Predicting Falls in Community-Dwelling Older Adults Using the Repetitive Step Test

Background/Purpose: The Repetitive Step Test (RST) is a newly developed dynamic balance test that requires stepping in multiple directions. It has previously demonstrated excellent test-retest and inter-rater reliability, along with ability to retrospectively classify individuals who had fallen more than once in 12 months though its ability to predict falls has not been evaluated. This study aimed to determine the capability of the RST to identify individuals likely to fall prospectively over 12 months. Methods: 63 community-dwelling adults \u3e65 years old were tested using the following balance and mobility measures: RST, 10 Meter Walk Test (10MWT), Activities-specific Balance Confidence scale (ABC), Four Square Step Test (FSST), and Timed Up and Go (TUG). For the RST, participants completed as many steps as possible in 15 seconds at 50% and 75% of their right leg length in the anterolateral and posterolateral directions bilaterally. Participants completed a fall log that was reported on a monthly basis for 12 months. Results: Based on 12 months of data, receiver operating characteristic (ROC) curve analysis was used to compare adults who fell \u3e 2 times to adults (n=17) who did not fall (n=29). Area under the curve (AUC) results with 95% confidence interval are as follows: RST at 50% 0.40 (0.22-0.58), RST at 75% 0.41 (0.24-0.57), FSST 0.45 (0.28-0.62), TUG 0.49 (0.32-0.66), ABC 0.61 (0.44-0.78) and 10MWT 0.67 (0.51-0.83). Conclusion: At 12 months, the RST and other balance and mobility measures either failed to or poorly predicted the number of falls. Research is needed to determine how to best predict falls in this population, and whether any single balance test can effectively identify individuals who are most likely to fall. Clinical Relevance: Currently, there is no simple measure of balance and mobility that can accurately predict falls in community-dwelling older adults. The RST was ineffective in predicting falls at 12 months. Given the unique characteristics of the RST, it may still be a useful tool for assessing and monitoring bilateral lower extremity performance and stepping ability, especially in individuals who present with asymmetrical impairments (e.g., stroke, multiple sclerosis, Parkinson’s disease).https://ecommons.udayton.edu/dpt_symposium/1005/thumbnail.jp

Association of Rice and Rice-Product Consumption With Arsenic Exposure Early in Life

Rice—a typical first food and major ingredient in various infant foods—contains inorganic arsenic (As), but the extent of As exposure from these foods has not been well characterized in early childhood

Provenance of invaders has scale-dependent impacts in a changing wetland ecosystem

Exotic species are associated with a variety of impacts on biodiversity, but it is unclear whether impacts of exotic species differ from those of native species with similar growth forms or native species invading disturbed sites. We compared presence and abundance of native and exotic invaders with changes in wetland plant species diversity over a 28-year period by re-surveying 22 ponds to identify factors correlated with observed changes. We also compared communities found within dense patches of native and exotic emergent species with similar habits. Within patches, we found no categorical diversity differences between areas dominated by native or exotic emergent species. At the pond scale, the cover of the exotic grass Phragmites australis best predicted change in diversity and evenness over time, likely owing to its significant increase in coverage over the study period. These changes in diversity and evenness were strongest in younger, less successionally-advanced ponds. Changes associated with cover of P. australis in these ponds were not consistent with expected diversity decreases, but instead with a dampening of diversity gains, such that the least-invaded ponds increased in diversity the most over the study period. There were more mixed effects on evenness, ranging from a reduction in evenness gains to actual losses of evenness in the ponds with highest invader cover. In this wetland complex, the habit, origin and invasiveness of species contribute to diversity responses in a scale- and context-dependent fashion. Future efforts to preserve diversity should focus on preventing the arrival and spread of invaders that have the potential to cover large areas at high densities, regardless of their origin. Future studies should also investigate more thoroughly how changes in diversity associated with species invasions are impacted by other ongoing ecosystem changes

