Implementation of Project EngAGE: A Leadership Initiative to Improve the Health and Quality of Life of Older Adults in Orange County, NC

Background: The world is aging, creating both challenges and opportunities for improving quality of life for older adults. The number of people worldwide aged 60 years and over is projected to increase from 605 million to 2 billion between 2000 and 2050, doubling from about 11% to 22% of the population in the same time period. North Carolina and Orange County match the national aging trends. The Orange County Department on Aging (OCDOA) Master Aging Plan (MAP) outlines pertinent areas to improve the quality of life for older adults living in Orange County. Project EngAGE is a 12- week action-oriented senior leadership program that addresses two major goals of the MAP: (1) information dissemination and (2) service gap resolution. In Project EngAGE, senior leaders are trained to become resource leaders who address concerns in their communities. Upon graduation from Project EngAGE, senior leaders organize themselves in Senior Resource Teams (SRTs) to collaborate on community projects. Methods: Two major activities were conducted during the Capstone project: (1) development of Project EngAGE and (2) implementation of the first phase of Project EngAGE. To develop Project EngAGE, we established long-term goals, adapted the existing Haywood County EngAGED curriculum to meet the needs of Orange County older adults, and created an evaluation plan and tools for the program. Subsequently, to implement Project EngAGE, we recruited for the program and managed program logistics such as budget creation, session planning and coordination, program facilitation and program evaluation. Results: Our key findings can be sorted into two groups: (1) results from development of Project EngAGE and (2) results from implementation of Project EngAGE. Within the development of Project EngAGE, we created the mission statement, goals, objectives, and logic model for Project EngAGE that informed the development of 12 lesson plans to address a variety of topics. Each lesson plan contains a brief description of the session, objectives, key knowledge points, methods, operational materials, an agenda of the class, and resources related to the topic. The evaluation plan and tools guided the Capstone team to ensure that all of the data were properly collected throughout the implementation of the program. During the implementation of Project EngAGE we recruited 15 senior leaders, exceeding our goal of 10-12, through personal interviews, snowballing and promotional materials. The participants came from a variety of rural communities, including three participants from Bingham, four participants from Little River, and one participant from each of the following communities: Cedar Grove, Mebane, Eno, and New Hope. The implementation of the program led to the development of handouts that can be utilized for future iterations of the program. Additionally, the utilization of the evaluation tools led to a multitude of data that was interpreted and presented in the evaluation report. Feasibility, reach, satisfaction, and fidelity were all achieved. Project EngAGE also resulted in 100% completion rate of the program, an increase in sense of community amongst participants, and high intention to participate in Senior Resource Teams. Discussion: Our Capstone project has significant implications for OCDOA as well as for older adult development, leadership, and volunteerism programs in other settings. The first cohort of Project EngAGE graduates are prepared to act as resource leaders in their respective communities, which will affect how OCDOA will gather information about the needs of Orange County citizens, design programs, and disseminate information to intended recipients of -- or participants in -- their programs. Furthermore, the process of planning and implementing Project EngAGE has created a framework for future iterations of the program that will aid in sustaining the program and network. More globally, the process evaluation findings indicate that this adaptation of Project EngAGE from the Haywood EngAGED model was acceptable and satisfactory to all stakeholders -- program participants, OCDOA staff and administrators, Advisory Committee members, and student implementers. Short-term outcome evaluation findings indicate that Project EngAGE retains the core components of a successful senior leadership program.Master of Public Healt

Barn-Raising on the Digital Frontier: The L.A.U.N.C.H. Collaborative

A meta-analysis of oncology papers from around the world revealed that cancer patients who lived more than 50 miles away from hospital centers routinely presented with more advanced stages of disease at diagnosis, exhibited lower adherence to prescribed treatments, presented with poorer diagnoses, and reported a lower quality of life than patients who lived nearer to care facilities. Connected health approaches—or the use of broadband and telecommunications technologies to evaluate, diagnose, and monitor patients beyond the clinic—are becoming an indispensable tool in medicine to overcome the obstacle of distance

Co-Exposure to Cigarette Smoke and Alcohol Decreases Airway Epithelial Cell Cilia Beating in a Protein Kinase Cε-Dependent Manner

