Evaluation of Healthy South Texas Asthma Program on improving health outcomes and reducing health disparities among the underserved Hispanic population: using the RE-AIM model

Background In the United States, childhood asthma prevalence is higher among low-income communities and Hispanic populations. Previous studies found that asthma education could improve health and quality of life, especially in vulnerable populations lacking healthcare access. This study aims to describe Healthy South Texas Asthma Program (HSTAP), an evidence-based asthma education and environmental modification program in South Texas, and evaluate its associations with health-related outcomes among Hispanic children with asthma and their families. Methods The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) planning and evaluation framework was used as an overarching tool to evaluate the impact of the HSTAP. This educational program included 451 children with asthma and their families living in South Texas, an impoverished area at the Texas-Mexico border. The program consisted of (a) the asthma education (2-h) for children with asthma provided by Respiratory Therapy students at the children’s schools and (b) the home visit Asthma and Healthy Homes education and walk-through sessions (at baseline and 3 months) for parents and two follow-up visits (6 and 9–12 months later) led by community health workers. The education was provided in either English or Spanish between September 2015 and August 2020 as part of the Healthy South Texas Initiative. A pre-and post-test design was implemented to assess the differences in health outcomes, knowledge, and behaviors using standardized self-reported surveys as reported by parents. Analyses included primary descriptive analyses, generalized estimating equation models, the Wilcoxon signed-rank test, and the McNemar test. Results The HSTAP was significantly associated with improved individual-level outcomes on the frequency of asthma-related respiratory symptoms, including shortness of breath, chest tightness, coughing, and sleep difficulty, among children with asthma, as well as an enhanced asthma knowledge in their family. This study also showed significant associations with children’s school attendance and participation in physical activities and family social events and decreased families’ worry about their asthma management. Conclusions The RE-AIM model was a helpful framework to assess the HSTAP on all its components. The results suggest that participation in an asthma education and environmental modification program was associated with improved individual-level health conditions and reduced health disparities among children with asthma in low-income communities.

The Visual, Auditory, and Physical Environment of Livestock Handling Facilities and Its Effect on Ease of Movement of Cattle, Pigs, and Sheep

The visual, auditory, and physical environment livestock are handled in will have an effect on the ease of movement through races and corrals that are used for veterinary treatment, loading trucks or at slaughter houses. When livestock refuse to move easily through a handling facility, people are more likely to use electric goads (prods) or other aversive methods to move them forward. This is a major animal welfare concern. Modification of the environment can improve livestock movement and reduce aversive handling methods. In existing facilities used for handling cattle, pigs or sheep, simple changes such as, adding a light to a dark race entrance or reducing loud intermittent noise may improve livestock movement. Eliminating distractions such as, a noisy truck near a lairage can also facilitate cattle movement and reduce stopping or turning back. In an outdoor facility, sharp shadows on the floor were more likely to be associated with cattle stopping compared to no shadows or soft faint shadows. The installation of small solid walls to prevent approaching animals from seeing either moving equipment, vehicles or people in front of them may also improve forward livestock movement. Non-slip flooring is essential to prevent slipping and falling during handling. Rebuilding or completely redesigning an existing facility is often not required. Outcome based indicators should be used to assess continuous improvements in handling. Some of the commonly used measurable of handling are slipping and falling, stopping, turning back, vocalization during handling and electric prod use. Collecting data both before and after an environmental modification can be used to determine its effectiveness.

Ancient Giant Sequoias Are Dying: Scientists Refuse to Acknowledge the Cause

California’s Giant Sequoias and Coast Redwoods, long symbols of strength, longevity, and resilience, have survived natural climate change for as long as 3,000 years, but are now succumbing to human manipulation of the natural environment. Scientists concerned with the wellbeing of these magnificent trees blame their recent die-offs on climate change, drought, and insects while turning a blind eye to the primary underlying cause: environmental modification by jet-emplacement in the troposphere of toxic particles evidenced as coal combustion fly ash. Said aerosolized particulates cause droughts and deluges, heat the troposphere, contaminate rain, snow, and fog with plant-killing toxins including chemically-mobile aluminum, coat foliage, and exacerbate forest fires. The aerial spraying depletes stratospheric ozone, allowing damaging ultraviolet radiation B and C to reach Earth’s surface. These environmental stressors weaken the trees to the point they are attacked by insects and pathogenic fungi. Here we disclose the unspoken, underlying cause of the die-offs of Giant Sequoias and Coast Redwoods. Through a diabolically-deceptive, Trojan horse, United Nations’ International Treaty the governments of sovereign nations were coerced to wage environmental warfare against their own citizens and the natural environment under the guise of peaceful environmental modification. Remaining trees, and indeed much of the life on Earth, can only be saved if this environmental modification is halted.

