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Abstract Background Early detection of cognitive impairment is among the top research priorities aimed at reducing the global burden of dementia. Currently used screening tools have high sensitivity but lack specificity at their original cut-off, while decreasing the cut-off was repeatedly shown to improve specificity, but at the cost of lower sensitivity. In 2012, a new screening tool was introduced that aims to overcome these limitations – the Quick mild cognitive impairment screen (Qmci). The original English Qmci has been rigorously validated and demonstrated high diagnostic accuracy with both good sensitivity and specificity. We aimed to determine the optimal cut-off value for the German Qmci, and evaluate its diagnostic accuracy, reliability (internal consistency) and construct validity. Methods We retrospectively analyzed data from healthy older adults (HOA; n = 43) and individuals who have a clinical diagnosis of ‘mild neurocognitive disorder’ (mNCD; n = 37) with a biomarker supported characterization of the etiology of mNCD of three studies of the ‘Brain-IT’ project. Using Youden’s Index, we calculated the optimal cut-off score to distinguish between HOA and mNCD. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic accuracy based on the area under the curve (AUC). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Reliability (internal consistency) was analyzed by calculating Cronbach’s α. Construct validity was assessed by analyzing convergent validity between Qmci-G subdomain scores and reference assessments measuring the same neurocognitive domain. Results The optimal cut-off score for the Qmci-G was ≤ 67 (AUC = 0.96). This provided a sensitivity of 91.9% and a specificity of 90.7%. The PPV and NPV were 89.5% and 92.9%, respectively. Cronbach’s α of the Qmci-G was 0.71 (CI95% [0.65 to 0.78]). The Qmci-G demonstrated good construct validity for subtests measuring learning and memory. Subtests that measure executive functioning and/or visuo-spatial skills showed mixed findings and/or did not correlate as strongly as expected with reference assessments. Conclusion Our findings corroborate the existing evidence of the Qmci’s good diagnostic accuracy, reliability, and construct validity. Additionally, the Qmci shows potential in resolving the limitations of commonly used screening tools, such as the Montreal Cognitive Assessment. To verify these findings for the Qmci-G, testing in clinical environments and/or primary health care and direct comparisons with standard screening tools utilized in these settings are warranted.

Abstract Background Vagally-mediated heart rate variability (vm-HRV) shows promise as a biomarker of internal training load (ITL) during exergame-based training or motor-cognitive training in general. This study evaluated the test-retest reliability of vm-HRV during exergaming in healthy older adults (HOA) and its validity to monitor ITL. Methods A within-subjects (repeated-measures) randomized study was conducted that included baseline assessments and 4 measurement sessions. Participants played 5 exergames at 3 standardized levels of external task demands (i.e., “easy”, “challenging”, and “excessive”) in random order for 90 s. Test-retest reliability was assessed on the basis of repeated-measures analyses of variance (ANOVA), intraclass correlation coefficients (ICC3,1), standard errors of measurement (SEM), and smallest detectable differences (SDD). Validity was determined by examining the effect of game level on vm-HRV in the ANOVA. Results Fourty-three HOA (67.0 ± 7.0 years; 58.1% females (25 females, 18 males); body mass index = 23.7 ± 3.0 kg·m−2) were included. Mean R-R time intervals (mRR) and parasympathetic nervous system tone index (PNS-Index) exhibited mostly good to excellent relative test-retest reliability with no systematic error. Mean SEM% and SDD% were 36.4% and 100.7% for mRR, and 44.6% and 123.7% for PNS-Index, respectively. Significant differences in mRR and PNS-Index were observed between standardized levels of external task demands, with mostly large effect sizes (mean r = 0.847). These results persisted irrespective of the type of neurocognitive domain trained and when only motoric and cognitive demands were manipulated while physical intensity was kept constant. The remaining vm-HRV parameters showed inconsistent or poor reliability and validity. Conclusion Only mRR and PNS-Index demonstrated reliable measurement and served as valid biomarkers for ITL during exergaming at a group level. Nonetheless, the presence of large SEMs hampers the detection of individual changes over time and suggests insufficient precision of these measurements at the individual level. Future research should further investigate the reliability and validity of vm-HRV with a specific focus on comparing different measurement methodologies and exercise conditions, particularly focusing on ultra-short-term HRV measurements, and investigate the potential implications (i.e., superiority to other markers of ITL or monitoring strategies?) of using vm-HRV as a biomarker of ITL.

