Understanding the Influence of Fear of Falling on Clinical Balance Control - Efforts in Fall Prediction and Prevention

Introduction: A review of the literature shows that standard clinical balance measures do not adequately predict fall risk in community-dwelling older individuals. There is significant evidence demonstrating the interactions of fear, anxiety, and confidence with the control of standing posture. Little is known however about the nature of this relationship under more challenging balance conditions, particularly in the elderly. The primary purpose of this work was to evaluate the relationship between fear of falling, clinical balance measures and fall-risk. Methods: Three studies were conducted evaluating the effects of postural threat (manipulated by support surface elevation) and/or cognitive loading (working memory secondary task) on clinical balance performance and task-specific psychological measures. Predictive and construct validity as well as test-retest reliability was evaluated for measures used to assess fear of falling and related psychological constructs . Results: Postural threat resulted in reduced balance confidence and perceived stability as well as increased state anxiety and fear of falling. These changes were significantly correlated to decrements in performance of clinical balance tasks. Neither standard clinical scales of balance and mobility nor generalized psychological measures, alone or in combination, could predict falls in community-dwelling elderly. However, combined scores on selected challenging clinical balance tasks could significantly predict falls. Furthermore, improved predictive precision resulted from having these tasks performed under combined postural threat and cognitive loading. Finally, the inclusion of task-specific psychological measures resulted in further improvements to predictive precision. Psychological measures demonstrated fair to excellent test-retest reliability in both healthy young and independent-living older individuals. Conclusions: Clinical balance tasks performed under more challenging conditions likely better reflect everyday experiences in which a fall is likely to occur. Incorporating easy-to-administer task-specific psychological evaluations and self-reported health estimates with clinical balance assessments might improve the likelihood of correctly identifying community-dwelling individuals at risk for falls. Improved estimates of fall-risk may lead to a reduction in the number of falls experienced in this population, thereby reducing the significant burden of fall-related hospitalizations, treatments and rehabilitation on the individual, families and health care system

Use of tethered prey for estimating the impact of the invasive European green crab

Various mollusks, including small bivalves and gastropod snails, are a common food source for intertidal crabs. Prey opening techniques used on hard-shell prey are dependent on claw size and morphology. For example, large, strong claws can crush a snail outright while smaller, weaker claws leave characteristic peels, pulls and upper whorl peels. It is therefore often possible to identify the predator responsible for a specific breakage pattern. A feeding study was conducted to "fingerprint" the shell opening techniques of the European green crab and five common native Pacific Northwest crab species on three size classes of the intertidal snail Littorina sitkana. A multiple linear regression analysis utilizing a statistical program resulted in an odds ratio that identified the crab species most likely to perform a given technique. For example, the green crab was 19 times more likely to utilize the pulling technique than a Dungeness crab, while the Dungeness crab primarily relied on crushing. The green crab was the only crab species to utilize an upper whorl peel technique. Shell breakage patterns found on snails tethered to predation lines at various sampling sites in Coos Bay and Yaquina Bay, Oregon, were then used to identify the size and species of foraging crab predators at those sites. A predation line is a tool designed to quantify the foraging impact upon small gastropod snails by various crab species in the intertidal zone. A given number of Littorina sitkana snails are attached to monofilament line with marine epoxy. These lines are then tied to metal rebar rods and left in the intertidal for one full tidal cycle. The fate of the snails on the lines is then scored as: live, attempted peel, peeled, pulled or crushed. The final results yield the overall crab foraging rate and indicate the most likely crab species responsible for the predation. This information can be very useful when comparing predation rates between sampling sites that host the invasive European green crab, and those sites that have not yet been invaded

A non-pharmacological intervention to manage behavioral and psychological symptoms of dementia and reduce caregiver distress: Design and methods of project ACT3

Project ACT is a randomized controlled trial designed to test the effectiveness of a non-pharmacological home-based intervention to reduce behavioral and psychological symptoms of dementia (BPSD) and caregiver distress. The study targets 272 stressed racially diverse family caregivers providing in-home care to persons with moderate stage dementia with one or more behavioral disturbances. All participants are interviewed at baseline, 4-months (main trial endpoint), and 6-months (maintenance). The four-month intervention involves up to 13 visits from an occupational therapist who works with families to problem-solve potential triggers (communication style, environmental clutter) contributing to behaviors, and instruct in strategies to reduce caregiver stress and manage targeted behaviors. To rule out infection or other potential medical contributors to behaviors, a nurse obtains blood and urine samples from the dementia patient, and conducts a medication review. Participants in the no-treatment control group are offered the nurse arm and one in-home session following trial completion at 6-months. This paper describes the research methods, theoretical and clinical aspects of this multi-component, targeted psycho-social treatment approach, and the measures used to evaluate quality of life improvements for persons with dementia and their families

La flora exótica ruderal del Parque Nacional La Campana, Región de Valparaíso, Chile central

