

    PubMed

    Dart, Hank; Wolin, Kathleen Y; Colditz, Graham A

    2012-04-01

    Research over the past 40 years has convincingly shown that lifestyle factors play a huge role in cancer incidence and mortality. The public, though, can often discount the preventability of cancer. That health information on the Internet is a vast and often scientifically suspect commodity makes promoting important and sound cancer prevention messages to the public even more difficult. To help address these issues and improve the public's knowledge of, and attitudes toward, cancer prevention, there need to be concerted efforts to create evidence-based, user-friendly information about behaviors that could greatly reduce overall cancer risk. Toward this end, we condensed the current scientific evidence on the topic into eight key behaviors. While not an end in themselves, "Eight Ways to Stay Healthy and Prevent Cancer" forms an evidence-based and targeted framework that supports broader cancer prevention efforts. PMID:22367724

  19. Prevalence of and factors associated with head impact during falls in older adults in long-term care

    PubMed Central

    Schonnop, Rebecca; Yang, Yijian; Feldman, Fabio; Robinson, Erin; Loughin, Marie; Robinovitch, Stephen N.

    2013-01-01

    Background: Falls cause more than 60% of head injuries in older adults. Lack of objective evidence on the circumstances of these events is a barrier to prevention. We analyzed video footage to determine the frequency of and risk factors for head impact during falls in older adults in 2 long-term care facilities. Methods: Over 39 months, we captured on video 227 falls involving 133 residents. We used a validated questionnaire to analyze the mechanisms of each fall. We then examined whether the probability for head impact was associated with upper-limb protective responses (hand impact) and fall direction. Results: Head impact occurred in 37% of falls, usually onto a vinyl or linoleum floor. Hand impact occurred in 74% of falls but had no significant effect on the probability of head impact (p = 0.3). An increased probability of head impact was associated with a forward initial fall direction, compared with backward falls (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.3–5.9) or sideways falls (OR 2.8, 95% CI 1.2–6.3). In 36% of sideways falls, residents rotated to land backwards, which reduced the probability of head impact (OR 0.2, 95% CI 0.04–0.8). Interpretation: Head impact was common in observed falls in older adults living in long-term care facilities, particularly in forward falls. Backward rotation during descent appeared to be protective, but hand impact was not. Attention to upper-limb strength and teaching rotational falling techniques (as in martial arts training) may reduce fall-related head injuries in older adults. PMID:24101612

  20. Reinterpreting Dissemination of Prevention Programs as Widespread Implementation with Effectiveness and Fidelity.

    ERIC Educational Resources Information Center

    Elias, Maurice J.

    This article urges a reexamination of the concept of dissemination of health-related prevention programs. The article discusses factors that serve as sustaining conditions for dissemination of prevention programs including: (1) the nature of preventive intervention and parameters of effective community-based prevention praxis; (2) aspects of the…

  1. Proximate Effects of a Child Sexual Abuse Prevention Program in Elementary School Children.

    ERIC Educational Resources Information Center

    Hebert, Martine; Lavoie, Francine; Piche, Christiane; Poitras, Michele

    2001-01-01

    The effects of the sexual child abuse prevention program ESPACE were evaluated with 133 Canadian children (grades 1-3). Children participating in the prevention program showed greater preventive knowledge and skills relative to children not participating. Follow-up data showed knowledge gains were maintained while the preventive skill gains may


  2. Reinterpreting Dissemination of Prevention Programs as Widespread Implementation with Effectiveness and Fidelity.

    ERIC Educational Resources Information Center

    Elias, Maurice J.

    This article urges a reexamination of the concept of dissemination of health-related prevention programs. The article discusses factors that serve as sustaining conditions for dissemination of prevention programs including: (1) the nature of preventive intervention and parameters of effective community-based prevention praxis; (2) aspects of the


  3. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial

    PubMed Central

    Morello, Renata T; Wolfe, Rory; Brand, Caroline A; Haines, Terry P; Hill, Keith D; Brauer, Sandra G; Botti, Mari; Cumming, Robert G; Livingston, Patricia M; Sherrington, Catherine; Zavarsek, Silva; Lindley, Richard I; Kamar, Jeannette

    2016-01-01

    Objective To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. Design Cluster randomised controlled trial. Setting Six Australian hospitals. Participants All patients admitted to 24 acute wards during the trial period. Interventions Participating wards were randomly assigned to receive either the nurse led 6-PACK programme or usual care over 12 months. The 6-PACK programme included a fall risk tool and individualised use of one or more of six interventions: “falls alert” sign, supervision of patients in the bathroom, ensuring patients’ walking aids are within reach, a toileting regimen, use of a low-low bed, and use of a bed/chair alarm. Main outcome measures The co-primary outcomes were falls and fall injuries per 1000 occupied bed days. Results During the trial, 46 245 admissions to 16 medical and eight surgical wards occurred. As many people were admitted more than once, this represented 31 411 individual patients. Patients’ characteristics and length of stay were similar for intervention and control wards. Use of 6-PACK programme components was higher on intervention wards than on control wards (incidence rate ratio 3.05, 95% confidence interval 2.14 to 4.34; P<0.001). In all, 1831 falls and 613 fall injuries occurred, and the rates of falls (incidence rate ratio 1.04, 0.78 to 1.37; P=0.796) and fall injuries (0.96, 0.72 to 1.27; P=0.766) were similar in intervention and control wards. Conclusions Positive changes in falls prevention practice occurred following the introduction of the 6-PACK programme. However, no difference was seen in falls or fall injuries between groups. High quality evidence showing the effectiveness of falls prevention interventions in acute wards remains absent. Novel solutions to the problem of in-hospital falls are urgently needed. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12611000332921. PMID:26813674

  4. Fall Risk Assessment Tools for Elderly Living in the Community: Can We Do Better?

    PubMed Central

    Palumbo, Pierpaolo; Palmerini, Luca; Bandinelli, Stefania; Chiari, Lorenzo

    2015-01-01

    Background Falls are a common, serious threat to the health and self-confidence of the elderly. Assessment of fall risk is an important aspect of effective fall prevention programs. Objectives and methods In order to test whether it is possible to outperform current prognostic tools for falls, we analyzed 1010 variables pertaining to mobility collected from 976 elderly subjects (InCHIANTI study). We trained and validated a data-driven model that issues probabilistic predictions about future falls. We benchmarked the model against other fall risk indicators: history of falls, gait speed, Short Physical Performance Battery (Guralnik et al. 1994), and the literature-based fall risk assessment tool FRAT-up (Cattelani et al. 2015). Parsimony in the number of variables included in a tool is often considered a proxy for ease of administration. We studied how constraints on the number of variables affect predictive accuracy. Results The proposed model and FRAT-up both attained the same discriminative ability; the area under the Receiver Operating Characteristic (ROC) curve (AUC) for multiple falls was 0.71. They outperformed the other risk scores, which reported AUCs for multiple falls between 0.64 and 0.65. Thus, it appears that both data-driven and literature-based approaches are better at estimating fall risk than commonly used fall risk indicators. The accuracy–parsimony analysis revealed that tools with a small number of predictors (~1–5) were suboptimal. Increasing the number of variables improved the predictive accuracy, reaching a plateau at ~20–30, which we can consider as the best trade-off between accuracy and parsimony. Obtaining the values of these ~20–30 variables does not compromise usability, since they are usually available in comprehensive geriatric assessments. PMID:26716861

  5. The effectiveness of HIV prevention and the epidemiological context.

    PubMed Central

    Grassly, N. C.; Garnett, G. P.; Schwartländer, B.; Gregson, S.; Anderson, R. M.

    2001-01-01

    Planning an intervention to prevent infections with the human immunodeficiency virus (HIV) should be guided by local epidemiological and socioeconomic conditions. The socioeconomic setting and existing public service capacity determine whether an intervention can have a significant outcome in terms of a reduction in a defined risk. The epidemiological context determines whether such risk reduction translates into a measurable impact on HIV incidence. Measurement of variables describing the epidemiological context can be used to determine the local suitability of interventions, thereby guiding planners and policy-makers in their choice of intervention. Such measurements also permit the retrospective analysis of the impact of interventions where HIV incidence was not recorded. The epidemiological context is defined for four different categories of intervention, shown to be effective in lower-income countries by randomized controlled trials. Appropriate indicators for the epidemiological context and methodological guidelines for their measurement are proposed. Their use in the transfer of a successful intervention from one context to another and in scaling up the effort to control HIV infection is explored. These indicators should provide a useful resource for those involved in planning HIV prevention interventions. PMID:11799444

  6. Long-term Impact of Prevention Programs to Promote Effective Parenting: Lasting Effects but Uncertain Processes

    PubMed Central

    Sandler, Irwin; Schoenfelder, Erin; Wolchik, Sharlene; MacKinnon, David

    2010-01-01

    This chapter reviews findings from 46 randomized experimental trials of preventive parenting interventions. The findings of these trials provide evidence of effects to prevent a wide range of problem outcomes and to promote competencies from one to twenty years later. However, there is a paucity of evidence concerning the processes that account for program effects. Three alternative pathways are proposed as a framework for future research on the long-term effects of preventive parenting programs; 1) through program effects on parenting skills, perceptions of parental efficacy and reduction in barriers to effective parenting; 2) through program-induced reductions in short-term problems of youth that persist over time, improvements in youth adaptation to stress, and improvements in youth belief systems concerning the self and their relationships with others; and 3) through effects on contexts in which youth become involved and on youth-environment transactions. PMID:20822438

  7. Connect: An Effective Community-Based Youth Suicide Prevention Program

    ERIC Educational Resources Information Center

    Bean, Gretchen; Baber, Kristine M.

    2011-01-01

    Youth suicide prevention is an important public health issue. However, few prevention programs are theory driven or systematically evaluated. This study evaluated Connect, a community-based youth suicide prevention program. Analysis of pre and posttraining questionnaires from 648 adults and 204 high school students revealed significant changes in


  8. Connect: An Effective Community-Based Youth Suicide Prevention Program

    ERIC Educational Resources Information Center

    Bean, Gretchen; Baber, Kristine M.

    2011-01-01

    Youth suicide prevention is an important public health issue. However, few prevention programs are theory driven or systematically evaluated. This study evaluated Connect, a community-based youth suicide prevention program. Analysis of pre and posttraining questionnaires from 648 adults and 204 high school students revealed significant changes in…

  9. Effects of Flow and Spill on the Migratory Behavior and Survival of Juvenile Fall and Summer Chinook Salmon in John Day Reservior : Annual Report 1987.

    SciTech Connect

    Miller, David R.; Glorgi, Albert E.

    1987-12-01

    Juvenile fall chinook salmon, Oncorhynchus tshawytscha, were freeze branded, coded wire tagged, and released into the Columbia River in the tailrace below McNary Dam during the summers of 1981--1983. The objectives of the study were to examine the effects of river flow on the passage time and migrational behavior of the juveniles and to subsequently assess any relationship to adult survival. This report details adult recovery data to June 1987. 2 refs., 11 tabs.

  10. Effect of simulated fall heat waves on cold hardiness and winter survival of hemlock looper, Lambdina fiscellaria (Lepidoptera: Geometridae).

    PubMed

    Vallières, Rosemarie; Rochefort, Sophie; Berthiaume, Richard; Hébert, Christian; Bauce, Éric

    2015-02-01

    The hemlock looper (Lambdina fiscellaria) is an important pest of eastern Canadian forests. The ongoing climate warming could modify the seasonal ecology of this univoltine species that lays eggs at the end of summer and overwinters at this stage. Indeed, the increase in frequency and intensity of extreme climatic events such as fall heat waves could interfere with the winter metabolism of the hemlock looper. Moreover, the host plant quality, which influences the quantity of insect energetic reserves, the geographic origin of populations and the conditions prevailing during the cold acclimation period, could cause various responses of this pest to climate warming. The main objective of this study is to determine the impact of these factors on hemlock looper winter biology. In October 2010, hemlock looper eggs initially collected from two geographic areas in the province of Québec, and from parents reared on two host plants, were exposed to fall heat waves of different intensities during 5 consecutive days. Supercooling points and cryoprotectant levels were measured on eggs on four different dates in 2010-2011 and survival rate was measured in April 2011. Our results show that hemlock looper eggs have a very low supercooling point and high levels of trehalose, glucose and mannitol in September and November. However, there is no clear relationship between the concentration of these compounds and the decrease in supercooling points. Contents in trehalose, glucose and mannitol were significantly influenced by fall heat waves and by the origin of the population. Winter survival of eggs from the temperate population was negatively affected by strong heat waves while the boreal population was not affected. This study suggests that the metabolism and winter survival of temperate hemlock looper populations in Québec will be more affected by fall heat waves that will increase in frequency due to climate change, than boreal populations. PMID:25585353

  11. The Effect of Medicaid Primary Care Provider Reimbursement on Access to Early Childhood Caries Preventive Services

    PubMed Central

    Herndon, Jill Boylston; Tomar, Scott L; Catalanotto, Frank A; Vogel, W Bruce; Shenkman, Elizabeth A

    2015-01-01

    Objective To examine receipt of early childhood caries preventive services (ECCPS) in two states' Medicaid programs before and after the implementation of reimbursement to medical primary care providers (M-PCPs). Data Sources Enrollment and claims data from the Florida and Texas Medicaid programs for children ≀54 months of age during the period 2006–2010. Study Design We conducted time trend-adjusted, difference-in-differences analyses by using modified Poisson regressions combined with generalized estimating equations (GEEs) to analyze the effect of M-PCP reimbursement on the likelihood that an enrollee had an ECCPS visit after controlling for age, sex, health status, race/ethnicity, geographic location, and enrollment duration. Data Extraction Methods Enrollment data were linked to claims data to create a panel dataset with child-month observations. Principal Findings Reimbursement to M-PCPs was associated with an increased likelihood of ECCPS receipt in general and topical fluoride application specifically in both states. Conclusions Reimbursement to M-PCPs can increase access to ECCPS. However, ECCPS receipt continues to fall short of recommended care, presenting opportunities for performance improvement. PMID:25039907

  12. Effects on centre-based training and home-based training on physical function, quality of life and fall incidence in community dwelling older adults.