Introduction Individuals with Type 2 Diabetes Mellitus may benefit from exergaming training. Exergaming, technology-driven physical activities requiring participants to be physically active or exercise to play the game, allows combining cognitive with motor training. This trial aimed to primarily evaluate the feasibility of an exergame-based training protocol. Secondarily, possible effects on physical, functional, and patient-reported outcomes were explored. Methods Type 2 diabetic individuals performed an exergaming protocol on a pressure sensitive platform. After a 6-week control period, training was administered 2–3 times weekly for another six weeks for 30–60 minutes per session. Outcome variables were assessed during baseline (T0), pre-intervention (T1) and twice at postintervention (T1 and T2). An interview after completion ended the study program. Feasibility was determined by recruitment, adherence, compliance, attrition rates, motivation, satisfaction, and technology acceptance. Results Eleven of 13 participants completed the study protocol. The feasibility criteria adherence-mandatory (86.4%), adherence-voluntary (70.2%), compliance (99.7%), attrition (15.4%) rate, motivation (82%), satisfaction (80%), and technology acceptance (62.5%) were all deemed acceptable, except for the recruitment rate (13.7%). There were inconsistent effects on functional outcomes, appraisal of diabetes, and health-related quality of life. Qualitative patient-reported experience was overall positive, which is in line with the quantitative results. Conclusion The exergame-based training program is feasible and safe and type 2 diabetic participants’ acceptance of this approach was high, although the recruitment procedure needs minor changes. Furthermore, results were obtained that might be useful in selecting appropriate assessments and sample sizes in future trials.

Mangrove ecosystems are crucial for mitigating climate change by sequestering significant amounts of carbon, providing habitat for diverse species, and protecting coastal areas. Their sustainability is vital for global environmental balance and human welfare. Analysis using the Eidos system reveals the threats to mangrove forest health, considering both negative and positive factors and analyzing the strength and direction of each threat's influence. The Eidos system facilitated the development of a statistical model and cognitive system, demonstrating effectiveness in identifying and classifying degradation risks based on empirical data, allowing for early predictions at relatively low operational costs. These findings can be leveraged by coastal protection organizations worldwide, as the Eidos system is freely accessible online in multiple languages. The results have the potential to inform targeted mangrove conservation policies and enhance environmental protection initiatives in various regions.

Abstract The tumor microenvironment plays a crucial role in determining response to treatment. This involves a series of interconnected changes in the cellular landscape, spatial organization, and extracellular matrix composition. However, assessing these alterations simultaneously is challenging from a spatial perspective, due to the limitations of current high-dimensional imaging techniques and the extent of intratumoral heterogeneity over large lesion areas. In this study, we introduce a spatial proteomic workflow termed Hyperplexed Immunofluorescence Imaging (HIFI) that overcomes these limitations. HIFI allows for the simultaneous analysis of > 45 markers in fragile tissue sections at high magnification, using a cost-effective high-throughput workflow. We integrate HIFI with machine learning feature detection, graph-based network analysis, and cluster-based neighborhood analysis to analyze the microenvironment response to radiation therapy in a preclinical model of glioblastoma, and compare this response to a mouse model of breast-to-brain metastasis. Here we show that glioblastomas undergo extensive spatial reorganization of immune cell populations and structural architecture in response to treatment, while brain metastases show no comparable reorganization. Our integrated spatial analyses reveal highly divergent responses to radiation therapy between brain tumor models, despite equivalent radiotherapy benefit.

Stunting is a nutritional problem that people around the world are facing. The World Health Organization (WHO) has determined Indonesia as one of the five stunting prevalence subregions in the Southeast Asia region. Zinc includes micro-nutrients that are important for the growth and development of children. The prevalence of zinc deficiency in children in Indonesia in 2006 was 36.1%. This study aims to determine the relationship between zinc intake and the length/height of children aged 6-59 months in the Districts of Jelbuk and Sumberjambe. This research is an analytic observational study with a cross-sectional design. The sample used was 119, derived from secondary data from previous studies. Zinc intake in children was obtained through 24-hour food recall data and then analyzed using nutrisurvey software, while body length/height is the maximum distance from the vertex to the soles of the feet. The study results were that 57.2% of the samples had insufficient zinc intake, with an average daily intake of 4.37 ± 2.35 mg, and as many as 60.5% had TB below normal. The data analysis showed a significant relationship between zinc intake and the length/height of children aged 6-59 months (p=0.001), with a reasonably strong relationship (r=0.295). This study concludes that there is a relationship between zinc intake and the length/height of children aged 6-59 months in the Jelbuk and Sumberjambe Districts. Keywords: Zinc, Stunted, Stunting