Central Chile belongs to one of the world’s Mediterranean ecosystems, which are especially prone to biological invasions. Although not all exotic plants can be considered as invaders, they contain an invasion potential that can drastically modify native ecosystems and the relationships between species. This is especially relevant in protected areas that have the explicit mission of biodiversity conservation of native and endemic species through time. The presence of ruderal exotic plants in La Campana National Park, central Chile, was evaluated by means of the transect method applied to both sides of each pathway. The best-represented families in the exotic flora of the park are Poaceae, Asteraceae and Fabaceae. In terms of life form, 71% are therophytes. The vast majority (92.7%) are of Euroasian-North African origin. Considering the presence of exotic plants within specific vegetation units, the Puyal con suculentas is the most affected type. In contrast, introduced species were sparse in both the deciduous forest and the alpine scrub. Two factors seem to have an important influence on the potential of the invasion: the amount of available light and the altitude of the vegetation unit. To evaluate the rate of expansion and possible effects on native species and the whole ecosystem of La Campana National Park, a monitoring plan should be designed, especially towards species that are more widespread in the park and appear systematically in the sampling within different vegetation types.Los ecosistemas mediterráneos, entre los que se cuenta la zona central de Chile, se consideran globalmente entre los más afectados por las invasiones biológicas. Si bien no todas las especies de plantas exóticas se pueden considerar invasoras, en ellas se encuentra el potencial de invasibilidad que eventualmente puede significar cambios sustanciales en la composición de los ecosistemas y las relaciones entre sus especies. Ello es especialmente crítico en espacios protegidos en los cuales se pretende asegurar la conservación presente y futura de las poblaciones de especies nativas y endémicas. En esta investigación se estudió la presencia de plantas exóticas ruderales en los márgenes de los senderos del Parque Nacional La Campana, con el método de transectos. Las familias mejor representadas en la flora exótica ruderal del Parque son Poaceae, Asteraceae y Fabaceae. En cuanto a su forma de vida, el 71% corresponde a terófitos. La gran mayoría (92,7%) es de origen euroasiático-norafricano. Al examinar la presencia de las plantas exóticas ruderales en las diferentes unidades de vegetación se obtiene que el Puyal con suculentas es la unidad más afectada. En cambio, las unidades a mayor altitud como el Bosque caducifolio y el Matorral altoandino son las que muestran una menor presencia de especies introducidas. Hay dos factores que parecen ejercer una influencia importante en el grado de invasibilidad: la cantidad de luz disponible y la altitud a la que se encuentra la unidad de vegetación. Para poder evaluar la tasa de expansión y los posibles efectos sobre las especies nativas y el ecosistema del PN La Campana, conviene diseñar un plan de monitoreo, sobre todo de las especies que están más difundidas en el Parque y que aparecen sistemáticamente en los muestreos en distintos tipos de vegetación

Spillover HIV prevention effects of a cash transfer trial in East Zimbabwe: evidence from a cluster-randomised trial and general-population survey

Background: Benefits of cash transfers (CTs) for HIV prevention have been demonstrated largely in purposively designed trials, commonly focusing on young women. It is less clear if CT interventions not designed for HIV prevention can have HIV-specific effects, including adverse effects. The cluster-randomised Manicaland Cash Transfer Trial (2010–11) evaluated effects of CTs on children’s (2–17 years) development in eastern Zimbabwe. We evaluated whether this CT intervention with no HIV-specific objectives had unintended HIV prevention spillover effects (externalities). Methods: Data on 2909 individuals (15–54 years) living in trial households were taken from a general-population survey, conducted simultaneously in the same communities as the Manicaland Trial. Average treatment effects (ATEs) of CTs on sexual behaviour (any recent sex, condom use, multiple partners) and secondary outcomes (mental distress, school enrolment, and alcohol/cigarette/drug consumption) were estimated using mixed-effects logistic regressions (random effects for study site and intervention cluster), by sex and age group (15–29; 30–54 years). Outcomes were also evaluated with a larger synthetic comparison group created through propensity score matching. Results: CTs did not affect sexual debut but reduced having any recent sex (past 30 days) among young males (ATE: − 11.7 percentage points [PP] [95% confidence interval: -26.0PP, 2.61PP]) and females (− 5.68PP [− 15.7PP, 4.34PP]), with similar but less uncertain estimates when compared against the synthetic comparison group (males: -9.68PP [− 13.1PP, − 6.30PP]; females: -8.77PP [− 16.3PP, − 1.23PP]). There were no effects among older individuals. Young (but not older) males receiving CTs reported increased multiple partnerships (8.49PP [− 5.40PP, 22.4PP]; synthetic comparison: 10.3PP (1.27PP, 19.2PP). No impact on alcohol, cigarette, or drug consumption was found. There are indications that CTs reduced psychological distress among young people, although impacts were small. CTs increased school enrolment in males (11.5PP [3.05PP, 19.9PP]). Analyses with the synthetic comparison group (but not the original control group) further indicated increased school enrolment among females (5.50PP [1.62PP, 9.37PP]) and condom use among younger and older women receiving CTs (9.38PP [5.90PP, 12.9PP]; 5.95PP [1.46PP, 10.4PP]). Conclusions: Non-HIV-prevention CT interventions can have HIV prevention outcomes, including reduced sexual activity among young people and increased multiple partnerships among young men. No effects on sexual debut or alcohol, cigarette, or drug consumption were observed. A broad approach is necessary to evaluate CT interventions to capture unintended outcomes, particularly in economic evaluations. Trial registration: ClinicalTrials.gov, NCT00966849. Registered August 27, 2009

