Effect of a novel transition program on disability after stroke: A trial protocol

Importance: A gap in care for stroke survivors exists at the point of transition from inpatient rehabilitation to home, when survivors encounter new environmental barriers because of the cognitive and sensorimotor sequelae of stroke. Resolving these barriers and improving independence in the community have the potential to significantly improve stroke survivors\u27 long-term morbidity. Objective: To investigate the efficacy and safety of a novel enhanced rehabilitation transition program to reduce environmental barriers and improve daily activity performance and community participation among stroke survivors. Design, Setting, and Participants: This is a phase 2b, single-blind, parallel-group, randomized clinical trial. Participants will be randomized using a 1:1 allocation ratio, stratified by Functional Independence Measure and age, to either attentional control or the intervention. Community Participation Transition After Stroke (COMPASS) is a complex intervention that uses 2 complementary evidence-based interventions: home modifications and strategy training delivered in the home. Community participation after stroke, measured by the Reintegration to Normal Living Index, is the primary outcome. Secondary outcomes include quality of life after stroke, measured by the Stroke Impact Scale, and daily activity performance and magnitude of environmental barriers in the home, both measured by the In-Home Occupational Performance Evaluation. An intention-to-treat analysis will be used. A total of 180 participants, who are 50 years or older, were independent in activities of daily living prior to stroke, and are undergoing inpatient rehabilitation following stroke with a plan to be discharged home, will be included in the study. Discussion: Stroke is a leading cause of serious long-term disability in the United States. The COMPASS study is ongoing. To date, 99 participants have been recruited and 77 randomized, with 37 in the treatment group and 40 in the control group. Resumption of previous activities immediately after discharge can improve immediate and long-term community participation. Results from this study will fill a critical gap in stroke rehabilitation evidence by providing important information about the long-term community participation and daily activity performance among stroke survivors as well as environmental barriers in their homes. Trial Registration: ClinicalTrials.gov identifier: NCT03485820

ENVIRONMENTAL LAW—THE DEPARTMENT OF DEFENSE NATURAL RESOURCES CONSERVATION PROGRAM: HOW MILITARY ENVIRONMENTAL ACTIVISTS CONSERVED THIRTY MILLION ACRES FOR MILITARY USE AND THE PROTECTION OF ENDANGERED SPECIES

James N. Perkins’ research and efforts, along with those of Corey Ford, Alastair MacBain, and the generals leading the military in the 1950s, would result in the Department of Defense Natural Resources Conservation Program. The program functions as the model for the other official and informal programs and subsequent legislation to further the environmental stewardship by the military. This Article reviews the military’s use of its lands and stewardship practices, along with its authority over use, including its environmental controls. Decades later, the military recognizes the efforts of Perkins and the others that led to the creation of the Department of Defense National Resources Conservation Program and ultimately resulted in the placement of nearly thirty million acres of land managed by the Department of Defense into conservation and the protection of the world’s largest concentration of endangered species

Network Catalysts to Small Businesses: A Strategy for Fragmented Industries

The catalyst roles played by the New York City's Garment Industry Development Corporation (GIDC) and San Francisco's Garment 2000, two non-profit organizations providing services to the apparel industry, were analyzed using a network perspective. The networks of apparel businesses in the two cities were advanced by GIDC and Garment 2000 through their structures and strategies, including building trust, providing easy entry and exit mechanisms to network members, offering dynamic programming, and establishing partnerships with other organizations serving the apparel industry. The loosely structured business networks in the apparel industry and other fragmented industries benefit from catalyst organizations that can increase communication across the memberships, identify and address needs of member businesses, and seek funding to support programs. Implications for businesses that want to initiate catalyst organizations to serve small business networks in other industries are discussed

An Evidence Base of Vocabulary Development: Theory and Instruction

Researchers have discussed the importance of vocabulary instruction for elementary students at length. The magnitude of the task is daunting, as is trying to choose which words to teach out of the many thousands. The question of how best to teach the thousands of words students need to be successful is difficult to answer. Direct instruction or learning words incidentally are two approaches discussed in the research. There are multiple factors that affect a student\u27s vocabulary acquisition, including socioeconomic level, parental conversation, and whether English is a first or second language for the child. Additionally, the impact of vocabulary development on reading comprehension is of great importance. This paper will explore the various facets of vocabulary development

Down syndrome and Alzheimer\u27s disease: A scoping review of functional performance and fall risk