Introduction Injury rates in competitive alpine skiing are high. With current methods, identifying people at risk is expensive and thus often not feasible at the youth level. The aims of this study were (1) to describe the jump performance and movement quality of youth competitive alpine skiers according to age and sex, (2) to compare the jump distance among skiers of different sexes and movement quality grades, and (3) to assess the inter-rater grading reliability of the qualitative visual movement quality classification of such jumps and the agreement between live and video-based post-exercise grading.Materials and Methods This cross-sectional study is based on an anonymized dataset of 301 7- to 15-year-old competitive alpine skiers. The skiers performed two-legged forward triple jumps, whereby the jump distance was measured, and grades were assigned by experienced raters from the frontal and sagittal perspectives depending on the execution quality of the jumps. Furthermore, jumps were filmed and ultimately rated post-exercise. Differences in jump distance between various groups were assessed by multivariate analyses of variance (MANOVAs). Reliability was determined using Kendall’s coefficient of concordance.Results The jump distance was significantly greater in U16 skiers than in U11 skiers of both sexes and in skiers with good execution quality than in those with reduced or poor execution quality. Overall, jump distance in U16 skiers significantly differed between female (5.37 m with 95% CI [5.21, 5.53]) and male skiers (5.90 m with 95%CI [5.69, 6.10]). Slightly better inter-rater grading reliability was observed for video-based post-exercise (strong agreement) ratings than for live ratings (moderate agreement).Conclusion In competitive alpine skiers aged 7 to 15 years, jump performance increases with age, and around puberty, sex differences start to manifest. Our results highlight the importance of evaluating both jump distance and movement quality in youth skiers. To improve test-retest reliability, however, a video-based post-exercise evaluation is recommended.

A healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center- and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas.

Patellar tendon (PT) complaints are frequent in competitive alpine skiers and such complaints are characterized by a long-lasting affection. Since PTs are subject to maturation up to 1–2 years after growth spurt, this early career stage may be decisive for the further course of complaints. The aim of this study was to investigate the evolution of PT complaints and shear wave velocity patterns among competitive alpine skiers during a 4-year post-growth spurt follow-up. The PT complaints and SWV patterns of forty-seven skiers were analysed at baseline (i.e., immediately after their peak height growth at 13–15 years of age) and were re-analysed at 4-year follow-up. The PTs were scanned via three-dimensional SWE. Symptomatic skiers were identified based on pain sensation under loading and pressure-induced pain around the PT. The prevalence of PT complaints decreased from 29.8% at baseline to 12.8% at follow-up (Pearson’s χ2 = 9.429; p = 0.002). SWV decreased from the baseline assessment to the follow-up in the proximal and distal regions (p < 0.05). SWV coefficient of variation (CV) in the distal and mid-portion regions was greater at baseline than at follow-up (p < 0.05). At the follow-up assessment, compared to “healthy” skiers, “healed” skiers who recovered from PT complaints had lower SWVs in the proximal region (p = 0.020) and greater SWV CVs in the proximal region (p = 0.028). Moreover, symptomatic skiers had significantly greater SWV CVs in the mid-portion region than did “healthy” subjects with no history of PT complaints (p = 0.020). The average SWV was negatively correlated with the SWV (proximal: r = −0.74, p < 0.001; mid-portion: r = −0.37 p = 0.011; and distal: r = −0.58, p < 0.001). The occurrence of PT complaints decreased over a 4-year post-growth spurt follow-up. “Healed” skiers who were symptomatic at baseline had an even greater average decrease in the proximal and mid-portion SWV than “healthy” skiers with no history of PT complaints. This may lead to the hypothesis that PT complaints in adolescent skiers are not self-eliminating towards the end of adolescence, as at least structural irregularities appear to persist for several years after the onset of initial symptoms. Furthermore, “healed” and symptomatic tendons exhibited increased SWV variability, supporting the hypothesis that SWV CV may provide additional valuable information on the mechanical properties of PTs affected by overuse-related complaints.

BackgroundCoping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke.MethodsThe development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the “Framework for Developing and Evaluating Complex Interventions” by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed.ResultsA training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2–3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept.ConclusionWe propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.