Nurses\u27 Alumnae Association Bulletin - Volume 5 Number 8

Calling All Nurses Financial Report Calendar of Events Lest You Forget! Attention Review of the Alumnae Association Meetings President\u27s Report Barton Memorial Division Oxygen Therapy Welcome, White Haven Alumnae Clinical Use of Penicillin in Infections of the Ears, Nose and Throat Address - Graduation of Nurses, 1945 Miscellaneous Items The Blood that Kills The Story of Malaria Program Prizes - May, 1946 Capping Exercises The Economic Security Program of the Pennsylvania State Nurses\u27 Association The Clara Melville Scholarship Fund Card of Thanks The Poet\u27s Corner The Hospital Pharmacy Jefferson Medical College Hospital School of Nursing Faculty Jefferson Hospital Gray Lady Unite, A.R.R. The Volunteer Nurses\u27 Aides Salute Jefferson Nurses Changes in the Staff at Jefferson Hospital Red Cross Recruits Did You Know That The Pennsylvania Nurse Medical College News Magazine and Newspaper Items Central Dressing Room and Transfusion Unit Rules Concerning Central Dressing Room Radios and Electrical Appliances Attending College Nurses in Anesthesia Condolences Marriages New Arrivals Deaths The Bulletin Committee Attention, Alumnae New Addresse

Population dynamics of rhesus macaques and associated foamy virus in Bangladesh.

Foamy viruses are complex retroviruses that have been shown to be transmitted from nonhuman primates to humans. In Bangladesh, infection with simian foamy virus (SFV) is ubiquitous among rhesus macaques, which come into contact with humans in diverse locations and contexts throughout the country. We analyzed microsatellite DNA from 126 macaques at six sites in Bangladesh in order to characterize geographic patterns of macaque population structure. We also included in this study 38 macaques owned by nomadic people who train them to perform for audiences. PCR was used to analyze a portion of the proviral gag gene from all SFV-positive macaques, and multiple clones were sequenced. Phylogenetic analysis was used to infer long-term patterns of viral transmission. Analyses of SFV gag gene sequences indicated that macaque populations from different areas harbor genetically distinct strains of SFV, suggesting that geographic features such as forest cover play a role in determining the dispersal of macaques and SFV. We also found evidence suggesting that humans traveling the region with performing macaques likely play a role in the translocation of macaques and SFV. Our studies found that individual animals can harbor more than one strain of SFV and that presence of more than one SFV strain is more common among older animals. Some macaques are infected with SFV that appears to be recombinant. These findings paint a more detailed picture of how geographic and sociocultural factors influence the spectrum of simian-borne retroviruses

Arsenic, Organic Foods, and Brown Rice Syrup

Background: Rice can be a major source of inorganic arsenic (Asi) for many sub-populations. Rice products are also used as ingredients in prepared foods, some of which may not be obviously rice based. Organic brown rice syrup (OBRS) is used as a sweetener in organic food products as an alternative to high-fructose corn syrup. We hypothesized that OBRS introduces As into these products

Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study

Background: One goal of health systems seeking to evolve into learning health systems is to accelerate the implementation and sustainment of evidence-based practices (EBPs). As part of this evolution, the Veterans Health Administration (VHA) developed the Innovation Ecosystem, which includes the Diffusion of Excellence (DoE), a program that identifies and diffuses Gold Status Practices (GSPs) across facilities. The DoE hosts an annual Shark Tank competition in which leaders bid on the opportunity to implement a GSP with 6 months of implementation support. Over 750 diverse practices were submitted in cohorts 2 and 3 of Shark Tank; 23 were designated GSPs and were implemented in 31 VA networks or facilities. As part of a national evaluation of the DoE, we identified factors contributing to GSP implementation and sustainment. Methods: Our sequential mixed methods evaluation of cohorts 2 and 3 of Shark Tank included semi-structured interviews with at least one representative from 30/31 implementing teams (N = 78/105 people invited) and survey responses from 29/31 teams (N = 39/47 invited). Interviews focused on factors influencing implementation and future sustainment. Surveys focused on sustainment 1.5-2 years after implementation. The Consolidated Framework for Implementation Research (CFIR) informed data collection and directed content analysis. Ordinal scales were developed inductively to rank implementation and sustainment outcomes. Results: Over 50% of teams (17/30) successfully implemented their GSP within the 6-month implementation period. Despite extensive implementation support, significant barriers related to centralized decision-making, staffing, and resources led to partial (n = 6) or no (n = 7) implementation for the remaining teams. While 12/17 initially successful implementation teams reported sustained use of their GSP, over half of the initially unsuccessful teams (n = 7/13) also reported sustained GSP use 1.5 years after the initial implementation period. When asked at 6 months, 18/27 teams with complete data accurately anticipated their future sustainability based on reported sustainment an average of 1.5 years later. Conclusions: Most teams implemented within 6 months and/or sustained their GSP 1.5 years later. High levels of implementation and sustainment across diverse practices and teams suggest that VHA\u27s DoE is a successful large-scale model of diffusion. Team predictions about sustainability after the first 6 months of implementation provide a promising early assessment and point of intervention to increase sustainability

