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Background: Measurement of freezing of gait (FOG) relies on the sensitivity and reliability of tasks to provoke FOG. It is currently unclear which tasks provide the best outcomes and how medication state plays into this.Objective: To establish the sensitivity and test-retest reliability of various FOG-provoking tasks for presence and severity of FOG, with (ON) and without (OFF) dopaminergic medication.Methods: FOG-presence and percentage time frozen (% TF) were derived from video annotations of a home-based FOG-provoking protocol performed in OFF and ON. This included: the four meter walk (4MW), Timed Up and Go (TUG) single (ST) and dual task (DT), 360° turns in ST and DT, a doorway condition, and a personalized condition. Sensitivity was tested at baseline in 63 definite freezers. Test-retest reliability was evaluated over 5 weeks in 26 freezers.Results: Sensitivity and test-retest reliability were highest for 360° turns and higher in OFF than ON. Test-retest intra-class correlation coefficients of % TF varied between 0.63–0.90 in OFF and 0.18–0.87 in ON, and minimal detectable changes (MDCs) were high. The optimal protocol included TUG ST, 360° turns ST, 360° turns DT and a doorway condition, provoking FOG in all freezers in OFF and 91.9% in ON and this could be done reliably in 95.8% (OFF) and 84.0% (ON) of the sample. Combining OFF and ON further improved outcomes.Conclusions: The highest sensitivity and reliability was achieved with a multi-trigger protocol performed in OFF?+?ON. However, the high MDCs for % TF underscore the need for further optimization of FOG measurement.

Measurement of freezing of gait (FOG) relies on the sensitivity and reliability of tasks to provoke FOG. It is currently unclear which tasks provide the best outcomes and how medication state plays into this. To establish the sensitivity and test-retest reliability of various FOG-provoking tasks for presence and severity of FOG, with (ON) and without (OFF) dopaminergic medication. FOG-presence and percentage time frozen (% TF) were derived from video annotations of a home-based FOG-provoking protocol performed in OFF and ON. This included: the four meter walk (4MW), Timed Up and Go (TUG) single (ST) and dual task (DT), 360° turns in ST and DT, a doorway condition, and a personalized condition. Sensitivity was tested at baseline in 63 definite freezers. Test-retest reliability was evaluated over 5 weeks in 26 freezers. Sensitivity and test-retest reliability were highest for 360° turns and higher in OFF than ON. Test-retest intra-class correlation coefficients of % TF varied between 0.63–0.90 in OFF and 0.18–0.87 in ON, and minimal detectable changes (MDCs) were high. The optimal protocol included TUG ST, 360° turns ST, 360° turns DT and a doorway condition, provoking FOG in all freezers in OFF and 91.9% in ON and this could be done reliably in 95.8% (OFF) and 84.0% (ON) of the sample. Combining OFF and ON further improved outcomes. The highest sensitivity and reliability was achieved with a multi-trigger protocol performed in OFF + ON. However, the high MDCs for % TF underscore the need for further optimization of FOG measurement. Freezing of gait is a very burdensome and episodic symptom in Parkinson’s disease that is difficult to measure. Measurement of freezing is needed to determine whether someone has freezing and how severe this is, and relies on observation during a freezing-triggering protocol. However, it is unclear what protocol is sufficiently sensitive to trigger freezing in many freezers, and whether freezing can be triggered reliably at different timepoints. Here, we investigated 1) which tasks can trigger freezing-presence and freezing-severity sensitively and reliably, 2) how medication state influences this, and 3) what task combination was most reliable. Sixty-three patients with daily freezing performed several freezing-triggering tasks in their homes, both with (ON) and without (OFF) anti-Parkinsonian medication. In twenty-six patients, the measurement was repeated 5 weeks later to determine test-retest reliability. First, we found that performing 360° turns in place with a cognitive dual task was the most sensitive and reliable task to trigger FOG. Second, sensitivity and reliability were better in OFF than in ON. Third, the most reliable protocol included: the Timed-Up and Go, 360° turns in place with and without the dual task, and a doorway condition. This protocol triggered freezing in all patients in OFF and 91.9% in ON and did so reliably in 95.8% (OFF) and 84.0% (ON) of the sample. We recommend to measure freezing with this protocol in OFF + ON, which further improved reliability. However, the measurement error for freezing-severity was high, even for this optimal protocol, underscoring the need for further optimization of freezing measurement.

ObjectivesThis project used a systematic and integrated knowledge translation (IKT) approach to co-create theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury (SCI).MethodsGuided by the IKT Guiding Principles, we meaningfully engaged research users throughout this project. A systematic approach was used. An international, multidisciplinary expert panel (n = 15), including SCI researchers, counselors, and people with SCI, was established. Panel members participated in two online meetings to discuss the best practices by drawing upon new knowledge regarding counselor-client interactions, current evidence, and members’ own experiences. We used concepts from key literature on SCI-specific physical activity counseling and health behavior change theories. An external group of experts completed an online survey to test the clarity, usability and appropriateness of the best practices.ResultsThe best practices document includes an introduction, the best practices, things to keep in mind, and a glossary. Best practices focused on how to deliver a conversation and what to discuss during a conversation. Examples include: build rapport, use a client-centred approach following the spirit of motivational interviewing, understand your client’s physical activity barriers, and share the SCI physical activity guidelines. External experts (n = 25) rated the best practices on average as clear, useful, and appropriate.ConclusionWe present the first systematically co-developed theory- and evidence-based best practices for SCI physical activity counseling. The implementation of the best practices will be supported by developing training modules. These new best practices can contribute to optimizing SCI physical activity counseling services across settings.