Abstract Cis-genetic effects are key determinants of transcriptional divergence in discrete tissues and cell types. However, how cis- and trans-effects act across continuous trajectories of cellular differentiation in vivo is poorly understood. Here, we quantify allele-specific expression during spermatogenic differentiation at single-cell resolution in an F1 hybrid mouse system, allowing for the comprehensive characterisation of cis- and trans-genetic effects, including their dynamics across cellular differentiation. Collectively, almost half of the genes subject to genetic regulation show evidence for dynamic cis-effects that vary during differentiation. Our system also allows us to robustly identify dynamic trans-effects, which are less pervasive than cis-effects. In aggregate, genetic effects were strongest in round spermatids, which parallels their increased transcriptional divergence we identified between species. Our approach provides a comprehensive quantification of the variability of genetic effects in vivo, and demonstrates a widely applicable strategy to dissect the impact of regulatory variants on gene regulation in dynamic systems.

Abstract Background Highly multiplexed imaging enables single-cell-resolved detection of numerous biological molecules in their spatial tissue context. Interactive visualization of multiplexed imaging data is crucial at any step of data analysis to facilitate quality control and the spatial exploration of single cell features. However, tools for interactive visualization of multiplexed imaging data are not available in the statistical programming language R. Results Here, we describe cytoviewer, an R/Bioconductor package for interactive visualization and exploration of multi-channel images and segmentation masks. The cytoviewer package supports flexible generation of image composites, allows side-by-side visualization of single channels, and facilitates the spatial visualization of single-cell data in the form of segmentation masks. As such, cytoviewer improves image and segmentation quality control, the visualization of cell phenotyping results and qualitative validation of hypothesis at any step of data analysis. The package operates on standard data classes of the Bioconductor project and therefore integrates with an extensive framework for single-cell and image analysis. The graphical user interface allows intuitive navigation and little coding experience is required to use the package. We showcase the functionality and biological application of cytoviewer by analysis of an imaging mass cytometry dataset acquired from cancer samples. Conclusions The cytoviewer package offers a rich set of features for highly multiplexed imaging data visualization in R that seamlessly integrates with the workflow for image and single-cell data analysis. It can be installed from Bioconductor via https://www.bioconductor.org/packages/release/bioc/html/cytoviewer.html . The development version and further instructions can be found on GitHub at https://github.com/BodenmillerGroup/cytoviewer .

Background: There is mounting evidence that regular physical activity is an important prerequisite for healthy cognitive aging. Consequently, the finding that almost one-third of the adult population does not reach the recommended level of regular physical activity calls for further public health actions. In this context, digital and home-based physical training interventions might be a promising alternative to center-based intervention programs. Thus, this systematic review aimed to summarize the current state of the literature on the effects of digital and home-based physical training interventions on adult cognitive performance. Methods: In this pre-registered systematic review (PROSPERO; ID: CRD42022320031), 5 electronic databases (PubMed, Web of Science, PsycInfo, SPORTDiscus, and Cochrane Library) were searched by 2 independent researchers (FH and PT) to identify eligible studies investigating the effects of digital and home-based physical training interventions on cognitive performance in adults. The systematic literature search yielded 8258 records (extra 17 records from other sources), of which 27 controlled trials were considered relevant. Two reviewers (FH and PT) independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX scale). Results: Of the 27 reviewed studies, 15 reported positive effects on cognitive and motor-cognitive outcomes (i.e., performance improvements in measures of executive functions, working memory, and choice stepping reaction test), and a considerable heterogeneity concerning study-related, population-related, and intervention-related characteristics was noticed. A more detailed analysis suggests that, in particular, interventions using online classes and technology-based exercise devices (i.e., step-based exergames) can improve cognitive performance in healthy older adults. Approximately one-half of the reviewed studies were rated as having a high risk of bias with respect to completion adherence (≤85%) and monitoring of the level of regular physical activity in the control group. Conclusion: The current state of evidence concerning the effectiveness of digital and home-based physical training interventions is mixed overall, though there is limited evidence that specific types of digital and home-based physical training interventions (e.g., online classes and step-based exergames) can be an effective strategy for improving cognitive performance in older adults. However, due to the limited number of available studies, future high-quality studies are needed to buttress this assumption empirically and to allow for more solid and nuanced conclusions.

