Can information security deliver business value?
Information security remains a perennial priority for IT leaders.
Historically, security has been regarded as an insurance-type activity to keep the bad guys out, but this attitude is increasingly outdated, as forward-thinking organisations show how security can be an enabler and a means of gaining competitive advantage.
At a Computer Weekly roundtable, in association with Oracle, IT security leaders discussed the business value in information security and how best to deliver it.
Delegates discussed how the new government will change the security landscape, and focused on key security issues, such as the impact of new regulations, accreditation, a new era of openness, and what IT security professionals can learn from high-profile security failures.
Impact of the new government
The government has announced plans to roll back the database state, scrapping ID cards and the National Identity Register. But Toby Stevens, managing director of Enterprise Privacy Group (see box), said this risks creating "an identity vacuum" which will be filled with competing identity and authentication schemes.
The civil liberties agenda will change the way government and industry approaches information security. There will be a cap of £100m on government IT contracts and Stevens said splashing out on IT projects without thinking about security will end.
"Those organisations that were brave enough to say, 'If security is too expensive then maybe it's not a good project' will be held up as the champions and pioneers," he said.
Data handling failures by government have come under the spotlight since HM Revenue & Customs (HMRC) lost two CDs containing millions of child benefit records.
Historically, the Information Commissioner's Office (ICO) has not been able to do much to increase accountability, beyond censuring miscreants, said Stevens, but it now has new punitive powers to fine organisations up to £500,000 for serious breaches of the Data Protection Act.
However, Stevens questions the "value of fining a government department if it means taking away money so it can't deliver what it needs to deliver."
Instead, he thinks the ability to prosecute for repeated failures makes more sense and he believes this provision is likely to become law.
"The government was centralising and aggregating data in a way that private companies would shy away from doing," said Stevens.
A lack of accountability and security controls means we have seen "brand new systems bought with no attention to security," he added.
And as accountability increases in the wake of new regulations, there is an expectation that there will be greater rewards for information security and assurance professionals. "They will be paid better rates," said Stevens.
IT security chiefs agreed that ensuring systems are secure and information is managed securely is a priority for government and industry, although there is no magic wand.
Following the HMRC data-loss, the Hannigan Review of government data handling procedures called for security accreditation of new systems, but the word "new" was inserted eight hours before publication, said Stevens, who described this as a cop-out.
"We have a hugely interconnected environment. If one system is accredited and not others do you have any security?" he asked.
Stevens foresees a culture which will "force creeping accreditation across public services", with a mandate that accredited systems can only work with other accredited systems.
Organisations will have to look at their information assets and "assess what level of protection is required", said Stevens, who called for an end to a culture of accreditation "catching everyone by surprise" because it is added at the end of the procurement process.
Mike Trevett, deputy director for information security and legal services at the Office for National Statistics (ONS), questioned the financial implications of accreditation. "A chain is only as strong as the weakest link, but accreditation does not come cheap. How do you make that circle square?" he asked.
Des Powley, technical director for security and ID management at Oracle UK, said there is a risk associated with accreditation if organisations think they can do it once and forget about it, and suppliers are faced with the problem that security is not static.
"Accreditation can breed complacency because it happens at a point in time. A system changes, but is accreditation updated? The threat landscape is constantly changing and if you buy software with a gold standard of security to ensure it is accredited to the highest level at the point of sale, it only addresses the threat present at that current point in time," he said.
Stevens foresees the end of "security through obscurity". He described it as outmoded and said it has held back progress in government.
"So many organisations believe that they are a centre of security excellence, but they don't like sharing," he said.
A fundamental problem is that CESG [Communications-Electronics Security Group, which advises the government on IT security] has been holed up at GCHQ in Cheltenham and not provided enough direction to industry, said Stevens.
"People who should be talking and liaising should be moved to London with an open front door. There is nothing happening that should be under lock and key. This is not something that should be confidential," he said.
The language of security can be a hindrance to openness and clarity.
Callum Halliday, information security manager for the London 2010 Olympics, is focusing on providing clear communication about the importance of security to users.
"We are rolling out a security education awareness project with staff which will expand over the next months to improve the level of understanding about sensible user behaviour," he said.
Martyn Croft, CIO at The Salvation Army believes that making security open and easy for users to follow is advisable. "Make it incredibly easy for people to do the right thing and difficult for them to do the wrong thing," he said.
Suppliers also need to be more open about the cost of security. In the past they have been guilty of adding on security as a "forgot-to-do" to government IT projects because they "didn't want to increase their tender offer", said Stevens.
The actual cost of two lost CDs holding 25 million child benefit records to HMRC amounted to about £2, but the cost in terms of reputation and co-operation with the public is unquantifiable.
Independent research consultant John Leach said the breach damaged HMRC's ability to do its job. "HMRC relies on the average taxpayer doing their tax returns properly. The problem for HMRC if they lose data is the public won't play ball. Their operational costs went up through the roof trying to rebuild the damage caused," he said.
However, Powley said that although HMRC went into paralysis in the wake of the data breach and the chief executive lost his job, there are always some organisations that take the attitude "it is cheaper to pay the fine than address the issues".
But more organisations are beginning to appreciate the business imperative of getting IT security right.
"A database is worthless if it is corrupted," said Marcus Alldrick, senior manager, information protection and continuity, at Lloyds of London.
Trevett said, "It's not the value of the data; it's the value of replacing it. There is the physical cost of replacing the data asset and the reputational cost."
The future of security and privacy
Toby Stevens, managing director of Enterprise Privacy Group, is an expert on privacy and identity and has advised the Conservative Party, whose plans to scrap the ID card scheme and the next generation of biometric passports were announced in the Queen's Speech in May.
Stevens believes the strong civil liberties agenda heralds a new security direction for industry and government, and the "emotional quality" of privacy will be more keenly felt.
"There is an intangible quality that comes with privacy that gets people riled and security managers have to take this on board," he said.
Emotional quality means, for example, companies with a family reputation such as Marks & Spencer or Boots risk getting badly hurt if there is a security lapse, said Stevens.
Data losses and failures in handling sensitive information will not be tolerated by the public or customers and Stevens believes that the lack of accountability for handling sensitive information that was symptomatic in the past will change.
"We have an environment where the penalties for individuals in organisations who fail to protect data are going up rapidly. I don't like to scaremonger, but IT security heads have to ensure that senior executives are aware that they must take responsibility. They can delegate responsibility, but they can't delegate accountability and they will carry the can," said Stevens.
Within government IT security, Stevens expects an "opening of doors" which will be beneficial for industry.
"Industry can't see anything coming out of government such as standards to follow," he said.
Secrecy coupled with a lack of leadership, where the chief information security officer role is fudged into the CIO agenda, means that "each department must re-invent the wheel" resulting in a "diverse duplication of effort", said Stevens.
He believes improved security and professional standards, and better recognition of information security and assurance professionals is necessary and will help to prevent projects being completed with security flaws and blowing money on outdated technology.
"I want to see security seen an asset rather than an obstacle," said Stevens, and he believes this is possible with a new culture of leadership and openness in industry and government.
