bluuebunny/crossref_metadata_2025 huggingface dataset:
61 HIP Fracture Management of Older Adults in a Public Tertiary Hospital in Kuala Lumpur: Analysis and Comparison with the Standard of Care in UK
Authors: Pang Gordon Hwa Mang , Chong Elizabeth Gar Mit , Razali Rizah Mazzuin , Lee Fatt Soon , Yau Weng Keong
Published: December 2019

Background

There has been rapid improvement in evidence-based care for hip fracture in UK in which prompt, effective, multidisciplinary management has been shown to improve quality and reduce costs. The aim of this study was to evaluate the current outcome of hip fractures in our hospital, and to compare it to the outcome of evidence-based management of hip fractures in UK.

Methods

A cross-sectional study of all hip fracture patients aged 60 and above, admitted from 1st March 2018 until 28th Feb 2019. Medical records of 105 patients obtained from a hip fracture registry were reviewed. Clinical data such as patients’ sociodemographics, fall circumstances, fractures, peri-operative details, complications and mortality were extracted and analysed.

Results

The surgery rate was 67% (96.5% in UK). Among the 37 patients (35.2%) not operated, 15 refused operation. Rate of early surgery was only 9.3% (71.3% in UK). Medical stabilisation (28.2%) and no operating time (40.8%) were the main reasons for surgical delay. None had falls assessment (98% in UK) and only 7.6% was started on bone protection prior to discharge (60% in UK). The average length of stay was 17 days (15.8 days in UK). The 30 day mortality was 9.5% (8.5% in UK).

Discussion

Our results showed that there was no significant difference in length of stay and 30 day mortality compared to UK. However, this may be due to our small sample size. Lack of awareness of falls assessment and bone protection suggests that our current model of care needed improvement.

Conclusion

Our results highlighted the need to implement proactive strategies to improve the management of hip fracture in our centre. Ortho-geriatrics shared-care in hip fracture management was subsequently implemented in an effort to improve patient care and service. Further studies need to be done to re-evaluate the outcomes post implementation.
62 Are Junior Doctors aware about Risks of Falls in the Hospital
Authors: Chen Ng Chai , Chong Gar Mit , Karthigayan Aruna
Published: December 2019

Introduction

Falls are a leading cause of hospital acquired injuries. Junior doctors play a role as part of the multidisciplinary team, to prevent in-hospital falls and reduce harm following a fall. This study is to determine junior doctors’ level of knowledge regarding in-hospital falls.

Methods

A self-constructed and validated questionnaire was delivered to junior doctors during their weekly teaching session in the first 2weeks of May2019. It comprised of 1) Demography of participants 2) In- hospital falls prevention 3) In-hospital falls management. Correct responses from junior doctors working less than 1year and those more than 1year were compared.

Results

46% of the junior doctors responded to the questionnaire. Only 9.5% (n=23) had exposure to a course on management of falls. 82% of them (n=218) were not aware of Malaysia National Falls Guideline, whilst only a quarter of the responders (n=67) heard about the presence of Fall Intervention Team. Less than 50% junior doctors were aware of the use of Morse Fall Scale as a standardised risk assessment tool.

More than 50% of the correct responses are from more experienced junior doctors. 63.4% answered “Depression is a risk factor for falls” correctly, which represented the lowest of all the items. The second lowest item was “lines/catheters is a risk factor for falls”. The item which had the highest percentage of correct answers was “dizziness/vertigo is a risk factor for falls”, accounting for 260 subjects (98%). 56% of housemen considered physical restraints as part of fall intervention in hospital.

Conclusion

The more experienced junior doctors had better knowledge about falls in the hospital, however from this study it is shown that it is still lacking. Continuing medical education should be an avenue where in-hospital falls is emphasized, and their knowledge is regularly updated.
63 Impact of an Orthogeriatric Service on Osteoporosis Management in HIP Fracture Patients
Authors: Amini Homaira , Ong Kevin , Strivens Edward
Published: December 2019

Background

Osteoporosis which is now treatable is the major risk factor for hip fractures in the elderly. Having a hip fracture increases morbidity and mortality. Hip fractures are costly. Incidence increases with age.

Aims

To examine how introduction of an orthogeriatric service (OGS) improves osteoporosis management.

Method

A dedicated OGS was established in the orthopaedic unit in an Australian tertiary teaching hospital in July 2014. Retrospective analyses were undertaken to compare osteoporosis diagnosis and treatment rates in patients ≥ 65 years old presenting with minimal trauma hip fractures (MTHF) before and after the OGS was established.

Results

1. 108 MTHF (mean age 81 years) and 107 MTHF (mean age 82 years) were admitted in 2014 respectively before and after the OGS was established.

2. New osteoporosis diagnoses increased by 27%, new calcium &/or vitamin D prescription increased by 17% and new antiresorptive treatment increased by 30%, after the OGS was established.

3. The odds ratio for receiving a new diagnosis of osteoporosis post MTHF with the OGS compared to pre-OGS was 4.4 (2.1 – 9.0), p<0.0001.

4. The odds ratio for initiating new antiresorptive treatment post fractured NOF with OGS compared to pre-OGS was 6.2 (3.0 – 12.7), p<0.0001.

5. Rates of new diagnoses of osteoporosis and initiation of antiresorptive treatments with the OGS were not affected by age or gender.