Study design: Guided by the 4-step process outlined in the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline, multiple methodologies were used: Delphi, literature reviews, ratings with consensus, think-aloud, and test-retest. Objectives: The purpose of this study was to develop and test a spinal cord injury (SCI) peer support evaluation tool that meets the needs of community-based SCI organizations in Canada. Setting: Peer support programs for people with SCI delivered by community-based SCI organizations. Methods: This research was co-constructed with executives and staff from SCI community-based organizations, people with SCI, researchers, and students. Given the multiple steps of this study, sample size and characteristics varied based on each step. Participants included people with SCI who received peer support (mentees) or provided peer support (mentors/supporters) and staff of community-based organizations. Results: In step 1, the 20 most important outcomes for SCI peer support were identified. In step 2 and 3, the 97 items were identified to assess the outcomes and by using rating and multiple consensus methodologies 20 items, one to assess each outcome, were selected. In step 4, content and face validity and test-retest reliability were achieved. The resulting SCI Peer Support Evaluation Tool consists of 20 single-item questions to assess 20 outcomes of SCI peer support. Conclusion: Through a systematic process, the SCI Peer Support Evaluation Tool is now ready to be implemented to assess outcomes of SCI peer support programs delivered by community-based SCI organizations.

The historically male‐dominated discourse encompassing artistic creativity has often failed to acknowledge the voices and contributions of women. Female artists continue to face barriers in terms of accessing opportunities, attaining positions of prominence, and earning potential, in comparison with their male counterparts. This inequality is deleterious to female artists and society. Therefore, it is important to understand the relationship between artistic creativity and gender, with a particular emphasis on elite female artistic exemplars. The present qualitative study utilized in‐depth semi‐structured interviews, in accordance with the methodology of Interpretive Phenomenological Analysis, to explore the role of gender in relation to artistic creativity among 10 eminent Australian female visual artists. Findings indicated that participants were affected detrimentally by gender‐based inequality on personal, professional, and sociocultural levels. Their experiences as women, however, also inspired and informed their artistic creativity aesthetically and conceptually. The findings challenge patriarchal conceptualizations of the “male artistic genius” by presenting a female‐focused counternarrative. Implications for educating, supporting, and empowering current and emerging female artists to excel are discussed.

The Physical Activity Recall Assessment for People with SCI (PARA-SCI) has demonstrated the best test-retest reliability and validity of self-report measures of leisure-time physical activity (LTPA) for adults with SCI. However, the absence of internal consistency reliability data has been raised as a concern. Internal consistency is relevant only for unidimensional measures. In other populations, LTPA is known to be a multidimensional construct, evaluated with multidimensional measures. We tested for unidimensionality through secondary analysis of PARA-SCI data (n = 703). Cronbach’s α was 0.227. Principal components analysis showed two components/dimensions (‘Moderate and Heavy Intensity LTPA’ and ‘Mild Intensity LTPA’) explained 73% of the variance. Binary logic crosstabulation produced no discernible patterns of behavioural interrelatedness across LTPA intensities. Together, these data demonstrate the multidimensionality of LTPA and the PARA-SCI is not unidimensional. Internal consistency should not be a criterion for evaluating LTPA questionnaires for use in studies of people with SCI.

Children and youth with disabilities (CYD) are more likely to experience poor mental health compared to non-disabled peers. Disability type may impact mental health outcomes; however, a more comprehensive understanding of mental health outcomes in CYD with diverse disability types is needed. This study examined the mental health status of CYD. Parents of 473 CYD completed a survey including a measure of mental health indicators. Approximately 72% of the sample had above average total difficulties scores. Boys scored higher than girls on the hyperactivity subscale, and those with comorbid disabilities scored the highest on total difficulties. Overall, the results indicate CYD experience mental health challenges at rates well above population norms. Research exploring interventions that may buffer these effects is warranted.

Studies including diagnostic workups on true drug allergy in children are limited.

Regular leisure time physical activity (LTPA) has beneficial health effects in people with spinal cord injury (SCI). Yet, participation in LTPA is low, and little is known about changes many years after injury.

ABSTRACTLeisure-time physical activity (LTPA) participation involves two dimensions: quantity and quality. Research has been undertaken to explore strategies for increasing the quantity of LTPA among ambulators with spinal cord injury (SCI). Yet, no studies have been conducted to examine the quality of LTPA participation among ambulators with SCI, which may be important for well-being, health, and maintaining participation. Thus, the purpose of this study was to explore conditions and elements involved in positive and negative quality LTPA experiences. Semi-structured interviews were conducted with 22 ambulators with SCI. Using pragmatism and integrated knowledge translation as guiding approaches, the data were thematically analysed. Following inductive coding, the Quality Participation Framework and the Quality Parasport Participation Framework were employed for deductively coding the elements and conditions associated with LTPA experiences, respectively. Three principal themes were identified which provide broad insights for LTPA among ambulators with SCI: ableism, feeling sidelined, and effects of SCI. These themes capture conditions that fostered a positive or negative quality PA experience, including: three intrapersonal, five social, four programme, and one physical condition(s). Elements identified in the Quality Participation Framework were also related to both positive and negative quality LTPA experiences. This study provides insight on how LTPA is uniquely experienced by ambulators with SCI, including conditions and elements that influence quality participation. Self-determination theory may be useful to inform the design of behavioural interventions due to its alignment with the Quality Participation Framework. Behavioural interventions should employ behaviour change techniques to target conditions and elements of LTPA participation.

ContextIndonesia, Japan, Korea, Thailand.ObjectiveTo culturally validate and translate the Scientific Exercise Guidelines for Adults with Spinal Cord Injury (SEG-SCI) for use in four Asian countries.DesignSystematic ReviewParticipantsN/AMethodsA systematic review was conducted to identify all published English- and local-language studies conducted in Indonesia, Japan, Korea, and Thailand, testing the effects of exercise training interventions on fitness and cardiometabolic health in adults with acute or chronic SCI. Protocols and results from high-quality controlled studies were compared with the SEG-SCI. Forward and backward translation processes were used to translate the guidelines into Bahasa Indonesian, Japanese, Korean and Thai languages.ResultsFifteen studies met the review criteria. At least one study from each country implemented exercise prescriptions that met or exceeded the SEG-SCI. Two were controlled studies. In those two studies, relative to control conditions, participants in exercise conditions achieved significant improvements in fitness or cardiometabolic health outcomes only when the exercise intervention protocol met or exceeded the SEG-SCI. During the language translation processes, end-users confirmed that SEG-SCI language and terminology were clear.ConclusionClinical researchers in Indonesia, Japan, Korea and Thailand have implemented exercise protocols that meet or exceed the SCI-SEG. Results of high-quality studies align with the SEG-SCI recommendations. Based on this evidence, we recommend that the SEG-SCI be adopted in these countries. The cultural validation and translation of the SEG-SCI is an important step towards establishing consistent SCI exercise prescriptions in research, clinical and community settings around the world.