Read more on IT risk management
HMRC warns locked-down freshers of ‘wave’ of tax scams
Western Australia government goes all-in on Microsoft
Coronavirus: HMRC job retention scheme targeted by cyber criminals
EDS wins training accreditation – ComputerWeekly.com
HMRC left the door open to data loss – ComputerWeekly.com
IAS 6 aims to lock down data from government ... – ComputerWeekly.com


News Overuse Injuries More Common in Kids Who Specialize in Individual Sport
Overuse Injuries More Common in Kids Who Specialize in Individual Sport
Young athletes who specialize in an individual sport – such as gymnastics, tennis and dance – were at higher risk for overuse injuries (i.e. gradual onset of pain and symptoms), compared to those who focus on a single team sport, according to a study published in The Physician and Sportsmedicine. Acute injuries (i.e. from a single traumatic event) were more common in young athletes whose single sport was a team sport, especially football, cheerleading and soccer.
“Kids in an individual sports usually start specializing at a younger age than those in team sports, and individual sport athletes tend to spend more hours per week training, which might explain why we see a greater proportion of overuse injuries among these athletes,” said senior author Cynthia LaBella, MD, Medical Director of the Institute for Sports Medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago and Associate Professor at Northwestern University Feinberg School of Medicine.
Of 1190 athletes, 7-18 years of age, enrolled in the study, 313 reported participating in a single sport and training in that sport more than eight months of the year. Sports with the highest proportion of single-sport-specialized athletes were tennis, gymnastics and dance. These three sports also had the highest rate of serious overuse injury. The youngest age of sports specialization was seen in gymnastics (8.9 years), dance (10.8 years) and soccer (10.9 years).
“Better understanding of the relationships between sports specialization and injury risk can help us design more effective injury prevention strategies,” said LaBella. “For example, we know from previous studies that neuromuscular training may help to improve motor skills and performance while decreasing risk for injury among athletes specializing in a single sport. Our data suggest that young athletes specializing in individual sports may reap the greatest benefits from this sort of preventive neuromuscular training.”
The study was funded by the American Medical Society for Sports Medicine Foundation.
Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through the Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals in U.S.News &World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 198,000 children from 50 states and 51 countries.
News Release Research Innovation
Lurie Children’s Seeks Proposals to Support All Hands Health Network
iREACH Study Aims to Enhance Prevention of Peanut Allergy in Pediatric Practices
Grant for Collaborative National Center for Safe Supportive Schools Awarded to the Center for Childhood Resilience (CCR) at Ann & Robert H. Lurie Children’s Hospital of Chicago
Parents Want More Bullying Prevention in Schools


CSS Planter
In May 1862, Robert Smalls (1839-1915) committed an act that would lead to him being known as a daring hero during the Civil War.
The Confederates had commandeered into service the Planter, a transport steamer whose crew included Smalls and three other slaves. From the Planter in Charleston Harbor, the men could see the Union ships tantalizingly close as the Union Navy blockaded Fort. Sumter. When all of the white crew went ashore for the evening on May 12, 1862, Smalls and the other slaves gathered their families on the Planter for a daring escape to freedom. Casting off, Smalls eased the ship into the current and headed out of Charleston harbor. Familiar with the waters and the Confederate routines, he steamed the Planter past five Confederate gun batteries, giving the correct signals for safe passage at each.
By dawn on May 13, 1862, Smalls had successfully cleared the harbor and surrendered the Planter to the Union forces.
“One of the most heroic acts of the war,” reported the New York Times on May 19, 1862. The commander of the Union Navy along the South Atlantic coast, Rear Admiral Samuel F. Du Pont, pronounced it “one of the coolest and most gallant naval acts of war.” Southern newspapers considered it “one of the most shameful events of this or any other war.”
In addition to providing the Union forces with the Planter, Smalls and the other former slaves provided invaluable intelligence, including information that allowed for the establishment of an important base on the Stono Inlet and Stono River for future military operations.
Photo courtesy of the Naval Historical Center, Washington, D.C.


FBI: Missouri man planning to bomb hospital killed himself
by: HEATHER HOLLINGSWORTH, Associated Press
FILE – In this April 2020, file photo is the Belton Regional Medical Center in Belton, Mo. A Missouri man who was planning to bomb a Kansas City-area hospital killed himself in March as FBI agents served a probable cause arrest warrant, the FBI said Friday, May 15, 2020. An autopsy determined that FBI agents shot Timothy Wilson, 36, of Raymore, Mo., in the upper and lower extremities on March 24 on a street in Belton, Mo., but that his cause of death was a self-inflicted wound to the head, the agency said. (Tammy Ljungblad/The Kansas City Star via AP, File)
MISSION, Kan. (AP) — A Missouri man who was planning to bomb a Kansas City-area hospital killed himself in March as FBI agents served a probable cause arrest warrant, the FBI said Friday.
An autopsy determined that FBI agents shot Timothy Wilson, 36, of Raymore, Missouri, in the upper and lower extremities on March 24 on a street in Belton, Missouri, but that his cause of death was a self-inflicted wound to the head, the agency said. The FBI didn’t say if Wilson shot himself before or after the agents shot him.
Investigators said Wilson was distressed by the government’s response to the coronavirus crisis and motivated by racial, religious and anti-government animus, according to court documents. The plot was reminiscent of the 1995 bombing of a federal building in Oklahoma City. Wilson first talked of plans for an attack in April or June, but FBI agents say he moved up that timeline as the coronavirus made its way to Missouri.
The violent take-down followed a long-running domestic terrorism investigation that began in 2019 with Wilson’s encrypted communications about bomb-building with Jarrett William Smith, a 24-year-old Army infantry soldier who faces prison for distributing bomb-making information through social media.
Wilson considered attacking the University of Kansas Hospital in Kansas City, Kansas, before settling on a plan to park a vehicle loaded with explosives and detonate it in the parking lot of Belton Regional Medical Center in Cass County, investigators state in court documents.
Just two days before his death, Wilson and an undercover FBI agent visited Belton Regional to inspect the hospital property and conduct a dry run of their plot, court records say.
The records show that for months, Wilson had discussed ideas for a terrorist attack, telling an undercover FBI agent that he was considering sites including a nuclear plant and Islamic centers in Missouri and the Walmart headquarters or a synagogue in Arkansas. He also discussed last year shooting up a predominantly black elementary school, the FBI said in the affidavits.


Director Guillermo del Toro has been attached to a “Justice League Dark” film since 2012, but a new report says he’s left the project. In The Hollywood Reporter’s article on Vertigo-based films including “Sandman” moving from Warner Bros. to New Line Cinema, the industry outlet also disclosed that del Toro is “no longer attached” to “Justice League Dark.”
Word first surfaced in November 2012 of a possible del Toro-directed “Justice League Dark” film, based on the comic book series of the time starring John Constantine, Zatanna, Deadman and more. Updates came periodically from del Toro at various events — including a working title of “Dark Universe” — though based on reports, the film never seemed to move past preliminary stages. Notably, though THR says del Toro is no longer attached to the movie, it doesn’t rule out another direct taking on the project.