Conclusion

1. Introduction of a dedicated OGS improved osteoporosis diagnoses and initiation of antiresorptive treatments.

2. Patients who received a new diagnosis of osteoporosis and/or started on antiresorptive treatment were also likely to be prescribed calcium and/or vitamin D supplements as well.

3. There did not appear to be any age or gender bias towards giving more new diagnoses of osteoporosis and/or more new antiresorptive treatments with a dedicated OGS.

4. These results may be useful for benchmarking and comparison purposes.
67 Determine Risk of Fall in Medical Ward: An Exploratory Study
Authors: Embong Julaida , Lee L K , Nawawi M A , Razali R M , Chong E C M , Keong Y W , Rajadurai S
Published: December 2019

Introduction

Patient fall is very common in hospital. It is the biggest reason of hospitalization, morbidity and mortality. However there were few evidence on risk of fall. Thus, the aim of this study was to determine risk of fall and factor associated.

Method

A Cross-sectional study has been carried out from 3 January until 7 June 2019. A total number of 151 subject were recruited from selected medical ward. Data on Socio-demographic, medication, medical related history, vision and hearing impairment were collected. The outcome measures used were Hand Grip Strength, Timed Up and Go (TUG), and Berg Balance Score (BBS).

Result

There were significant difference between risk of fall with balance (p=0.00), right and left grip strengths (p=0.004&0.001), osteoarthritic Knee (p=0.006) and Functional reach (p=0.000).

Conclusion

The results show greater risk of fall associated with balance, grip strengths, osteoarthritic knee and Functional reach.
68 Task Specificity in Fall Prevention
Authors: Lord Stephen
Published: December 2019

Falls pose a major threat to the well-being and quality of life of older people. Falls can result in fractures and other injuries, disability and fear and are can trigger a decline in physical function and loss of autonomy. This presentation with synthesises recent published findings on fall risk and mobility assessments and fall prevention interventions and considers how this field of research may evolve in future, Fall risk topics include the utility of remote monitoring using wearable sensors and recent work investigating brain activation and gait adaptability. New approaches for exercise for fall fall prevention including dual task training, cognitive-motor training with exergames and reactive step training are discussed. The presentation will discuss how these new initiatives and technologies have potential for effective fall prevention and improved quality of life. It concludes by emphasising the need for a continued focus on translation of evidence into practice including robust effectiveness evaluations of so that resources can be appropriately targeted into the future.
72 Test-Retest Reliability and Minimal Detectable Change for Postural Sway by using Sway Meter in Elderly Subjects
Authors: Rongsawad Kitima , Worawan Laddawon , Jirarojprapa Karnsiree , Kaewkham Sararat , Khattiwong Sarawut
Published: December 2019

Introduction

Static postural stability is the ability to maintain the posture with minimum sway. Increasing postural sway during standing in different sensory conditions is associated with aging due to decline in sensory and motor functions. Sway area measured by using sway meter is usually simple method for assessing postural stability in elderly subjects. Like many biological measurements, sway area has an intrinsic variability that affects their test-retest reliability and responsiveness of postural stability assessment. The minimal detectable change (MDC) is ability to detect smallest change beyond measurement error that reflects a reliable change. Therefore, the MDC value could provide information of clinical relevance on postural stability. The aims of this study were to determine test-retest reliability and MDC of sway area obtained from sway meter in elderly subjects.

Methods

Twelve healthy elderly subjects aged 60 years and above were participated in this study. The test and retest repeatability of postural sway measurements were performed twice with a 1-hour interval. For each subject was assess postural sway using Lord’s sway meter during standing on 4 sensory conditions for 30 seconds of each condition. The test-retest reliability of sway area was calculated using intraclass correlation coefficient. The MDC for each sway area was calculated to quantify clinical relevance.

Results

The test-retest reliability of sway area revealed good to excellent reliability ranged from 0.85 to 0.94. Standard error of measurement (SEM) and MDC ranged from 75 to 205 mm2 and 209 to 568 mm2, respectively.

Discussion and Conclusion

Our findings reveal that sway area in different sensory conditions could be used in assessment of postural stability in elderly subjects. SEM and MDC of sway area increased when subjects were asked to close their eyes and on foam surface. The sway meter is a reliable tool for assessing postural stability in clinical setting.
73 Exercise Habit is Associated with Lower Fall Risks among Elderly People Living in Urban Areas
Authors: Yokoyama Hisayo , Watanabe Hitoshi , Saito Kazumi , Shibata Ayane , Suzuki Yuta , Imai Daiki , Okazaki Kazunobu , Ogita Akira
Published: December 2019