    PubMed

    Kwok, Thomas M K; Tong, C Y

    2014-05-01

    This was a quasi-experimental study to compare the effects of center-based training with home-based training on physical function, quality of life and fall incidence in older adults. Fifty older adults were recruited to receive exercise training for 6?months. Participants in the center-based group received training under supervision of a physiotherapist at the day training center. Those in the home-based group received training assisted by a care worker at home. The outcome measures were the Elderly Mobility Scale (EMS), Berg Balance Scale (BBS), Numeric Pain Rating Scale (NPRS), Short-form 12 (SF-12) and fall incidence. Assessments were performed on all participants before and after the 6-month intervention period. Center-based training supervised by a physiotherapist was found to have beneficial effects on physical function, quality of life and fall incidence while home-based training assisted by a care worker had no effect on physical condition and self-rated health status in community dwelling older adults. Service agents should provide center-based or home-based training to the ageing population in a user-friendly way with consideration of factors such as rehabilitation potential and accessibility of transportation. PMID:24328932

  13. Effects of the Strategic Prevention Framework State Incentives Grant (SPF SIG) on state prevention infrastructure in 26 states.

    PubMed

    Orwin, Robert G; Stein-Seroussi, Alan; Edwards, Jessica M; Landy, Ann L; Flewelling, Robert L

    2014-06-01

    The Strategic Prevention Framework State Incentive Grant (SPF SIG) program is a national public health initiative sponsored by the U.S. Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention to prevent substance abuse and its consequences. State grantees used a data-driven planning model to allocate resources to 450 communities, which in turn launched over 2,200 intervention strategies to target prevention priorities in their respective populations. An additional goal was to build prevention capacity and infrastructure at the state and community levels. This paper addresses whether the state infrastructure goal was achieved, and what contextual and implementation factors were associated with success. The findings are consistent with claims that, overall, the SPF SIG program met its goal of increasing prevention capacity and infrastructure across multiple infrastructure domains, though the mediating effects of implementation were evident only in the evaluation/monitoring domain. The results also show that an initiative like the SPF SIG, which could easily have been compartmentalized within the states, has the potential to permeate more broadly throughout state prevention systems. PMID:24619188

  14. [Newborn screening: a prime example for effective secondary prevention].

    PubMed

    Nennstiel-Ratzel, U; LĂŒders, A; Blankenstein, O

    2015-02-01

    Newborn screening is a medical population-based preventive measure for the early detection and initiation of therapy for all newborns with treatable endocrine and metabolic diseases. Left untreated, these diseases may lead to severe disabilities or even death. Target diseases have to meet the Wilson and Junger criteria on screening. A high sensitivity and specificity is ensured by an excellent analytic process. High process quality is achieved by offering newborn screening to all newborns and by clarifying pathologic findings very quickly. Therefore, in some federal states tracking centers have been established. Nationwide evaluation of process quality is annually performed and published online. The long-term outcome of diseased children has been investigated on a population-based level in Bavaria and at the University of Heidelberg in other studies. Between 2004 and 2012, 6.1 million children were screened (this is equivalent to 99 % of all newborns). The percentage of pathologic findings was 0.6 %. One out of 1300 children was affected by a target disease. For 90 % of these children, therapy started within the first 2 weeks of life. Studies on the long-term outcome show a positive effect on the course of disease, development of children, and the quality of life. In these studies, further challenges in care such as the first information given to parents regarding a pathologic finding or the care of adolescents with less compliance could also be identified. Newborn screening is an established preventive measure. With regard to ethical criteria and effectiveness, continuous evaluation of the process quality and the long-term outcome assure a high quality of the screening process. PMID:25475525

  15. Developing and Negotiating Effective School-Based Drug Abuse Prevention Programs.

    ERIC Educational Resources Information Center

    Zavela, Kathleen J.

    2002-01-01

    Investigated effective drug prevention strategies for school-aged populations from drug prevention programs funded by the Department of Health and Human Services Center for Substance Abuse Prevention. Interviews with model programs' directors and staff highlighted 15 strategies essential for developing effective programs. Strategies focused on…

  16. Effect of the long-term care prevention project on the motor functions and daily life activities of the elderly

    PubMed Central

    Wada, Yoshihiro; Sakuraba, Keisyoku; Kubota, Atsushi

    2015-01-01

    [Purpose] The purpose of this study was to verify the effects of the long-term care prevention project and develop an effective program. [Subjects] A total of 81 elderly people (age, 79 ± 5.1?years; height, 149.2 ± 9.2?cm; weight, 54.2 ± 11.4?kg). [Methods] Grip, knee extension muscular strength, 10?m walking speed, and Timed Up and Go time were measured for evaluation of motor functions, and the “Locomo 25”, a 25-question risk assessment questionnaire, was used as the judgment criterion for evaluation of daily life activities, with measurements being taken at the beginning of the project and after three months. [Results] In the motor functions evaluation, significant differences were observed in 10?m walking speed, Timed Up and Go time, and knee extension strength. In the daily life activities evaluation, scores for pain, rising movement, standing movement, indoor walking, outdoor walking, and fear of falling were significantly reduced. In addition, a significant correlation was also observed between motor functions and daily life activities. [Conclusion] The result of this study indicated that the long-term care prevention project is effective in maintaining or improving muscular strength and mitigating pain in the elderly and that it is an effective program for maintaining daily life activities. We were also able to show that it would be effective to develop programs with a low exercise intensity that can be performed on a continuing by the elderly. PMID:25642073

  17. Caries-preventive Effect of Supervised Toothbrushing and Sealants.

    PubMed

    Hilgert, L A; Leal, S C; Mulder, J; Creugers, N H J; Frencken, J E

    2015-09-01

    To investigate the effectiveness of 3 caries-preventive measures on high- and low-caries risk occlusal surfaces of first permanent molars over 3 y. This cluster-randomized controlled clinical trial covered 242 schoolchildren, 6 to 7 y old, from low socioeconomic areas. At baseline, caries risk was assessed at the tooth surface level, through a combination of ICDAS II (International Caries Detection and Assessment System) and fissure depth codes. High-caries risk occlusal surfaces were treated according to daily supervised toothbrushing (STB) at school and 2 sealants: composite resin (CR) and atraumatic restorative treatment-high-viscosity glass-ionomer cement (ART-GIC). Low-caries risk occlusal surfaces received STB or no intervention. Evaluations were performed after 0.5, 1, 2, and 3 y. A cavitated dentine carious lesion was considered a failure. Data were analyzed according to the proportional hazard rate regression model with frailty correction, Wald test, analysis of variance, and t test, according to the jackknife procedure for calculating standard errors. The cumulative survival rates of cavitated dentine carious lesion-free, high-caries risk occlusal surfaces were 95.6%, 91.4%, and 90.2% for STB, CR, and ART-GIC, respectively, over 3 y, which were not statistically significantly different. For low-caries risk occlusal surfaces, no statistically significant difference was observed between the cumulative survival rate of the STB group (94.8%) and the no-intervention group (92.1%) over 3 y. There was neither a difference among STB, CR, and ART-GIC on school premises in preventing cavitated dentine carious lesions in high-caries risk occlusal surfaces of first permanent molars nor a difference between STB and no intervention for low-caries risk occlusal surfaces of first permanent molars over 3 y. PMID:26116491

  18. Designing an Effective Prevention Program: Principles Underlying the Rand Smoking and Drug Prevention Experiment.

    ERIC Educational Resources Information Center

    Ellickson, Phyllis L.

    This paper describes the Project ALERT program (Adolescent Learning Experiences in Resistance Training) which was established by the Rand Corporation to prevent smoking and drug use among seventh graders. The program is based on the social influence model of drug use initiation. Curriculum features are described including motivation to resist and


  19. On the effective position of the free-fall solution and the self-attraction effect of the FG5 gravimeters

    NASA Astrophysics Data System (ADS)

    Pálinkáš, V.; Liard, J.; Jiang, Z.

    2012-08-01

    FG5 absolute gravimeters are the most accurate gravimeters available at present and have significant influence on the realization of a gravity reference through international comparisons of absolute gravimeters. The latter comparisons are the only way to maintain the traceability of absolute gravimetry to the International System of Units (SI). Sources of systematic error such as the self-attraction effect (SAE) have to be taken into account when determining accurate values of the acceleration due to gravity, as needed, for example, for the watt balance project or the International Gravity Reference System. In this paper the SAE for two types of FG5 gravimeter is estimated using two independent methods. The resulting SAEs are 1.2(0.2) ”Gal and 1.7(0.2) ”Gal for FG5 with fibre and bulk interferometer types, respectively. The importance of accurately defining the measurement height is emphasized in the context of the SAE. The accuracy and advantages of referring gravity measurements to an effective position of the free-fall solution are demonstrated together with a simple and accurate empirical estimation of this effective position.

  20. Path instabilities of heavy bodies in free fall in a viscous fluid: wake dynamics vs. aerodynamic effects

    NASA Astrophysics Data System (ADS)

    Fabre, David; Selvam, Kamal; Tchoufag, Joël; Assemat, Pauline; Magnaudet, Jacques

    2013-11-01

    Solid bodies in free fall in a viscous fluid generally fall along a non-straight path, and a variety of periodic (fluttering, tumbling) and non-periodic regimes can be observed. We analyze the structure of the couplings between the fluid and the body, restricting to a linear stability framework. Introducing a simple toy model consisting of a infinitely long plate sliding along a vertical wall, we show that in the limit of large solid-to-fluid masses a decoupling takes place, allowing us to distinguish two kinds of modes: ``wake'' modes in which the body motion has virtually no influence, and ``body'' modes for which the intrinsic wake dynamics can be neglected. Turning to more realistic objects, we show that the ``body'' modes can be described through a rationally derived aerodynamic model (based on quasi-static assumptions), yielding either a static instability, or a dynamic, low-frequency, instability. Considering 2D rectangular rods and 3D disks, we explore the competition between the three kinds of instabilities. For objects elongated in the spanwise direction, it is found that wake instability dominates in case of 2D rectangles and low-frequency instability dominates in case of disks. For objects elongated in the streamwise direction, static instability always dominate.

  1. Fall management of eastern gamagrass

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Recent research has suggested that eastern gamagrass (EGG) may be an effective alternative to chopped straw in the blended diets of dairy heifers and cows. Most extension materials discussing appropriate fall management of EGG recommend avoiding harvest within 6 weeks of first frost. Using this guid...

  2. Differential Susceptibility to Prevention: GABAergic, Dopaminergic, and Multilocus Effects

    ERIC Educational Resources Information Center

    Brody, Gene H.; Chen, Yi-fu; Beach, Steven R. H.

    2013-01-01

    Background: Randomized prevention trials provide a unique opportunity to test hypotheses about the interaction of genetic predispositions with contextual processes to create variations in phenotypes over time. Methods: Using two longitudinal, randomized prevention trials, molecular genetic and alcohol use outcome data were gathered from more than


  3. Effectiveness of a Social Change Approach to Sexual Assault Prevention

    ERIC Educational Resources Information Center

    Edwards, Keith E.

    2009-01-01

    The author examined the impact on resident assistants of a social change approach to sexual assault prevention. The interactive multi-media program focused on engaging men on sexual assault prevention, accurately defining rape for college men and women, identifying aspects of the rape culture in society and on-campus, and empowering college…

  4. Effectiveness of a Social Change Approach to Sexual Assault Prevention

    ERIC Educational Resources Information Center

    Edwards, Keith E.

    2009-01-01

    The author examined the impact on resident assistants of a social change approach to sexual assault prevention. The interactive multi-media program focused on engaging men on sexual assault prevention, accurately defining rape for college men and women, identifying aspects of the rape culture in society and on-campus, and empowering college


  5. Predicting the Effectiveness of Prevention: A Role for Epidemiological Modeling

    ERIC Educational Resources Information Center

    Walls, Helen L.; Peeters, Anna; Reid, Christopher M.; Liew, Danny; Mcneil, John J.

    2008-01-01

    It is well known that the current combination of aging populations and advances in health technology is resulting in burgeoning health costs in developed countries. Prevention is a potentially important way of containing health costs. In an environment of intense cost pressures, coupled with developments in disease prevention and health promotion,…

  6. Differential Susceptibility to Prevention: GABAergic, Dopaminergic, and Multilocus Effects

    ERIC Educational Resources Information Center

    Brody, Gene H.; Chen, Yi-fu; Beach, Steven R. H.