Graphical Abstract

Artistic creativity has long been associated with physical and psychological suffering. This phenomenon has also been the subject of empirical research. The anguished “artistic genius” stereotype is ubiquitous, and there is evidence to suggest that artists may have heightened susceptibility to psychopathology. The present qualitative study utilized in‐depth semi‐structured interviews, in accordance with the methodology of Interpretive Phenomenological Analysis to explore inter‐relationships between artistic creativity, and physical and mental health among 10 eminent Australian female visual artists. Results revealed complex, reciprocal interactions whereby physical and mental health impacted creativity and vice versa. Physical and psychological illnesses were found to either diminish or stimulate creativity due to the interplay of biological predispositions, personal vulnerabilities, and environmental factors. It was also revealed that immersive creative engagement could have therapeutic, cathartic effects and facilitate post‐traumatic growth. The stressors and demands of professional creative practice could, however, also have a detrimental impact upon artists physically and psychologically. These findings contribute to existing understandings regarding the intricacy of the relationship between creativity, physical and psychological health. They highlight the need to challenge romantic societal mythologies regarding the impact of suffering on creativity in the visual arts and explore these issues in a nuanced manner to best support those in creative industries.

Study design: Multi-centre randomized clinical trial. Objectives: (1) compare the effects of arm-cycle ergometry (ACET) and body weight supported treadmill training (BWSTT) on quality of life (QOL) and intermediary variables in individuals with spinal cord injury (SCI); (2) examine correlations between baseline measures, and changes in physical activity, QOL, and intermediaries. Setting: Hospital-based research institutes (Vancouver, Toronto) and University-based exercise program (Hamilton). Methods: 35 participants with motor-complete SCI above T6 completed baseline assessments of physical activity, life satisfaction, independence, autonomy, positive and negative affect, and pain. Twenty-eight participants were randomized to 72 sessions of ACET (n= 14) or BWSTT (n= 14) with measures repeated following 36 sessions, 72 sessions, and 6-months post-intervention. Results: Neither intervention significantly impacted QOL. Pain was reduced in ACET compared to BWSTT (interaction effect p= 0.022) and was significantly less at 72 sessions vs. baseline in the ACET group (p= 0.009). At baseline, QOL was positively correlated with independence, autonomy, and positive affect and negatively correlated with negative affect (all p< 0.05). Following BWSTT, changes in moderate-vigorous physical activity correlated with changes in QOL (r= 0.87, p= 0.010). Following ACET, changes in autonomy and independence were positively correlated with changes in QOL (both r> 0.64, p< 0.048). Conclusions: Contrary to previous studies, there was no benefit of either intervention on measures of QOL. The social context of exercise may be important for improving QOL. However, individuals may benefit more from active (ACET) than passive (BWSTT) exercise modalities through reduced pain. Exercise interventions that improve autonomy and independence may lead to improvements in QOL.

Graphical Abstract

Objectives: Mobility is a core challenge to transition towards sustainability. Cities are, therefore, rethinking their mobility to reduce negative externalities such as (greenhouse) gas emissions or congestion. When trying to implement sustainable urban mobility plans, there is often resistance from citizens. This can indicate a disconnect between the public and policymakers due to a lack of participation, coupled with the fact that current data-collection methods often used (such as travel surveys) are limited in scope. Advances in big data analysis and user-generated content provide opportunities to gain deeper insights into citizens' perceptions of mobility policy changes. This paper explores how sentiment analysis through deep learning can be used in transport planning. Materials and Methods: In this research, we analyse the sentiments of citizens towards recent changes in mobility policy in Brussels, Belgium, through Twitter data. We analyse 1998 tweets about changing mobility policy in Brussels between July 18th, 2019 (forming of the last Brussels regional government), and December 31st, 2022 (starting date of the analyses). For our analysis, we employ two pre-trained language models: XLM-Tand GPT4. Results: Our results show that the sentiment with regard to the new mobility interventions is, as reflected by Twitter posts, not overwhelmingly negative. Furthermore, we find that the performance scores of XLM-Twhen no domain-specific fine-tuning has occurred (zero-shot evaluation) is fairly low (0.48). Once the model is trained on our domain-specific data, it reaches an accuracy of 0.67. When using GPT4, the model reaches an accuracy of 0.66. Additionally, GPT4seems better suited at identifying mismatched tweets, i.e. tweets using vocabulary that has a different sentiment than the one the tweets expresses (e.g., sarcasm). This might indicate that large language models might be better suited to obtain implicit sentiments expressed in a text. Conclusions: From a machine learning perspective, our experiments highlight the difficulty of recognising contextual sentiment (in this case, a sentiment towards changes in mobility policies), which may differ from the sentiment reflected in the vocabulary used. This is especially important if these two sentiments do not correspond, a problem both models struggled with. Additionally, we show that GPT4can provide additional information when performing sentiment analysis by prompting it to attribute scores to texts. This paper opens new perspectives on understanding and addressing public sentiment in urban mobility policies. The advancements in language models, and the effective integration of user-generated content, can provide policymakers with a more comprehensive understanding of public sentiment, facilitating the implementation of certain policies. Clinical Relevance: None.

