Association of Accelerometry-Measured Physical Activity and Cardiovascular Events in Mobility-Limited Older Adults: The LIFE (Lifestyle Interventions and Independence for Elders) Study.

BACKGROUND:Data are sparse regarding the value of physical activity (PA) surveillance among older adults-particularly among those with mobility limitations. The objective of this study was to examine longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study. METHODS AND RESULTS:Cardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home-based activity data were collected by hip-worn accelerometers at baseline and at 6, 12, and 24 months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 [SD] years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500 steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84-0.96; P=0.001). At baseline, every 30 minutes spent performing activities ≥500 counts per minute (hazard ratio, 0.75; confidence interval, 0.65-0.89 [P=0.001]) were also associated with a lower incidence of cardiovascular events. Throughout follow-up (6, 12, and 24 months), both the number of steps per day (per 500 steps; hazard ratio, 0.90, confidence interval, 0.85-0.96 [P=0.001]) and duration of activity ≥500 counts per minute (per 30 minutes; hazard ratio, 0.76; confidence interval, 0.63-0.90 [P=0.002]) were significantly associated with lower cardiovascular event rates. CONCLUSIONS:Objective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score >10 on the Short Physical Performance Battery) both using baseline and longitudinal data. CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT01072500

The role of conversation in health care interventions: enabling sensemaking and learning

<p>Abstract</p> <p>Background</p> <p>Those attempting to implement changes in health care settings often find that intervention efforts do not progress as expected. Unexpected outcomes are often attributed to variation and/or error in implementation processes. We argue that some unanticipated variation in intervention outcomes arises because unexpected conversations emerge during intervention attempts. The purpose of this paper is to discuss the role of conversation in shaping interventions and to explain why conversation is important in intervention efforts in health care organizations. We draw on literature from sociolinguistics and complex adaptive systems theory to create an interpretive framework and develop our theory. We use insights from a fourteen-year program of research, including both descriptive and intervention studies undertaken to understand and assist primary care practices in making sustainable changes. We enfold these literatures and these insights to articulate a common failure of overlooking the role of conversation in intervention success, and to develop a theoretical argument for the importance of paying attention to the role of conversation in health care interventions.</p> <p>Discussion</p> <p>Conversation between organizational members plays an important role in the success of interventions aimed at improving health care delivery. Conversation can facilitate intervention success because interventions often rely on new sensemaking and learning, and these are accomplished through conversation. Conversely, conversation can block the success of an intervention by inhibiting sensemaking and learning. Furthermore, the existing relationship contexts of an organization can influence these conversational possibilities. We argue that the likelihood of intervention success will increase if the role of conversation is considered in the intervention process.</p> <p>Summary</p> <p>The generation of productive conversation should be considered as one of the foundations of intervention efforts. We suggest that intervention facilitators consider the following actions as strategies for reducing the barriers that conversation can present and for using conversation to leverage improvement change: evaluate existing conversation and relationship systems, look for and leverage unexpected conversation, create time and space where conversation can unfold, use conversation to help people manage uncertainty, use conversation to help reorganize relationships, and build social interaction competence.</p

Environmental baseline study for geothermal development in Puna, Hawaii

With illustrations.The Hawaii Geothermal Project, a coordinated research effort of the University of Hawaii funded by the County and State of Hawaii, as well as ERDA, was initiated in mid-1973 in order to identify and help develop geothermal energy on the Big Island of Hawaii. To develop a geothermal resource, a number of stages preliminary to production are required: exploration and selection of a site for drilling; exploratory drilling; testing to determine critical characteristics of the well or wells; and -- optionally -- operating a model plant to test output potential. By the spring of 1974 Phase I of the Project had been completed, when a site for an exploratory well was located and permission for drilling was obtained from the private corporation owning the site. After the competitive bidding process was completed, a drilling contract was awarded in November, 1975 and actual drilling began in December of last year. The drilling was completed late in April, 1976, when a depth of approximately 6,400 feet had been penetrated -- approximately 6,000 feet below sea level. A slotted liner for the bottom portion of the well was installed in June, 1976. The well flashed spontaneously on 3 July and was blown to rid it of drilling debris on 22 July 1976, after which testing of its physical properties was begun. From the beginning of the Hawaii Geothermal Project, it has been recognized that the successive steps of geothermal development starting with drilling must be carefully scrutinized to ascertain in a timely way if there would be any adverse effects on the environment and local ecosystems, and, should they occur, that it was necessary to identify and recommend measures to minimize such impacts. For this reason, in the summer of 1975, once the drill site had been selected and long before the drilling began, baseline data were collected on critical aspects of environmental conditions as they existed before any significant disturbance by the Project. These included ground water supply, air, soil and the flora, as well as the archaeology of the area surrounding the drill site. In February, 1976 the area was studied to see if it provided a habitat for birds which are endemic, or otherwise of special interest. Generally, the area examined for environmental impact lies within a circle having a radius of approximately a half mile from the center of the four-acre drill site. However, the testing of ground water included sampling wells and a spring more than a mile from the site. Additional tests of the water and air were conducted at the site in June, 1976, after the drilling was completed but before the well was blown to free it of debris accumulated during drilling. The results of that testing, along with results obtained before the drilling began, are summarized in this assessment statement. The results of the pre-drilling studies were such as to enable the University of Hawaii, under the regulations of the Hawaii Environmental Quality Commission, to issue a negative declaration concerning the exploratory hole -- i.e. that the drilling of the well seemed to pose no significant threat to the environment in the vicinity of the well site in Puna, Hawaii. It is hoped and intended that the environmental data established by this study will serve as baselines from which to measure changes which may be associated with geothermal development, not only in the area immediately neighboring the present drill site, but, with appropriate adjustments, for development which may occur elsewhere in the Puna District. How transferable the baselines may be to other areas, say other districts of the Island of Hawaii or to other islands within this archipelago, is a question which must be examined in context as further geothermal exploration is undertaken.U.S. Energy Research & Development AdministrationState of HawaiiCounty of Hawai