    2013-01-01

    Background: Randomized prevention trials provide a unique opportunity to test hypotheses about the interaction of genetic predispositions with contextual processes to create variations in phenotypes over time. Methods: Using two longitudinal, randomized prevention trials, molecular genetic and alcohol use outcome data were gathered from more than…

  7. Effects of Nicotine Fading and Relapse Prevention on Smoking Cessation.

    ERIC Educational Resources Information Center

    Brown, Richard A.; And Others

    1984-01-01

    Conducted a pilot study which combined nicotine-fading and relapse prevention with smokers (N=30) and compared this program to conditions where subjects (N=46) received nicotine-fading or relapse prevention only. Results showed no difference among groups in abstinence or rate at any follow-up point. (LLL)

  8. Cost-effectiveness of a helpline for suicide prevention.

    PubMed

    Pil, Lore; Pauwels, Kirsten; Muijzers, Ekke; Portzky, Gwendolyn; Annemans, Lieven

    2013-07-01

    We evaluated the cost-effectiveness and budget impact of a suicide helpline in Belgium, consisting of a telephone- and a chat service. An age- and gender-dependent Markov model with a ten-year time horizon and a one-year cycle length was developed, assuming a societal perspective, to predict cumulative costs and quality-adjusted life-years (QALYs) in the helpline users. The model included six transition states: the initial state (at risk), first attempt, re-attempt, follow-up, suicide and death from other causes. Data on the effect of the helpline and costs associated with model states were obtained from the literature. One-way and probabilistic sensitivity analyses were performed to capture uncertainty. In addition, the budget impact of the helpline was analysed. Over ten years, the telephone- as well as the chat service could avoid about 36% of suicides and attempts in this high-risk population. In males, 0.063 QALYs (95% confidence interval, CI 0.030-0.097) and 0.035 QALYs (95%CI -0.026-0.096) were gained by users of the telephone- and chat service respectively. The corresponding values for females were 0.019 QALYs (95%CI -0.015-0.052) and a QALY-neutral result of -0.005 (95%CI -0.071-0.062). There were net societal savings of respectively €2382 (95%CI 1953-2859) and €2282 (95%CI 1855-2758) in male users; €2171 (95%CI 1735-2664) and €2458 (95%CI 1945-3025) in female users. At the population level, an investment of €218,899 saved €1,452,022 for the public health service (national health insurance), mainly due to the telephone service. The analysis predicted that both means of telemedicine for suicide prevention in Flanders are cost-saving, and have a modest effect on QALYs. PMID:24163237

  9. Falls and Fall-Related Injuries among Community-Dwelling Adults in the United States

    PubMed Central

    Verma, Santosh K.; Willetts, Joanna L.; Corns, Helen L.; Marucci-Wellman, Helen R.; Lombardi, David A.; Courtney, Theodore K.

    2016-01-01

    Introduction Falls are the leading cause of unintentional injuries in the U.S.; however, national estimates for all community-dwelling adults are lacking. This study estimated the national incidence of falls and fall-related injuries among community-dwelling U.S. adults by age and gender and the trends in fall-related injuries across the adult life span. Methods Nationally representative data from the National Health Interview Survey (NHIS) 2008 Balance and Dizziness supplement was used to develop national estimates of falls, and pooled data from the NHIS was used to calculate estimates of fall-related injuries in the U.S. and related trends from 2004–2013. Costs of unintentional fall-related injuries were extracted from the CDC’s Web-based Injury Statistics Query and Reporting System. Results Twelve percent of community-dwelling U.S. adults reported falling in the previous year for a total estimate of 80 million falls at a rate of 37.2 falls per 100 person-years. On average, 9.9 million fall-related injuries occurred each year with a rate of 4.38 fall-related injuries per 100 person-years. In the previous three months, 2.0% of older adults (65+), 1.1% of middle-aged adults (45–64) and 0.7% of young adults (18–44) reported a fall-related injury. Of all fall-related injuries among community-dwelling adults, 32.3% occurred among older adults, 35.3% among middle-aged adults and 32.3% among younger adults. The age-adjusted rate of fall-related injuries increased 4% per year among older women (95% CI 1%–7%) from 2004 to 2013. Among U.S. adults, the total lifetime cost of annual unintentional fall-related injuries that resulted in a fatality, hospitalization or treatment in an emergency department was 111 billion U.S. dollars in 2010. Conclusions Falls and fall-related injuries represent a significant health and safety problem for adults of all ages. The findings suggest that adult fall prevention efforts should consider the entire adult lifespan to ensure a greater public health benefit. PMID:26977599

  10. Fall armyworm migration patterns.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Fall armyworm, Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae), infestations in most of North America arise from annual migrations of populations that overwinter in southern Texas and Florida. Cytochrome Oxidase I haplotype profiles within the fall armyworm corn-strain, the subgroup tha...

  11. Fall Leaf Portraits

    ERIC Educational Resources Information Center

    O'Hara, Cristina

    2012-01-01

    In this article, the author describes how students can create a stunning as well as economical mosaic utilizing fall's brilliantly colored leaves, preserved at their peak in color. Start by choosing a beautiful fall day to take students on a nature walk to collect a variety of leaves in different shapes, sizes, and colors. Focus on collecting a…

  12. Fall Enrollment Report 2009

    ERIC Educational Resources Information Center

    Iowa Department of Education, 2009

    2009-01-01

    This report summarizes fall enrollment in Iowa's community colleges. Every year Iowa's 15 community college districts submit data on students enrolled on the 10th day of the fall semester. Highlights include: (1) Enrollment grew at its fastest pace since 1975 to a record high of 100,736 students; (2) Year-to-year growth was 14.3 percent, which is


  13. Predicting the risk of falling – efficacy of a risk assessment tool compared to nurses' judgement: a cluster-randomised controlled trial [ISRCTN37794278

    PubMed Central

    Meyer, Gabriele; Köpke, Sascha; Bender, Ralf; MĂŒhlhauser, Ingrid

    2005-01-01

    Background Older people living in nursing homes are at high risk of falling because of their general frailty and multiple pathologies. Prediction of falls might lead to an efficient allocation of preventive measures. Although several tools to assess the risk of falling have been developed, their impact on clinically relevant endpoints has never been investigated. The present study will evaluate the clinical efficacy and consequences of different fall risk assessment strategies. Study design Cluster-randomised controlled trial with nursing home clusters randomised either to the use of a standard fall risk assessment tool alongside nurses' clinical judgement or to nurses' clinical judgement alone. Standard care of all clusters will be optimised by structured education on best evidence strategies to prevent falls and fall related injuries. 54 nursing home clusters including 1,080 residents will be recruited. Residents must be ≄ 70 years, not bedridden, and living in the nursing home for more than three months. The primary endpoint is the number of participants with at least one fall at 12 months. Secondary outcome measures are the number of falls, clinical consequences including side effects of the two risk assessment strategies. Other measures are fall related injuries, hospital admissions and consultations with a physician, and costs. PMID:16285880

  14. A Concise History of School-Based Smoking Prevention Research: A Pendulum Effect Case Study

    ERIC Educational Resources Information Center

    Sussman, Steve; Black, David S.; Rohrbach, Louise A.

    2010-01-01

    School-based cigarette smoking prevention was initiated shortly after the first Surgeon General's Report in 1964. This article highlights a sequence of events by which school-based tobacco use prevention research developed as a science, and illustrates a pendulum effect, with confidence in tobacco use prevention increasing and decreasing at…

  15. Building and Maintaining an Effective Campus-Wide Coalition for Suicide Prevention

    ERIC Educational Resources Information Center

    Kaslow, Nadine J.; Garcia-Williams, Amanda; Moffitt, Lauren; McLeod, Mark; Zesiger, Heather; Ammirati, Rachel; Berg, John P.; McIntosh, Belinda J.

    2012-01-01

    Preventing suicide is a commonly shared priority among college administrators, faculty, staff, students, and family members. Coalitions are popular health promotion mechanisms for solving community-wide problems and are valuable in campus-wide suicide prevention efforts. This article provides an example of an effective suicide prevention…

  16. A Concise History of School-Based Smoking Prevention Research: A Pendulum Effect Case Study

    ERIC Educational Resources Information Center

    Sussman, Steve; Black, David S.; Rohrbach, Louise A.

    2010-01-01

    School-based cigarette smoking prevention was initiated shortly after the first Surgeon General's Report in 1964. This article highlights a sequence of events by which school-based tobacco use prevention research developed as a science, and illustrates a pendulum effect, with confidence in tobacco use prevention increasing and decreasing at


  17. Initial Indicators of Effectiveness for a High School Drug Prevention Program

    ERIC Educational Resources Information Center

    Fearnow-Kenney, Melodie D.; Wyrick, David L.; Jackson-Newsom, Julia; Wyrick, Cheryl H.; Hansen, William B.

    2003-01-01

    All Stars, Sr. is a comprehensive high school health education supplement designed to prevent high-risk behaviors among adolescents. The program includes topics such as personal health, nutrition, interpersonal relationships, and stress, with a special emphasis on drug prevention. Effective research-based programs that target late onset prevention…

  18. Evaluating a pediatric trauma program: effectiveness versus preventable death rate.

    PubMed

    Wesson, D E; Williams, J I; Salmi, L R; Spence, L J; Armstrong, P F; Filler, R M

    1988-08-01

    We compared effectiveness (E), the proportion of severely injured patients who were salvageable and survived, to the preventable death rate (PDR) over three consecutive 1-year periods. Severely injured patients were those with at least one injury with an Abbreviated Injury Score (AIS) of greater than or equal to 4. Those with one fatal injury (AIS greater than or equal to 6), a critical head injury (AIS greater than or equal to 5) apart from acute epidural hematoma, or massive multiple injuries (Injury Severity Score greater than 59) were considered nonsalvageable; the remainder were considered salvageable. In the first year, six of 74 salvageable patients died, in the second year five of 76, and in the third year one of 69. The PDR rates were 0.32 (6/19), 0.23 (5/22), and 0.06 (1/17), respectively. There was no significant difference in the E of our trauma program over the 3 years. The apparent improvement in PDR in the second and third years resulted from an increased number of deaths among nonsalvageable patients and fewer deaths among salvageable patients. This finding demonstrates that PDR is sensitive to case mix and not just quality of care, and confirms the superiority of E over PDR for assessing a trauma program. PMID:3411644

  19. Preconception screening for cytomegalovirus: an effective preventive approach.

    PubMed

    Reichman, Orna; Miskin, Ian; Sharoni, Limor; Eldar-Geva, Talia; Goldberg, Doron; Tsafrir, Avi; Gal, Michael

    2014-01-01

    Congenital cytomegalovirus (CMV) is the leading infectious cause of sensorineural hearing loss and delayed psychomotor development. Viral transmission to the fetus is far more likely to occur following a primary than a secondary maternal infection. Primary prevention seems to be the best means to reduce the burden of congenital CMV due to the lack of treatment options during pregnancy. We evaluated this approach on a cohort of 500 women planning pregnancy who attended our fertility clinic. Of the 444 who underwent CMV screening, 18 (4.1%) had positive IgM serology for CMV; of these, IgG avidity was high in 12 (remote infection) and low in 6 (recent infection). The latter were advised to delay pregnancy. All women who were seroimmune for CMV (366/444, 82.4%), including the 12 with remote infection, continued fertility treatment. The remaining patients (72/444, 16.2%), who were not immune to CMV at the initial screen, were advised to minimize CMV exposure by improving personal hygiene and to continue fertility treatment. None of the 69/72 (95.8%) women who were followed for one year were infected with CMV. Cytomegalovirus testing and counselling at preconception seemed effective in reducing CMV exposure in pregnancy. PMID:25013756

  20. Can a multi-factorial assessment and interventional programme decrease inpatient falls in an elderly care ward?

    PubMed

    Gibson, Rebecca Sj; Heaney, April; Hull, Karen

    2013-01-01

    Each year approximately 282,000 inpatient falls are reported to the National Patient Safety Agency (NPSA). A significant number result in death, or moderate to severe injury. (1) Research shows that falls may be reduced by 18 to 31% through multi-factorial assessments and interventions. (4) If a fall cannot be prevented, the patient should receive a prompt and effective response to achieve the best possible recovery and avoidance of further falls. Using 'Plan-Do-Study-Act' learning cycles, our aims were to decrease the inpatient falls rate in an Elderly Care ward by 20% and to improve post-fall care. A baseline audit reviewed incident report forms to establish the number of falls per 1000 patient bed days for one calendar year; the baseline falls rate was 14.70 falls per 1000 bed days between November 2010 and October 2011. A care plan to highlight at-risk patients and allow adaptation of care, a 'walking-stick' incentive poster to encourage nursing staff, and post-fall guidelines, were introduced. Feedback sessions with ward staff and a re-audit were organised subsequent to each intervention. Completion of the care plan was monitored to improve compliance. A re-audit at one year was conducted to assess impact. Feedback was positive regarding the interventions. Monthly monitoring of care plans achieved a compliance rate of 89% and highlighted up to 81% of patients were considered high-risk. The inpatient falls rate, re-audited at one year, was 12.44 falls / 1000 patient bed days, November 2011 to October 2012; a 15.4% reduction. This study demonstrates a 15.4% reduction in falls through use of a multi-factorial assessment and care plan and an incentive poster. As we are yet to obtain our initial goal of 20%, implementation and re-audit is ongoing. PMID:26734206