Eyewitness identification in child witnesses on the autism spectrum

Background. Although there is increasing interest in the capabilities of children with autism at different stages of the criminal justice process, there is little research into how well this group perform when asked to identify perpetrators from identification lineups. This is despite theoretical and empirical literature suggesting that autistic children experience face recognition memory difficulties. Method. As part of a broader study into eyewitness memory skills, 50 children with autism and 162 children with typical development (TD) (all with IQs > 69) watched a mock crime event (either live or on a video) involving two male perpetrators. One week later, their eyewitness identification skills were compared, with children asked to identify the perpetrators from two ecologically valid video lineups. The children were also assessed on a standardised face memory task. Results. When asked to identify perpetrators in the video lineups, in many respects the autistic children performed at an equivalent level to the TD children. This was despite the TD children outperforming the autistic children on the standardized face memory task. Conclusions. These preliminary findings suggest that group differences between autistic and TD children may not always emerge on an ecologically valid, real world eyewitness identification lineup task, despite autistic children showing poorer performance on a standardized face memory task. However, as identification performance in both groups was low, it remains important for future research to identify how to scaffold eyewitness identification performance in both children with and without an autism diagnosis

Estimating background rates of Guillain-Barré Syndrome in Ontario in order to respond to safety concerns during pandemic H1N1/09 immunization campaign

Abstract Background The province of Ontario, Canada initiated mass immunization clinics with adjuvanted pandemic H1N1 influenza vaccine in October 2009. Due to the scale of the campaign, temporal associations with Guillain-Barré syndrome (GBS) and vaccination were expected. The objectives of this analysis were to estimate the number of background GBS cases expected to occur in the projected vaccinated population and to estimate the number of additional GBS cases which would be expected if an association with vaccination existed. The number of influenza-associated GBS cases was also determined. Methods Baseline incidence rates of GBS were determined from published Canadian studies and applied to projected vaccine coverage data to estimate the expected number of GBS cases in the vaccinated population. Assuming an association with vaccine existed, the number of additional cases of GBS expected was determined by applying the rates observed during the 1976 Swine Flu and 1992/1994 seasonal influenza campaigns in the United States. The number of influenza-associated GBS cases expected to occur during the vaccination campaign was determined based on risk estimates of GBS after influenza infection and provincial influenza infection rates using a combination of laboratory-confirmed cases and data from a seroprevalence study. Results The overall provincial vaccine coverage was estimated to be between 32% and 38%. Assuming 38% coverage, between 6 and 13 background cases of GBS were expected within this projected vaccinated cohort (assuming 32% coverage yielded between 5-11 background cases). An additional 6 or 42 cases would be expected if an association between GBS and influenza vaccine was observed (assuming 32% coverage yielded 5 or 35 additional cases); while up to 31 influenza-associated GBS cases could be expected to occur. In comparison, during the same period, only 7 cases of GBS were reported among vaccinated persons. Conclusions Our analyses do not suggest an increased number of GBS cases due to the vaccine. Awareness of expected rates of GBS is crucial when assessing adverse events following influenza immunization. Furthermore, since individuals with influenza infection are also at risk of developing GBS, they must be considered in such analyses, particularly if the vaccine campaign and disease are occurring concurrently

Developing multiscale and integrative nature–people scenarios using the Nature Futures Framework

1. Scientists have repeatedly argued that transformative, multiscale global scenarios are needed as tools in the quest to halt the decline of biodiversity and achieve sustainability goals. 2. As a first step towards achieving this, the researchers who participated in the scenarios and models expert group of the Intergovernmental Science‐Policy Platform on Biodiversity and Ecosystem Services (IPBES) entered into an iterative, participatory process that led to the development of the Nature Futures Framework (NFF). 3. The NFF is a heuristic tool that captures diverse, positive relationships of humans with nature in the form of a triangle. It can be used both as a boundary object for continuously opening up more plural perspectives in the creation of desirable nature scenarios and as an actionable framework for developing consistent nature scenarios across multiple scales. 4. Here we describe the methods employed to develop the NFF and how it fits into a longer term process to create transformative, multiscale scenarios for nature. We argue that the contribution of the NFF is twofold: (a) its ability to hold a plurality of perspectives on what is desirable, which enables the development of joint goals and visions and recognizes the possible convergence and synergies of measures to achieve these visions and (b), its multiscale functionality for elaborating scenarios and models that can inform decision‐making at relevant levels, making it applicable across specific places and perspectives on nature. 5. If humanity is to achieve its goal of a more sustainable and prosperous future rooted in a flourishing nature, it is critical to open up a space for more plural perspectives of human–nature relationships. As the global community sets out to develop new goals for biodiversity, the NFF can be used as a navigation tool helping to make diverse, desirable futures possible