Study design: Knowledge translation (KT) study. Objectives: To demonstrate how to use systematic, community-engaged methods to (1) translate the international scientific spinal cord injury (SCI) exercise guidelines into community and clinical practice guidelines, and (2) develop supporting resources. Setting: Canada. Methods: An expert panel of SCI researchers and stakeholders translated the guidelines and developed a supporting resource, using a KT process guided by an adapted version of the Appraisal of Guidelines, Research and Evaluation (AGREE) II Instrument. Pilot tests with end-users were conducted throughout. Results: The panel recommended (1) the two scientific exercise guidelines be combined and presented in a single message titled “The Canadian SCI physical activity guidelines”; (2) development of an online supporting resource, with educational and motivational information presented in “layers” to address the needs and preferences of diverse end-users. The top layer presents and explains the Canadian SCI physical activity guidelines. The deeper layers include information on benefits, overcoming barriers, activity examples, safety tips, and links to existing resources. Interviews with adults with SCI (n= 8) and survey-data from end-users (n= 90) showed that the guidelines and supporting resource were perceived as clear, useful, and appropriate. Conclusion: Using community-engaged methods, the two scientific SCI exercise guidelines were combined into one single physical activity guideline message. This KT process provides a template for groups in other countries to translate the scientific SCI exercise guidelines to their local settings using a similar systematic, community-engaged approach. Sponsorship: Rick Hansen Institute; Social Sciences and Humanities Research Council of Canada.

Study design: Type II hybrid effectiveness-implementation trial protocol. Objectives: To (1) evaluate the implementation of coordinated physical activity (PA) coaching delivered by physiotherapists and spinal cord injury (SCI) peers during the transition from in-hospital care to living in a community (implementation objective) and (2) assess the effect of coaching on PA behaviour and psychosocial predictors among people with SCI (effectiveness objective). Setting: Rehabilitation hospital and home/community settings in British Columbia, Canada. Methods: Implementation objective: PA coaches (physiotherapists and SCI peers) receive an implementation intervention including training, monitoring, feedback, and champion support. A Theoretical Domains Framework-based questionnaire is collected at baseline, post-training, 2, and 6 months follow-up and semi-structured interviews conducted at 6 months. Effectiveness objective: Using a quasi-experimental design, 55 adults with SCI are allocated to intervention (PA coaching, n= 30) or control (usual care, n= 25) groups. Participants in the intervention group are referred by physiotherapists to receive 11 SCI peer-delivered PA coaching sessions in the community. Control participants received usual care. Questionnaires assessing PA behaviour and psychosocial predictors are administered at baseline, 2-months, 6-months, and 1-year. Semi-structured interviews are conducted to assess intervention satisfaction at 6 months. Analyses include one-way (implementation objective) and two-way (effectiveness objective) repeated measures ANCOVAs for questionnaire-reported outcomes and thematic content analysis for interview data. Data are summarised using the reach effectiveness adoption implementation maintenance (RE-AIM) framework. Ethics and dissemination: The University of British Columbia Clinical Research Ethics Board approved the protocol (#H19-02694), clinicaltrials.gov registration NCT04493606. Documentation of the adoption process will inform implementation in future sites.

Since its advent in the 1970s, optical tweezers have been widely deployed as a preferred non-contact technique for manipulating microscale objects. On-chip integrated optical tweezers, which afford significant size, weight, and cost benefits, have been implemented, relying upon near-field evanescent waves. As a result, these tweezers are only capable of manipulation in near-surface regions and often demand high power since the evanescent interactions are relatively weak. We introduce on-chip optical tweezers based on freeform micro-optics, which comprise optical reflectors or refractive lenses integrated on waveguide end facets via two-photon polymerization. The freeform optical design offers unprecedented degrees of freedom to design optical fields with strong three-dimensional intensity gradients, useful for trapping and manipulating suspended particles in an integrated chip-scale platform. We demonstrate the design, fabrication, and measurement of both reflective and refractive micro-optical tweezers. The reflective tweezers feature a remarkably low trapping threshold power, and the refractive tweezers are particularly useful for multiparticle trapping and interparticle interaction analysis. Our integrated micro-optical tweezers uniquely combine a compact footprint, broadband operation, high trapping efficiency, and scalable integration with planar photonic circuits. This class of tweezers is promising for on-chip sensing, cell assembly, particle dynamics analysis, and ion trapping.

Study design: Cross-sectional construct validation study. Objectives: To test the construct validity of the Leisure Time Physical Activity Questionnaire for People with Spinal Cord Injury (LTPAQ-SCI) by examining associations between the scale responses and cardiorespiratory fitness (CRF) in a sample of adults living with spinal cord injury (SCI). Setting: Three university-based laboratories in Canada. Methods: Participants were 39 adults (74% male; Mage: 42 ± 11 years) with SCI who completed the LTPAQ-SCI and a graded exercise test to volitional exhaustion using an arm-crank ergometer. One-tailed Pearson’s correlation coefficients were computed to examine the association between the LTPAQ-SCI measures of mild-, moderate-, heavy-intensity and total minutes per week of LTPA and CRF (peak volume of oxygen consumption [V̇O2peak] and peak power output [POpeak]). Results: Minutes per week of mild-, moderate- and heavy-intensity LTPA and total LTPA were all positively correlated with V̇O2peak. The correlation between minutes per week of mild intensity LTPA and V̇O2peakwas small-medium (r= 0.231, p= 0.079) while all other correlations were medium-large (rs ranged from 0.276 to 0.443, ps < 0.05). Correlations between the LTPAQ-SCI variables and POpeakwere also positive but small (rs ranged from 0.087 to 0.193, ps > 0.05), except for a medium-sized correlation between heavy-intensity LTPA and POpeak(r= 0.294, p= 0.035). Conclusions: People with SCI who report higher levels of LTPA on the LTPAQ-SCI also demonstrate greater levels of CRF, with stronger associations between moderate- and heavy-intensity LTPA and CRF than between mild-intensity LTPA and CRF. These results provide further support for the construct validity of the LTPAQ-SCI as a measure of LTPA among people with SCI.