  1. Connect: an effective community-based youth suicide prevention program.

    PubMed

    Bean, Gretchen; Baber, Kristine M

    2011-02-01

    Youth suicide prevention is an important public health issue. However, few prevention programs are theory driven or systematically evaluated. This study evaluated Connect, a community-based youth suicide prevention program. Analysis of pre and posttraining questionnaires from 648 adults and 204 high school students revealed significant changes in knowledge and attitudes about suicide, increased belief in the usefulness of mental health care, and reduction of stigma associated with seeking help. Adults' preparedness to help also increased significantly as did the likelihood that youth participants would seek adult assistance if they were concerned about a peer. Implications of findings are discussed. PMID:21309827

  2. Effects of dam removal on Tule Fall Chinook salmon spawning habitat in the White Salmon River, Washington

    USGS Publications Warehouse

    Hatten, James R.; Batt, Thomas R.; Skalicky, Joseph J.; Engle, Rod; Barton, Gary J.; Fosness, Ryan L.; Warren, Joe

    2015-01-01

    Condit Dam is one of the largest hydroelectric dams ever removed in the USA. Breached in a single explosive event in October 2011, hundreds-of-thousands of cubic metres of sediment washed down the White Salmon River onto spawning grounds of a threatened species, Columbia River tule fall Chinook salmon Oncorhynchus tshawytscha. We investigated over a 3-year period (2010–2012) how dam breaching affected channel morphology, river hydraulics, sediment composition and tule fall Chinook salmon (hereafter ‘tule salmon’) spawning habitat in the lower 1.7?km of the White Salmon River (project area). As expected, dam breaching dramatically affected channel morphology and spawning habitat due to a large load of sediment released from Northwestern Lake. Forty-two per cent of the project area that was previously covered in water was converted into islands or new shoreline, while a large pool near the mouth filled with sediments and a delta formed at the mouth. A two-dimensional hydrodynamic model revealed that pool area decreased 68.7% in the project area, while glides and riffles increased 659% and 530%, respectively. A spatially explicit habitat model found the mean probability of spawning habitat increased 46.2% after dam breaching due to an increase in glides and riffles. Shifting channels and bank instability continue to negatively affect some spawning habitat as sediments continue to wash downstream from former Northwestern Lake, but 300?m of new spawning habitat (river kilometre 0.6 to 0.9) that formed immediately post-breach has persisted into 2015. Less than 10% of tule salmon have spawned upstream of the former dam site to date, but the run sizes appear healthy and stable. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

  3. Rock falls landslides in Abruzzo (Central Italy) after recent earthquakes: morphostructural control

    NASA Astrophysics Data System (ADS)

    Piacentini, T.; Miccadei, E.; Di Michele, R.; Esposito, G.

    2012-04-01

    Recent earthquakes show that damages due to collateral effects could, in some cases exceed the economic and social losses directly connected to the seismic shaking. The earthquake heavily damaged urban areas and villages and induced several coseismic deformations and geomorphologic effects, including different types of instability such as: rock falls, debris falls, sink holes, ground collapses, liquefaction, etc. Among the effects induced by the seismic energy release, landslides are one of the most significant in terms of hazard and related risk, owing to the occurrence of exposed elements. This work analyzes the geomorphological effects, and particularly the rock falls, which occurred in the L'Aquila area during and immediately after the April 2009 earthquake. The analysis is focused mainly on the rock fall distribution related to the local morphostructural setting. Rock falls occurred mostly on calcareous bedrock slopes or on scarps developed on conglomerates and breccias of Quaternary continental deposits. Geological and geomorphological surveys have outlined different types of rock falls on different morpho-structural settings, which can be summarized as follow: 1)rock falls on calcareous faulted homoclinal ridges; 2)rock falls on calcareous rock slopes of karst landforms; 3)rock falls on structural scarps on conglomerates and breccias of Quaternary continental deposits. The first type of rockfall occurred particularly along main gorges carved on calcareous rocks and characterised by very steep fault slopes and structural slopes (i.e. San Venanzio Gorges, along the Aterno river). In these cases already unstable slopes due to lithological and structural control were triggered as rockfalls also at high distance from the epicentre area. These elements provide useful indications both at local scale, for seismic microzonation studies and seismic risk prevention, and at regional scale, for updating studies and inventory of landslides.

  4. Risk Factors Associated With Injury Attributable to Falling Among Elderly Population With History of Stroke

    PubMed Central

    Divani, Afshin A.; Vazquez, Gabriela; Barrett, Anna M.; Asadollahi, Marjan; Luft, Andreas R.

    2010-01-01

    Background and Purpose Stroke survivors are at high risk for falling. Identifying physical, clinical, and social factors that predispose stroke patients to falls may reduce further disability and life-threatening complications, and improve overall quality of life. Methods We used 5 biennial waves (1998–2006) from the Health and Retirement Study to assess risk factors associated with falling accidents and fall-related injuries among stroke survivors. We abstracted demographic data, living status, self-evaluated general health, and comorbid conditions. We analyzed the rate ratio (RR) of falling and the OR of injury within 2 follow-up years using a multivariate random effects model. Results We identified 1174 stroke survivors (mean age±SD, 74.4±7.2 years; 53% female). The 2-year risks of falling, subsequent injury, and broken hip attributable to fall were 46%, 15%, and 2.1% among the subjects, respectively. Factors associated with an increased frequency of falling were living with spouse as compared to living alone (RR, 1.4), poor general health (RR, 1.1), time from first stroke (RR, 1.2), psychiatric problems (RR, 1.7), urinary incontinence (RR, 1.4), pain (RR, 1.4), motor impairment (RR, 1.2), and past frequency of ?3 falls (RR, 1.3). Risk factors associated with fall-related injury were female gender (OR, 1.5), poor general health (OR, 1.2), past injury from fall (OR, 3.2), past frequency of ?3 falls (OR, 3.1), psychiatric problems (OR, 1.4), urinary incontinence (OR, 1.4), impaired hearing (OR, 1.6), pain (OR, 1.8), motor impairment (OR, 1.3), and presence of multiple strokes (OR, 3.2). Conclusions This study demonstrates the high prevalence of falls and fall-related injuries in stroke survivors, and identifies factors that increase the risk. Modifying these factors may prevent falls, which could lead to improved quality of life and less caregiver burden and cost in this population. PMID:19628798

  5. Influential Students Effective at Bully Prevention, Study Finds

    MedlinePLUS

    ... 7, 2016 (HealthDay News) -- When it comes to bullying prevention, certain students may turn out to be ... academic year, schools with students promoting the anti-bullying messages had a 30 percent drop in reports ...

  6. 149. TWIN FALLS MAIN CANAL DIVERSION, TWIN FALLS COUNTY, MILNER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    149. TWIN FALLS MAIN CANAL DIVERSION, TWIN FALLS COUNTY, MILNER DAM; CLOSE-UP OF MAIN CANAL GATES, SOUTH VIEW. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  7. 99. POINT SPILL, TWIN FALLS MAIN CANAL, TWIN FALLS COUNTY ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    99. POINT SPILL, TWIN FALLS MAIN CANAL, TWIN FALLS COUNTY NORTHWEST OF MURTAUGH, IDAHO; CLOSE-UP OF OUTLET SIDE OF GATES, SOUTH VIEW. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  8. 98. SHOESTRING, TWIN FALLS MAIN CANAL, TWIN FALLS COUNTY NORTHWEST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    98. SHOESTRING, TWIN FALLS MAIN CANAL, TWIN FALLS COUNTY NORTHWEST OF MURTAUGH, IDAHO; PROFILE VIEW, SOUTH. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  9. 141. TWIN FALLS MAIN CANAL DIVERSION, TWIN FALLS COUNTY, MILNER, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    141. TWIN FALLS MAIN CANAL DIVERSION, TWIN FALLS COUNTY, MILNER, IDAHO; CLOSE-UP OF MAIN HEADGATES, RADIAL GATES INSIDE, SOUTHEAST VIEW. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  10. 97. POINT SPILL, TWIN FALLS MAIN CANAL, TWIN FALLS COUNTY ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    97. POINT SPILL, TWIN FALLS MAIN CANAL, TWIN FALLS COUNTY NORTHWEST OF MURTAUGH, IDAHO; OVERALL WEST VIEW FROM CANAL SIDE. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  11. 147. TWIN FALLS MAIN CANAL DIVERSION, TWIN FALLS COUNTY, MILNER, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    147. TWIN FALLS MAIN CANAL DIVERSION, TWIN FALLS COUNTY, MILNER, IDAHO; VIEW OF MAIN HEADGATES, EAST VIEW. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  12. 148. TWIN FALLS MAIN CANAL DIVERSION, TWIN FALLS COUNTY, MILNER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    148. TWIN FALLS MAIN CANAL DIVERSION, TWIN FALLS COUNTY, MILNER DAM; HEADGATES AT INLET, SOUTHWEST VIEW. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  13. Non-pharmacological means to prevent fractures among older adults.

    PubMed

    Kannus, Pekka; Uusi-Rasi, Kirsti; Palvanen, Mika; Parkkari, Jari

    2005-01-01

    Bone fractures affecting elderly people are a true public health burden, because they represent one of the most important causes of long-standing pain, functional impairment, disability, and death among this population. Compromised bone strength (osteoporosis) and falling, alone, or more frequently in combination, are the two independent and immediate risk factors of elderly people's fractures through which all the other, more distant risk factors, such as aging, inactivity, poor nutrition, smoking, use of alcohol, diseases, medications, functional impairments, and disabilities, operate. Of these two, falling, not osteoporosis, is the strongest single risk factor for a fracture. The most usual occurrence resulting in a fracture of an older adult is a 'simple' fall from standing height or less. Although in general terms this type of trauma is mild or moderate only (compared with, for example, motor vehicle collisions), to the specific injury site these traumas are high-impact injuries often creating forces clearly exceeding the breaking strength of the bone. Therefore, fractures affecting elderly people should be called 'fall-induced high-impact injuries' instead of the commonly used, partly misleading terms of osteoporotic fractures or minimal-trauma fractures. Prevention of elderly people's fractures consists of prevention of osteoporosis and of falling, and prevention of fractures using injury-site protection. Concerning osteoporosis, maximizing peak bone mass and preventing bone loss by regular exercise, calcium, and vitamin D, and, treatment of established osteoporosis with bone-specific drugs, have a strong scientific basis. In fall prevention, regular strength and balance training, reducing psychotropic medication, and diet supplementation with vitamin D and calcium have been shown to be effective. The multifaceted risk factor-assessing and modifying interventions have also been successful in preventing falls among the older adults by simultaneously affecting many of the risk factors of falling. Finally, concerning injury-site protection, padded strong-shield hip protectors whose effectiveness is scientifically proven seem to be a promising option in preventing hip fractures. PMID:16019730

  14. Evaluation of R. Paul Smith Steam Electric Station thermal discharge effects on finfish and macroinvertebrate communities, summer/fall 1980. Final report

    SciTech Connect

    Not Available

    1981-02-01

    The objectives of the study were to evaluate the thermal effects of the R. P. Smith steam Electric Station upon the finfish and macroinvertebrates communities during summer and fall, on the Potomac River. The finfish community was sampled during August and September 1980 with electrofishing gear. The increased water temperature along the Maryland shore appeared to influence the distribution of spotfin shiner and smallmouth bass. Carp, although not statistically tested, appeared to be more abundant in the thermal plume than at stations outside the thermal plume. The thermal discharge exhibited no discernible influence on the composition of the benthic or drift macroinvertebrate communities.

  15. Pathogenesis and treatment of falls in elderly

    PubMed Central

    Pasquetti, Pietro; Apicella, Lorenzo; Mangone, Giuseppe

    2014-01-01

    Summary Falls in the elderly are a public health problem. Consequences of falls are increased risk of hospitalization, which results in an increase in health care costs. It is estimated that 33% of individuals older than 65 years undergoes falls. Causes of falls can be distinguished in intrinsic and extrinsic predisposing conditions. The intrinsic causes can be divided into age-related physiological changes and pathological predisposing conditions. The age-related physiological changes are sight disorders, hearing disorders, alterations in the Central Nervous System, balance deficits, musculoskeletal alterations. The pathological conditions can be Neurological, Cardiovascular, Endocrine, Psychiatric, Iatrogenic. Extrinsic causes of falling are environmental factors such as obstacles, inadequate footwear. The treatment of falls must be multidimensional and multidisciplinary. The best instrument in evaluating elderly at risk is Comprehensive Geriatric Assessment (CGA). CGA allows better management resulting in reduced costs. The treatment should be primarily preventive acting on extrinsic causes; then treatment of chronic and acute diseases. Rehabilitation is fundamental, in order to improve residual capacity, motor skills, postural control, recovery of strength. There are two main types of exercises: aerobic and muscular strength training. Education of patient is a key-point, in particular through the Back School. In conclusion falls in the elderly are presented as a “geriatric syndrome”; through a multidimensional assessment, an integrated treatment and a rehabilitation program is possible to improve quality of life in elderly. PMID:25568657

  16. Keeping children safe at home: protocol for three matched case–control studies of modifiable risk factors for falls

    PubMed Central

    Kendrick, Denise; Stewart, Jane; Clacy, Rose; Coffey, Frank; Cooper, Nicola; Coupland, Carol; Hayes, Mike; McColl, Elaine; Reading, Richard; Sutton, Alex; M L Towner, Elizabeth; Craig Watson, Michael