The “Justice League Dark” DC Comics series ended earlier this year, and a “Dark Universe” title is expected to debut later this year. del Toro has a full slate even without “Dark Universe,” with his film “Crimson Peak” scheduled for release on Oct. 16, and a “Pacific Rim” sequel in the works.


HOME : Near Eastern Art : Achaemenid Art : Achamenid Bronze Dish
Achamenid Bronze Dish - BF.015
Origin: Central Asia
Circa: 500 BC to 400 BC
Dimensions: 2" (5.1cm) high x 9.5" (24.1cm) wide
Collection: Near Eastern Art
Location: Great Britain
The Achaemenid Empire (559 -330 BC) was one of the most dynamic and historically significant socio-political entities of the first millennium BC. Originally based in Persia, their borders extended eastwards and also into the Mediterranean region, where they were the notable foe of the ancient Greeks. The founder (the mythological founder of the Achaemenid empire was called Achaemenes) Cyrus, following an abortive raid on the Peloponnese, besieged and captured Babylon in 539 BC; his release of Jews who had been held captive there earned him immortality in the Book of Isaiah. The empire continued to grow until Cyrus’ death in 529 BC, by which time the kingdom extended as far as the Hindu Kush in present-day Afghanistan. However, his successors were less successful and the empire was gradually eroded as intrigue and corruption threatened court stability. Darius, beaten at the battle of Marathon in 490 BC, led the Achaemenids back to Asia Minor where they attempted to consolidate the remains of their power. While successful in his lifetime, the court and empire returned to their usual downward cycle until the death in 330 of the last of the Achaemenids, Darius III, at the hands of his own subjects.
The cultural achievements of the Achaemenids were considerable, for although somewhat despotic in the technical sense, free trade and social tolerance went to provide a comparatively enlightened environment in which the arts flourished. The economy was healthy, fuelled by Darius’ introduction of stable gold currency, and the road system allowed the spread of trade, luxury items and ideas. As a result the artists and craftsmen of the time were extremely attuned to neighbouring and distant polities, and were able to produce a wide variety of elite items such as this. Most iconography of the time was based around enormously ornate zoomorphic statuary and architectural design as seen in Persepolis, and smaller items retain much of their grandiose monumentality. - (BF.015)


trespass on the case:
(15c.)
1. At common law, a lawsuit to recover damages that are not the immediate result of a wrongful act but rather a later consequence. The lawsuit was instituted by a writ of trespass on the case. It was the precursor to a variety of modern-day tort claims, including negligence, nuisance, & business torts. — Often shortened to case. — aka action on the case; breve de transgressione super casum. [1]
Excerpt from Edwin E. Bryant’s The Law of Pleading Under the Codes of Civl Procedure (2d ed. 1899):
“The most important of the writs framed under the authority of the statute of Westminster 2 is that of ‘trespass on the case’, to meet cases analogous to trespass in delict, but lacking the element of direct or immediate force or violence. This writ gave a form of action in which the court was enabled to render judgment of damages in cases of fraud, deceit, negligence, want of skill, defamation oral or written, & all other injurious acts or omissions resulting in harm to person or property, but wanting the vi et armis (“with force & arms”), the element of direct force & violence, to constitute trespass.” [2]
Another excerpt from Edwin E. Bryant’s The Law of Pleading Under the Codes of Civl Procedure (2d ed. 1899):
“Common law recognizes a distinction between the actions of trespass vi et armis (or simply trespass) and trespass on the case. This distinction has been expressed by stating that a tort committed by the direct application of force is remediable by an action for trespass, while a tort accomplished indirectly is a matter for trespass on the case. Other authority makes the distinction on the basis of the defendant’s intent, stating that trespass involves a willful and deliberate act while trespass on the case contemplates an act or omission resulting from negligence.” [2]
Disclaimer: All material throughout this website is pertinent to people everywhere, and is being utilized in accordance with Fair Use.
[1]: Black’s Law Dictionary Deluxe Tenth Edition by Henry Campbell Black, Editor in Chief Bryan A. Garner. ISBN: 978-0-314-61300-4
[2]: Edwin E. Bryant, The Law of Pleading Under the Codes of Civl Procedure 7 (2d ed. 1899)
To be Added:
[2]: Ballantine’s Law Dictionary Legal Assistant Edition
by Jack Ballantine (James Arthur 1871-1949). Doctored by Jack G. Handler, J.D. © 1994 Delmar by Thomson Learning. ISBN 0-8273-4874-6.
[3]: Ballantine’s Law Dictionary with Pronunciations
Third Edition by James A. Ballantine (James Arthur 1871-1949). Edited by William S. Anderson. © 1969 by THE LAWYER’S CO-OPERATIVE PUBLISHING COMPANY. Library of Congress Catalog Card No. 68-30931
Back to Types of Actions
Intro to U.S. Law
Legal Precepts Adopted (from Europe) into The U.S. Constitution
§ § of Law Embedded into the Constitution Pursuant to the American Revolution
Indian Country Law
Federal Rules of Procedure
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A Look Back at medical facilities
By Bill Stewart
Published 12:55 am Tuesday, November 3, 2020
When we old readers of the Hartselle Enquirer were born, if we were not born at the home of our parents, we probably came into the world at the Decatur General Hospital. In those days, Hartselle didn’t have a hospital.
Dr. Claude Lavender brought Hartselle Hospital on the scene largely thanks to the Hill-Burton Hospital Construction Act of 1946.
When men were examined prior to induction into the armed forces at the beginning of World War II, many of them – especially those from southern states – were found to have health problems attributable to inadequate medical care earlier in their lives. The main sponsor of the 1946 act was Alabama’s long-time Sen. Lister Hill. On Capitol Hill in Washington, some called Sen. Hill “Mr. Health” because of the leadership role he played in so many areas pertaining to public health.
In the not–too–distant past, Hartselle could boast of two fully functioning hospitals – the previously mentioned Hartselle Hospital, later called the Hartselle Medical Center, and Block-Chandler Hospital, later called Pineview, started by Drs. W. H. Block and David Chandler.
Now Hartselle is back to where it was before Dr. Lavender came back to the States after the War. It no longer has a complete hospital. Local residents who require hospitalization need to go to Decatur-Morgan Hospital or Cullman Regional Medical Center.
This column usually looks back to more distant times than the 1940s. When we “look back” for medical facilities, we find a complete absence of anything in our area that could be called a hospital according to the meaning of that word today. Here are some examples of what was done – or, more precisely, not done – for people who probably needed hospitalization many years ago because of accident or illness.
Even in those instances where death was probable, comfort could have been provided in the last hours of life.
–1902: A young man working with lumber got his shirt sleeve caught in the machinery and was whirled around and thrown against the ceiling. His arms and legs were broken, and he received internal injuries as well. Doctors bandaged his wounds, although they quickly realized his life probably could not be saved. There was no hospital; the young man was carried on a cot to his home, where he passed away.