In the present super aged society that has limited financial resources for efficient health care for the elderly population, fall prevention is an urgent issue. The present study examined the relationship between exercise habit and fall risks among elderly people living in an urban area. A total of 1,014 elderly people (age: 65–89 years) living in Osaka City were enrolled in this study and assigned to 5 different age groups. The motor abilities of the participants were evaluated by the Functional Reach Test (FRT) and the Timed Up and Go (TUG) test, with the cutoff value for fall risk set at 25 cm and 13.5 s, respectively. Exercise habit (≤1 h, 1–2 h, or ≥2 h per week), history of recent falls, and anxiety about falling were also assessed using a questionnaire modified from the checklist by the Ministry of Health, Labour and Welfare of Japan. The results of the FRT and TUG tests were increasingly poorer in higher age groups. History of recent falls and anxiety about falling were also more frequent in higher age groups (all p < .05). The prevalence of exercise habits was similar among the age groups. In the age groups >75 years, there was an association between exercise habit and a decrease in fall risks, based on the FRT results (all p < .05). The mean FRT value of the participants with the greatest exercise habit was equivalent to that of the generation 10 years younger with the lowest exercise habit. There was an association between exercise habit and decreased anxiety about falling (p = .003), but not with a history of recent falls. Our results suggest that exercise should be promoted among elderly people living in urban areas to contribute to fall prevention.
79 A Life Course Approach to Standing Balance: Risk Factors Across Life
Authors: Blodgett Joanna , Cooper Rachel , Davis Daniel H J , Kuh Diana , Hardy Rebecca
Published: December 2019

Introduction

Poor balance ability in mid and later life is associated with increased risk of adverse health outcomes. Understanding what factors across life contribute to balance ability in the ageing population is important in order to prevent, delay or minimise balance decline. Our aim was to identify socioeconomic indicators, health behaviours, health status indicators and cognition that are associated with balance and identify how these associations varied by age and sex.

Methods

Data from the MRC National Survey of Health and Development, a British birth cohort study, were utilised (n=3111). Multilevel models examined associations between twelve different factors across life (maternal education, paternal occupational class, education, own occupational class, physical activity, smoking, diabetes, respiratory symptoms, cardiovascular events, knee pain, depression and verbal memory) and one-legged standing balance (assessed at ages 53, 60-64 and 69).

Results

Men had better balance than women at age 53 (b=18.8% (95%CI: 13.6, 23.9), although this difference decreased with age (11.8% at age 60-64 and 7.6% at age 69). Low socioeconomic position, poor health behaviours, poor health status and lower cognition were associated with poorer balance at all three ages. For example, those from the lowest paternal occupational class had 29.6% (95% CI: 22.2, 38.8%) worse balance than those from the highest class. There were no sex differences in patterns of associations. Associations of balance with socioeconomic indicators, cognition and physical activity got smaller with age, while the associations with knee pain and depression increased.

Discussion

Factors across life that contribute to balance are multifaceted and complex. A multifactorial intervention to minimise balance decline and falls could be more appropriate than a single factor approach. Due to different patterns of association with age (i.e. knee pain or depression), different factors should be targeted depending on age.
80 The Effects of Predisposing and Precipitating Factors on Gravity of Falls
Authors: Isacu Daniella , Slimani Mohand , Margine Daniela , Reben Isabelle , Gabteni Ghazoua , Marais Sarah
Published: December 2019

During 14 months, on the Geriatric Department of HC of Loches were hospitalised for falls 97 patients with an average age of 82,2 years.

We studied the effect of predisposing (neuro-sensitive deficiency; walking disabilities; cognitive disorders; depression; malnutrition; vitamin D deficiency; iatrogenic factors; abnormal feet) and precipitating (infections; stroke; confusion; ionic disturbances; toxic substances; anemia; rhythm and conduction heart disorders; orthostatic hypotension) factors on gravity of falls using ANOVA statistical analysis tests.

Following the interrogation we found that from the 62,88% women and 37,12% men, 79,38% have fallen at home, in nursing homes 12,37% and in our department 8,25%. The falls have had as consequences in 45 cases no trauma, in 34 cases mild trauma and 18 fractures.

The results showed that the most representatives predisposing factors were walking disabilities 76,28%; cognitive disorders 66% and iatrogenic 54,63%. Among the precipitating factors the most representatives were arhythmia and conduction heart disorders 62,88% and infections 56,7%.

There was a significant difference (p<0,0001) between the predisposing factors and precipitating factors in no trauma and mild falls (p<0,001), showing that precipitating factors have less influence on falls without sever consequences. There was no difference (p=0,4) between the factors when a fracture was the consequence. In this case the precipitating factors have the same impact on gravity of falls as the predisposing factors.

Iatrogenic factors (39,62% beta–blockers) and arrhythmias had significantly higher values in patients with falls and fractures than in those with falls without trauma (p<0,05) or mild trauma (p<0,001).

The addition of some two types of factors influences the severity of falls in elderly people.
81 Balance Ability and Falls in Mid-Life: Understanding Associations and Potential Diagnostic Screening
Authors: Blodgett Joanna , Cooper Rachel , Davis Daniel H J , Kuh Diana , Hardy Rebecca
Published: December 2019

Background

Falls in older adults are a growing public health concern. Evidence shows that balance ability is associated with falls and may be a useful screening tool to identify high-risk individuals. However, research has primarily focused on individuals aged 65+. This evidence has used regression modeling, without assessing the diagnostic accuracy of balance. We aimed to investigate both associations and screening accuracy of balance ability at ages 53 and 60-64 with falls at ages 60-64 and 68.

Methods

Data from the MRC National Survey of Health and Development, a British birth cohort study, were utilised (n=3563). At ages 53 and 60-64, one-legged balance time with eyes-closed was assessed. At ages 60-64 and 68, participants self-reported fall frequency (0, 1, 2+) and type (injurious, non-injurious) within the last year. Sex-adjusted multinomial logistic regressions assessed associations of balance with fall frequency and type. Areas under the curve (AUCs) of balance and sex prediction models were calculated.