    2012-01-01

    Background Childhood falls result in considerable morbidity, mortality and health service use. Despite this, little evidence exists on protective factors or effective falls prevention interventions in young children. Objectives To estimate ORs for three types of medically attended fall injuries in young children in relation to safety equipment, safety behaviours and hazard reduction and explore differential effects by child and family factors and injury severity. Design Three multicentre case–control studies in UK hospitals with validation of parental reported exposures using home observations. Cases are aged 0–4?years with a medically attended fall injury occurring at home, matched on age and sex with community controls. Children attending hospital for other types of injury will serve as unmatched hospital controls. Matched analyses will use conditional logistic regression to adjust for potential confounding variables. Unmatched analyses will use unconditional logistic regression, adjusted for age, sex, deprivation and distance from hospital in addition to other confounders. Each study requires 496 cases and 1984 controls to detect an OR of 0.7, with 80% power, 5% significance level, a correlation between cases and controls of 0.1 and a range of exposure prevalences. Main outcome measures Falls on stairs, on one level and from furniture. Discussion As the largest in the field to date, these case control studies will adjust for potential confounders, validate measures of exposure and investigate modifiable risk factors for specific falls injury mechanisms. Findings should enhance the evidence base for falls prevention for young children. PMID:22628151

  17. Medications Are Associated with Falls in People with Multiple Sclerosis

    PubMed Central

    Karstens, Lisa; Hoang, Phu; Bourdette, Dennis; Lord, Stephen

    2015-01-01

    Background: Medication use is associated with falls in many populations, but the relationship between medications and falls in people with multiple sclerosis (MS) is not well understood. Methods: The number and types of medications used by 248 ambulatory adults with MS in the United States (n = 53) and Australia (n = 195) were assessed. Participants completed fall diaries for 6 months. Associations between number and type of medications reported and falls, adjusting for age, disease severity, comorbidities, sex, and country, were evaluated using multiple logistic regression. Results: Participants reported taking a median of three medications and two supplements. A total of 143 participants (58%) fell at least once in the 6 months, and 110 (44%) experienced one or more injurious falls. The adjusted relative odds of a fall or an injurious fall increased by 13% (P = .048) and 11% (P = .049), respectively, for each medication and by 43% (P = .015) and 55% (P = .001) for each neurologically active medication. Reported use of MS disease-modifying therapy was associated with 48% decreased odds of falling (P = .035) but not significantly decreased odds of injurious falls. Conclusions: Reporting use of more medications and more neurologically active medications is associated with falls and injurious falls in people with MS. Close evaluation of the need for each medication, with associated minimization of neurologically active medications in patients with MS, may help prevent falls. Use of MS disease-modifying therapies may be associated with fewer falls. This relationship needs further evaluation. PMID:26472941

  18. Base of Bridalveil Fall

    USGS Multimedia Gallery

    In this image, Bridalveil Fall can be seen from its base in Yosemite National Park. The waterfall is 617 ft (188 m) in height and is one of the most well-known of Yosemite National Park's waterfalls....

  19. Editors' Fall Picks

    ERIC Educational Resources Information Center

    Hoffert, Barbara; Heilbrun, Margaret; Kuzyk, Raya; Kim, Ann; McCormack, Heather; Katterjohn, Anna; Burns, Ann; Williams, Wilda

    2008-01-01

    From the fall's cascade of great new books, "Library Journal's" editors select their favorites--a dark rendition of Afghan life, a look at the "self-esteem trap," a celebration of Brooklyn activism, and much more.

  20. Effects of antihistamines on the lung vascular response to histamine in unanesthetized sheep. Diphenhydramine prevention of pulmonary edema and increased permeability.

    PubMed Central

    Brigham, K L; Bowers, R E; Owen, P J

    1976-01-01

    To see whether antihistamines could prevent and reverse histamine-induced pulmonary edema and increased lung vascular permeability, we compared the effects of a 4-h intravenous infusion of 4 mug/kg per min histamine phosphate on pulmonary hemodynamics, lung lymph flow, lymph and plasma protein content, arterial blood gases, hematocrit, and lung water with the effects of an identical histamine infusion given during an infusion of diphenhydramine or metiamide on the same variables in unanesthetized sheep. Histamine caused lymph flow to increase from 6.0+/-0.5 to 27.0+/-5.5 (SEM) ml/h (P less than 0.05), lymph; plasma globulin concentration ratio to increase from 0.62+/-0.01 to 0.67+/-0.02 (P less than 0.05), left atrial pressure to fall from 1+/-1 to -3+/-1 cm H2O (P less than 0.05), and lung lymph clearance of eight protein fractions ranging from 36 to 96 A molecular radius to increase significantly. Histamine also caused increases in lung water, pulmonary vascular resistance, arterial PCO2, pH, and hematocrit, and decreases in cardiac output and arterial PO2. Diphenhydramine (3 mg/kg before histamine followed by 1.5 mg/kg per h intravenous infusion) completely prevented the histamine effect on hematocrit, lung lymph flow, lymph protein clearance, and lung water content, and reduced histamine effects on arterial blood gases and pH. 6 mg/kg diphenhydramine given at the peak histamine response caused lymph flow and lymph: plasma protein concentration ratios to fall. Metiamide (10 mg/kg per h) did not affect the histamine lymph response. We conclude that diphenhydramine can prevent histamine-induced pulmonary edema and can prevent and reverse increased lung vascular permeability caused by histamine, and that histamine effects on lung vascular permeability are H1 actions. PMID:956373

  1. [The biological effects of a nuclear explosion. Introduction of a new system on a colorimetric scale (black, grey, red, orange, yellow and white zone) to estimate the effects of fall-out on civilian populations].

    PubMed

    Nacci, G

    2002-08-01

    Following September 11 the eventuality of terrorist attacks using bags containing nuclear devices is considered possible in western cities like New York, London, Paris, Rome, Berlin, Moscow etc. However, with a modern Civil Defence programme the effects of a catastrophe of this nature can be partially limited, at least as far as Fall-out is concerned. The present paper explains the medical reasons for building anti-fall-out shelters for the larger part of western populations: from the USA to Russia. The paper also sets out a new method for classifying levels of radioactive Fall-out based on a scale of colours (black, grey, red, orange, yellow and white) whatever kind of radioactivity is involved (total gamma levels, Cesium 137 levels, Strontium 90 levels). The arrival times for fall-out in each area of the scale are fixed, whatever the energy of the explosion and the speed of the wind might be. The radioactive decay in each area of the scale, from the time of arrival of the fall-out is described with precision. Also described are the acute radiation syndrome, tumours, miscarriages and genetic diseases. A nomogram is attached for civil defence purposes showing the leeward extension of these areas, easily measurable in just a few minutes, if four parameters are known: ground zero (locality) of the explosion, the energy of the explosion, the direction of the wind and the speed of the wind. PMID:12207196

  2. Effect of upper and lower extremity control strategies on predicted injury risk during simulated forward falls: a study in healthy young adults.

    PubMed

    Lo, Jiahsuan; Ashton-Miller, James A

    2008-08-01

    Fall-related wrist fractures are common at any age. We used a seven-link, sagittally symmetric, biomechanical model to test the hypothesis that systematically alterations in the configuration of the body during a forward fall from standing height can significantly influence the impact force on the wrists. Movement of each joint was accomplished by a pair of agonist and antagonist joint muscle torque actuators with assigned torque-angle, torque-velocity, and neuromuscular latency properties. Proportional-derivative joint controllers were used to achieve desired target body segment configurations in the pre- andor postground contact phases of the fall. Outcome measures included wrist impact forces and whole-body kinetic energy at impact in the best, and worst, case impact injury risk scenarios. The results showed that peak wrist impact force ranged from less than 1 kN to more than 2.5 kN, reflecting a fourfold difference in whole-body kinetic energy at impact (from less than 40 J to more than 160 J) over the range of precontact hip and knee joint angles used at impact. A reduction in the whole-body kinetic energy at impact was primarily associated with increasing negative work associated with hip flexion. Altering upper extremity configuration prior to impact significantly reduced the peak wrist impact force by up to 58% (from 919 N to 2212 N). Increased peak wrist impact forces associated greater shoulder flexion and less elbow flexion. Increasing postcontact arm retraction can reduce the peak wrist impact force by 28% (from 1491 N to 1078 N), but postcontact hip and knee rotations had a relatively small effect on the peak wrist impact force (8% reduction; from 1411 N to 1303 N). In summary, the choice of the joint control strategy during a forward fall can significantly affect the risk of wrist injury. The most effective strategy was to increase the negative work during hip flexion in order to dissipate kinetic energy thereby reducing the loss in potential energy prior to first impact. Extended hip or elbow configurations should be avoided in order to reduce forearm impact forces. PMID:18601457

  3. 147. Linville Falls Recreation Area. View of Linville Falls from ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    147. Linville Falls Recreation Area. View of Linville Falls from castle view looking northwest. - Blue Ridge Parkway, Between Shenandoah National Park & Great Smoky Mountains, Asheville, Buncombe County, NC

  4. 148. Linville Falls Recreation Area. View of Linville Falls from ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    148. Linville Falls Recreation Area. View of Linville Falls from Erwin's view looking west. - Blue Ridge Parkway, Between Shenandoah National Park & Great Smoky Mountains, Asheville, Buncombe County, NC

  5. 1991 Fall Meeting Report

    NASA Astrophysics Data System (ADS)

    Chapman, David S.

    The AGU 1991 Fall Meeting, held in San Francisco December 9-13, was the largest national AGU meeting ever held. Meeting participation continued the steady growth trend set throughout the previous decade. A total of 4,037 papers and posters were presented, and by Friday noon of the meeting over 5,500 members had registered.Several special events were scheduled to inform and engage members on societal and programmatic aspects of our science. AGU's Committee on Education and Human Resources sponsored an open forum that addressed opportunities and problems associated with dual-career couples. A discussion of NASA's strategic plan by Berrien Moore and Joseph Alexander drew a large audience, and a special session on societal aspects of the Mt. Pinatubo eruption drew an overflow crowd. Two special lectures— “Plumes, Plates, and Deep Earth Structure” by Don L. Anderson and “New Frontiers in Aeronomy: Effects of Global Atmospheric Change” by P. M. Banks-also drew overflow crowds.

  6. Effects of an Exercise Programme on Functional Capacity, Body Composition and Risk of Falls in Patients with Cirrhosis: A Randomized Clinical Trial

    PubMed Central

    Romån, Eva; García-Galcerån, Cristina; Torrades, Teresa; Herrera, Silvia; Marín, Ana; Doñate, Maite; Alvarado-Tapias, Edilmar; Malouf, Jorge; Nåcher, Laura; Serra-Grima, Ricard; Guarner, Carlos; Soriano, German

    2016-01-01

    Patients with cirrhosis often have functional limitations, decreased muscle mass, and a high risk of falls. These variables could improve with exercise. The aim was to study the effects of moderate exercise on functional capacity, body composition and risk of falls in patients with cirrhosis. Twenty-three cirrhotic patients were randomized to an exercise programme (n = 14) or to a relaxation programme (n = 9). Both programmes consisted of a one-hour session 3 days a week for 12 weeks. At the beginning and end of the study, we measured functional capacity using the cardiopulmonary exercise test, evaluated body composition using anthropometry and dual energy X-ray absorptiometry, and estimated risk of falls using the Timed Up&Go test. In the exercise group, cardiopulmonary exercise test showed an increase in total effort time (p<0.001) and ventilatory anaerobic threshold time (p = 0.009). Upper thigh circumference increased and mid-arm and mid-thigh skinfold thickness decreased. Dual energy X-ray absorptiometry showed a decrease in fat body mass (-0.94 kg, 95%CI -0.48 to -1.41, p = 0.003) and an increase in lean body mass (1.05 kg, 95%CI 0.27 to 1.82, p = 0.01), lean appendicular mass (0.38 kg, 95%CI 0.06 to 0.69, p = 0.03) and lean leg mass (0.34 kg, 95%CI 0.10 to 0.57, p = 0.02). The Timed Up&Go test decreased at the end of the study compared to baseline (p = 0.02). No changes were observed in the relaxation group. We conclude that a moderate exercise programme in patients with cirrhosis improves functional capacity, increases muscle mass, and decreases body fat and the Timed Up&Go time. Trial Registration: ClinicalTrials.gov NCT01447537 PMID:27011355

  7. Effects of hearing aids in the balance, quality of life and fear to fall in elderly people with sensorineural hearing loss

    PubMed Central

    Lacerda, Clara Fonseca; Silva, Luciana Oliveira e; de Tavares Canto, Roberto SĂ©rgio; Cheik, Nadia Carla

    2012-01-01

    Summary Introduction: The aging process provokes structural modifications and functional to it greets, compromising the postural control and central processing. Studies have boarded the necessity to identify to the harmful factors of risk to aged the auditory health and security in stricken aged by auditory deficits and with alterations of balance. Objective: To evaluate the effect of auditory prosthesis in the quality of life, the balance and the fear of fall in aged with bilateral auditory loss. Method: Carried through clinical and experimental study with 56 aged ones with sensorineural auditory loss, submitted to the use of auditory prosthesis of individual sonorous amplification (AASI). The aged ones had answered to the questionnaires of quality of life Short Form Health Survey (SF-36), Falls Efficacy International Scale- (FES-I) and the test of Berg Balance Scale (BBS). After 4 months, the aged ones that they adapted to the use of the AASI had been reevaluated. Results: It had 50% of adaptation of the aged ones to the AASI. It was observed that the masculine sex had greater difficulty in adapting to the auditory device and that the variable age, degree of loss, presence of humming and vertigo had not intervened with the adaptation to auditory prosthesis. It had improvement of the quality of life in the dominance of the State General Health (EGS) and Functional Capacity (CF) and of the humming, as well as the increase of the auto-confidence after adaptation of auditory prosthesis. Conclusion: The use of auditory prosthesis provided the improvement of the domains of the quality of life, what it reflected consequently in one better auto-confidence and in the long run in the reduction of the fear of fall in aged with sensorineural auditory loss. PMID:25991930

  8. Effective fall treatment of Varroa jacobsoni (Acari: Varroidae) with a new formulation of formic acid in colonies of Apis mellifera (Hymenoptera: Apidae) in the northeastern United States.