Study design: Scoping review of experimental and quasi-experimental studies. Objective: To systematically synthesize research testing the effects of leisure time physical activity (LTPA) interventions on chronic pain and subjective well-being (SWB) among adults with spinal cord injury (SCI). Methods: Literature searches were conducted using multiple databases (Web of Science, Embase, CINAHL, Medline, PsychINFO and SPORTDiscus) to identify studies involving persons with SCI that measured and reported the effects of LTPA interventions on both chronic pain and at least one measure of SWB (e.g., affect, life satisfaction, satisfaction with various life domains). Relevant data were extracted from the studies and synthesized. Results: A total of 3494 articles were screened. Fifteen published articles, consisting of 12 different studies met the review inclusion criteria. Four different patterns of findings were observed regarding the effect of LTPA on chronic pain and SWB outcomes: (1) increased chronic pain, decreased SWB (1 article); (2) decreased chronic pain, improved SWB (12 articles); (3) increased chronic pain, improved SWB (1 article); and (4) unchanged levels of pain, improved SWB (1 article). Conclusions: Results of most articles included in this scoping review suggest that LTPA interventions can reduce chronic pain and improve SWB for persons with SCI. Further research is needed to identify the mechanisms by which LTPA affects pain and SWB, in order to formulate LTPA prescriptions that maximize improvements in these outcomes.

Machine learning offers the potential to revolutionize the inverse design of complex nanophotonic components. Here, we propose a novel variant of this formalism specifically suited for the design of resonant nanophotonic components. Typically, the first step of an inverse design process based on machine learning is training a neural network to approximate the non-linear mapping from a set of input parameters to a given optical system’s features. The second step starts from the desired features, e.g. a transmission spectrum, and propagates back through the trained network to find the optimal input parameters. For resonant systems, this second step corresponds to a gradient descent in a highly oscillatory loss landscape. As a result, the algorithm often converges into a local minimum. We significantly improve this method’s efficiency by adding the Fourier transform of the desired spectrum to the optimization procedure. We demonstrate our method by retrieving the optimal design parameters for desired transmission and reflection spectra of Fabry–Pérot resonators and Bragg reflectors, two canonical optical components whose functionality is based on wave interference. Our results can be extended to the optimization of more complex nanophotonic components interacting with structured incident fields.

Introduction: Two phase 3 studies in adolescents and young adults demonstrated that MenB-FHbp, a meningococcal serogroup B (MenB) vaccine, elicits protective immune responses after 2 or 3 doses based on serum bactericidal antibody assays using human complement (hSBA) against 4 primary and 10 additional diverse, vaccine-heterologous MenB test strains. Lower limits of quantitation (LLOQs; titers 1:8 or 1:16; titers ≥ 1:4 correlate with protection) were used to evaluate responses to individual strains and all 4 primary strains combined (composite response). A post hoc analysis evaluated percentages of subjects with protective responses to as many as 8 strains combined (4 primary plus additional strains). Methods: Immune responses were measured using hSBAs against 4 primary strains in adolescents (n= 1509, MenB-FHbp; n= 898, hepatitis A virus vaccine/saline) and young adults (n= 2480, MenB-FHbp; n= 824, saline) receiving MenB-FHbp or control at 0, 2, and 6 months. Ten additional strains were evaluated in subsets of subjects from approximately 1800 MenB-FHbp recipients across both studies. Percentages of subjects with hSBA titers ≥ LLOQ for different numbers of primary strains or primary plus additional strains combined (7 or 8 strains total per subset) were determined before vaccination, 1 month post-dose 2, and 1 month post-dose 3. Results: Across the panel of primary plus additional strains, at 1 month post-dose 3, titers ≥ LLOQ were elicited in 93.7–95.7% of adolescents and 91.7–95.0% of young adults for ≥ 5 test strains combined and in 70.5–85.8% of adolescents and 67.5–81.4% of young adults for ≥ 7 strains combined. Among adolescents, 99.8%, 99.0%, 92.8%, and 82.7% had titers ≥ LLOQ against at least 1, 2, 3, and all 4 primary strains, respectively; corresponding percentages for young adults were 99.7%, 97.7%, 94.0%, and 84.5%. Conclusions: Results support the ability of MenB-FHbp to provide broad coverage against MenB strains expressing diverse FHbp variants. Trial Registration: ClinicalTrials.gov identifiers NCT01830855, NCT01352845.

Orbital angular momentum (OAM) from lasers holds promise for compact, at-source solutions for applications ranging from imaging to communications. However, conjugate symmetry between circular spin and opposite helicity OAM states (±ℓ) from conventional spin–orbit approaches has meant that complete control of light’s angular momentum from lasers has remained elusive. Here, we report a metasurface-enhanced laser that overcomes this limitation. We demonstrate new high-purity OAM states with quantum numbers reaching ℓ= 100 and non-symmetric vector vortex beams that lase simultaneously on independent OAM states as much as Δℓ= 90 apart, an extreme violation of previous symmetric spin–orbit lasing devices. Our laser conveniently outputs in the visible, producing new OAM states of light as well as all previously reported OAM modes from lasers, offering a compact and power-scalable source that harnesses intracavity structured matter for the creation of arbitrary chiral states of structured light.