Alcohol use disorders are associated with increased lung infections and exacerbations of chronic lung diseases. Whereas the effects of cigarette smoke are well recognized, the interplay of smoke and alcohol in modulating lung diseases is not clear. Because innate lung defense is mechanically maintained by airway cilia action and protein kinase C (PKC)-activating agents slow ciliary beat frequency (CBF), we hypothesized that the combination of smoke and alcohol would decrease CBF in a PKC-dependent manner. Primary ciliated bronchial epithelial cells were exposed to 5% cigarette smoke extract plus100 mmol/L ethanol for up to 24 hours and assayed for CBF and PKCε. Smoke and alcohol co-exposure activated PKCε by 1 hour and decreased both CBF and total number of beating cilia by 6 hours. A specific activator of PKCε, DCP-LA, slowed CBF after maximal PKCε activation. Interestingly, activation of PKCε by smoke and alcohol was only observed in ciliated cells, not basal bronchial epithelium. In precision-cut mouse lung slices treated with smoke and alcohol, PKCε activation preceded CBF slowing. Correspondingly, increased PKCε activity and cilia slowing were only observed in mice co-exposed to smoke and alcohol, regardless of the sequence of the combination exposure. No decreases in CBF were observed in PKCε knockout mice co-exposed to smoke and alcohol. These data identify PKCε as a key regulator of cilia slowing in response to combined smoke and alcohol-induced lung injury

Alcohol Exposure Alters Mouse Lung Inflammation in Response to Inhaled Dust

Alcohol exposure is associated with increased lung infections and decreased mucociliary clearance. Occupational workers exposed to dusts from concentrated animal feeding operations (CAFOs) are at risk for developing chronic inflammatory lung diseases. Agricultural worker co-exposure to alcohol and organic dust has been established, although little research has been conducted on the combination effects of alcohol and organic dusts on the lung. Previously, we have shown in a mouse model that exposure to hog dust extract (HDE) collected from a CAFO results in the activation of protein kinase C (PKC), elevated lavage fluid cytokines/chemokines including interleukin-6 (IL-6), and the development of significant lung pathology. Because alcohol blocks airway epithelial cell release of IL-6 <em>in vitro</em>, we hypothesized that alcohol exposure would alter mouse lung inflammatory responses to HDE. To test this hypothesis, C57BL/6 mice were fed 20% alcohol or water <em>ad libitum</em> for 6 weeks and treated with 12.5% HDE by intranasal inhalation method daily during the final three weeks. Bronchoalveolar lavage fluid (BALF), tracheas and lungs were collected. HDE stimulated a 2–4 fold increase in lung and tracheal PKCε (epsilon) activity in mice, but no such increase in PKCε activity was observed in dust-exposed mice fed alcohol. Similarly, alcohol-fed mice demonstrated significantly less IL-6 in lung lavage in response to dust than that observed in control mice instilled with HDE. TNFα levels were also inhibited in the alcohol and HDE-exposed mouse lung tissue as compared to the HDE only exposed group. HDE-induced lung inflammatory aggregates clearly present in the tissue from HDE only exposed animals were not visually detectable in the HDE/alcohol co-exposure group. Statistically significant weight reductions and 20% mortality were also observed in the mice co-exposed to HDE and alcohol. These data suggest that alcohol exposure depresses the ability of the lung to activate PKCε-dependent inflammatory pathways to environmental dust exposure. These data also define alcohol as an important co-exposure agent to consider in the study of inhalation injury responses

Barn-Raising on the Digital Frontier: The L.A.U.N.C.H. Collaborative.

A meta-analysis of oncology papers from around the world revealed that cancer patients who lived more than 50 miles away from hospital centers routinely presented with more advanced stages of disease at diagnosis, exhibited lower adherence to prescribed treatments, presented with poorer diagnoses, and reported a lower quality of life than patients who lived nearer to care facilities. Connected health approaches-or the use of broadband and telecommunications technologies to evaluate, diagnose, and monitor patients beyond the clinic-are becoming an indispensable tool in medicine to overcome the obstacle of distance