    PubMed

    Calderone, N W

    2000-08-01

    New formulations of formic acid and thymol, both individually and in combination with various essential oils, were compared with Apistan to determine their efficacy as fall treatments for control of Varroa jacobsoni (Oudemans), a parasitic mite of the honey bee, Apis mellifera L. Percent mite mortality in colonies treated with 300 ml of 65% formic acid averaged 94.2 +/- 1.41% (least square means +/- SE, n = 24), equivalent to those receiving four, 10% strips of Apistan (92.6 +/- 1.79%, n = 6). Treatment with thymol (n = 24) resulted in an average mite mortality of 75.4 +/- 5.79%, significantly less than that attained with Apistan or formic acid. The addition of essential oils did not affect treatment efficacy of either formic acid or thymol. The ratio of the coefficients of variation for percentage mortality for the formic acid (CVFA) and Apistan (CVA) groups was CVFA/CVA = 0.66. This indicates that the formic acid treatment was as consistent as the Apistan treatment. Thymol treatments did not provide as consistent results as Apistan or formic acid. Coefficient variation ratios for percentage mortality for the thymol group (CVT) with the Apistan and formic acid groups were CVT/CVA = 4.47 and CVT/CVFA = 6.76, respectively. In a second experiment, colonies received a 4-wk fall treatment of either 300 ml of 65% formic acid (n = 24) or four, 10% strips of Apistan (n = 6). The next spring, mite levels in the formic acid group (554.3 +/- 150.20 mites) were similar to those in the Apistan treatment group (571.3 +/- 145.05 mites) (P = 0.93). Additionally, the quantities of bees, brood, pollen, and nectar/honey in the two treatment groups were not significantly different (P > or = 0.50 each variable). These results suggest that formic acid is an effective alternative to Apistan as a fall treatment for varroa mites in temperate climates. PMID:10985013

  9. Characteristics of outdoor falls among older people: a qualitative study

    PubMed Central

    2013-01-01

    Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people. PMID:24245830

  10. Accelerating Recovery from Poverty: Prevention Effects for Recently Separated Mothers

    ERIC Educational Resources Information Center

    Forgatch, Marion S.; DeGarmo, David S.

    2007-01-01

    This study evaluated benefits of a preventive intervention to the living standards of recently separated mothers. In the Oregon Divorce Study's randomized experimental design, data were collected 5 times over 30 months and evaluated with Hierarchical Linear Growth Models. Relative to their no-intervention control counterparts, experimental mothers…

  11. Adolescent Pregnancy Prevention Programs: Theoretical Models for Effective Program Development

    ERIC Educational Resources Information Center

    Saunders, Jeanne A.

    2005-01-01

    Adolescent pregnancy and parenting remains a pressing social and public health concern because the United States continues to have the highest teen pregnancy rate among Western developed nations and because of the attendant social, psychological, and physical problems for young parents and their children. Prevention efforts to reduce the incidence


  12. Adolescent Pregnancy Prevention Programs: Theoretical Models for Effective Program Development

    ERIC Educational Resources Information Center

    Saunders, Jeanne A.

    2005-01-01

    Adolescent pregnancy and parenting remains a pressing social and public health concern because the United States continues to have the highest teen pregnancy rate among Western developed nations and because of the attendant social, psychological, and physical problems for young parents and their children. Prevention efforts to reduce the incidence…

  13. Teen Depression and Suicide: Effective Prevention and Intervention Strategies

    ERIC Educational Resources Information Center

    King, Keith A.; Vidourek, Rebecca A.

    2012-01-01

    Teen depression and suicidal behaviors are intricately intertwined, with untreated depression being a leading cause of adolescent suicide. Most depressed or suicidal teens tend to show warning signs and possess specific risk factors. A key component to preventing teen depression is for adults to remain aware of such warning signs and risk factors


  14. Effective School-Based Substance Abuse Prevention Programs.

    ERIC Educational Resources Information Center

    Hickin, Nancy L.; Christenberry, Nola J.

    Substance abuse among school age youth continues to be a significant and costly problem in U.S. society. Schools are asked with increasing frequency to become involved in finding and implementing solutions. A review of the literature regarding school-based substance abuse prevention programs reveals their evolution from a basic informational…

  15. Effectiveness of a School-Based Substance Abuse Prevention Program.

    ERIC Educational Resources Information Center

    Shope, Jean T.; And Others

    1996-01-01

    A grade five through grade eight substance abuse prevention program was developed, implemented, and evaluated. Students received either two years of the program or none. At the end of grade seven, program students' rates of substance use slowed significantly and knowledge of alcohol pressures increased compared to non-program students. (RJM)

  16. Disseminating Effective Community Prevention Practices: Opportunities for Social Work Education

    ERIC Educational Resources Information Center

    Hawkins, J. David; Shapiro, Valerie B.; Fagan, Abigail A.

    2010-01-01

    In the United States, about 17% of adolescents meet diagnostic criteria for mental, emotional, and behavioral (MEB) disorders. Six million young people receive treatment services annually for mental, emotional, or behavioral problems. These problems affect one in five families and cost $247 million annually. Some strategies for preventing MEB


  17. How HIV treatment could result in effective prevention

    PubMed Central

    Venkatesh, Kartik K; Lurie, Mark N; Mayer, Kenneth H

    2010-01-01

    As the number of HIV infections continues to surpass treatment capacity, new HIV prevention strategies are imperative. Beyond individual clinical benefits, by rendering an individual less infectious, expanding access to highly active antiretroviral therapy (HAART) could also have a larger public health impact of curbing new HIV infections. Recent guidelines have moved towards initiating HAART at higher CD4 cell counts, thus increasing the number of individuals in need of treatment. A new treatment strategy is wanting that can simultaneously curb the epidemic and provide necessary treatment to those most in need. A recent debate has centered on whether an expansion of free and universal treatment, regardless of CD4 cell count, could be a means of HIV prevention. In light of the growing access to HAART in resource-limited settings and increasing evidence suggesting the clinical and prevention benefits of initiating treatment at higher CD4 cell counts, it is conceivable that, in the future, HAART will be an integral part of both individual-level clinical treatment programs as well as public health-based HIV prevention interventions. PMID:20814447

  18. Disseminating Effective Community Prevention Practices: Opportunities for Social Work Education

    ERIC Educational Resources Information Center

    Hawkins, J. David; Shapiro, Valerie B.; Fagan, Abigail A.

    2010-01-01

    In the United States, about 17% of adolescents meet diagnostic criteria for mental, emotional, and behavioral (MEB) disorders. Six million young people receive treatment services annually for mental, emotional, or behavioral problems. These problems affect one in five families and cost $247 million annually. Some strategies for preventing MEB…

  19. Teen Depression and Suicide: Effective Prevention and Intervention Strategies

    ERIC Educational Resources Information Center

    King, Keith A.; Vidourek, Rebecca A.

    2012-01-01

    Teen depression and suicidal behaviors are intricately intertwined, with untreated depression being a leading cause of adolescent suicide. Most depressed or suicidal teens tend to show warning signs and possess specific risk factors. A key component to preventing teen depression is for adults to remain aware of such warning signs and risk factors…

  20. Effects of Hyporheic Exchange Flows on Egg Pocket Water Temperature in Snake River Fall Chinook Salmon Spawning Areas, 2002-2003 Final Report.

    SciTech Connect

    Hanrahan, T.; Geist, D.; Arntzen, C.

    2004-09-01

    The development of the Snake River hydroelectric system has affected fall Chinook salmon smolts by shifting their migration timing to a period (mid- to late-summer) when downstream reservoir conditions are unfavorable for survival. Subsequent to the Snake River Chinook salmon fall-run Evolutionary Significant Unit being listed as Threatened under the Endangered Species Act, recovery planning has included changes in hydrosystem operations (e.g., summer flow augmentation) to improve water temperature and flow conditions during the juvenile Chinook salmon summer migration period. In light of the limited water supplies from the Dworshak reservoir for summer flow augmentation, and the associated uncertainties regarding benefits to migrating fall Chinook salmon smolts, additional approaches for improved smolt survival need to be evaluated. This report describes research conducted by the Pacific Northwest National Laboratory (PNNL) that evaluated relationships among river discharge, hyporheic zone characteristics, and egg pocket water temperature in Snake River fall Chinook salmon spawning areas. This was a pilot-scale study to evaluate these relationships under existing operations of Hells Canyon Dam (i.e., without any prescribed manipulations of river discharge) during the 2002-2003 water year. The project was initiated in the context of examining the potential for improving juvenile Snake River fall Chinook salmon survival by modifying the discharge operations of Hells Canyon Dam. The potential for improved survival would be gained by increasing the rate at which early life history events proceed (i.e., incubation and emergence), thereby allowing smolts to migrate through downstream reservoirs during early- to mid-summer when river conditions are more favorable for survival. PNNL implemented this research project at index sites throughout 160 km of the Hells Canyon Reach (HCR) of the Snake River. The HCR extends from Hells Canyon Dam (river kilometer [rkm] 399) downstream to the upper end of Lower Granite Reservoir near rkm 240. We randomly selected 14 fall Chinook salmon spawning locations as study sites, which represents 25% of the most used spawning areas throughout the HCR. Interactions between river water and pore water within the riverbed (i.e., hyporheic zone) at each site were quantified through the use of self-contained temperature and water level data loggers suspended inside of piezometers. Surrounding the piezometer cluster at each site were 3 artificial egg pockets. In mid-November 2002, early-eyed stage fall Chinook salmon eggs were placed inside of perforated polyvinyl chloride (PVC) tubes, along with a temperature data logger, and buried within the egg pockets. Fall Chinook salmon eggs were also incubated in the laboratory for the purpose of developing growth curves that could be used as indicators of emergence timing. The effects of discharge on vertical hydrologic exchange between the river and riverbed were inferred from measured temperature gradients between the river and riverbed, and the application of a numerical model. The hydrologic regime during the 2002-2003 sampling period exhibited one of the lowest, most stable daily discharge patterns of any of the previous 12 water years. The vertical hydraulic gradients (VHG) between the river and the riverbed suggested the potential for predominantly small magnitude vertical exchange. The VHG also showed little relationship to changes in river discharge at most sites. Despite the relatively small vertical hydraulic gradients at most sites, results from the numerical modeling of riverbed pore water velocity and hyporheic zone temperatures suggested that there was significant vertical hydrologic exchange during all time periods. The combined results of temperature monitoring and numerical modeling indicate that only 2 of 14 sites were significantly affected by short-term (hourly to daily) large magnitude changes in discharge. Although the two sites exhibited acute flux reversals between river water and hyporheic water resulting from short-term large magnitude changes in discharge, these flux reversals had minimal effect on emergence timing estimates. Indeed, the emergence timing estimates at all sites were largely unaffected by the changes in river stage resulting from hydropower operations at Hells Canyon Dam. Our results indicate that the range of emergence timing estimates due to differences among the eggs from different females can be as large as or larger than the emergence timing estimates due to site differences (i.e., bed temperatures among sites). We conclude that during the 2002-2003 fall Chinook salmon incubation period, hydropower operations of Hells Canyon Dam had an insignificant effect on fry emergence timing at the study sites.

  1. Optimizing Violence Prevention Programs: An Examination of Program Effectiveness among Urban High School Students

    ERIC Educational Resources Information Center

    Thompkins, Amanda C.; Chauveron, Lisa M.; Harel, Ofer; Perkins, Daniel F.

    2014-01-01

    Background: While demand for youth violence prevention programs increases, the ability of the school-day schedule to accommodate their time requirements has diminished. Viable school-based prevention programs must strike a balance between brevity and effectiveness. This article reports results from an effectiveness trial of a 12-session…

  2. The Cost and Effectiveness of School-Based Preventive Dental Care.

    ERIC Educational Resources Information Center

    Klein, Stephen P.; And Others

    1985-01-01

    The cost and effectiveness of various types and combinations of school-based preventive dental care procedures were assessed in the National Preventive Dentistry Demonstration Program, a four-year study involving more than 20,000 students, from ten schools nationwide. Communal water fluoridation was reaffirmed as the most cost-effective means of…

  3. Optimizing Violence Prevention Programs: An Examination of Program Effectiveness among Urban High School Students

    ERIC Educational Resources Information Center

    Thompkins, Amanda C.; Chauveron, Lisa M.; Harel, Ofer; Perkins, Daniel F.