Cell-to-cell gene expression variability is an inherent feature of complex biological systems, such as immunity and development. Single-cell RNA sequencing is a powerful tool to quantify this heterogeneity, but it is prone to strong technical noise. In this article, we describe a step-by-step computational workflow that uses the BASiCS Bioconductor package to robustly quantify expression variability within and between known groups of cells (such as experimental conditions or cell types). BASiCS uses an integrated framework for data normalisation, technical noise quantification and downstream analyses, propagating statistical uncertainty across these steps. Within a single seemingly homogeneous cell population, BASiCS can identify highly variable genes that exhibit strong heterogeneity as well as lowly variable genes with stable expression. BASiCS also uses a probabilistic decision rule to identify changes in expression variability between cell populations, whilst avoiding confounding effects related to differences in technical noise or in overall abundance. Using a publicly available dataset, we guide users through a complete pipeline that includes preliminary steps for quality control, as well as data exploration using the scater and scran Bioconductor packages. The workflow is accompanied by a Docker image that ensures the reproducibility of our results.

Background and Purpose: Microbeam Radiation Therapy (MRT) aims to deliver higher doses to the target while minimizing radiation damage to healthy tissues using synchrotron x-ray microbeams. Translational MRT research has now started, driven by promising results from preclinical studies. This study aimed to propose a first dose-outcome model by analyzing micrometric dose distributions obtained with high-resolution 3D dose calculations, accounting for the inherent physical dose distribution complexity in MRT. The feasibility of integrating penMRT, our full Monte Carlo multiscale dose calculation algorithm based on PENELOPE into translational research on veterinary patients was also investigated. Material and Methods: Micrometric dose distributions were calculated in tumor-bearing rats and for a veterinary patient with penMRT, for conformal multi-directional MRT treatment plans. Absorbed dose maps were obtained with 0.005 × 0.005 × 1 mm3 voxel sizes. High-resolution dose-volume histograms were extracted and analyzed against radiobiology studies. Results: The complexity of the MRT dose distribution was properly rendered at a micrometer scale on 3D dose maps, with well separated dose regions observed on the differential dose-volume histograms. The median survival time of glioma-bearing rats varied linearly with the volume fraction of the planning target volume that received doses higher than 50 Gy (R2 = 0.98). The feasibility of using penMRT for treatment planning in large volumes has been shown on a veterinary patient. Conclusions: This study demonstrated the significant added value of penMRT for planning and prescribing MRT treatments. It also shed light on the correlation between the high-resolution 3D dose distributions and the treatment outcome.

Abstract Sickle cell disease (SCD) is a group of inherited blood disorders caused by a mutation in the beta subunit of hemoglobin (HbS). SCD will hereafter be referred to as sickle cell anemia (SCA) as this is the term our patients and their families prefer. There are approximately 5000 Canadians living with SCA including children. Pediatric SCA patient education can: improve knowledge, decrease hospitalization, improve medication possession ratio, lead to better SCA‐related functioning, and lower pain impact. Innovative educational materials were developed to improve knowledge and self‐efficacy regarding the illness management of patients and parents/guardians. Patients (n = 5; aged 8–18) with SCA and parents (n = 5) of patients (aged 0–18) were recruited via flyers sent directly to patients and distributed through partner patient organization Sickle Cell Awareness Network of Saskatchewan. Patient and parent focus groups were held separately over Zoom to receive feedback for the video. An additional interview was held for a participant that required a translation of the video. Audio recordings were transcribed using Zoom and Otter.ai. The coding of transcripts was facilitated by NVivo (QSR International Pty Ltd, 2022, release 1.6.2). The thematic analysis centered around SCA management concepts relevant to the research aims. Important themes that emerged included ‘Age Appropriateness’, ‘Empowerment’, ‘Knowledge Gaps’, ‘Linguistic Accessibility’, ‘Medication Adherence’, ‘Strength in Community’, and ‘Transition to Adult Care’. The video was well received, and “brought peace of mind”. Patient feedback was incorporated into the final version of the educational materials.

