Falls and mobility in Parkinson’s disease : protocol for a randomised controlled clinical trial

Background Although physical therapy and falls prevention education are argued to reduce falls and disability in people with idiopathic Parkinson's disease, this has not yet been confirmed with a large scale randomised controlled clinical trial. The study will investigate the effects on falls, mobility and quality of life of (i) movement strategy training combined with falls prevention education, (ii) progressive resistance strength training combined with falls prevention education, (iii) a generic life-skills social program (control group).
Methods/Design People with idiopathic Parkinson's disease who live at home will be recruited and randomly allocated to one of three groups. Each person shall receive therapy in an out-patient setting in groups of 3-4. Each group shall be scheduled to meet once per week for 2 hours for 8 consecutive weeks. All participants will also have a structured 2 hour home practice program for each week during the 8 week intervention phase. Assessments will occur before therapy, after the 8 week therapy program, and at 3 and 12 months after the intervention. A falls calendar will be kept by each participant for 12 months after outpatient therapy. Consistent with the recommendations of the Prevention of Falls Network Europe group, three falls variables will be used as the primary outcome measures: the number of fallers, the number of multiple fallers and the falls rate. In addition to quantifying falls, we shall measure mobility, activity limitations and quality of life as secondary outcomes.
Discussion This study has the potential to determine whether outpatient movement strategy training combined with falls prevention education or progressive resistance strength training combined with falls prevention education are effective for reducing falls and improving mobility and life quality in people with Parkinson's disease who live at home.

Cost effectiveness of preventing falls and improving mobility in people with Parkinson disease : protocol for an economic evaluation alongside a clinical trial

Background Cost of illness studies show that Parkinson disease (PD) is costly for individuals, the healthcare system and society. The costs of PD include both direct and indirect costs associated with falls and related injuries.
Methods This protocol describes a prospective economic analysis conducted alongside a randomised controlled trial (RCT). It evaluates whether physical therapy is more cost effective than usual care from the perspective of the health care system. Cost effectiveness will be evaluated using a three-way comparison of the cost per fall averted and the cost per quality adjusted life year saved across two physical therapy interventions and a control group.
Conclusion This study has the potential to determine whether targetted physical therapy as an adjunct to standard care can be cost effective in reducing falls in people with PD.

Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition,Economics (DAnCE) fall prevention randomised controlled trial

Background:  Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the ‘holistic’ approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people.

Methods/design: A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed.

Discussion: This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise.

Indigenous knowledge and climate change : the Wathaurong and Gadubanud narrative for the Great Ocean Road region

For more than forty thousand years Aboriginal people of Australia have been confronted with major climate, ecological and geological changes as well as annual seasonal variations. Many of these changes have been captured in the cultural traditions of Maar (the people) of the south-west Victorian coast and the knowledge has been transferred from generation to generation through Dreaming stories. Many Dreaming stories recount the forming of the coastal landscape and Sea Country. Weather patterns and climate change were gauged by the occurrence of natural events such as the tidal changes, sea level rise, landscape changes, behaviour of animals, and the availability of food sources. Can this ancient knowledge provide answers for adaptation and resilience to a rapid changing climate? Drawing upon recent literature on coastal climate change in the Great Ocean Road Region (GORCC, 2012), literature review of indigenous environmental planning (Kooyang Sea Country Plan, 2004), and investigation of settlement patterns of the Wathaurong and Gadubanud people, this paper reviews the changes in the landscape due to climate change and explores traditional knowledge as input to a potential design based adaptation model for coastal settlements of the Great Ocean Road Region.

In-hospital falls and fall-related injuries: a protocol for a cost of fall study

Background:
In-hospital falls are common and pose significant economic burden on the healthcare system. To date, few studies have quantified the additional cost of hospitalisation associated with an in-hospital fall or fall-related injury. The aim of this study is to determine  the additional length of stay and hospitalisation costs associated with in-hospital falls and fall-related injuries, from the acute hospital perspective.

Methods and design: 
A multisite prospective study will be conducted as part of a larger falls-prevention clinical trial—the 6-PACK project. This study will involve 12 acute medical and surgical wards from six hospitals across Australia. Patient and admission characteristics, outcome and hospitalisation cost data will be prospectively collected on approximately 15 000 patients during the 15-month study period. A review of all inhospital fall events will be conducted using a multimodal method (medical record review and daily verbal report from the nurse unit manager, triangulated with falls recorded in the hospital incident reporting and administrative database), to ensure complete case ascertainment. Hospital clinical costing data will be used to calculate patient-level hospitalisation costs incurred by a patient during their inpatient stay. Additional hospital and hospital resource utilisation costs attributable to inhospital falls and fall-related injuries will be calculated using linear regression modelling, adjusting for a prioridefined potential confounding factors.

Discussion:
This protocol provides the detailed statement of the planned analysis. The results from this study will be used to support healthcare planning, policy making and allocation of funding relating to falls prevention within acute hospitals.

'In the court of a great king': some remarks on Leo Strauss' introduction to the guide for the perplexed

This essay, which will be divided between two SOPHIA editions, proposes to test the consensus in Maimonidean scholarship on the alleged intellectualism of Leo Strauss’ Maimonides by making a close interpretive study of Strauss’ 1963 essay ‘How to Begin to Study the Guide for the Perplexed’. While the importance of this essay, which is Strauss’ last extended piece on the Guide, is established in Maimonidean scholarship, its recognised esotericism has been matched by a dearth of detailed studies of the piece. We aim in this essay to try to rectify this situation, by reading ‘How to Begin to Study’ as Strauss directs us to read esoteric texts in Persecution and the Art of Writing. As one control on our exegetical claims, we will close by situating our reading of ‘How to Begin to Study’ and Strauss’ positions there on philosophy, prophecy and the Torah alongside the claims of his earlier, much less esoteric, but also rarely studied: ‘Some Remarks on the Political Science of Maimonides and Farabi’. Because of the now widely recognised foundational importance of Maimonides in understanding Leo Strauss’ own lasting positions, this work will have wider importance in Strauss scholarship, and hopefully make a contribution to the continuing task of trying to understand Strauss’ important thoughts on Athens and Jerusalem, reason and revelation, the city and man.