Reduction of Outdoor and Indoor PM2.5 Source Contributions via Portable Air Filtration Systems in a Senior Residential Facility in Detroit, Michigan.

Background: The Reducing Air Pollution in Detroit Intervention Study (RAPIDS) was designed to evaluate cardiovascular health benefits and personal fine particulate matter (particulate matter < 2.5 µm in diameter, PM2.5) exposure reductions via portable air filtration units (PAFs) among older adults in Detroit, Michigan. This double-blind randomized crossover intervention study has shown that, compared to sham, air filtration for 3 days decreased 3-day average brachial systolic blood pressure by 3.2 mmHg. The results also showed that commercially available HEPA-type and true HEPA PAFs mitigated median indoor PM2.5 concentrations by 58% and 65%, respectively. However, to our knowledge, no health intervention study in which a significant positive health effect was observed has also evaluated how outdoor and indoor PM2.5 sources impacted the subjects. With that in mind, detailed characterization of outdoor and indoor PM2.5 samples collected during this study and a source apportionment analysis of those samples using a positive matrix factorization model were completed. The aims of this most recent work were to characterize the indoor and outdoor sources of the PM2.5 this community was exposed to and to assess how effectively commercially available HEPA-type and true HEPA PAFs were able to reduce indoor and outdoor PM2.5 source contributions. Methods: Approximately 24 h daily indoor and outdoor PM2.5 samples were collected on Teflon and Quartz filters from the apartments of 40 study subjects during each 3-day intervention period. These filters were analyzed for mass, carbon, and trace elements. Environmental Protection Agency Positive Matrix Factorization (PMF) 5.0 was utilized to determine major emission sources that contributed to the outdoor and indoor PM2.5 levels during this study. Results: The major sources of outdoor PM2.5 were secondary aerosols (28%), traffic/urban dust (24%), iron/steel industries (15%), sewage/municipal incineration (10%), and oil combustion/refinery (6%). The major sources of indoor PM2.5 were organic compounds (45%), traffic + sewage/municipal incineration (14%), secondary aerosols (13%), smoking (7%), and urban dust (2%). Infiltration of outdoor PM2.5 for sham, HEPA-type, and true HEPA air filtration was 79 ± 24%, 61 ± 32%, and 51 ± 34%, respectively. Conclusions: The results from our study showed that intervention with PAFs was able to significantly decrease indoor PM2.5 derived from outdoor and indoor PM2.5 sources. The PAFs were also able to significantly reduce the infiltration of outdoor PM2.5. The results of this study provide insights into what types of major PM2.5 sources this community is exposed to and what degree of air quality and systolic blood pressure improvements are possible through the use of commercially available PAFs in a real-world setting.

Reduction of personal PM2.5 exposure via indoor air filtration systems in Detroit: an intervention study.

The adverse health effects of fine particulate matter (PM < 2.5 µm in diameter [PM2.5]) air pollution are well-documented. There is a growing body of evidence that high-efficiency particulate arrestance (HEPA) filtration can reduce indoor PM2.5 concentrations and deliver some health benefits via the reduction of exposure to PM. However, few studies have tested the ability of portable air filtration systems to lower overall personal-level PM2.5 exposures. The Reducing Air Pollution in Detroit Intervention Study (RAPIDS) was designed to evaluate cardiovascular health benefits and personal PM2.5 exposure reductions via indoor portable air filtration systems among senior citizens in Detroit, Michigan. We evaluated the utility of two commercially available high-efficiency (HE: true-HEPA) and low-efficiency (LE: HEPA-type) indoor air filtration to reduce indoor PM2.5 concentrations and personal PM2.5 exposures for 40 participants in a double-blinded randomized crossover intervention. Each participant was subjected to three intervention scenarios: HE, LE, or no filter (control) of three consecutive days each, during which personal, indoor, and outdoor PM2.5 concentrations were measured daily. For mean indoor PM2.5 concentrations, we observed 60 and 52% reductions using HE and LE filters, respectively, relative to no filtration. Personal PM2.5 exposures were reduced by 53 and 31% using HE and LE filters, respectively, when compared with the control scenario. To our knowledge, this is the first indoor air filtration intervention study to examine the effectiveness of both HE and LE filters in reducing personal PM2.5 exposures.

Effect of Portable Air Filtration Systems on Personal Exposure to Fine Particulate Matter and Blood Pressure Among Residents in a Low-Income Senior Facility: A Randomized Clinical Trial.