    2014-01-01

    Background: While demand for youth violence prevention programs increases, the ability of the school-day schedule to accommodate their time requirements has diminished. Viable school-based prevention programs must strike a balance between brevity and effectiveness. This article reports results from an effectiveness trial of a 12-session


  4. Effects of the rate of muscle post mortem pH fall on the technological quality of turkey meat.

    PubMed

    Fernandez, X; Santé, V; Baeza, E; Lebihan-Duval, E; Berri, C; Rémignon, H; Babilé, R; Le Pottier, G; Astruc, T

    2002-05-01

    1. This experiment evaluated the influence of the rate of post mortem pH fall on the processing ability of turkey meat. 2. Four hundred and twenty male turkeys from a selected pure line (grand-parental female line, BUT Ltd) were slaughtered at 16 weeks of age in a commercial plant and pH was measured in the Pectoralis superficialis (PS) and Ilio tibialis (IT) muscles, at 20 min post mortem. Three groups of PS muscle differing in pH20 and two groups of IT muscle differing in pH20 were constituted and processed as cured-cooked white meat and turkey ham, respectively. 3. The technological yield was lower in the groups showing the lowest pH20 (97.4% at pH20 5.90 vs 98.6 and 98.3% at pH20 6.24 and 6.55, respectively, for white meat and 97.2% (pH20 6.28) vs 98.3% (pH20 6.56) for turkey hams). The groups showing the lowest pH20 also showed higher drip loss in commercially packed products. 4. Acceptability tests of processed products were carried out in the commercial plant. Texture and taste of white meat were better in the highest pH group but the overall impression was similar in the lowest and the highest pH groups (mean scores of 4.2 and 4.1, respectively), due to better colour in the former (mean scores of 4.4 for the lowest pH20 group vs 4.0 and 3.9 for the medium and highest pH20 groups, respectively). 5. For turkey hams, the meat processed from the highest pH group got the best score for all items. PMID:12047089

  5. Prevention System Mediation of Communities That Care Effects on Youth Outcomes

    PubMed Central

    Hawkins, J. David; Rhew, Isaac C.; Shapiro, Valerie B.; Abbott, Robert D.; Oesterle, Sabrina; Arthur, Michael W.; Briney, John S.; Catalano, Richard F.

    2013-01-01

    This study examined whether the significant intervention effects of the Communities That Care (CTC) prevention system on youth problem behaviors observed in a panel of eighth-grade students (Hawkins et al. Archives of Pediatrics and Adolescent Medicine 163:789–798 2009) were mediated by community-level prevention system constructs posited in the CTC theory of change. Potential prevention system constructs included the community’s degree of (a) adoption of a science-based approach to prevention, (b) collaboration on prevention activities, (c) support for prevention, and (d) norms against adolescent drug use as reported by key community leaders in 24 communities. Higher levels of community adoption of a science-based approach to prevention and support for prevention in 2004 predicted significantly lower levels of youth problem behaviors in 2007, and higher levels of community norms against adolescent drug use predicted lower levels of youth drug use in 2007. Effects of the CTC intervention on youth problem behaviors by the end of eighth grade were mediated fully by community adoption of a science-based approach to prevention. No other significant mediated effects were found. Results support CTC’s theory of change that encourages communities to adopt a science- based approach to prevention as a primary mechanism for improving youth outcomes. PMID:23828448

  6. The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk?

    PubMed Central

    Segev-Jacubovski, Orit; Herman, Talia; Yogev-Seligmann, Galit; Mirelman, Anat; Giladi, Nir; Hausdorff, Jeffrey M

    2011-01-01

    In this article, we briefly summarize the incidence and significant consequences of falls among older adults, the insufficient effectiveness of commonly used multifactorial interventions and the evidence linking falls and cognitive function. Recent pharmacologic and nonpharmacologic studies that evaluated the effects of cognitive therapy on fall risk are reviewed. The results of this article illustrate the potential utility of multiple, diverse forms of cognitive therapy for reducing fall risk. The article also indicates that large-scale, randomized controlled trials are warranted and that additional research is needed to better understand the pathophysiologic mechanisms underlying the interplay between human mobility, fall risk and cognitive function. Nonetheless, we suggest that multimodality interventions that combine motor and cognitive therapy should, eventually, be incorporated into clinical practice to enable older adults and patients to move safer and with a reduced fall risk. PMID:21721921

  7. Modern Rehabilitation in Osteoporosis, Falls, and Fractures

    PubMed Central

    Dionyssiotis, Yannis; Skarantavos, Grigorios; Papagelopoulos, Panayiotis

    2014-01-01

    In prevention and management of osteoporosis, modern rehabilitation should focus on how to increase muscular and bone strength. Resistance exercises are beneficial for muscle and bone strength, and weight-bearing exercises help maintain fitness and bone mass. In subjects at higher risk for osteoporotic fractures, particular attention should be paid to improving balance – the most important element in falls prevention. Given the close interaction between osteoporosis and falls, prevention of fractures should be based on factors related to bone strength and risk factors for falls. Fractures are the most serious complication of osteoporosis and may be prevented. The use of modern spinal orthosis helps to reduce pain and improve posture. Vibration platforms are used in rehabilitation of osteoporosis, based on the concept that noninvasive, short-duration, mechanical stimulation could have an impact on osteoporosis risk. Pharmacologic therapy should be added for those at high risk of fracture, and vitamin D/calcium supplementation is essential in all prevention strategies. Success of rehabilitation in osteoporotic and fractured subjects through an individualized educational approach optimizes function to the highest level of independence while improving the overall quality of life. PMID:24963273

  8. Efficacy, effectiveness and side effects of medications used to prevent fractures.

    PubMed

    Reid, I R

    2015-06-01

    There is an increasing number of effective therapies for fracture prevention in adults at risk of osteoporosis. However, shortcomings in the evidence underpinning our management of osteoporosis still exist. Evidence of antifracture efficacy in the groups of patients who most commonly use calcium and vitamin D supplements is lacking, the safety of calcium supplements is in doubt, and the safety and efficacy of high doses of vitamin D give cause for concern. Alendronate, risedronate, zoledronate and denosumab have been shown to prevent spine, nonspine and hip fractures; in addition, teriparatide and strontium ranelate prevent both spine and nonspine fractures, and raloxifene and ibandronate prevent spine fractures. However, most trials provide little information regarding long-term efficacy or safety. A particular concern at present is the possibility that oral bisphosphonates might cause atypical femoral fractures. Observational data suggest that the incidence of this type of fracture increases steeply with duration of bisphosphonate use, resulting in concern that the benefit-risk balance may become negative in the long term, particularly in patients in whom the osteoporotic fracture risk is not high. Therefore, reappraisal of ongoing use of bisphosphonates after about 5 years is endorsed by expert consensus, and 'drug holidays' should be considered at this time. Further studies are needed to guide clinical practice in this area. PMID:25495429

  9. Effect of Emergent Aquatic Vegetation on Sediment Transport Within the St. Anthony Falls Laboratory Outdoor StreamLab

    NASA Astrophysics Data System (ADS)

    Lightbody, A.; Rominger, J. T.; Nepf, H. M.; Paola, C.

    2008-12-01

    Riparian vegetation on channel bars and banks can significantly influence flow, sediment transport, and channel morphology within fluvial systems. Changes in flow and sedimentation, caused by vegetation, may reciprocally affect biological stability and growth. Model predictions were tested against field-scale measurements obtained within the Outdoor StreamLab~(OSL) at the St. Anthony Falls Laboratory~(SAFL). Two floodway basins adjacent to SAFL's main building are being transformed into a new outdoor laboratory to study physical, chemical, and biological interactions among a channel, its floodplain, and wetland vegetation. Experiments were conducted within a 3-m-wide, 30-cm-deep, and 50-m-long sand-bed meandering channel constructed within the first of two OSL basins, which has a total length of 40~m and a total width of 20~m. Water discharge varied between 36 ± 6~L/s at base flow to 210 ± 20~L/s during weekly 9-hour-long bankfull flood events. Bed sediment (d50 = 0.7~mm) was also metered continuously into the channel. When constructed, the bed was flat, but beginning with the first flood event the streamflow created point bars on the inside of two replicate meander bends. Seedlings of native wetland vegetation species, including Juncus effusus and Scirpus atrovirens, were planted from the baseflow waterline to the top of bank along one side of the meandering channel, including all exposed areas of one point bar. Vegetation frontal area was measured in situ using photographs of the vegetation against a red board. Bed erosion was quantified as the time for a thin layer of sediment to be removed from flexible contrasting-color tiles mounted flush with the bed surface. All trials were repeated at different neighboring locations to sample the spatial heterogeneity at the stem scale. Erosion rates were significantly higher on the inside of meander bends, when compared both to the outside of meander bends and to riffle (straight) reaches. Moreover, in all of these locations erosion rates were lower when aquatic vegetation was present. Results suggest that the velocity within a patch of vegetation correlates with the potential for sediment trapping within the patch.

  10. Falls resulting from a laboratory-induced slip occur at a higher rate among individuals who are obese.

    PubMed

    Allin, Leigh J; Wu, Xuefang; Nussbaum, Maury A; Madigan, Michael L

    2016-03-21

    Falls due to slipping are a serious concern, with slipping estimated to cause 40-50% of all fall-related injuries. Epidemiological data indicates that older and obese adults experience more falls than young, non-obese individuals. An increasingly heavier and older U.S. population and workforce may be exacerbating the problem of slip-induced falls. The purpose of this study was to investigate the effects of obesity and age on slip severity and rate of falling resulting from laboratory-induced slips. Four groups of participants (young obese, young non-obese, older obese, older non-obese) were slipped while walking at a self-selected, slightly hurried pace. Slip severity (slip distance, slip duration, mean slip speed and peak slip speed) and slip outcome (fall or recovery) were compared between groups. Obese individuals experienced 22% faster slips than non-obese individuals in terms of mean slip speed (p=0.022). Obesity did not affect slip distance, slip duration or peak slip speed. Obese individuals also exhibited a higher rate of falls; 32% of obese individuals fell compared to 10% of non-obese (p=0.005). Obese individuals were more than eight times more likely to experience a fall than non-obese individuals when adjusting for age, gender and gait speed. No age effects were found for slip severity or slip outcome. These results, along with epidemiological data reporting higher fall rates among the obese, indicate that obesity may be a significant risk factor for experiencing slip-induced falls. Slip severity thresholds were also reported that may have value in developing controls for fall prevention. PMID:26897650

  11. [Current prevention and treatment strategies for osteoporosis : Fracture-oriented, effective, low side effects and inexpensive].

    PubMed

    Bartl, R; Bartl, C

    2015-12-01

    Osteoporosis is still an underdiagnosed and insufficiently therapied widespread disease in Germany. Of the estimated 7 million osteoporosis patients only 1.5 million receive a guideline conform diagnosis and even less receive appropriate treatment. Some 90 % of patients are provided with analgesics but only 10 % receive an effective therapy, although efficacious, well-tested and affordable medications are available. In addition, approximately one half of the patients terminate treatment after only 1 year although according to the results of recent studies the duration of therapy should be at least 3-5 years. In view of the increasing average life expectancy, a consistent management for prevention of fractures associated with osteoporosis is always most important for society, even if only for reasons of costs. Achievement of this target depends on four circumstances: clarification of the origin of osteoporosis and fractures (bone consciousness), prophylaxis of bone loss and fractures (primary prevention), consistent guideline conform diagnostics and therapy (secondary and tertiary prevention) and cooperation of all disciplines in medicine (bone is everybody's business). This article describes the current state of diagnostics (bone density measurement with dual X-ray absorptiometry, FRAX¼), prophylaxis of fractures (screening program) and therapy (use of economic and effective medications with low side effects). Novel medications are already undergoing clinical testing and a "healing" of bone reduction with restoration of the normal bone structure is to be expected. PMID:26452578

  12. Death Rates from Major Illnesses Fall in U.S.

    MedlinePLUS

    ... nlm.nih.gov/medlineplus/news/fullstory_155367.html Death Rates From Major Illnesses Fall in U.S. Prevention ... Cancer Society researchers analyzed age-standardized rates of death for six leading diseases and conditions over nearly ...

  13. Testing the Universality of the Effects of the Communities That Care Prevention System for Preventing Adolescent Drug Use and Delinquency

    PubMed Central

    Oesterle, Sabrina; Hawkins, J. David; Fagan, Abigail A.; Abbott, Robert D.; Catalano, Richard F.

    2010-01-01

    Universal community-oriented interventions are an important component in the prevention of youth health and behavior problems. Testing the universality of the effects of an intervention that was designed to be universal is important because it provides information about how the program operates and for whom and under what conditions it is most effective. The present study examined whether the previously established significant effects of the universal, community-based Communities That Care (CTC) prevention program on the prevalence of substance use and the variety of delinquent behaviors held equally for boys and girls and in risk-related subgroups defined by early substance use, early delinquency, and high levels of community-targeted risk at baseline. Interaction analyses of data from a panel of 4,407 students followed from Grade 5 to Grade 8 in the first randomized trial of CTC in 12 matched community pairs suggests that CTC reduced students' substance use and delinquency equally across risk-related subgroups and gender, with two exceptions: the effect of CTC on reducing substance use in 8th grade was stronger for boys than girls and the impact of CTC on reducing 8th-grade delinquency was stronger for students who were nondelinquent at baseline. PMID:20422289

  14. [Spain's process of passing effective smoking prevention legislation].