EFFECT OF SCREEN HOUSE MODIFICATION AT FLOWER BUD STADIA ON FLOWER QUALITY OF CHRYSANTHEMUM AT MEDIUM UPLAND ELEVATION

<p class="abstrakinggris">Higher temperature and light intensity at the medium upland elevation decrease the number of blooming flowers, flower diameter, and red color flower intensity of <em>Chrysanthemum morifolium</em>compared to that at the high upland elevation. The environmental modification was needed during the flower development phase to improve the quality of chrysantheum at a medium upland elevation. The study aimed to find the suitable screen house environmental modification for increasing the chrysanthemum quality at the medium upland elevation. The study consisted of two factors. First, environmental modification of a screen house, such as (1) control, (2) the addition of shading net on the rooftop of the screen house, (3) the addition of a misting system in the screen house, and (4) the addition of a combination of shading net on the rooftop and misting system in the screen house. Second, the chrysanthemum varieties, including (1) Yastayuki (white flower), (2) Arosuka Pelangi (yellow flower), and (3) Socakawani (red flower). Experiments were arranged in a completely randomized design with three replications. Data were analyzed by combined ANOVA. The results showed that either the addition of a shading net or misting system reduced the number of flower buds growing. The competition among flower buds was found to be reduced by decreasing the number of flower buds. Consequently, the number and diameter of the blooming flower increased. The addition of a shading net on top of the screen house was the most suitable environmental modification to increase the chrysanthemum quality at the medium upland elevation.</p>

Home hazard assessment and environmental modification to prevent falls in older people: the OTIS trial

Background: Falls in older people are a major cause of morbidity and mortality. There is some evidence to suggest that home hazard assessment and environmental modification delivered by an occupational therapist may reduce falls. The objective of this study was to evaluate the effectiveness of this intervention, relative to usual care. Methods: A pragmatic, two-arm modified cohort randomised controlled trial in eight NHS trusts in primary and secondary care in England. In total, 1331 community-dwelling adults aged 65 years and over with a history of falls or fear of falling were randomised in a 2:1 allocation to either usual care plus a falls prevention leaflet (n=901) or to receive the home hazard assessment and environmental modification intervention, plus usual care and a falls prevention leaflet (n=430). The primary outcome was the number of falls per participant over the 12 months from randomisation. Secondary outcomes included: proportion of fallers and multiple fallers, time to fall, and fear of falling. Results: All 1331 randomised participants (mean age 80 years, 872 [65.5%] female) were included in the primary analysis. There was a small increase in the rate of falls in the intervention group relative to usual care (adjusted incidence rate ratio 1.17, 95% CI 0.99 to 1.38; p=0.07). A similar proportion of participants in the intervention (57.0%) and usual care group (56.2%) reported at least one fall over 12 months. There were no differences in any of the other secondary outcomes and no serious, related adverse events were reported. Conclusions: Home hazard assessment and environmental modification delivered by an occupational therapist did not reduce falls in community-dwelling older people deemed at higher risk of falling recruited to this trial.

Physiotherapy and related management for childhood obesity: A systematic scoping review

Introduction Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity. Method A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via “file:pdf”. A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy. Results From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively. Conclusion When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.

THE USE OF METHODS OR MEANS OF WARFARE WHICH CAUSED DAMAGE TO THE NATURAL ENVIRONMENT BASED ON THE INTERNATIONAL HUMANITARIAN LAW