Study designs: Cross-sectional survey, semi-structured interview, and randomized-controlled trial. Objectives: Optimal spinal cord injury (SCI)-specific PA intervention strategies appropriate for the physiotherapist setting are unknown. The purpose of this paper is to describe the rigorous co-development process of a theory-based, physiotherapist-led PA intervention for people with SCI and assess its feasibility for implementation in the rehabilitation setting. Setting: Community. Methods: Co-development of the intervention included (1) a review of the literature; (2) key informant interviews with people with SCI (n= 26); (3) a national online survey of physiotherapists’ barriers, needs, and preferences (n= 239); (4) a review of the evidence and recommendations for the intervention from a stakeholder expert panel (n= 13); and (5) a randomized controlled trial of intervention training and its effects on implementation determinants amongst physiotherapists (n= 20). Results: Almost 300 people with SCI and physiotherapists were engaged in the intervention development process. Optimal intervention delivery should be tailored and include (1) education on safety, PA guidelines, and behaviour change techniques, (2) referral to other peers, local programmes, and health professionals, and (3) adapted exercise prescriptions. Following intervention implementation training, physiotherapists demonstrated stronger tested and perceived knowledge, skills, resources, and confidence for promoting PA to people with SCI, ps < 0.05. Conclusions: This development process serves as an example methodology for using theory to co-create a leisure-time physical activity behaviour change intervention tailored for people with SCI.

Study design: Systematic scoping review. Objectives: The purpose of this project was to conduct a scoping review to understand the amounts, types, correlates, and outcomes of physical activity (PA) participation for ambulators with SCI. Methods: A systematic search was employed among five large databases and two theses/dissertation databases, yielding 3257 articles. Following a two-phase screening process by independent coders, 17 articles were included in the review. Data were charted and summarized, and correlates were coded using the COM-B model. Results: 11 studies were cross-sectional, 5 studies involved an exercise intervention, and 1 study used mixed methods. Overall, ambulators with SCI participated in low levels of PA. The type of PA investigated across all studies was leisure-time PA (e.g., sports, exercise). Psychological and physical capability (e.g., perceived behavioral control, fatigue), social and environmental opportunity (e.g., perceptions of disability, cost), and automatic and reflective motivation (e.g., boredom, intentions) were correlates of PA measured within studies. Exercise intervention studies measured physical (e.g., strength, fitness) and one psychological outcome (i.e., depression). No studies examined the quality of PA experiences. Conclusions: Only leisure-time PA has been investigated among ambulators with SCI, and low levels of leisure-time PA have been reported. Correlates of leisure-time PA can be mapped onto all COM-B model constructs and are potential targets for PA-enhancing interventions. Further investigation is warranted into the physical and psychosocial outcomes across all types of LTPA in addition to understanding the quality of LTPA experiences.

Study design: Protocol for a pragmatic randomized controlled trial (the Exercise guideline Promotion and Implementation in Chronic SCI [EPIC-SCI] Trial). Primary objectives: To test if home-/community-based exercise, prescribed according to the international SCI exercise guidelines, significantly reduces chronic bodily pain in adults with SCI. Secondary objectives: To investigate: (1) the effects of exercise on musculoskeletal and neuropathic chronic pain; (2) if reduced inflammation and increased descending inhibitory control are viable pathways by which exercise reduces pain; (3) the effects of chronic pain reductions on subjective well-being; and (4) efficiency of a home-/community-based exercise intervention. Setting: Exercise in home-/community-based settings; assessments in university-based laboratories in British Columbia, Canada. Method: Eighty-four adults with chronic SCI, reporting chronic musculoskeletal or neuropathic pain, and not meeting the current SCI exercise guidelines, will be recruited and randomized to a 6-month Exercise or Wait-List Control condition. Exercise will occur in home/community settings and will be supported through behavioral counseling. All measures will be taken at baseline, 3-months and 6-months. Analyses will consist of linear mixed effect models, multiple regression analyses and a cost–utility analysis. The economic evaluation will examine the incremental costs and health benefits generated by the intervention compared with usual care. Ethics and dissemination: The University of British Columbia Clinical Research Ethics Board approved the protocol (#H19–01650). Using an integrated knowledge translation approach, stakeholders will be engaged throughout the trial and will co-create and disseminate evidence-based recommendations and messages regarding the use of exercise to manage SCI chronic pain. Trial registration: ClinicalTrials.gov identifier NCT04160858.

Continued progress in our understanding of the food protein–induced allergic proctocolitis (FPIAP) will provide the development of diagnostic tests and treatments. We aimed to identify precisely the clinical features and natural course of the disease in a large group of patients. Also, we investigated the predicting risk factors for persistent course since influencing parameters has not yet been established. Infants who were admitted with rectal bleeding and had a diagnosis of food protein–induced allergic proctocolitis in 5 different allergy or gastroenterology outpatient clinics were enrolled. Clinical features, laboratory tests, and prognosis were evaluated. Risk factors for persistent course were determined by logistic regression analyses. Among the 257 infants, 50.2% (n?=?129) were girls and cow's milk (99.2%) was the most common trigger. Twenty-four percent of the patients had multiple food allergies and had more common antibiotic use (41.9% vs 11.8%), atopic dermatitis (21% vs 10.2%), wheezing (11.3% vs 1.5%), colic (33.8% vs 11.2%), and IgE sensitization (50% vs 13.5%) compared to the single-food allergic group (P?

The purpose of this work was to evaluate peripheral image quality in the pseudophakic eye using computational, physical, and psychophysical methods. We designed and constructed a physical model of the pseudophakic human eye with realistic dimensions using a corneal phantom and a board-only camera that was pivoted around an axis that matched the anatomical center of a human retina, assuming a radius of curvature of 12 mm, while it was submersed in a 23.4 mm long water filled chamber to emulate human ocular axial length. We used this optical setup to perform direct recording of the point spread function (PSF) and the associated retinal images for a commercial intraocular lens (IOL). Additionally, psychophysical tests were carried out to investigate the impact of the off-axis astigmatism in peripheral visual performance, where spectacle-induced astigmatism simulated the pseudophakic conditions in healthy subjects. Our findings using the physical eye model confirm the existence of large amounts of astigmatism in the periphery of the pseudophakic eye. The psychophysical tests revealed a significant reduction of detection sensitivity in the peripheral visual field. The latter suggests that off-axis astigmatism in patients implanted with IOLs may have performance and safety implications for activities requiring efficient peripheral vision.