Results

Better balance ability at age 53 was associated with lower risk of recurrent falls at ages 60-64 [RRR(95%CI) of 0.97(0.94,1.00)] and 68 [0.97(0.94,0.99)], and balance at age 60-64 was associated with risk of recurrent falls at age 68 [0.92(0.88,0.97)]. Higher balance at age 53 was associated with injurious falls at age 60-64 [0.95(0.92,0.99)], while higher balance at age 60-64 was associated with non-injurious falls in women [0.90(0.85,0.96)]. AUCs for all models remained low (<0.650); the addition of balance to a sex-only model improved diagnostic accuracy for recurrent and injurious falls.

Conclusions

Balance and falls are associated, even at younger ages. The poor discriminatory ability of balance tests suggests that it may not be an appropriate tool to identify those at risk of falling. Despite an underlying aetiological association between balance and falls, further translational research is needed before balance screenings are implemented into primary care.
84 Identifying Potential Recurrent Fallers in the Community using Frailty Indicators
Authors: Lam Freddy M H , Leung Jason C S , Kwok Timothy C Y
Published: December 2019

Introduction

Frailty indicators were proposed to be significant predictors of falls. However, their comparative and additional value to other simple fall predictors has not been evaluated. This study aims to compare the clinical value of three frailty indicators to fall history in predicting recurrent falls in older adults.

Methods

Four thousand community-dwelling elderly (2000 female) aged 65 years or above were recruited in Hong Kong. The three candidate frailty indicators were the FRAIL scale, the Cardiovascular Health Study Criteria (CHS), and the Study for Osteoporosis and Fracture Criteria (SOF). The comparative predictor was fall history. The area under the receiver operating characteristic curve (AUC) was used to assess their ability to predict recurrent falls in the second year after baseline. Classification and Regression Tree (CART) analysis was used to evaluate the clinical potential of significant predictors on identifying older recurrent fallers in a simulated clinical pathway.

Results

Fall history is better than all frailty indicators in predicting recurrent falls in men and women (Fall History: AUC: men=0.681; women=0.645; Frailty indicators: AUC≤0.641). Upon adjusting for fall history, FRAIL and SOF remained as significant predictors for women but no frailty indicator remained significant for men. FRAIL could separate older women into two groups with different proportion of recurrent fallers in those with history of recurrent falls (16.0% vs 30.8%), single fall history (9.5% vs 37.5%), and no fall history (3.8% vs 7.5%). SOF provides limited value in people with a single fall history (history of recurrent falls: 16.5% vs 20.6%; single fall history: 10.2% vs 10.9%; no fall history: 3.9% vs 8.6%).

Conclusion

Adding FRAIL or SOF on top of fall history improves the prediction of recurrent falls in older women but not men. FRAIL could be a useful tool for identifying community-dwelling older women at high risk of recurrent falls.
85 Exploring the Feasibility of the Adapted Lifestyle - Integrated Functional Exercise (ALIFE) Programme to Prevent Falls among Older Adults in Thailand
Authors: Ounjaichon Sasiporn , Todd Chris , Stanmore Emma , Boulton Elisabeth
Published: December 2019

Background

Falls are the leading cause of injuries in older adults in Thailand. Exercise appears to be a strategy to reduce falls. There is a need to develop a fall prevention exercise programme to encourage participation and adherence. The adapted Lifestyle-integrated Functional Exercise (aLiFE) programme may be suitable by integrating exercise into daily routines as opposed to attending an exercise class. This study aimed to explore the acceptability and feasibility of the aLiFE programme in older Thai adults and identify if modifications are necessary for this population.

Method

To obtain older Thai adults' perspectives and stakeholders’ views, 40 community-dwelling older adults aged ≥ 60 years, in urban and rural locations in Thailand, and 14 stakeholders (e.g. healthcare professionals) working with older Thai adults were included. Qualitative methods were used to conduct focus groups and in-depth interviews with older adults, and semi-structured interviews with stakeholders. Thematic analyses using Framework Approach were conducted.

Results

Findings revealed positive views and identified four themes including: (a) individual factors, (b) perceptions of aLiFE, (c) recommendations for implementing aLiFE in Thailand, and (d) motivation. Older participants expressed interest in performing aLiFE in their daily activities, although some activities may need to be modified to fit the Thai cultural context. Stakeholders were concerned about how to motivate older Thai adults to adhere to aLiFE. Healthcare professionals and family members could play a major role to support older adults in uptake of aLiFE. Benefits (e.g. independence and fall prevention) may motivate older adults to engage in aLiFE. Clear and simple instructions were requested.

Conclusion

The aLiFE programme should be feasible and acceptable among older Thai adults. The aLiFE programme has been appropriately modified to be ‘Thai LiFE (TLiFE)’. A feasibility randomised controlled trial of the TLiFE programme has been conducted in older Thai adults.
89 Randomised Controlled Trial of the Effect of Tai Chi on Postural Balance of People with Dementia
Authors: Nyman Samuel , Ingram Wendy , Sanders Jeanette , Thomas Peter , Thomas Sarah , Vassallo Michael , Raftery James , Bibi Iram , Barrado-Martín Yolanda
Published: December 2019

Introduction

We investigated the effect of Tai Chi exercise on postural balance among people with dementia (PWD), and the feasibility of a definitive trial on falls prevention.