–1902: Another young man was shot during a baseball game by the father of the young woman he was dating. The father felt the young man had not shown proper respect for his daughter and, because of this, shot him. The bullet lodged in the breast, and a doctor who was called to the patient’s grandmother’s house was uncertain whether his life could be saved.
–1903: F. F. Davis, who was seriously shot several weeks ago by Will Peppers, has recovered sufficiently to be removed from Dr. Davis’s residence to his home on College Street, and his many friends trust he will soon be able to be back at his place of business.
–1908: Mrs. Dorsett and daughter, who were painfully hurt in the recent storm, have been brought to this place and are being cared for by friends here.
Sometimes physicians were negligent in using findings of research laboratories even given the absence of hospitals in which to place their patients. Examinations made by the Tennessee Valley laboratory during 1926, according to Dr. A. J. Perolio, the director, showed that 61.7 percent of all the physicians in the Valley were not using the services of the laboratory.
In 1911 a specialty hospital was on the horizon. Dr. McWhorter was in the area looking for a suitable location for the establishment of a tuberculosis sanitarium for the state and a state epileptic sanitarium. He was much impressed with the high altitude of Morgan County, saying this portion of the state should be free from consumption and kindred lung trouble.
Perhaps it “should” have been free of TB, but it definitely was not.


Student follows her dream of a Royal Navy career
We are delighted that Year 13 UTC Swindon student, Kate Kerrane, has been offered an apprenticeship with the Royal Navy.
Kate’s family has always worked with the Royal Navy, which sparked her interest in joining the force several years ago. She originally applied for a job, but when they saw the qualifications she was working towards they put her through a test to see whether she would be more suited to the apprenticeship scheme instead.
By completing an Aviation Engineering Apprenticeship, Kate will gain a Masters qualification after three years rather than 22 years if she were to join as a Regular.
Kate said: “I will spend 10 weeks at HMS Riley, which is normal for a Regular, then I will go to HMS Collingwood for 18 months where I’ll be learning about all the different parts of helicopters, fixed wing, rotary wing etc. I will then go on deployments and start working through a course, before I’ll have to take charge of a group.
“It’s all very hands-on and practical, which I like. I don’t mind theory and there is some of that, but it’s more focused on the practical side which is more suited to me.”
Commenting on her time at UTC Swindon, Kate said: “I’m definitely glad I made the move to UTC Swindon from my old school. I used to have no confidence at all, but this has dramatically improved. I also didn’t used to do very well academically, but we’re given lots of independence here and having more independent study time has really helped me focus and improve.”
We wish Kate the best of luck.


"Here We Are, Folks!" - Sign O' the Times Deluxe Edition Unboxing
I received my copy of the deluxe edition of Prince's 1987 album, "Sign O' the Times." Check out my unboxing video below!
Subscribe to my newsletter for updates on my book on Prince's spiritual journey. Click here.
Posted by E. Thompson at 8:38 AM No comments:
"Shock-a-lock-a, Boom!" - Giveaway
Congrats, Amy A.!
This contest is closed.
Posted by E. Thompson at 3:03 PM No comments:
"We Can Work It Out" - Experimenting with Facebook Ads
I set a goal for myself to increase my monthly newsletter list to 1,000 this year (I have just over 700 as of today). I've had great success collecting email addresses through my giveaways (come back next week for another one, btw), but I wanted to explore other avenues. Over the past week, I ran two Facebook ads to gain new subscribers, and things were decent for my first try!
See below for the details and if you haven't subscribed to my monthly newsletter, you can do so right here.
First, I created a "lead generation" ad, which collects email addresses directly on Facebook. I'm pretty happy with these results. The ad will be finished tomorrow, and I think I'm going to hit 50 leads. I spent approximately 70 cents per email address, which isn't too expensive for me. I would run this type of ad again and spend more money to get 100 new subscribers.
Cost: $33.63 (of $35)
Duration: 6 Days (of 7)
Reach: 2,017
Leads: 46
I wasn't sure if people would put their email addresses directly on Facebook, so I ran a "website visitors" ad that took them off Facebook and directly to my signup form on MailChimp. Although this ad reached more people, fewer people signed up for my newsletter. So, moving forward, I will only run the ad above to collect email addresses, but I will utilize the "website visitors" ad to send people to my blog to get more views on my content. I'll also plan to run some ads to boost the number of people who "like" my Facebook page.
Subscribers: 16
Posted by E. Thompson at 10:26 PM No comments:
"Count the Days" - Song of the Month
Each month I will share some brief, personal thoughts on one of my favorite Prince songs.
"Count the Days" is technically a New Power Generation song, released as the third single from the band's 1995 album, Exodus. Of course, Prince played an integral role, though disguised as "Tora Tora," one of his many alter egos. Bass player Sonny T. takes the lead vocal, but Prince's guitar is the real star. (By the way, Prince positioning Sonny as a lead vocalist reminds me a lot of Jimi Hendrix featuring drummer Buddy Miles as a singer in the Band of Gypsys, but that's another discussion for another blog.) I fell in love with this song watching a video of a live performance on British TV program "The White Room." First of all, Prince, aka Tora Tora, somehow made a costume of a face-obscuring scarf, hat and black-and-white suit look appealing. I love how he was so meticulous about image and mystique.
The song is a perfect example of how Prince is able to write in layers. If you don't listen closely, you might think "Count the Days" is a love song. That was my first reaction because the TV host introduced the song by commenting on Prince and Mayte Garcia's relationship. The music is pretty, pleasant and almost tranquil. Listening again, I heard a deep connection to Curtis Mayfield, and I began to think Prince was simply focused on evoking a feeling of old-school soul music, especially because the lyrics seemed so cryptic.
"Here's a church, here's a steeple/Here's a motherfucker that I gotta blow away."
But I knew something was missing. I talked through the song with my friend and writer Scott Woods. We asked ourselves, how often is Prince purposely nonsensical, and how often is he writing personal lyrics? In my opinion, "Count the Days" is very personal, and there's a thread of anger under the lovely melody. You could imply the song is about his deteriorating relationship with Warner Bros. Prince is literally counting down the days until he is out of his contract. And you could read the whole Exodus album as an escape from the control of the record label, but also as Prince's mission to free other artists, especially Black artists, from the limitations and abuse in the music industry.
The video for the song adds another layer. It features historic footage of events during the Civil Rights Movement, including Martin Luther King, Jr. at the March on Washington, and his wife, Coretta Scott King, standing over his coffin. Prince felt very strongly that he could use both his celebrity and advocacy for artist rights to help create a better future for Black people in America, and much has come to light about his charitable contributions since his death. So, it makes perfect sense to me that he paired a song about being enslaved to a corporation with a video about the plight of Black people.
I once found myself thinking, "This song would be more enjoyable without the abrasive lyrics." But that's precisely the point. We can't be fully at peace with the world because we aren't fully free. Think about what Black people are still enduring in 2020. We're still counting the days...
Count The Days from Irresistible Rich on Vimeo.
Posted by E. Thompson at 11:09 PM 1 comment:
"With an Intellect and a Savoir-Faire" - Purple Recommendations
There are a lot of folks consistently creating great content about Prince. Here are some recent examples that caught my eye.