Introduction Falls are a major cause for injuries in older adults and are associated with motor and cognitive impairments (Hsu, 2012). Thus, sensitive assessment tools capturing subtle changes in motor and cognitive functioning are crucial for the prediction of falls. Aim of this study was to test the ability of a novel, instrumented, cognitive-motor assessment battery, to distinguish between older persons who experienced a fall in the past 12 months (fallers) and persons who did not (non-fallers) as well as its added value to predict fall status compared to gold-standard clinical fall risk assessments. Methods This is a secondary analysis using baseline data of an international randomized controlled trial. Participants (age > 60, categorized in two groups: fallers and non-fallers) performed five instrumented tests (Reaction time test (psychomotor speed), Flexibility test (mental flexibility), Go/No-Go task (inhibition), Sway test (postural control), and Coordinated Stability test (dynamic balance control), as well as the Timed-up and Go (TUG) test as a gold standard assessment. Binominal logistic regression analyses were conducted for each cognitive-motor assessment separately to identify test variables significantly associated with group assignment which could then be included in a further logistic regression model. Furthermore, a Receiver Operating Characteristic (ROC) analysis was performed. Results Preliminary results of n = 38 showed among the instrumented assessments only inhibition (p = .016) and dynamic balance control (p = .014) were significantly associated with fall status and therefore included in the second regression model. In this second model, both functions contributed significantly in predicting fall status (inhibition: p = .040, dynamic balance control: p = .028). This regression model was statistically significant and resulted in a good amount of explained variance (χ2(2) = 14.283 (p = .001), R2 = .418) with a sensitivity of 84.2% and a specificity of 73.7%. Similarly, the ROC analysis showed significant Area under the Curve (AUC) values only for inhibition (AUC = .751, p = .008) and dynamic balance control (AUC = .765, p = .005), whereas the AUC value of the TUG test remained non-significant (AUC = .681, p = .056). Discussion/Conclusion Based on this preliminary analysis, two tests of the novel instrumented cognitive-motor assessment battery assessing inhibition and dynamic balance control were able to distinguish between fallers and non-fallers and these tests showed better discriminative properties compared with the TUG. This supports the results of previous research which showed only limited discriminant validity of the TUG in terms of fall risk (Schoene et al., 2013). Therefore, the cognitive-motor assessments might provide an added value for clinical fall risk assessment. The study is still ongoing, and thus, the complete results (of N = 145) will be presented at the conference. References Hsu, C. L., Nagamatsu, L. S., Davis, J. C., & Liu-Ambrose, T. (2012). Examining the relationship between specific cognitive processes and falls risk in older adults: A systematic review. Osteoporosis International, 23, 2409-2424. https://doi.org/10.1007/s00198-012-1992-z Schoene, D., Wu, S. M. S., Mikolaizak, A. S., Menant, J., Smith, S. T., & Delbaere, K. (2013). Discriminative ability and predictive validity of the timed up and go test in identifying older people who fall: Systematic review and meta-analysis. Journal of the American Geriatrics Society, 61, 202-208. https://doi.org/10.1111/jgs.12106

Introduction Patellar tendinopathy is frequent in adolescent athletes and particularly accentuated in competitive alpine skiers (Fröhlich et al., 2020). Tendinopathies are characterized by long disease histories, and whether they can be healed completely is an open question (Kettunen et al., 2002). Three-dimensional (3D) shear wave elastography (SWE) has proven valuable in the early detection of tendinopathies (Götschi et al., 2023). The aims of this study were to (1) describe the longitudinal progression of patellar tendon complaint prevalence in competitive alpine skiers during adolescence, (2) compare the SWV patterns of skiers that were symptomatic four years ago with those with no history of patellar tendon complaints and (3) analyse whether shear wave velocity (SWV) average values correlate with SWV coefficient of variation (CV). Methods Forty-seven subjects were analysed in this 4-year follow-up study regarding their patellar tendon complaints and SWV patterns. Symptomatic and asymptomatic skiers were identified by clinical examinations including the criteria of pain sensation under loading and palpation-induced pain. SWV was determined by ultrasound-based 3D SWE. Prevalence differences were assessed using Pearson’s χ2 tests. Group differences in the SWV patterns were analysed using unpaired sample t tests. Correlations between SWV average and CV values were analysed by means of Pearson’s correlation coefficient. Results With proceeding adolescence, the prevalence of patellar tendon complaints significantly decreased from 29.8% at baseline assessment (13-16 years) to 12.7% at follow-up assessment (Pearson’s χ2 = 9.429; p = 0.002). Those skiers who were symptomatic at baseline but asymptomatic at the follow-up still had lower average SWV values and higher CVs than asymptomatic skiers with no history of patellar tendon complaints (p = 0.054 and p = 0.011, respectively). Furthermore, there was a significant negative correlation between the tendon SWV average values and their CVs (R = -0.55; p < 0.001). Discussion/Conclusion Despite the decreasing prevalence of patellar tendon complaints in youth competitive alpine skiers after their growth spurt, structural abnormalities appear to remain in asymptomatic subjects with a previous history of patellar tendinopathy, indicating potential long-term implications for mechanical tendon proprieties. The SWV average and CV values were negatively correlated, which underlines our hypothesis that a low SWV is associated with a high CV. This altogether may reflect the degenerative processes in patellar tendons affected by complaints in the early stages of a sports career. References Fröhlich, S., Peterhans, L., Stern, C., Frey, W. O., Sutter, R., & Spörri, J. (2020). Remarkably high prevalence of overuse-related knee complaints and MRI abnormalities in youth competitive alpine skiers: A descriptive investigation in 108 athletes aged 13-15 years. BMJ Open Sport & Exercice Medicine, 6(1), Aticle e000738. https://doi.org/10.1136/bmjsem-2020-000738 Götschi, T., Franchi, M. V., Schulz, N., Fröhlich, S., Frey, W. O., Snedeker, J. G., & Spörri, J. (2023). Altered regional 3D shear wave velocity patterns in youth competitive alpine skiers suffering from patellar tendon complaints – A prospective case–control study. European Journal of Sport Science, 23(6), 1068-1076. https://doi.org/10.1080/17461391.2022.2088404 Kettunen, J. A., Kvist, M., Alanen, E., & Kujala, U. M. (2002). Long-term prognosis for jumper’s knee in male athletes. A prospective follow-up study. The American Journal of Sports Medicine, 30(5), 689-692. https://doi.org/10.1177/03635465020300051001