Method

We conducted a randomised controlled trial. Dyads, comprising community-dwelling PWD and their informal carer (N=85), were randomised to usual care (n=43) or usual care plus the intervention (n=42). For the intervention, over 20 weeks, Tai Chi classes were provided weekly and Tai Chi home practice was facilitated by the carer. The primary outcome was the timed up and go test. Secondary outcomes for PWD included functional balance, static balance, fear of falling, cognitive functioning, quality of life, and falls. Secondary outcomes for carers included dynamic balance, static balance, quality of life, and carer burden. Outcomes were assessed six months post-baseline, except for falls, which were collected prospectively over the six-month follow-up period.

Results

For PWD, there was no significant difference at follow-up on the timed up and go test (mean difference [MD] = 0.82, 95% confidence interval [CI] = -2.17, 3.81, standardised effect size [ES] = 0.14). Among the secondary outcomes, at follow-up, PWD in the Tai Chi group had significantly higher quality of life (MD = 0.051, 95% CI = 0.002, 0.100, ES = 0.51) and a significantly lower rate of falls (rate ratio = 0.35, 95% CI =0.15, 0.81), which was no longer significant when an outlier was removed. Carers in the Tai Chi group at follow-up were significantly worse on the timed up and go test (MD = 1.83, 95% CI = 0.12, 3.53, ES = 0.61). The remaining secondary outcomes were not significant. No serious adverse events were related to participation in Tai Chi.

Conclusion

With refinement, this Tai Chi intervention has potential to reduce the incidence of falls and improve quality of life among community-dwelling PWD.
91 Individuals Aged 65-69 Years Have Poorer Postural Control Related to Fear of Falling than Individuals Aged 70-74 Years
Authors: Mat Sumaiyah , Ng Chin Teck , Tan Maw Pin
Published: December 2019

Background

Fear of falling (FoF) is common in older people with a history of falls and increases the risk of future falls. It is postulated that individuals with FoF may lose the balance control in response to threatening situations due to psycho-emotional responses to a previous event. Little is known of how FoF influences postural control in older people.

Aim

To compare the influence of age in the association between FoF and postural control among older persons

Methods

A case-control study involving individuals aged ≥65 years with ≥2 falls or one injurious fall over 12 months with volunteers aged ≥65 years with no falls in the past year. Postural sway was quantified by using a long force-plate balance platform (Balancemaster, NeuroCom, USA). Fear of falling was assessed using the short Falls Efficacy Scale-International questionnaire.

Result

Of 102 participants recruited in this study, 33 (32.4%) were aged 65-69y, 36 (35.3%) aged 70-74y, and 33 (32.4%) age≥ 75y. There was no significant difference in FoF across the groups. The oldest age group had poorer postural control. Fear of falling in the youngest old group was associated with poorer standing balance in ‘eyes closed, firm surface’ conditions (p-value=0.012), forward maximal excursion (p-value=0.007), forward end point (p-value=0.001), forward movement velocity (p-value=0.008) and forward directional control (p-value <0.001). The associations remained significant even after adjustment of history of falls, body mass index and comorbidities.

Conclusion

The influence of FoF on postural control is age dependent with posturography measurements only significantly associated with FoF within the 65-69y age group, but not the 70-74y or ≥ 75y age groups. Psychological interventions for fall prevention may therefore be more appropriately targeted according to age groups, rather than treating all over 65s as a homogenous group. This approach should be evaluated in future studies.
92 Development and Validity of a Fall-Risk Score for Older People who Receive Nursing-Care-Service
Authors: Oshima Kensuke , Asai Tsuyoshi , Naruse Fumihiro , Yamamoto Junshiro , Minami Chie
Published: December 2019

Introduction

Older people who receive nursing-care-service have multiple fall-risk than well-functioning older people. To our knowledge, there is no appropriate fall-risk assessment for them. Most of the fall-risk assessments in previous researches were subjective. Thus, we aimed to develop a new fall-risk score included major fall-related factors such as objective motor-functions for older who receive nursing-care-service, and to verify the validity of the score.

Method

We recruited 264 older people who receive nursing-care-service. They were randomly allocated to the fall-risk score development group (Development group) and the score validity group (Validity group). All assessment items were major fall-risk related factors. As motor-function tests, Short-Physical-Performance-Battery (SPPB) including single-task-walking (STW), and dual-task-walking (DTW) were performed. Dual-task-cost (DTC) was computed. The DTC score was made with 0 = lower than 20%, 1 = more than 20%, 2 = incomplete DTW. As a cognitive-function test, Mini-Mental-State-Examinations was examined. Basic-health-related-information and past one-year fall-history were obtained via patient care records. Information of fear of falling was obtained via interview. In the Development group, the association between fall-history and the major fall-related factors were analyzed using multiple-logistic-regression analysis. Based on these results, we developed the 4-point fall-risk score consisted of DTC score and SPPB score (0=more than 10-point, 1=7 to 9 point, 2=less than 6-point). Finally, in the Validity group, the association between fall-history and the fall-risk score was investigated using logistic-regression analysis, and we computed area-under-the-curve (AUC).