    PubMed

    Córdoba, Rodrigo; Villalbí, Joan R; Salvador-Llivina, Teresa; López-García Aranda, Víctor

    2006-01-01

    The prevention movement has been the key agent involved in smoking control policies. This study describes the context and the process in which Law 28/2005 was passed in Spain with a synthesis of its substance. It provides the background of the events leading up to Spain's current smoking control law in addition to an analysis of the role played by the different social actors in the process and the arguments and strategies employed in opposition by the tobacco industry. A review is also provided of the political agents, highlighting that decentralized countries have further problems in enforcing regulations. This case offers lessons for the future. PMID:17147303

  15. Towards the prevention of potential aluminum toxic effects and an effective treatment for Alzheimer's disease.

    PubMed

    Percy, Maire E; Kruck, Theo P A; Pogue, Aileen I; Lukiw, Walter J

    2011-11-01

    In 1991, treatment with low dose intramuscular desferrioxamine (DFO), a trivalent chelator that can remove excessive iron and/or aluminum from the body, was reported to slow the progression of Alzheimer's disease (AD) by a factor of two. Twenty years later this promising trial has not been followed up and why this treatment worked still is not clear. In this critical interdisciplinary review, we provide an overview of the complexities of AD and involvement of metal ions, and revisit the neglected DFO trial. We discuss research done by us and others that is helping to explain involvement of metal ion catalyzed production of reactive oxygen species in the pathogenesis of AD, and emerging strategies for inhibition of metal-ion toxicity. Highlighted are insights to be considered in the quests to prevent potentially toxic effects of aluminum toxicity and prevention and intervention in AD. PMID:22099160

  16. Preventive effects of cranberry products on experimental colitis induced by dextran sulphate sodium in mice.

    PubMed

    Xiao, Xiao; Kim, Jonggun; Sun, Quancai; Kim, Daeyoung; Park, Cheon-Seok; Lu, Tzong-Shi; Park, Yeonhwa

    2015-01-15

    With the prevalence of inflammatory bowel disease (IBD) and its associated risk for development of colorectal cancer, it is of great importance to prevent and treat IBD. However, due to the complexity of etiology and potentially serious adverse effects, treatment options for IBD are relatively limited. Thus, the purpose of this study was to identify a safe food-based approach for the prevention and treatment of IBD. In this study, we tested the effects of cranberry products on preventing dextran sulphate sodium-induced murine colitis. Our results suggest that both cranberry extract and dried cranberries-fed groups had a significantly reduced disease activity index, where dried cranberries were more effective in preventing colitis than cranberry extract. Shortening of colon length, colonic myeloperoxidase activity and production of pro-inflammatory cytokines were attenuated in animals fed dried cranberries compared to the controls. The current report suggests that cranberries can be applied to prevent and reduce the symptoms of IBD. PMID:25149009

  17. Stacked Deck: An Effective, School-Based Program for the Prevention of Problem Gambling

    ERIC Educational Resources Information Center

    Williams, Robert J.; Wood, Robert T.; Currie, Shawn R.

    2010-01-01

    School-based prevention programs are an important component of problem gambling prevention, but empirically effective programs are lacking. Stacked Deck is a set of 5-6 interactive lessons that teach about the history of gambling; the true odds and "house edge"; gambling fallacies; signs, risk factors, and causes of problem gambling; and skills


  18. Testing Mediators of Intervention Effects in Randomized Controlled Trials: An Evaluation of Three Depression Prevention Programs

    ERIC Educational Resources Information Center

    Stice, Eric; Rohde, Paul; Seeley, John R.; Gau, Jeff M.

    2010-01-01

    Objective: Evaluate a new 5-step method for testing mediators hypothesized to account for the effects of depression prevention programs. Method: In this indicated prevention trial, at-risk teens with elevated depressive symptoms were randomized to a group cognitive-behavioral (CB) intervention, group supportive expressive intervention, CB


  19. Effective Instruction. National Dropout Prevention Center/Network Newsletter. Volume 21, Number 2

    ERIC Educational Resources Information Center

    Duckenfield, Marty, Ed.

    2009-01-01

    The "National Dropout Prevention Newsletter" is published quarterly by the National Dropout Prevention Center/Network. This issue contains the following articles: (1) Strategies for Success (Charles W. Hatch); (2) 2009 NDPN Crystal Star Winners; (3) Strategies for More Effective Instruction (Micki Gibson); (4) Some Thoughts on Teaching Strategies…

  20. Effects of Comprehensive, Multiple High-Risk Behaviors Prevention Program on High School Students

    ERIC Educational Resources Information Center

    Collier, Crystal

    2013-01-01

    The purpose of this mixed methods study was to examine the effect of a multiple high-risk behaviors prevention program applied comprehensively throughout an entire school-system involving universal, selective, and indicated levels of students at a local private high school during a 4-year period. The prevention program was created based upon the…

  1. The Effect of a College Sexual Assault Prevention Program on First-Year Students' Victimization Rates

    ERIC Educational Resources Information Center

    Rothman, Emily; Silverman, Jay

    2007-01-01

    Objective: Although a variety of sexual assault prevention programs are currently available to college health professionals, there is a dearth of information about the effect of these programs on sexual assault victimization rates. Participants: The authors evaluated the efficacy of a sexual assault prevention program for first-year students at a…

  2. The European Smoking Prevention Framework Approach (ESFA): Effects after 24 and 30 Months

    ERIC Educational Resources Information Center

    de Vries, Hein; Dijk, Froukje; Wetzels, Joyce; Mudde, Aart; Kremers, Stef; Ariza, Carles; Vitoria, Paulo Duarte; Fielder, Anne; Holm, Klavs; Janssen, Karin; Lehtovuori, Riku; Candel, Math

    2006-01-01

    The European Smoking Prevention Framework Approach (ESFA) study in six countries tested the effects of a comprehensive smoking prevention approach after 24 (T3; N = 10751) and 30 months (T4; N = 9282). The programme targeted four levels, i.e. adolescents in schools, school policies, parents and the community. In Portugal, 12.4% of the T1…

  3. Effects of Comprehensive, Multiple High-Risk Behaviors Prevention Program on High School Students

    ERIC Educational Resources Information Center

    Collier, Crystal

    2013-01-01

    The purpose of this mixed methods study was to examine the effect of a multiple high-risk behaviors prevention program applied comprehensively throughout an entire school-system involving universal, selective, and indicated levels of students at a local private high school during a 4-year period. The prevention program was created based upon the


  4. Stacked Deck: An Effective, School-Based Program for the Prevention of Problem Gambling

    ERIC Educational Resources Information Center

    Williams, Robert J.; Wood, Robert T.; Currie, Shawn R.

    2010-01-01

    School-based prevention programs are an important component of problem gambling prevention, but empirically effective programs are lacking. Stacked Deck is a set of 5-6 interactive lessons that teach about the history of gambling; the true odds and "house edge"; gambling fallacies; signs, risk factors, and causes of problem gambling; and skills…

  5. Testing Mediators of Intervention Effects in Randomized Controlled Trials: An Evaluation of Three Depression Prevention Programs

    ERIC Educational Resources Information Center

    Stice, Eric; Rohde, Paul; Seeley, John R.; Gau, Jeff M.

    2010-01-01

    Objective: Evaluate a new 5-step method for testing mediators hypothesized to account for the effects of depression prevention programs. Method: In this indicated prevention trial, at-risk teens with elevated depressive symptoms were randomized to a group cognitive-behavioral (CB) intervention, group supportive expressive intervention, CB…

  6. Effective Instruction. National Dropout Prevention Center/Network Newsletter. Volume 21, Number 2

    ERIC Educational Resources Information Center

    Duckenfield, Marty, Ed.

    2009-01-01

    The "National Dropout Prevention Newsletter" is published quarterly by the National Dropout Prevention Center/Network. This issue contains the following articles: (1) Strategies for Success (Charles W. Hatch); (2) 2009 NDPN Crystal Star Winners; (3) Strategies for More Effective Instruction (Micki Gibson); (4) Some Thoughts on Teaching Strategies


  7. The Cost and Effectiveness of School-Based Preventive Dental Care.

    ERIC Educational Resources Information Center

    Klein, Stephen P.; And Others

    The National Preventive Dentistry Demonstration Program assessed the cost and effectiveness of various types and combinations of school-based preventive dental care procedures. The program involved 20,052 first, second, and fifth graders from five fluoridated and five non-fluoridated communities. These children were examined at baseline and…

  8. Effects of a Single-Lesson Tobacco Prevention Curriculum on Knowledge, Skill Identification and Smoking Intention

    ERIC Educational Resources Information Center

    Brown, Stephen; Birch, David; Thyagaraj, Sujan; Teufel, James; Phillips, Cheryl

    2007-01-01

    One in five students report experimenting with tobacco before the age of 13 and most prevention efforts take place in the school setting. This study measures the effect of a single-lesson tobacco prevention curriculum, conducted by a health education center, focusing on knowledge of tobacco, ability to identify refusal techniques, and intent not


  9. Fall 2005 Enrollment Report

    ERIC Educational Resources Information Center

    West Virginia Higher Education Policy Commission, 2005

    2005-01-01

    This annual report includes the following information presented in tabular form: (1) Location of West Virginia Public Institutions of Higher Education; (2) Location of West Virginia Independent Institutions of Higher Education; (3) Freshmen Headcount Enrollment, by Attendance Status, Early Fall 2005; (4) Headcount Enrollment by Residence,…

  10. Fall 2013 International Comparisons

    ERIC Educational Resources Information Center

    Northwest Evaluation Association, 2014

    2014-01-01

    This Fall report is an aggregated statistical analysis of Measures of Academic Progressź (MAPź) data from international schools. The report provides a consistent means of comparisons of specific sub-groups by subject and grade, which allows partners to compare their MAPź results with other schools within their region or membership organization.…

  11. Editors' Fall Picks

    ERIC Educational Resources Information Center

    Heilbrun, Margaret; McCormack, Heather; Katterjohn, Anna; Kuzyk, Raya; Roncevic, Mirela; Fox, Bette-Lee; Hoffert, Barbara

    2009-01-01

    "Library Journal's" review editors select fall titles readers won't want to miss--"Waiting on a Train: The Embattled Future of Passenger Rail Service" (James McCommons); "Happy" (Alex Lemon); "Free for All: Joe Papp, the Public, and the Greatest Theater Story Ever Told" (Kenneth Turan & Joseph Papp); "In My Father's Shadow: A Daughter Remembers…

  12. Fall 2006 Newsletter

    Cancer.gov

    Diet&Health Stud? Ne?sPublished for Study Participants by the National Cancer Institute Fall 2006 A Hear?fel? Thank? Dear Participant, My team and I are indebted to you and your fellow cohort members for your continued participation in the NIH-AARP Diet

  13. Fall 1984 Retention Study.

    ERIC Educational Resources Information Center

    Peralta Community Coll. District, Oakland, CA. Office of Research, Planning and Development.

    A study was conducted of the retention patterns of students enrolled in the Peralta Community College District (PCCD) in fall 1984 using college reports on withdrawals and grade distributions. The study focused on successful retention (i.e., all students who received a passing grade) and on total retention (i.e., all students who received any…

  14. Fall 1982 Retention Study.

    ERIC Educational Resources Information Center

    Peralta Community Coll. District, Oakland, CA. Office of Research, Planning and Development.

    In fall 1982, a study was conducted in the Peralta Community College District (PCCD) using withdrawal and grade distribution data to analyze student retention patterns. Successful retention rates were based on the percentage of students who received a passing grade, while total retention rates were based on the percentage of students who received…

  15. The News, Fall 2002.

    ERIC Educational Resources Information Center

    Giles, Ray, Ed.

    2002-01-01

    This fall 2002 newsletter from the Community College League of California contains several articles, news stories, and the brochure from the 2002 Annual Convention, "Celebrating the Way California LEARNS." Articles include: (1) "Nursing Shortage Poses Dilemma for Colleges: Access vs. Efficiency," a discussion of the debate over how to increase the


  16. Bridalveil Fall in Fog

    USGS Multimedia Gallery

    In this image, Bridalveil Fall can be seen shrouded in fog from Tunnel View in Yosemite National Park. The waterfall is 617 ft (188 m) in height and is one of the most well-known of Yosemite National Park's waterfalls....

  17. Editors' Fall Picks

    ERIC Educational Resources Information Center

    Heilbrun, Margaret; McCormack, Heather; Katterjohn, Anna; Kuzyk, Raya; Roncevic, Mirela; Fox, Bette-Lee; Hoffert, Barbara

    2009-01-01

    "Library Journal's" review editors select fall titles readers won't want to miss--"Waiting on a Train: The Embattled Future of Passenger Rail Service" (James McCommons); "Happy" (Alex Lemon); "Free for All: Joe Papp, the Public, and the Greatest Theater Story Ever Told" (Kenneth Turan & Joseph Papp); "In My Father's Shadow: A Daughter Remembers


  18. Freshmen Survey. Fall 1985.

    ERIC Educational Resources Information Center

    Goodyear, Don

    In 1985, College of the Sequoias (COS) was asked by the Cooperative Institutional Research Program (conducted jointly by the American Council on Education and the University of California, Los Angeles) to participate in a survey of incoming freshmen for the fall 1985 semester. During the summer counseling session, 259 new COS freshmen were…

  19. Precision Falling Body Experiment

    ERIC Educational Resources Information Center

    Blackburn, James A.; Koenig, R.

    1976-01-01

    Described is a simple apparatus to determine acceleration due to gravity. It utilizes direct contact switches in lieu of conventional photocells to time the fall of a ball bearing. Accuracies to better than one part in a thousand were obtained. (SL)

  20. Illilouette Falls Detail

    USGS Multimedia Gallery

    In this image, Illilouettea Falls, a tributary of the Merced River can be seen just upstream of Happy Isles and the USGS Benchmark Streamgage in Yosemite National Park. The Merced River is a 145 mile (233 km) long tributary of the San Joaquin River. It drains a large section of the Sierra Nevad...