Introduction A collaborative international guideline recommends physical exercise (PE) for the secondary prevention of mild neurocognitive disorder (mNCD; Veronese et al., 2023). PE is proposed to promote brain plasticity, maintain or increase cognitive reserve, and alleviate the pathological state in individuals with mNCD, which is characterized by an abnormal accumulation of proteins, excessive oxidative stress, metabolic disorder, and neuroinflammation within the brain (Lu et al., 2023). Individuals with mNCD often also have disrupted self-regulatory capacity to flexibly adapt to daily life challenges. This capacity is supported by the central autonomic network (CAN), which can be viewed as an integrated component of an internal regulatory system in which the brain controls visceromotor, neuroendocrine, and behavioral responses that are critical for goal-directed behavior, adaptability, and health (Thayer, 2009). To maximize the effectiveness of secondary prevention of mNCD, interventions should be designed to also target this network specifically. This could be achieved by combining motor-cognitive training with resonance breathing guided by heart rate variability biofeedback (HRV-BF). HRV-BF training aims to increase cardiac autonomic control, enhance homeostatic regulation, and regulate emotional state. It is effective in improving cardiac autonomic control, cognitive functioning (in particular executive functions), and emotional regulation (i.e., by decreasing symptoms of depression, anxiety, and stress) across different age groups and clinical populations (Laborde et al., 2022; Lehrer et al., 2020). Evidence also supports a causal role of cardiac autonomic control in modulating plasma Alzheimer’s disease-related biomarkers (Min et al., 2023). Although HRV-BF has been suggested as a complementary treatment (Lehrer et al., 2020), its combination with motor-cognitive training remains to be investigated. Methods We systematically designed, developed, and evaluated a novel training concept (called ‘Brain-IT’) specifically for older adults with mNCD. It addresses the mechanism of action described above. The projects’ methodology (Manser & de Bruin, 2021) followed the guidelines of the Medical Research Council for the development and evaluation of complex interventions as well as the Multidisciplinary Iterative Design of Exergames (MIDE) - Framework. The Brain-IT project was structured in three phases. In phase 1, we systematically combined a comprehensive literature synthesis (Manser & de Bruin, 2021) with qualitative research including primary end users (older adults with mNCD), secondary end users (physiotherapists, occupational therapists, healthcare professionals), exergaming researchers, as well as experts from the exergaming industry (Manser et al., 2023) to specify a set of design requirements for the Brain-IT training concept. In phase 2, possible concepts were co-designed and elaborated based on the set of design requirements defined in phase 1. The first prototype of the resulting Brain-IT training concept (Manser & de Bruin, 2021) then entered the iterative cycle of feasibility, usability, safety, and acceptance testing and integrating study results for further development based on co-design until an "acceptable" solution was achieved. In this regard, we conducted a pilot randomized controlled study (RCT) including 18 individuals with mNCD. (Manser et al., 2023) Finally, in phase 3, the effectiveness of the addition of the Brain-IT training to usual care to improve global cognitive functioning is investigated in a RCT including 41 individuals with mNCD (study protocol: Manser et al., 2023). As secondary objectives, the effects of the Brain-IT training on: (1) domain-specific cognitive functioning, (2) spatiotemporal parameters of gait, (3) instrumental activities of daily living and (4) psychosocial factors (i.e. quality of life, and levels of depression, anxiety, and stress), and (5) cardiac vagal modulation are explored. Additionally, brain structure and function is evaluated by magnetic resonance imaging to explore underlying neural changes of the training in relation to adaptations in cognitive performance. Results Ten secondary end users, exergaming researchers, and experts from the exergaming industry (80% females) and eight older adults with mNCD (38% females) contributed to the qualitative research (Manser et al., 2023) which allowed us to successfully integrate all the acquired knowledge of phase 1 to determine a set of design