Provenance of invaders has scale-dependent impacts in a changing wetland ecosystem

Exotic species are associated with a variety of impacts on biodiversity, but it is unclear whether impacts of exotic species differ from those of native species with similar growth forms or native species invading disturbed sites. We compared presence and abundance of native and exotic invaders with changes in wetland plant species diversity over a 28-year period by re-surveying 22 ponds to identify factors correlated with observed changes. We also compared communities found within dense patches of native and exotic emergent species with similar habits. Within patches, we found no categorical diversity differences between areas dominated by native or exotic emergent species. At the pond scale, the cover of the exotic grass Phragmites australis best predicted change in diversity and evenness over time, likely owing to its significant increase in coverage over the study period. These changes in diversity and evenness were strongest in younger, less successionally-advanced ponds. Changes associated with cover of P. australis in these ponds were not consistent with expected diversity decreases, but instead with a dampening of diversity gains, such that the least-invaded ponds increased in diversity the most over the study period. There were more mixed effects on evenness, ranging from a reduction in evenness gains to actual losses of evenness in the ponds with highest invader cover. In this wetland complex, the habit, origin and invasiveness of species contribute to diversity responses in a scale- and context-dependent fashion. Future efforts to preserve diversity should focus on preventing the arrival and spread of invaders that have the potential to cover large areas at high densities, regardless of their origin. Future studies should also investigate more thoroughly how changes in diversity associated with species invasions are impacted by other ongoing ecosystem changes

The Building Blocks of Interoperability. A Multisite Analysis of Patient Demographic Attributes Available for Matching.

BackgroundPatient matching is a key barrier to achieving interoperability. Patient demographic elements must be consistently collected over time and region to be valuable elements for patient matching.ObjectivesWe sought to determine what patient demographic attributes are collected at multiple institutions in the United States and see how their availability changes over time and across clinical sites.MethodsWe compiled a list of 36 demographic elements that stakeholders previously identified as essential patient demographic attributes that should be collected for the purpose of linking patient records. We studied a convenience sample of 9 health care systems from geographically distinct sites around the country. We identified changes in the availability of individual patient demographic attributes over time and across clinical sites.ResultsSeveral attributes were consistently available over the study period (2005-2014) including last name (99.96%), first name (99.95%), date of birth (98.82%), gender/sex (99.73%), postal code (94.71%), and full street address (94.65%). Other attributes changed significantly from 2005-2014: Social security number (SSN) availability declined from 83.3% to 50.44% (p<0.0001). Email address availability increased from 8.94% up to 54% availability (p<0.0001). Work phone number increased from 20.61% to 52.33% (p<0.0001).ConclusionsOverall, first name, last name, date of birth, gender/sex and address were widely collected across institutional sites and over time. Availability of emerging attributes such as email and phone numbers are increasing while SSN use is declining. Understanding the relative availability of patient attributes can inform strategies for optimal matching in healthcare

Sex-Specific Associations of Infants’ Gut Microbiome with Arsenic Exposure in A US Population

Arsenic is a ubiquitous environmental toxicant with antimicrobial properties that can be found in food and drinking water. The influence of arsenic exposure on the composition of the human microbiome in US populations remains unknown, particularly during the vulnerable infant period. We investigated the relationship between arsenic exposure and gut microbiome composition in 204 infants prospectively followed as part of the New Hampshire Birth Cohort Study. Infant urine was analyzed for total arsenic concentration using inductively coupled plasma mass spectrometry. Stool microbiome composition was determined using sequencing of the bacterial 16S rRNA gene. Infant urinary arsenic related to gut microbiome composition at 6 weeks of life (p = 0.05, adjusted for infant feeding type and urine specific gravity). Eight genera, six within the phylum Firmicutes, were enriched with higher arsenic exposure. Fifteen genera were negatively associated with urinary arsenic concentration, including Bacteroides and Bifidobacterium. Upon stratification by both sex and feeding method, we found detectable associations among formula-fed males (p = 0.008), but not other groups (p \u3e 0.05 for formula-fed females and for breastfed males and females). Our findings from a US population indicate that even moderate arsenic exposure may have meaningful, sex-specific effects on the gut microbiome during a critical window of infant development