Environment has been widely recognized as international interest and all states shall avoid any activities that may damage the environment. The adoption of Stockholm Declaration 1972, World Charter for Nature 1982, and Rio Declaration 1992 denotes that protection of the environment reflects customary international law. War or armed conflict was one of the principal contributors to the environmental damages. As in the Vietnam War, the United States attempted to create artificial rain by seeding the cloud which led to the establishment of the 1976 Convention on the Prohibition of Military or Any Hostile Use of Environmental Modification Techniques (ENMOD Convention) and the Additional Protocol I 1977. However, the Gulf War 1990-1991 gave rise to the questions whether those two instruments were sufficient to encompass the environmental damages caused by the Iraqi methods of warfare by burning oil wells and spilling oil to the sea. This issue was raised by the author since these two instruments set a high threshold and unclear terms on a degree of environmental damages to be considered as a violation. Accordingly, this paper discusses whether the environmental damages caused by the Persian Gulf War meets the threshold set by the Additional Protocol I and the ENMOD Convention, and further discusses the international responsibility that arose from the damages caused by the War. The result of this research shows that environmental damages caused by Iraqi burning oil wells and oil spill apparently did not satisfy the threshold set by the Additional Protocol I and the ENMOD Convention. Keywords: Armed Conflict, Environment, Gulf War, International Humanitarian Law, Responsibility Abstrak Lingkungan sudah diakui sebagai permasalahan internasional dan semua negara wajib untuk menghindari kegiatan yang berakibat kerusakan terhadap lingkungan. Pembentukan Deklarasi Stockholm 1972, Piagam Dunia Untuk Lingkungan 1982 dan Deklarasi Rio 1992 menunjukkan bahwa perlindungan terhadap lingkungan telah merefleksikan hukum kebiasaan internasional. Perang atau konflik bersenjata merupakan salah satu penyebab utama kerusakan lingkungan. Seperti percobaan untuk membuat hujan buatan yang dilakukan oleh Amerika Serikat dalam Perang Vietnam yang berujung dibentuknya Convention on the Prohibition of Military or Any Hostile Use of Environmental Modification Techniques 1976 (Konvensi ENMOD) dan Protokol Tambahan I 1977. Namun, Perang Teluk 1990-1991 menimbulkan pertanyaan apakah kedua instrumen tersebut dapat mencakup kerusakan lingkungan yang diakibatkan oleh metode berperang Irak dengan membakar dan menumpahkan minyak. Permasalahan tersebut diangkat oleh penulis karena kedua instrumen tersebut menetapkan kriteria kerusakan lingkungan yang kurang jelas dan standar yang terlalu tinggi untuk dinyatakan sebagai pelanggaran. Oleh karena itu, penelitian ini akan membahas apakah kerusakan lingkungan yang diakibatkan oleh Perang Teluk memenuhi syarat yang ditetapkan oleh Protokol Tambahan I dan Konvensi ENMOD, dan juga membahas tanggung jawab internasional yang timbul sebagai akibat dari kerusakan lingkungan yang diakibatkan oleh perang. Hasil penelitian menunjukkan bahwa kerusakan lingkungan yang diakibatkan oleh Irak dengan membakar dan menumpahkan minyak ternyata tidak memenuhi standar yang ditetapkan oleh Protokol Tambahan I dan Konvensi ENMOD. Kata kunci: Hukum Humaniter Internasional, Konflik Bersenjata, Lingkungan, Perang Teluk, Pertanggungjawaban

‘Don’t pee on that!’ Comparing environmental modification and medical management in cats with FIC

PICO question In cats with feline idiopathic cystitis (FIC) is environmental modification superior than medical management in preventing reoccurrence? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed 16 papers were critically reviewed; 14 randomised trials and two case studies Strength of evidence Critical appraisal of the selected papers meeting the inclusion criteria collectively provide weak evidence in terms of their experimental design and implementation Outcomes reported There is weak evidence that any medication or environmental modification is successful in reducing the reoccurrence of FIC when compared to a placebo. Short-term use of amitriptyline can contribute to an increase in occurrence of FIC Conclusion In view of the strength of evidence and the outcomes from the studies the following conclusion is made; in cats with feline idiopathic cystitis there is weak evidence that environmental modification or medication are effective at preventing reoccurrence. Further research is required into the cause of FIC before comparisons on treatment options can be made, however, with the exception of short-term use of amitriptyline, environmental modification and systemic treatment of clinical signs did not contribute to an increase in occurrence of FIC How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Greenhouses and protected cultivation.

Protected cultivation of horticultural crops involves the use of structures, barriers, films, mulches, screens, glass and other materials to provide a modified and more favourable environment for optimal plant growth. The main objectives of this environmental modification are multiple and include protection from damaging natural elements such as wind, rain, hail, snow, frost, cold/high temperatures, excessive light, insects and predators, as well as providing conditions which increase yields and quality. Further advantages of modern protected cultivation structures now incorporate the efficient use of increasingly scarce water, fertilizer, energy and land resources with greater productivity per unit area. This allows production in regions otherwise unfavourable for cropping as well as for out-of-season supply of fresh local produce worldwide.

REKAYASA LINGKUNGAN PEMELIHARAAN BENIH IKAN BAUNG (Hemibagrus nemurus ) UNTUK MENINGKATKAN PERTUMBUHAN DAN SINTASAN

Hemibagrus nemurus is a local commodity fish that is especially favored by people in South Sumatra, Java and Kalimantan. The low survival rate of H. nemurus in the seed rearing phase is one of the obstacles in developing its cultivation. In this study an environmental modification was carried out in the rearing of H. nemurus seed containers through the addition of aeration and recirculation to increase the growth and survival. The study was conducted at a hatchery of farmers in the Kemang area, West Java. The initial length of seed was 10.1 ± 0.17 mm. The container size used was 300 liters of fiberglass. Stocking density was 10 fish / L. The maintenance period was 1 month. The treatments tested were rearing of seeds in an aquarium using A) Aeration system, B) Recirculation System, and C) Aeration + Recirculation System. The results showed that the use of rearing containers equipped with Aeration + Recirculation system resulted in better growth (29.4 mm) and survival (24.5%) compared to rearing in containers with only aeration or recirculation systems. Key words : Aeration,Growth, Hemibagrus nemurus, Recirculation, Survival rate