Importance: Fine particulate matter (smaller than 2.5 µm) (PM2.5) air pollution is a major global risk factor for cardiovascular (CV) morbidity and mortality. Few studies have tested the benefits of portable air filtration systems in urban settings in the United States. Objective: To investigate the effectiveness of air filtration at reducing personal exposures to PM2.5 and mitigating related CV health effects among older adults in a typical US urban location. Design, Setting, and Participants: This randomized, double-blind crossover intervention study was conducted from October 21, 2014, through November 4, 2016, in a low-income senior residential building in Detroit, Michigan. Forty nonsmoking older adults were enrolled, with daily CV health outcome and PM2.5 exposure measurements. Interventions: Participants were exposed to the following three 3-day scenarios separated by 1-week washout periods: unfiltered air (sham filtration), low-efficiency (LE) high-efficiency particulate arrestance (HEPA)-type filtered air, and high-efficiency (HE) true-HEPA filtered air using filtration systems in their bedroom and living room. Main Outcomes and Measures: The primary outcome was brachial blood pressure (BP). Secondary outcomes included aortic hemodynamics, pulse-wave velocity, and heart rate variability. Exposures to PM2.5 were measured in the participants' residences and by personal monitoring. Results: The 40 participants had a mean (SD) age of 67 (8) years (62% men). Personal PM2.5 exposures were significantly reduced by air filtration from a mean (SD) of 15.5 (10.9) µg/m3 with sham filtration to 10.9 (7.4) µg/m3 with LE fitration and 7.4 (3.3) µg/m3 with HE filtration. Compared with sham filtration, any filtration for 3 days decreased brachial systolic and diastolic BP by 3.2 mm Hg (95% CI, -6.1 to -0.2 mm Hg) and 1.5 mm Hg (95% CI, -3.3 to 0.2 mm Hg), respectively. A continuous decrease occurred in systolic and diastolic BP during the 3-day period of LE filtration, with a mean of 3.4 mm Hg (95% CI, -6.8 to -0.1 mm Hg) and 2.2 mm Hg (95% CI, -4.2 to -0.3 mm Hg), respectively. For HE filtration, systolic and diastolic BP decreased by 2.9 mm Hg (95% CI, -6.2 to 0.5 mm Hg) and 0.8 mm Hg (95% CI, -2.8 to 1.2 mm Hg), respectively. Most secondary outcomes were not significantly improved. Conclusions and Relevance: Results of this study showed that short-term use of portable air filtration systems reduced personal PM2.5 exposures and systolic BP among older adults living in a typical US urban location. The use of these relatively inexpensive systems is potentially cardioprotective against PM2.5 exposures and warrants further research. Trial Registration: ClinicalTrials.gov identifier: NCT03334565.

Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review.

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review" found on pages 19-28, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 29, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Discuss problematic barriers during care transitions. 2. Describe the significance of interprofessional collaboration in the delivery of quality health care. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. The purpose of the current project was to (a) examine the type of information accompanying patients on transfer from acute care to skilled nursing facilities (SNFs), (b) discuss how these findings meet existing standards, and (c) make recommendations to improve transfer of essential information. The study was a retrospective convenience sample chart audit in one SNF. All patients admitted from an acute care hospital to the SNF were examined. The audit checklist was developed based on recommendations by local and national standards. One hundred fifty-five charts were reviewed. Transferring of physician contact information was missing in 65% of charts. The following information was also missing from charts: medication lists (1%), steroid tapering instructions (42%), antiarrhythmic instructions (38%), duration/indication of anticoagulant medications (25%), and antibiotic medications (22%). Findings support the need for improved transitional care models and better communication of information between care settings. Recommendations include designating accountability and chart audits comparing timeliness, completeness, and accuracy. [Journal of Gerontological Nursing, 43(3), 19-28.].

Using International Videoconferencing to Extend the Global Reach of Community Health Nursing Education.

Travel abroad provides college students with a unique learning experience. When plans to take undergraduate community health nursing students from the United States to Haiti were cancelled due to health and safety concerns, faculty piloted international videoconferencing with a nursing program in Haiti as an alternative. During this semester-long course, students in both countries assessed a local community using the Community as Partner framework and compared findings during videoconferences with their international peers. Despite communication challenges such as language barriers and limited internet access in Haiti, evaluative data suggests that all students valued learning with their nursing student peers in another country. For future international videoconferencing endeavors, especially with under-resourced communities, we provide recommendations in the following categories: 1) Building relationships with a partner school, 2) Technology, 3) Pedagogy, and 4) Facilitating interactions between students.