1. Muse 2 the Pharaoh: The Sun, The Moon and Stars
Darling Nisi's podcast explores Prince-related topics from a female perspective. Her latest episode explores Prince's natal chart.
2. Podcast on Prince: Bernie Grundman Interview (Patreon only)
This long-running Prince podcast features news, reviews and interviews. The latest episode features a noted mastering engineer who recently worked on the forthcoming remaster of Prince's "Sign O' the Times" album.
3. Press Rewind Prince - Lyrics Podcast
Jason Breininger's podcast analyzes the lyrics of Prince's music, album by album. He's currently on Around the World in a Day. Check out all the episodes featuring a lineup of special guests.
4. Dance/Music/Sex/Romance: The Dawn: How Prince’s Troubled Followup to 1999 Almost Became His Feature Film Debut
Zachary Hoskin's blog analyzes Prince's discography, song by song, but he often has some interesting detours along the way. This post imagines "a circa-1984 Prince without Purple Rain." Creative stuff!
5. polished solid Newsletter
This is a new venture by De Angela L. Duff, the mastermind behind some compelling Prince symposia. Subscribe to keep up with all of her Prince projects and much more!
6. #PrinceTwitterThread: 3121
DJ UMB and Edgar Kruize have been inviting guests to dissect each track on certain Prince albums. The latest in the series included a surprise contributor who worked with Prince for years.
7. Purple Playground: Academy of Prince performance
This summer music program "enriches teens' lives with Prince history and a chance to make music inspired by him, helped by musicians who played with him." Watch the young people play a song they wrote with help from Shelby J., Adrian Crutchfield and Elisa Fiorillo.
"Here We Are, Folks!" - Sign O' the Times Deluxe E...
"We Can Work It Out" - Experimenting with Facebook...
"With an Intellect and a Savoir-Faire" - Purple Re...


Omar Khorshid
Belly Dance, Vol. 1 (Omar Khorshid and His Magic Guitar)
Cairo, Al Qāhirah, Egypt
Star of the cinema and leading guitarist of the Orient, Omar Khorshid (Arabic: عمر خورشيد) (* 1945 in Kairo; † 29. May 1981) has also composed the music for thirteen ﬁlms and in 1971 won the Premier Prix at the Film Festival of Tachkand for his music for the ﬁlm "Tbnati El Aziza" . He is renowned as one of the greatest guitarists of the Arab world and has accompanied its leading singers, including Umm Kulthum, Abdel Wahab, & Abdul Halim Hafez. In 1981 Khorshid was tragically killed in a car accident three days after returning back to Cairo from a tour in Australia. A… read more
Star of the cinema and leading guitarist of the Orient, Omar Khorshid (Arabic: عمر خورشيد) (* 1945 in Kairo; † 29. May 1981) has also composed the music for thirteen ﬁlms and in 1971 won the Premier Prix at the Film Festival of Tachkand for his music for the ﬁlm "Tbnati El Aziza" … read more
Star of the cinema and leading guitarist of the Orient, Omar Khorshid (Arabic: عمر خورشيد) (* 1945 in Kairo; † 29. May 1981) has also composed the music for thirteen ﬁlms and in 1971 won the Premier Prix at the Film Festival of Tachkand for his music for the ﬁlm "Tbnati El Aziza" . He is renowned as one of the greatest guitarists of the Arab world and… read more
Baligh Hamdi
Raksat El Kheyl
Arrissassa
Sabirine
Ka'an Azzaman
Wadil Muluk
Casatschok
Ya Salat Ezzein
Guitar El Chark
30 Mar 2010 · 18 tracks
Belly Dance, Vol. 1
1 Jan 1992 · 12 tracks
Belly Dance From Lebanon
Rhythms From The Orient
Facebook (omarkhorshidofficial)
Troupe Majidi


Determination in recount sets stage for challenge
November 30, 2020 3:49 pm WKOW News, Political, Top Stories
MADISON (WKOW) – Chairperson Ann Jacobs of the Wisconsin Elections Commission today made what election officials call "a determination" of the recount in Wisconsin's presidential race.
With the determination made, President Donald Trump's campaign now has five days to appeal the results of the recount.
Technically the chair does not certifying the presidential race, according to a news release from the WEC.
“This is a very different process than for the other contests on the November 3 ballot where the WEC Chair does determine the winner and issues certificates of election. There is no certificate of election in a presidential contest,” said Meagan Wolfe, administrator of the WEC and Wisconsin’s chief election official.
In presidential elections, the law requires that the chair determines the result, or the numbers, of the recount and the contest based on the certified result statements submitted by each of the 72 counties.
This determination is what can be appealed. If there is not a determination, then parties to a recount do not have anything to appeal.
Today's determination allows President Trump's campaign to exercise the five-day recount appeal rights afforded to it under Wis. Stat. 9.01(6) if the campaign believes the determination inaccurately reflects the election outcome.
As part of today’s determination, a copy of the canvass determination for president and a statement of ascertainment will be sent to the governor’s office. The governor then decides whether to sign off on the slate of presidential electors, according to a WEC news release.
On Tuesday, during the regularly-scheduled Commission meeting, the Chair will certify the other contests, which will result in the issuance of certificates of election to the winners, because there is no recount in those contests and therefore no appeal time period.


Background and Statement of the Problem
Implications for Research and Education
Systematic Review of the Effect of Home Modification and Fall Prevention Programs on Falls and the Performance of Community-Dwelling Older Adults
Carla A. Chase; Kathryn Mann; Sarah Wasek; Marian Arbesman
Carla A. Chase, EdD, OTR/L, is Associate Professor, Western Michigan University, 1903 West Michigan Avenue, CHHS 5333, Kalamazoo, MI 49008; carla.chase@wmich.edu
Kathryn Mann, MS, OTR/L, is Occupational Therapist, Rehabilitation Hospital of Indiana, Indianapolis
Sarah Wasek, MS, OTR/L, is Occupational Therapist, Ingham County Medical Center and Rehabilitation, Lansing, MI
Marian Arbesman, PhD, OTR/L, is Consultant, AOTA Evidence-Based Practice Project; President, ArbesIdeas, Inc.; and Adjunct Assistant Professor, Department of Rehabilitation Science, University at Buffalo, State University of New York, Williamsville
Complementary/Alternative Approaches / Evidence-Based Practice / Geriatrics/Productive Aging / Home Accessibility/Environmental Modification / Special Issue on the Relationship Between Occupation and Productive Aging
Carla A. Chase, Kathryn Mann, Sarah Wasek, Marian Arbesman; Systematic Review of the Effect of Home Modification and Fall Prevention Programs on Falls and the Performance of Community-Dwelling Older Adults. Am J Occup Ther 2012;66(3):284–291. https://doi.org/10.5014/ajot.2012.005017
This systematic review explored the impact of fall prevention programs and home modifications on falls and the performance of community-dwelling older adults. It was conducted as part of the American Occupational Therapy Association’s Evidence-Based Practice Project. Thirty-three articles were analyzed and synthesized. The strongest results were found for multifactorial programs that included home evaluations and home modifications, physical activity or exercise, education, vision and medication checks, or assistive technology to prevent falls. Positive outcomes included a decreased rate of functional decline, a decrease in fear of falling, and an increase in physical factors such as balance and strength. The strength of the evidence for physical activity and home modification programs provided individually was moderate. Implications for practice, education, and research are also discussed.