Results

In the Development group, the fall-history was associated with SPPB (Odds ratio[95%CI] = 0.73[0.61-0.87]), and DTC score (Odds ratio[95%CI] = 2.50[1.14-5.79]). In the Validity group, our fall-risk score was significantly associated with fall-history [ AUC=73%, sensitivity=67%, specificity=71% ].

Conclusion

In the fall-risk assessment for older people who receive nursing-care-service, our fall-risk score included SPPB and DTC are useful. The validity of our fall-risk score was confirmed.
97 Effect of Functional Electrical Stimulation of Ankle Muscles in Standing Positions on Postural Stability in Elderly Adults
Authors: Rongsawad Kitima , Jirarojprapa Karnsiree , Kaewkham Sararat , Worawan Laddawon , Khattiwong Sarawut
Published: December 2019

Introduction

Declines in postural stability in standing with aging are associated with a reduction in ankle muscle control. Increasing postural sway may lead to fall and limit activities of daily living in elderly people. There are evidences demonstrate that exercise interventions can improve postural stability and decrease risk of falling. However, to our knowledge, there are no studies have reported the effect of functional electrical stimulation (FES) of ankle muscles on postural stability in elderly people. So, the purpose of this study was to determine the effect of 4-week FES protocols applied to ankle dorsiflexor and plantar flexor muscles on postural stability in elderly adults.

Methods

Ten elderly adults (67.5±6.9) participated in this study. Electrical stimulation (biphasic pulse current with a pulse duration of 0.3 ms, 50 Hz) for bilateral ankle dorsiflexor and plantar flexor muscles combined with standing balance, 3 times a week for 4 weeks. Postural sway was assessed using Lord’s sway meter during standing on 4 sensory conditions. Balance and gait speed were assessed using short physical performance battery (SPPB). All outcome measures were performed before and after 4-week period.

Results

After 4-week, all subjects showed decreased postural sway during standing on 4 sensory conditions. But statistical significance was clearly achieved for eyes closed and closed on foam surface condition. Gait speed time and score of SPPB was significantly different between before and after training.

Discussion and Conclusion

Findings from this study showed that FES of ankle muscles in standing positions for 4-week period could improve postural stability and gait speed in elderly adults. The decrease in postural sway could possibly explain by the better coordinated control of both ankle dorsiflexor and plantar flexor muscles in standing balance. However, this study assessed only the immediate effect of training. Further study should be to determine whether long-term effect.
Reflexivity in Applied Linguistics Research in the Tourism Workplace
Authors: Sharma Bal Krishna
Published: December 2019

Linguistic ethnographers largely agree that engaging in self-reflexivity enables researchers to identify how their actions, subjectivities, and motivations influence research. In this article, I argue for a discourse-oriented ethnographic account as an alternative method for documenting and reporting such reflexivity. The overall goal of this article is to examine reflexive research practices in the study of tourism communication. Presenting illustrative cases, I closely analyze how the researcher’s co-presence naturally opens up opportunities for some form of intervention in tourist–guide dyads. I show that researcher participation that is intended to resolve local interactional problems can have unintended consequences resulting in marginalization or exclusion of the key participants. The analysis shows that the researcher is not only the knowledge-maker in applied linguistics research but is also an object of analysis in the process. Overall, the study is intended to invite workplace researchers to reflect on whether and how much to participate, how their participation shapes researcher–participant relationships, how their relationship impacts data and knowledge claims, and how issues of balance and distance can be negotiated.
Subthalamic nucleus activity dynamics and limb movement prediction in Parkinson’s disease
Authors: Khawaldeh Saed , Tinkhauser Gerd , Shah Syed Ahmar , Peterman Katrin , Debove Ines , Nguyen T A Khoa , Nowacki Andreas , Lachenmayer M Lenard , Schuepbach Michael , Pollo Claudio , Krack Paul , Woolrich Mark , Brown Peter
Published: December 2019

Whilst exaggerated bursts of beta frequency band oscillatory synchronization in the subthalamic nucleus have been associated with motor impairment in Parkinson’s disease, a plausible mechanism linking the two phenomena has been lacking. Here we test the hypothesis that increased synchronization denoted by beta bursting might compromise information coding capacity in basal ganglia networks. To this end we recorded local field potential activity in the subthalamic nucleus of 18 patients with Parkinson’s disease as they executed cued upper and lower limb movements. We used the accuracy of local field potential-based classification of the limb to be moved on each trial as an index of the information held by the system with respect to intended action. Machine learning using the naïve Bayes conditional probability model was used for classification. Local field potential dynamics allowed accurate prediction of intended movements well ahead of their execution, with an area under the receiver operator characteristic curve of 0.80 ± 0.04 before imperative cues when the demanded action was known ahead of time. The presence of bursts of local field potential activity in the alpha, and even more so, in the beta frequency band significantly compromised the prediction of the limb to be moved. We conclude that low frequency bursts, particularly those in the beta band, restrict the capacity of the basal ganglia system to encode physiologically relevant information about intended actions. The current findings are also important as they suggest that local subthalamic activity may potentially be decoded to enable effector selection, in addition to force control in restorative brain-machine interface applications.
Trade patterns in a globalised world: Brazil as a case of regressive specialisation
Authors: Nassif André , Castilho Marta R
Published: December 2019