Assessing the educational and support needs of nursing staff serving older adults: a case study of a community coalition/university partnership.

Given the expected changes in demography and dependent care ratios, communities are preparing for the needs of older populations. Sometimes, communities form coalitions to address health-care needs. This case study evaluates a coalition/university partnership formed to assess the educational and support needs of nursing staff who are taking care of older adults across all service settings in one geographically defined community. A 17-member community-based coalition contracted with researchers from an external university to determine the perceptions of three key stakeholder groups: older adults and their families, all levels of nursing staff, and agency administrators. By applying principles of Participatory Action Research (PAR), this case study presents the challenges faced in the community-based coalition/university research team partnership. This coalition/research partnership is unique, differing from most academic examples of PAR because nursing professionals initiated the partnership.

Dog ownership, functional ability, and walking in community-dwelling older adults.

BACKGROUND: Regular walking improves overall health and functional ability of older adults, yet most are sedentary. Dog ownership/pet responsibility may increase walking in older adults. Goals of this study were to identify factors that influence older adult walking and compare physical activity, functional ability and psychosocial characteristics by dog ownership status. METHODS: In this cross-sectional study, older adults (65-95 years of age, n = 1091) completed and returned questionnaires via postal mail. Measures included: Physical Activity Scale for the Elderly, Physical Functioning Questionnaire and Theory of Planned Behavior Questionnaire. RESULTS: Dog owner/dog walkers (n = 77) reported significantly (P < .05) more total walking, walking frequency, leisure and total physical activity and higher total functional ability than dog owner/nondog walkers (n = 83) and nondog owners (n = 931). Dog owner/nondog walkers reported lower intention and perceived behavioral control and a less positive attitude than dog owner/dog walkers (P < .05). CONCLUSIONS: Dog owner/ dog walkers were significantly different than the nondog walker groups in nearly every study variable. Many dog owners (48.1%) reported walking their dogs regularly and the dog owner/dog walkers participated in nearly 50% more total walking than the 2 nondog walking groups, suggesting that pet obligation may provide a purposeful activity that motivates some older dog owners to walk.

"That model is sooooo last millennium!" Residential long term care as a system, not a place.

The current quandary with the design of existing long term care (LTC) settings results from focus on structures ("institutions") instead of on a system of supports and services that transcends physical and traditional boundaries across settings, including nursing homes, assisted living residences and the home. Supported by analysis of the commonalities, socio-historical and political contexts, core values and fallacies of social and medical models in existing and emerging LTC options, a holistic model is proposed based on new core values which facilitate community and family integration, and which asserts dignity and personhood as universal attributes in an array of settings.

Families' perceptions of services in assisted living residences.

Assisted living residences (ALRs) are increasingly used to deliver services to older adults. Proposed policies for ALRs are gradually evolving. Although families are partners in this process, little is known about their understanding of nursing services available, compared with services needed and desired. A survey was conducted to better inform the inclusion of ALRs in Michigan's regulatory process. A total of 46 respondents reported assistance with activities of daily living as the most frequently offered ALR service. Respondents found all 13 nursing services asked about in the survey highly desirable and, for each category, the current need exceeds the availability of the service.

Preparedness for taking care of elderly parents:"first, you get ready to cry".

The results reported in this article are from a larger, mixed-methods study of the factors influencing the preparedness of adult daughters for taking care of elderly parents. This article focuses on findings surfacing in unstructured interviews with daughters revealing an area of caregiving not addressed in survey items, that of daughters' emotional reactions to multiple losses. Actual and anticipatory losses clustered into two categories: loss of the parent and loss of one's own youth. Implications for health care providers are detailed, including: recognizing each daughter's unique life situation; providing anticipatory and long-term emotional support and counseling; and assisting with problem solving, grief work, and making meaning of losses.

Acute effects of noise on blood pressure and heart rate.

The authors assessed the acute effects of exposure to noise on systolic and diastolic blood pressure, and heart rate, among 46 workers in a midwestern auto assembly plant. Workers wore ambulatory blood pressure monitors and personal noise dosimeters during one work shift. After adjustment for covariates of cardiovascular function, systolic and diastolic blood pressure, along with heart rate, were shown to be significantly positively associated with noise exposure. Although the long-term effect of these associations is not known, results from other studies suggest that they may be harmful. Replication of this study with a larger number of subjects, monitored for several days and in a variety of work settings, is recommended to verify these findings. The results of this and other studies imply that reducing acute noise exposure reduces cardiovascular stress.