Festination is an episodic gait disorder which is often a precursor of freezing of gait episodes in Parkinson's disease patients. We discuss what lessons can be learned from a patient who had to quit playing tennis as he repeatedly fell due to backward festination-like steps.

Paralympic athletes with SCI report significantly greater neuropathic pain intensity than recreational athletes with SCI, but also higher levels of positive affect and well-being. Neither pain catastrophizing, pain coping, nor positive affect and well-being significantly moderated the relationship between athlete status (i.e., Paralympic or recreational athlete) and neuropathic pain intensity.Significant, positive correlations were observed between total weekly moderate-intensity exercise and neuropathic pain. No significant correlations were observed between frequency of heavy-intensity exercise and neuropathic pain .

Even though university students with disabilities are less active than their peers without disabilities, there is scarce knowledge on the predictors of physical activity (PA) in this population.

Health and recreation practitioners play an important role in promoting and supporting leisure time physical activity (LTPA) among persons with physical disabilities (PWPD), yet many practitioners lack training and education to provide the basic knowledge, skills, and resources necessary.1Little is known about existing LTPA information and training resources for health and recreation practitioners and there has been no known systematic effort to identify existing resources.

Background:Health care providers (HCPs) are preferred sources of physical activity (PA) information; however, minimal research has explored HCPs’ knowledge of spinal cord injury (SCI) PA guidelines, and no research has examined HCP trainees’ PA guideline knowledge.Objective:The current study explored HCPs’ and trainees’ initial knowledge of PA guidelines for both adults with SCI and the general population, and the utility of an event-based intervention for improving this knowledge.Methods:Participants (HCPs n = 129; trainees n = 573) reported guideline knowledge for both sets of guidelines (SCI and general population) immediately after, one-month, and six-months following the intervention. Frequencies determined guideline knowledge at each timepoint, while chi-squared tests examined differences in knowledge of both guidelines, as well as knowledge differences in the short- and long-term.Results:Results demonstrated that HCPs and trainees lack knowledge of PA guidelines, particularly guidelines for adults with SCI. The results further suggest that a single event-based intervention is not effective for improving long-term guideline knowledge.Conclusion:Suggestions are made for future research with the aim of improving interventions that target HCP and HCP trainees’ long-term guideline knowledge for adults with SCI and the general population.

Macular pigment is a yellowish pigment of purely dietary origin, which is thought to have a protective role in the retina. Recently, it was linked to age-related macular degeneration and improved visual function. In this work, we present a method and a corresponding optical instrument for the rapid measurement of its optical density. The method is based on fundus reflectometry and features a photodetector for the measurement of reflectance at different wavelengths and retinal locations. The method has been tested against a commercially available instrument on a group of healthy volunteers and has shown good correlation. The proposed instrument can serve as a rapid, non-midriatic, low-cost tool for the measurement of macular pigment optical density.

Study Design: This is a cross-sectional study. Objectives: To describe the association between cardiovascular risk factors (body mass index (BMI), waist circumference (WC), blood pressure, blood glucose and lipids) and leisure time physical activity (LTPA) in older adults with long-term spinal cord injury (SCI). Setting: Community settings, southern Sweden. Methods: Data from the baseline data collection of the Swedish Aging with Spinal Cord Injury Study (SASCIS) (n = 123, 71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D, mean age 63 years, mean time since injury 24 years). Data were collected through home interviews, assessments and blood samples. The Physical Activity Recall Assessment for People with SCI was used to assess LTPA. Associations were investigated using multivariable linear regression analyses adjusted for age, gender, level and severity of injury, cause of injury, time since injury and tobacco use. Results: More minutes per day of moderate-to-heavy LTPA were significantly associated with a lower BMI (Beta = −0.31; p= 0.001) and a lower WC (Beta = −0.24; p= 0.009). More minutes per day of total LTPA (mild intensity or greater) were associated with a higher systolic blood pressure (Beta = 0.27; p= 0.041) among participants with tetraplegia. No other significant associations between the cardiovascular risk factors and total LTPA were found. Conclusion: Participation in daily LTPA is associated with better cardiovascular health with regard to BMI and WC in older adults with long-term SCI. Further studies are needed to establish the specific amount of activity needed to obtain positive health effects in this group and the directional causality of the associations. Sponsorship: Not applicable.

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ObjectiveYoung adulthood is an important transitional life phase where careers are established. Young adults with chronic disabling health conditions are underrepresented in the labour market. Our study aims to examine the effectiveness of work-focused interventions that support the labour market transition of young adults with chronic disabling health conditions; and to examine whether the effectiveness of work-focused interventions differ across work transition phase (eg, preparation, entry and sustaining work, employment advancement) and disability type.MethodsA systematic review of articles published between January 1990 and July 2018 was conducted. Medline, EMBASE and PsycInfo were searched, and titles/abstracts and full texts of articles were reviewed for eligibility. Relevant articles were appraised for methodological quality. A best evidence synthesis was applied to medium-quality/high-quality studies to develop recommendations.Results5816 articles were identified; 10 articles were relevant and of moderate–high methodological quality. Six intervention categories were identified which focused on young adults with mental health or intellectual/learning disabilities (n=3) and addressed employment preparation (n=10) and/or work entry (n=9). No interventions addressed at-work issues or career advancement. Strong evidence existed for tailored supported employment (SE) interventions having a positive impact on preparation and entry into competitive employment. Also, moderate evidence existed for the positive impact of SE on preparation and entry into competitive employment for young adults with mental health conditions.ConclusionsTailored SE is recommended to foster preparation and entry into the labour market. Evidence-based interventions are needed to facilitate sustained work and career advancement of young adults living with different disabling health conditions.