This systematic review was part of a larger project that reviewed research studies examining the effect of occupation- and activity-based interventions designed to promote and support productive aging. The objective of this systematic review was to synthesize existing literature to answer the following focused question: “What is the evidence for the effect of home modification and fall prevention programs on the performance of community-dwelling older adults?” We reviewed the effect of home modification as both a separate intervention and a component of several fall prevention programs. Fall prevention programs that studied the effects of physical activity interventions on strength, endurance, or balance, such as exercise-based or tai chi intervention programs, were also included in this review.
Falls are a major public health concern and contribute significantly to mortality and morbidity in the older adult population. In many studies, falls are defined as unintentionally coming to rest on the ground, floor, or other lower level (Buchner et al., 1993). Falls are the leading cause of injury and deaths in people over age 65 (Centers for Disease Control and Prevention [CDC], 2011). One in 3 adults age 65 and older fall each year (Hausdorff, Rios, & Edelber, 2001; Hornbrook et al., 1994), and in 2009, 2.2 million nonfatal fall injuries were treated in emergency departments (CDC, 2011). The risk of a serious injury after a fall increases with age, and in 2009, the rate of fall injuries for adults age 85 and older was reported to be almost 4 times that for adults between ages 65 and 74 (CDC, 2011). In 2000, direct medical costs of falls were estimated to total more than $19 billion, and almost $200 million of that total was related to fatal fall injuries (Stevens, Corso, Finkelstein, & Miller, 2006).
After an injurious fall, an older adult may experience difficulties in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and have an increased risk of early death (Alexander, Rivara, & Wolf, 1992; Sterling, O’Connor, & Bonadies, 2001). Falls also affect performance in other areas of occupation (AOTA, 2008). Tinetti and Williams (1998) reported that older adults falling twice or more in a 3-yr period were less involved in social and leisure activities. In addition, even after a fall without injury, older adults may develop a fear of falling that leads to a decrease in activity level with a decrease in overall strength and endurance (Kressig et al., 2001; Tennstedt et al., 1998). This fear of falling is also reported to increase future risk of falling (Vellas, Wayne, Romero, Baumgartner, & Garry, 1997).
Health care practitioners of all types work with this population in an attempt to decrease falls and risk of falls through such interventions as medication management, vision screening, exercise or physical activity programs, home modifications, and education. Occupational therapy practitioners play a key role in supporting older adults who wish to remain safely in their homes and connected to their communities. Many occupational therapy practitioners provide services through home evaluations before discharge from a rehabilitation facility, through occupational therapy home health services, or by providing aging-in-place services through consultation or entrepreneurial opportunities.
Regardless of service pathway, occupational therapy practitioners provide interventions for community-dwelling older adults that include home evaluations with recommendations for home hazard reduction, home modifications, education on use of assistive technology and modified techniques, and training in fall prevention strategies related to physical activities to improve strength and balance. According to Steultjens et al. (2004, p. 459), occupational therapy brings a “client-centered, problem solving attitude” to the process of supporting community-dwelling older adults’ independence and safety. Reviewing the most recent evidence for various fall prevention and home modification strategies can provide guidance for occupational therapy practice decisions and can have implications for education and research.
The articles included in this review were the result of database searches for articles published from 1990 to November 2008. Selected articles published in 2009–2011 were recommended by experts in the field and included in the review. In addition, bibliographies of selected articles were reviewed for potentially relevant articles. Search terms for the review were determined by a team of experts for the overall project and included ADLs, adaptive equipment, aging in place, assistive technology, environmental barriers, environmental modification, fall prevention, falls, fear of falling, home assessment, home modification, home safety, independent living, IADLs, occupational performance, personal care, self-care skills, self-help devices, and universal design. Articles selected for the review included studies in which the focus was on older adults living in the community. In addition, the interventions studied were within the scope of practice of occupational therapy and included a fall prevention or home modification intervention.
After AOTA Project Consultant Marian Arbesman initially identified articles, lead author Carla A. Chase and two graduate students in occupational therapy involved in the project, Kathryn Mann and Sarah Wasek, individually reviewed each article to determine whether it fit the inclusion criteria. Discrepancies were resolved through discussion until group consensus about article eligibility was achieved. Studies were then further analyzed, categorized, and summarized according to established protocols. Detailed information about the methodology and a complete list of search terms for the entire project dedicated to productive aging can be found in “Methodology for the Systematic Reviews on Occupation- and Activity-Based Intervention Related to Productive Aging” in this issue (Arbesman & Lieberman, 2012).
Of the 33 studies included in this review (see Supplemental Table 1, available online at http://ajot.aotapress.net; navigate to this article, and click on “supplemental materials”), 31 were randomized controlled trials (RCTs; Level I studies) and 2 were Level II studies. Not all studies included occupational therapy services specifically; rather, they involved interventions within occupational therapy’s scope of practice. The results presented here are divided into themes on the basis of the intervention studied and include multifactorial studies, studies of physical activity alone, and studies assessing the effectiveness of home assessment and home modifications.
Multifactorial Interventions
Multifactorial approaches to fall prevention combine multiple interventions in one package. The types of interventions included may vary but often incorporate several of the following approaches: home modifications, education on health and safety, medication management, vision management, gait and balance training, and exercise. The disciplines providing these services may also vary but often include occupational therapy, internal medicine, physical therapy, nursing, and social services.
The evidence that multifactorial approaches reduce falls and difficulties with ADLs and IADLs in older adults is strong. Ten Level I RCTs explored multifactorial approaches (Clemson et al., 2004; Close et al., 1999; Davison, Bond, Dawson, Steen, & Kenny, 2005; Day et al., 2002; Gitlin et al., 2006; Hogan et al., 2001; Hornbrook et al., 1994; Logan et al., 2010; Nikolaus & Bach, 2003; Shumway-Cook et al., 2007). Clemson et al. (2004) reported a 31% reduction in falls at 14-mo follow-up for the Stepping On program, which included occupational therapy and incorporated environmental and home safety, balance, strength, vision screening, and medication management. Davison et al. (2005) reported 36% fewer falls after an intervention that combined occupational therapy, physical therapy, and medical management for older adults presenting to an emergency department after a fall. In addition, participants had a shorter duration of hospital admissions during follow-up and better falls efficacy than those in the control group. Groups did not differ, however, on the number of participants falling and the number of hospital admissions.
Nikolaus and Bach (2003) reported 31% fewer falls in the year after an intervention that included a diagnostic home visit and home intervention assessing the home for environmental hazards and providing advice for hazard reduction. In addition, training in the use of technical and mobility aids was provided, and a second home visit took place 3 mo later. Occupational therapy, physical therapy, nursing, and social work provided the intervention. Nikolaus and Bach reported that the intervention was most effective in a subgroup that had fallen 2 or more times before study recruitment. The results indicated that the rate of falls and proportion of frequent fallers was significantly reduced in this subgroup.