INTRODUCTION: Alzheimer\u27s disease (AD) occurs in aging adults with Down syndrome (DS) at a higher prevalence and an earlier age than in typical aging adults. As with the general aging adult population, there is an urgent need to understand the preclinical and early phases of AD progression in the adult population with DS. The aim of this scoping review was to synthesize the current state of the evidence and identify gaps in the literature regarding functional activity performance and falls and their significance to disease staging (i.e., mild, moderate, and severe defined staging criteria) in relation to Alzheimer\u27s disease and related dementias (ADRD) in adults with DS. METHODS: This scoping review included six electronic databases (e.g., PsycInfo, Academic Search Complete, CINAHL, COCHRANE Library, MEDLINE, and PubMed). Eligible studies included participants with DS ≥25 years of age, studies with functional measures and/or outcomes (e.g., activities of daily living, balance, gait, motor control, speech, behavior, and cognition; falls; and fall risks), and studies that investigated AD pathology and implications. RESULTS: Fourteen eligible studies were included and categorized through a thematic analysis into the following themes: (1) physical activity and motor coordination (PAMC), (2) cognition, (3) behavior, and (4) sleep. The studies indicated how functional activity performance and engagement may contribute to early identification of those at risk of cognitive decline and AD development and/or progression. DISCUSSION: There is a need to expand the research regarding ADRD pathology relative to functional outcomes in adults with DS. Functional measures related to disease staging and cognitive impairment are essential to understanding how AD progression is characterized within real-world settings. This scoping review identified the need for additional mixed-methods research to examine the use of assessment and intervention related to function and its detection of cognitive decline and AD progression

Physician and nurse acceptance of technicians to screen for geriatric syndromes in the emergency department

Introduction: The objective of this study was to evaluate emergency medicine physician and nurse acceptance of nonnurse, nonphysician screening for geriatric syndromes. Methods: This was a single-center emergency department (ED) survey of physicians and nurses after an 8-month project. Geriatric technicians were paid medical student research assistants evaluating consenting ED patients older than 65 years for cognitive dysfunction, fall risk, or functional decline. The primary objective of this anonymous survey was to evaluate ED nurse and physician perceptions about the geriatric screener feasibility and barriers to implementation. In addition, as a secondary objective, respondents reported ongoing geriatric screening efforts independent of the research screeners. Results: The survey was completed by 72% of physicians and 33% of nurses. Most nurses and physicians identified geriatric technicians as beneficial to patients without impeding ED throughput. Fewer than 25% of physicians routinely screen for any geriatric syndromes. Nurses evaluated for fall risk significantly more often than physicians, but no other significant differences were noted in ongoing screening efforts. Conclusion: Dedicated geriatric technicians are perceived by nurses and physicians as beneficial to patients with the potential to improve patient safety and clinical outcomes. Most nurses and physicians are not currently screening for any geriatric syndromes. [West J Emerg Med. 2011;12(4):489–495.]</p

A mobile app directory of occupational therapists who provide home modifications: Development and preliminary usability evaluation

BACKGROUND: Home modifications provided by occupational therapists (OTs) are effective in improving daily activity performance and reducing fall risk among community-dwelling older adults. However, the prevalence of home modification is low. One reason is the lack of a centralized database of OTs who provide home modifications. OBJECTIVE: This study aimed to develop and test the usability of a mobile app directory of OTs who provide home modifications in the United States. METHODS: In phase 1, a prototype was developed by identifying OTs who provide home modifications through keyword Web searches. Referral information was confirmed by phone or email. In phase 2, community-dwelling older adults aged older than 65 years and OTs currently working in the United States were purposefully recruited to participate in a single usability test of the mobile app, Home Modifications for Aging and Disability Directory of Referrals (Home Maddirs). Participants completed the System Usability Scale (SUS) and semistructured interview questions. Interview data were coded, and themes were derived using a grounded theory approach. RESULTS: In phase 1, referral information for 101 OTs across 49 states was confirmed. In phase 2, 6 OTs (mean clinical experience 4.3 years, SD 1.6 years) and 6 older adults (mean age 72.8 years, SD 5.0 years) participated. The mean SUS score for OTs was 91.7 (SD 8.0; out of 100), indicating good usability. The mean SUS score for older adults was 71.7 (SD 27.1), indicating considerable variability in usability. In addition, the SUS scores indicated that the app is acceptable to OTs and may be acceptable to some older adults. For OTs, self-reported barriers to acceptability and usability included the need for more information on the scope of referral services. For older adults, barriers included high cognitive load, lack of operational skills, and the need to accommodate sensory changes. For both groups, facilitators of acceptability and usability included perceived usefulness, social support, and multiple options to access information. CONCLUSIONS: Home Maddirs demonstrates good preliminary acceptability and usability to OTs. Older adults\u27 perceptions regarding acceptability and usability varied considerably, partly based on prior experience using mobile apps. Results will be used to make improvements to this promising new tool for increasing older adults\u27 access to home modifications