Mixing of the ocean beneath tropical cyclones (TC) cools the surface temperature thereby modifying the storm intensity. Modeling studies predict that surface wave forcing through Langmuir turbulence (LT) increases the mixing and cooling and decreases near‐surface vertical velocity shear. However, there are very few quantitative observational validations of these model predictions, and the validation efforts are often limited by uncertainties in the drag coefficient (Cd). We combine EM‐APEX and Lagrangian float measurements of temperature, salinity, velocity, and vertical turbulent kinetic energy (VKE) from five TCs with a coupled ocean‐wave model (Modular Ocean Model 6—WAVEWATCH III) forced by the drag coefficient Cddirectly constrained for these storms. On the right‐hand of the storms in the northern hemisphere, where wind and waves are nearly aligned, the measured VKE is consistent with predictions of models including LT and 2–3 times higher than predictions without LT. Similarly, vertical shear in the upper 20 m is small, consistent with predictions of LT models and inconsistent with the large shears predicted by models without LT. On the left‐hand of the storms, where wind and waves are misaligned, the observed VKE and cooling are reduced compared to those on the right‐hand, consistent with the measured decrease in Cd. These results confirm the importance of surface waves for ocean cooling and thus TC intensity, through both Cdand LT effects. However, the model predictions, even with the LT parameterization, underestimate the upper ocean cooling and mixed layer deepening by 20%–30%, suggesting possible deficiency of the existing LT parameterization. Strong wind under tropical cyclones increases wind forcing at the sea surface, enhances upper‐ocean currents and turbulence, and brings deep cold water to the sea surface. The resulting cooler sea surface temperature decreases the heat supply to the storm and weakens the storm. Therefore, it is important to understand how the upper ocean responds to tropical cyclone wind in order to improve the storm intensity forecast. In this study, we investigate how ocean surface waves affect such ocean responses by combining field observations and numerical simulations under five tropical cyclones. We find that upper ocean turbulence becomes more intense because of surface waves. Its intensity is strongly dependent on sea states as well as on wind speed. We also find that ocean responses are weaker on the left of the storm track, possibly because wind forcing at the sea surface is reduced when ocean swell direction and wind direction are misaligned. Field observations and numerical modeling are combined to study upper ocean responses under five tropical cyclonesWe find two evidences of the Langmuir turbulence, enhanced vertical velocity variance and reduced mean current shearLangmuir turbulence is weaker on the left of storm track possibly because drag coefficient is lower due to swell misaligned from wind Field observations and numerical modeling are combined to study upper ocean responses under five tropical cyclones We find two evidences of the Langmuir turbulence, enhanced vertical velocity variance and reduced mean current shear Langmuir turbulence is weaker on the left of storm track possibly because drag coefficient is lower due to swell misaligned from wind

Study design:Quasi-experimental pre–post design with 6-month follow-up.Objectives:Active Living Leaders Training Program (ALLTP) equips individuals with knowledge and skills to encourage those with spinal cord injury (SCI) to increase their leisure-time physical activity (LTPA). The purpose of this pilot study was to, first, (i) evaluate participants’ perceptions of the relevance/usefulness of ALLTP material/presentation, (ii) examine changes in participants’ self-efficacy to promote LTPA, (iii) identify program components associated with greater self-efficacy and, second, measure participants’ use of ALLTP skills and resources over the subsequent 6 months.Setting:Canada.Methods:Six SCI fitness trainers and six adults with SCI completed the three sections of ALLTP and, after each section, provided feedback. Six months later, participants’ use of resources and skills was assessed. Means, standard deviations, repeated measures analysis of variance and Pearson’s correlations were computed.Results:Relevance/usefulness of the program was rated favorably. Self-efficacy to speak about and encourage LTPA remained high throughout the ALLTP and was positively correlated with the relevance/usefulness of program content and presentation. At follow-up, participants had discussed LTPA with an average of seven people with disabilities and reported using at least one skill and resource from the ALLTP during those discussions.Conclusions:Users had positive perceptions of ALLTP and reported using the training to promote LTPA to others with disabilities. Participant feedback has been used to improve ALLTP. ALLTP can now be used to train people with SCI and SCI fitness trainers to promote LTPA to others with disabilities.

A particular class of focused, pulsed light beams can propagate self-similarly in free space at a fixed group velocity. Now, scientists present a law of refraction that determines how the group velocity of these beams changes as they refract at an interface between two materials.

Antiepileptic drugs (AEDs) can cause hypersensitivity reactions during childhood. Studies report a wide clinical spectrum of reactions with AED use, ranging from a mild rash to severe cutaneous reactions.

To examine the need for and availability and use of formal and informal workplace resources and to uncover differences across the life course in adults with arthritis. Focus groups and interviews were conducted with young (aged 18–34 years; n = 7), middle‐aged (35–54 years; n = 13), and older adults (≥55 years; n = 25) with a diagnosis of inflammatory arthritis, osteoarthritis, or other rheumatic disease. Participants were asked about their employment experiences, formal and informal workplace resource needs, and availability and use of workplace resources. Differences based on chronological, functional, psychosocial, organizational, and lifespan dimensions of age were examined. A modified grounded theory approach was used to inductively analyze the data. Young, middle‐aged, and older adult participants required similar workplace resources. Across all participants, scheduling modifications tended to be the most needed workplace resource. In contrast, the perceived availability and use of formal workplace resources differed among participants. Young adult participants and those who were newer to their jobs reported that workplace resources were less available and utilized. Middle‐aged and older adults reported greater availability of workplace resources. Scheduling accommodations and at‐work modifications were the workplace resources that were used most by middle‐aged and older adults, respectively. Similar workplace resources could meet the employment needs of individuals with arthritis across the life course. Attention should be paid to young adults and those who are new to their jobs, because they may perceive more barriers to accessing formal workplace resources and be susceptible to work disability.

The existing decision problems in urban planning, which have an influence on the sustainable urban development, are designated in this research. Factors are defined: the internal environment, a role, the relations and interrelations, a legal framework and institutional structure which need to be considered at decision-making in the course of urban planning. The formal model combining current scientific approaches for decision-making which can be applied to assessment of factors and adoption of the reasonable decision is offered. The mathematical model of the multicriteria choice of the best solution at fuzzy initial information is described. An example of finding of the best solution is reviewed.