Close et al. (1999) found that an occupational therapy home assessment and a medical visit with referrals as appropriate led to a reduction in falls and fall risk, a decrease in the chance of hospital admission, and a slower decline in ADL function at 1-yr follow-up. All participants were recruited to the study after presenting to the emergency department after a fall. Participants in the intervention group were provided with minor equipment and referred to social services for additional adaptations. All participants in the Logan et al. (2010) study were recruited after calling an ambulance after a fall. The multifactorial intervention incorporated strength and balance exercises, home assessment of hazards, and review of medications and blood pressure as provided by occupational therapy, physical therapy, and nursing. Referrals were made to other agencies as needed. The results indicated fewer calls for an ambulance, fewer falls, better performance in ADLs and IADLs, and a significant decrease in fear of falling at follow-up.
Gitlin et al. (2006) evaluated the effectiveness of an individualized program to reduce difficulties in ADLs and IADLs, improve self-efficacy, and reduce fear of falling in community-dwelling older adults >70 yr old with difficulty in one or more ADLs. Five sessions provided by an occupational therapist examined environmental hazards and incorporated problem solving to identify behavioral and environmental contributors to performance difficulties. A single visit by a physical therapist focused on balance and muscle strengthening and fall recovery techniques. Results of the study indicated that participants in the intervention group had less difficulty with ADLs and IADLs, improved self-efficacy, and decreased fear of falling compared with control participants. In addition, those in the intervention group had fewer home hazards and more use of adaptive strategies, with significant improvements persisting at 1-yr follow-up.
Day et al. (2002) studied falls among older adults living at home with good to excellent self-reported health. Using an intervention that incorporated group-based exercise, home hazard management, and vision in various combinations, they reported that exercise alone provided the strongest evidence for a single intervention. The addition of home hazard management, vision management, or both further reduced falls. Shumway-Cook et al. (2007) provided group exercise, fall prevention education, and falls risk assessment to older sedentary adults. Although the intervention group had a 25% decrease in falls at follow-up compared with the control group, the results were not significant. Hogan et al. (2001) found no difference in falls and emergency department visits between groups for an intervention providing an individualized treatment plan plus exercise for older adults who fell within 3 mo before study recruitment. They reported, however, that participants who had reported two or more falls during the prerecruitment period had a significantly longer time between falls and fewer falls.
Physical Activity Interventions
Studies of physical activity interventions in the systematic review included group and individual sessions that incorporated balance retraining, walking, general exercise in sitting and standing, lower-extremity strengthening, use of a workstation format, or tai chi. Mixed but overall positive results were found in studies that measured the impact of physical activity programs on the performance of community-dwelling older adults. Seven RCTs reported a significant decrease in falls and fall risk after physical activity, regardless of the type of exercise incorporated into each study (Buchner et al., 1997; Faber, Bosscher, Chin, Paw, & van Wieringen, 2006; Gardner, 1998; Lord, Ward, Williams, & Strudwick, 1995; Means, Rodell, & O’Sullivan, 2005; Skelton, Dinan, Campbell, & Rutherford, 2005; Voukelatos, Cumming, Lord, & Rissel, 2007). Exercise programs in these studies included functional walking, tai chi, balance, flexibility, lower-limb strengthening, and gait training. Voukelatos et al. (2007) also reported a reduction in fear of falling in a study of tai chi with community-dwelling older adults.
Lin, Wolf, Hwang, Gong, and Chen (2007) examined the effects of several fall prevention programs; the group participating in an exercise program showed improved functional reach and balance scores and a decreased fear of falling compared with either an education group or a home safety assessment and modification group. In a Level I RCT of Finnish older adults living in the community, Luukinen et al. (2007) found no significant difference between control and intervention groups in fall rates after exercise; however, results indicated a significant decrease in the decline of balance skills over a 6-mo period. In another Level I RCT, Lord et al., 2005) compared an extensive intervention combining exercise with strategies for maximizing vision and sensation with a minimal intervention providing brief advice and with a no-intervention control. Although researchers found no difference in fall rates, the participants receiving the most extensive intervention had a decrease in some physiological risk factors related to falls such as knee flexion and sit-to-stand time but no improvement in balance.
Nitz and Choy (2004), in a Level I RCT, compared a fall prevention pamphlet control group with a group participating in a series of workstations of balance activities in addition to receiving a pamphlet. Participants in the workstation group showed improvement in functional motor ability, lateral reach, and functional step compared with control participants, but no difference in falls was found between groups at follow-up. In Hauer et al. (2001), older adults in a geriatric rehabilitation unit were randomized to either an exercise program emphasizing strength, balance, and functional performance or a placebo control group before discharge to the community. Both groups received physical therapy twice a week that did not emphasize strength and balance. The results indicated that those in the exercise intervention group had improved strength, functional motor performance, and balance and reduced fear of falling compared with the control group. No differences were found between groups for falls.
In several Level I RCTs included in the systematic review, results varied with age, fall history, and participant’s activity level. For those over age 80, strengthening, balance retraining that progressed in difficulty, and a walking plan led to fewer falls and fewer injuries when falls did occur (Campbell et al., 1997; Robertson, Devlin, Gardner, & Campbell, 2001). Campbell et al. (1997), however, found no difference in ADL performance at follow-up. Means et al. (2005) reported that participants in an exercise intervention group with a history of multiple falls had fewer falls in follow-up than did the control group with a similar fall history. Morgan, Virnig, Duque, Abdel-Moty, and DeVito (2004) reported that falls among higher functioning older adults increased after an exercise program, whereas lower functioning adults had a decrease in the risk of falls.
Home Assessment and Home Modifications
The home assessment and home modification interventions in this section of the systematic review included hazard identification, structural changes to the inside and outside of the home, and provision of assistive technology and assistive devices. A Level II prospective cohort study (Liu & Lapane, 2009) surveyed older adults at baseline and during a 2-yr follow-up period as part of the second Longitudinal Study of Aging. Liu and Lapane (2009) found that those having residential modification at baseline (e.g., railings, bathroom modifications) were less likely to experience a decline in physical functioning. In a Level I RCT, Cumming et al. (1999) compared occupational therapy home visits for home modifications for older adults before hospital discharge with a no-intervention control group. The occupational therapist facilitated the implementation of the home modifications. Although both groups showed no difference in falls at follow-up, a significant difference was found between groups at follow-up for participants reporting one or more falls in the year before recruitment.
In a Level II nonrandomized controlled trial in Sweden (Petersson, Kottorp, Bergström, & Lilja, 2009), occupational therapists provided assessments for home modifications for older adults with disabilities reporting difficulty in at least one of these areas: getting in and out of the home, mobility indoors, or self-care in the bathroom. The local government provided grants to install the home modifications. Participants in the intervention group reported significantly less difficulty in everyday tasks at follow-up than the comparison group.