Globalisation is the extent and intensity with which a country’s production, trade and capital flows are integrated into the world economy. Our focus is on globalisation through international trade. We analyse the main theoretical predictions about the effects of global trade integration on trade patterns between countries of different levels of income and technology and compare this analysis to our investigation of Brazil’s trade integration between 1990 and 2016. Particularly, we investigate whether Brazil’s recent trajectory has been directed to a pattern of regressive specialisation. By regressive specialisation, we refer to that in which both production and export structures are strongly oriented to goods of low technological sophistication and low income elasticity of demand. The recent theoretical literature on technological gaps suggests that when a country enters a rapid pattern of regressive specialisation, a falling-behind trajectory is observed. Our main findings are as follows (i) the technological gap significantly widened for all groups of manufactured goods classified by factor content and technological sophistication; (ii) the income elasticity of demand for Brazilian imports is greater than that for Brazilian exports, implying a falling-behind trajectory of the economy in the past few decades and that growth has been constrained by long-term balance-of-payments equilibrium (Thirlwall’s law); and (iii) there has been a very marked trend of high concentration of Brazilian exports in primary goods, but imports composed of high technologically sophisticated manufactured goods, reinforcing the regressive specialisation of Brazil’s trade pattern in the last decades.
“Diet in the Etiopathogenesis of IBD: Is There A Culinary Culprit?”
Authors: Issokson Kelly
Published: December 2019

Lay Summary

Research suggests that diet plays a role in the development of inflammatory bowel disease (IBD). Eating more fiber, omega-3 fatty acids, and limiting food additives may lower risk. More research is needed to better understand diet factors that may protect against IBD.
Microbes Associated With Black Soldier Fly (Diptera: Stratiomiidae) Degradation of Food Waste
Authors: Shelomi Matan , Wu Meng-Kun , Chen Shu-Min , Huang Jing-Jiun , Burke Christopher Glen
Published: December 2019

Black soldier fly (Hermetia illucens L.) larvae are capable of valorizing waste by converting it into insect biomass that can be used as animal feed, leaving undigested residue that can be used as soil enrichment. Evidence is conflicting over whether larvae fed substrate containing pathogenic microbes emerge uncontaminated. Studies also differ on which clades comprise the species’ gut microbiome, and on whether and how diet affects these microbes. Using culturing and metabarcoding, the bacterial microbiota of black soldier fly larvae reared on two different kinds of food waste (postproduction soy pulp and postconsumer cafeteria waste) were analyzed, along with the microbes of their substrates. Little to no overlap was found between the wastes, the larvae, and the residues, but the larvae fed different foods had a significant percentage of their microbes in common. The data, in line with other works on this species, suggest the larvae have a conserved microbiota whose components vary geographically.
Repeated Bereavement Takes Its Toll on Subjective Well-Being
Authors: Infurna Frank J , Mayer Axel
Published: December 2019

Background and Objectives

The bereavement literature has shown that losing close loved ones can lead to sustained declines in quality of life. Research in this area has typically focused on singular bereavement events, such as the loss of a spouse or child. Much less is known regarding the consequences of repeated bereavement or repeated losses in one’s social network.

Research Design and Methods

We use longitudinal panel survey data from the Household Income and Labour Dynamics of Australia study to examine the effect of repeated bereavement in one’s social network on cognitive and affective measures of subjective well-being and whether there are age differences in the magnitude of these effects across young adulthood, midlife, and old age. To address our research questions, we use a multiple-group discontinuous change model with random effects.

Results

Repeated deaths in one’s social network had a nonlinear effect on life satisfaction and positive affect, suggesting that individuals were able to adapt to two bereavements, but each bereavement beyond two resulted in sustained lower levels. Negative affect did not show increases because of repeated bereavements. Repeated bereavement had the strongest effect for those in young adulthood and old age.

Discussion and Implications

Our findings demonstrate that repeated bereavement has consequences for subjective well-being and that young and older adults are most vulnerable to repeated bereavement. Our discussion focuses on the conceptual and methodological advancements of our study for the examination of major life stressors.
Invariant TE and TM impedances in the marine magnetotelluric method
Authors: Montiel-Álvarez A M , Romo J M , Constable S , Gómez-Treviño E
Published: December 2019

The magnetotelluric (MT) impedance tensor has a nil diagonal when one of the axes of the coordinate system coincides with the strike of a 2-D structure. In general, real data are full tensors either because of 3-D effects or measurements not aligned to the geological strike. The usual practice to adapt the field tensor to the 2-D assumption is to rotate to a new system of coordinates. In most cases, there is no single angle of rotation that warranties that the diagonal elements become zeros as in the ideal 2-D case. Even maximizing the off-diagonal elements does not necessarily produce a nil diagonal. Consequently, the 2-D inversions proceed by neglecting whatever there is left in the diagonals. In this work, we explore an alternative that places no constraints on direction but assures a nil diagonal. We use two rotational invariants that compact the four elements of the tensor into only two and reduce in 2-D to the TE and TM impedances. These are obtained readily by solving a quadratic equation. We explore four different scenarios: (1) using the invariants, (2) rotating the tensor perpendicular to the profile, (3) rotating to the average maximum orientation for each station and (4) maximizing the off-diagonal elements of the tensor for each site, frequency to frequency. These approaches were applied to 3-D synthetic and field data. The field data correspond to two marine magnetotelluric surveys in the Gulf of California. In one of them, there is no information on the instrument orientation because the compasses failed. In this case, the rotational invariants come handy to overcome the problem. In the other survey, there was orientation information and the 2-D inversions illustrate the better performance of the invariants relative to the traditional approaches.
Testing the clinical validity of the Bemelman Rib Fracture Management Guideline
Authors: Dorman Jessica R , Clarke Peter T M , Simpson Rosalind B , Edwards John G
Published: December 2019

Whilst surgical stabilization of rib fractures (SSRF) results in better outcomes, selection algorithms are lacking. We aimed to validate the Rib Fracture Management Guideline proposed by Bemelman. From a cohort of 792 patients with multiple rib fractures, 2 sequential cohorts were selected: 48 patients who underwent SSRF and 48 patients who managed conservatively. Admission computed tomography scans and records were reviewed by an investigator blinded to the SSRF outcome. Adherence to the Bemelman guideline, revised to take account of consensus rib fracture definitions, was tested. Fifty-seven patients had multiple rib fractures only, and 39 patients also had a flail segment. Thirty-nine patients with flail segment underwent SSRF, and 18 patients were managed conservatively. Of the patients that the guideline predicted should have received surgery, 87% did. Of those that it predicted should not receive SSRF, 98% did not. The guideline displayed a sensitivity (95% confidence interval) and specificity for predicting the fixation of 0.98 (0.89–0.9995) and 0.83 (0.70–0.93), respectively. The positive and negative predictive values for surgical fixation were 0.87 (0.76–0.92) and 0.98 (0.85–0.99), respectively. The Bemelman guideline was thus a good predictor of SSRF in retrospective cohort but should be used in conjunction with clinical judgement. Further validation is indicated in a prospective study.
Intestinal epithelial cell-derived IL-15 determines local maintenance and maturation of intra-epithelial lymphocytes in the intestine
Authors: Zhu Yuanbo , Cui Guangwei , Miyauchi Eiji , Nakanishi Yuki , Mukohira Hisa , Shimba Akihiro , Abe Shinya , Tani-ichi Shizue , Hara Takahiro , Nakase Hiroshi , Chiba Tsutomu , Sehara-Fujisawa Atsuko , Seno Hiroshi , Ohno Hiroshi , Ikuta Koichi
Published: December 2019

Abstract

Interleukin-15 (IL-15) is a cytokine critical for maintenance of intestinal intra-epithelial lymphocytes (IELs), especially CD8αα + IELs (CD8αα IELs). In the intestine, IL-15 is produced by intestinal epithelial cells (IECs), blood vascular endothelial cells (BECs) and hematopoietic cells. However, the precise role of intestinal IL-15 on IELs is still unknown. To address the question, we generated two kinds of IL-15 conditional knockout (IL-15cKO) mice: villin-Cre (Vil-Cre) and Tie2-Cre IL-15cKO mice. IEC-derived IL-15 was specifically deleted in Vil-Cre IL-15cKO mice, whereas IL-15 produced by BECs and hematopoietic cells was deleted in Tie2-Cre IL-15cKO mice. The cell number and frequency of CD8αα IELs and NK IELs were significantly reduced in Vil-Cre IL-15cKO mice. By contrast, CD8αα IELs were unchanged in Tie2-Cre IL-15cKO mice, indicating that IL-15 produced by BECs and hematopoietic cells is dispensable for CD8αα IELs. Expression of an anti-apoptotic factor, Bcl-2, was decreased, whereas Fas expression was increased in CD8αα IELs of Vil-Cre IL-15cKO mice. Forced expression of Bcl-2 by a Bcl-2 transgene partially restored CD8αα IELs in Vil-Cre IL-15cKO mice, suggesting that some IL-15 signal other than Bcl-2 is required for maintenance of CD8αα IELs. Furthermore, granzyme B production was reduced, whereas PD-1 expression was increased in CD8αα IELs of Vil-Cre IL-15cKO mice. These results collectively suggested that IEC-derived IL-15 is essential for homeostasis of IELs by promoting their survival and functional maturation.
Refiguring Baidehīśa Bilāsa: Reading the Queer and the Erotic in Upendra Bhanja’s Rāmāyaṇa
Authors: Ghosh Ujaan , Chowdhury Amrita
Published: December 2019

Baidehīśa Bilāsa is a seventeenth century Odiā erotic retelling of the Rāmāyaṇa. The work is particularly pertinent today, as the political right wing in India celebrates Rāma’s abstinence and represses his conjugal life in public memory. Rāma’s leaving of Sītā for his kingdom (read the Hindu nation) is further highlighted as his choosing of Dharma (duty) over Kāma (pleasure). This text reorders that binary and demonstrates how preoccupied Rāma was in fulfilling his duties as a husband. It contains multiple erotic encounters between the couple and some important (and subversive) instances of queer imagination and interaction. This article is an attempt to survey and decipher the same. And, in doing so, we intend to contribute to the scholarship on Rāmāyaṇa and the literary history of pre-modern Odisha, which has received relatively little scholarly attention.