In a Level I RCT, Campbell et al. (2005) studied targeted falls prevention provided to older adults ≥75 yr old with severe visual impairment. Home safety assessment and modification provided by an occupational therapist was compared with vitamin D supplementation and a home exercise program provided by a physical therapist, a combination of both interventions, or a social visit. Although the home safety group had significantly fewer falls than the exercise group, strict adherence to exercise was also associated with fewer falls. Neither group reported reduced injuries as a result of the falls. In a Level I RCT by Mann, Ottenbacher, Fraas, Tomita, and Granger (1999), an occupational therapist provided a functional assessment, environmental interventions, and assistive technology to frail older adults living alone. Although both intervention and control groups had a functional decline at 18-mo follow-up, the control group declined significantly more than the control group. Tomita, Mann, Stanton, Tomita, and Sundar (2007; Level I RCT) evaluated the effectiveness of commercially available smart home technology to operate lights, appliances, door, and windows for frail older adults living alone. Although no difference was found in IADL performance between groups at follow-up, those in the intervention group reported a high degree of satisfaction with the technology. Stevens, Holman, Bennett, and de Klerk (2001; Level I RCT) reported no differences between groups when a home modification assessment and information on hazard reduction was provided to healthy older adults by a research nurse.
A Level I RCT (Pighills, Torgerson, Sheldon, Drummond, & Bland, 2011) compared the effectiveness of a home modification assessment by an occupational therapist with that of a nonprofessional assessor. The study also included a no-treatment control group. Both the occupational therapists and the nonprofessional assessors received training in home modification assessment. Outside agencies provided the home modifications for the older adults. Although Pighills et al. (2011) found no effect on fear of falling, those in the occupational therapy assessment group had fewer falls than did those in the control group. No difference was found when comparing falls for the trained assessor and control groups, and no difference was found in ADLs at follow-up between either occupational therapy or assessor groups versus the control group.
The role of occupational therapy practitioners in fall prevention and in providing support for older adults striving to remain in their home and actively participate in their community as they age includes facilitation of exercise through individual and group sessions, education about strategies to remain safe and independent, and recommendations for assistive technology and home modifications. This review provided strong evidence that when used in combination, these interventions play a role in successfully reducing the number of falls, limiting fear of falling, and preserving independence in community-dwelling older adults. When physical activity and home modifications are provided individually, the evidence that these interventions reduce falls and maintain and promote ADL and IADL performance is moderate. The evidence also indicates that the subgroup of frequent fallers show the greatest benefits from individual and multifactorial interventions (Cumming et al., 1999; Hogan et al., 2001; Nikolaus & Bach, 2003). In addition, participants with better adherence to a physical activity program had a lower rate of falls at follow-up than those who did not have good adherence to the program (Campbell et al., 2005).
Fall prevention and home modification interventions are crucial for the reduction of morbidity and mortality related to falls. Occupational therapy practitioners are experts in this area because they provide client-centered and occupation-based interventions with older adults. In addition, occupational therapy practitioners recognize that the physical and psychological benefits of maintaining independence need to be weighed against potential physical damage if an injury occurs as a result of a fall (Arbesman, Campbell, & Rhynders, 2001). Pighills et al. (2011) emphasized the value of occupational therapy with community-dwelling older adults, and they reported that adherence to recommendations was significantly higher in the occupational therapy group than in the nonprofessional assessor group.
The systematic review presented here has several strengths. The methodology included a large time frame (since 1990) and incorporated several bibliographic databases, thus ensuring that relevant literature was captured. In addition, a wide range of interventions was studied in the articles included in the review. Of the 33 articles included in the review, 31, or 94%, were Level I RCTs, and 100% were Level II or Level I. Although studies at all levels may have limitations, those at Level I are less vulnerable to bias and more generalizable. In addition, the outcomes are more likely to be attributed to the intervention being studied.
Some of the articles included in this systematic review, however, had limitations. Several studies were not blinded, had high dropout rates, and had small sample sizes. Many of the studies used self-report, and the methods for recording falls and injuries varied among the studies. Self-reported function may have involved participants responding to general ADL and IADL status questions with a broad sweeping report rather than considering each task separately, which would provide a more detailed account of their abilities and challenges. Interventions included in studies may not have been clearly described, and the definition of home modifications and equipment may have varied among studies. The studies were conducted in several countries, and whether differences in health care systems had an impact on the design and implementation of the interventions is unknown. In addition, determining the contribution of individual components of multifactorial interventions is difficult, and it was also not always clear whether home modifications were completed on the basis of the recommendations provided or whether modifications were made appropriately.
The information provided in this systematic review provides occupational therapy educators with evidence on fall prevention and home modification that can be integrated into program curricula and student research activities. The results have the following implications for future research:
Specifying a population that would specifically benefit from a given type of intervention may be important; for example, one study found that people over age 80 and those considered frail responded particularly well to fall reduction interventions (Robertson et al., 2001).
Although the amount of research in the area of fall prevention through various physical activity or exercise programs is fairly large and growing, more research is needed that explores the impact of home modifications on fall prevention and performance in all areas of occupation.
Home modification studies have often missed the opportunity to measure outcomes related to maintained or increased ability to complete ADLs or IADLs and to analyze performance in a variety of environments and contexts. Using standardized outcome measures for functional status and safety in the home such as the Canadian Occupational Performance Measure (Law et al., 1994), the In-Home Occupational Therapy Evaluation (Stark, Somerville, & Morris, 2010), and the Safety Assessment of Function and the Environment for Rehabilitation (Chiu, Oliver, Marshall, & Letts, 2002) can provide a more consistent way to examine change by assessing the wide range of environments in which older adults participate, including the home and community.
The results of this systematic review contribute to evidence-based practice for occupational therapy practitioners working with older adults in community-based settings and reinforce the importance of the role of occupational therapy in the home and community. The findings have the following implications for occupational therapy practice:
In general, a client-centered intervention plan that includes a mix of exercise, education, home modifications, and assistive technology is supported by the best evidence for fall prevention and occupational performance in community-dwelling older adults.
Regardless of the setting in which one practices, occupational therapy practitioners can incorporate fall prevention and home modification strategies throughout the occupational therapy process, from evaluation to intervention planning and implementation and outcome review.
The evidence discussed here reinforces the role of occupational therapists on the home and community team and the importance of client-centered care with a mix of interventions to provide the best fit.
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Indicates studies that were systematically reviewed for this article.×
284_ds001.pdf
Occupational Therapy in Fall Prevention: Current Evidence and Future Directions
Effect of Occupation- and Activity-Based Interventions on Instrumental Activities of Daily Living Performance Among Community-Dwelling Older Adults: A Systematic Review
Extended Occupational Therapy Reintegration Strategies for a Woman With Guillain-Barré Syndrome: Case Report
Systematic Review of Occupation- and Activity-Based Health Management and Maintenance Interventions for Community-Dwelling Older Adults
Effect of Home Modification Interventions on the Participation of Community-Dwelling Adults With Health Conditions: A Systematic Review
Home Accessibility/Environmental Modification