requirements (Manser & de Bruin, 2021). This set of design requirements built the basis for phase 2, where we developed a first prototype of the Brain-IT training concept. Our reflections on the design considerations and our proposed solutions are summarized in (Manser & de Bruin, 2021; Manser et al., 2023). The Brain-IT training concept represents a guideline for applying a combination of exergame-based motor-cognitive training and HRV-BF training by standardizing the training characteristics as well as the structure and content of training and can be implemented with different hardware and software solutions. For an overview, the Brain-IT training consists of a personalized and individually adapted multi-domain exergame-based simultaneous motor–cognitive training with incorporated cognitive tasks combined with HRV-BF training. It is adopted with a deficit-oriented focus on the neurocognitive domains of (1) learning and memory, (2) executive function, (3) complex attention, and (4) visuospatial skills. Each participant is instructed to train ≥ 5x/week for ≥ 24 min per session resulting in a weekly training volume of ≥120 min. All training sessions are planned to take place at participants’ homes. In this project, we used technology of Dividat AG, Polar, and Kubios Oy to implement our training concept. In the pilot RCT we showed that Brain-IT training is feasible (mean adherence and compliance rates of 85.0 and 84.1%, respectively) and usable (mean system usability scale = 71.7 ± 15.4). In addition, high levels of exergame enjoyment, an increase in exergame enjoyment, and internalization of training motivation with large effect sizes (p = 0.03, r = 0.75 and p = 0.03, r = 0.74, respectively), as well as acceptable perceived usefulness were observed. Phase 3 is ongoing. To date, 41 participants were included into the study, of which two withdrew consent before pre-measurements, two dropped-out during intervention (one in each group), and 29 (72.6 ± 9.3 years; 24.1% females) successfully completed the study. Preliminary data suggest significant effects with large effects sizes in favor of the intervention group for global cognitive functioning (F(1, 29) = 4.692, p = 0.039, partial η2 = 0.153) as well as immediate (F(1, 29) = 6.501, p = 0.018, partial η2 = 0.213) and delayed (F(1, 29) = 5.227, p = 0.031, partial η2 = 0.179) verbal recall. The remaining (underpowered) statistical analyses revealed no significant effects, but favorable changes in descriptive statistics with small to moderate effects in favor of the intervention group, especially with regards to quality of life. Discussion/Conclusion The development of novel (exergame-based) training concepts is greatly facilitated when it is based on a theoretical framework. Applying the MIDE-framework resulted in a structured, iterative, and evidence-based approach that led to the identification of multiple key requirements for the exergame design as well as the training components that otherwise may have been overlooked or neglected. This resulted in a user-centered, personalized, and highly innovative training concept that is feasible, usable, and highly accepted by individuals with mNCD. Preliminary data regarding the effectiveness of the intervention is promising, suggesting that the training significantly improved global cognitive functioning, verbal immediate, and delayed recall with large effect sizes, and tends to be beneficial in improving quality of life. To be able to conclude about the effectiveness of the Brain-IT training concept, a full-scale confirmatory randomized controlled superiority trial is warranted. References Laborde, S., Aelle, M. S., Borges, U., Dosseville, F., Hosang, T. J., Iskra, M., Mosley, E., Salvotti, C., Spolverator, L., Zammit, N., & Javelle, F. (2022). Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. Neuroscience & Biobehavioral Reviews, 138, Article 104711. https://doi.org/10.1016/j.neubiorev.2022.104711 Lehrer, P., Kaur, K., Sharma, A., Shah, K., Huseby, R., Bhavsar, J., Sgobba, P., & Zhang, Y. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta analysis. Applied psychophysiology and biofeedback, 45(3), 109-129. https://doi.org/10.1007/s10484-020-09466-z Lu, Y., Bu, F.-Q., Wang, F., Liu, L., Zhang, S., Wang, G., & Hu, X.-Y. (2023). Recent advances on the molecular mechanisms of exercise-induced improvements of cognitive dysfunction. Translational Neurodegeneration, 12(1), 9. https://doi.org/10.1186/s40035-023-00341-5 Manser, P., Adcock-Omlin, M., & de Bruin, E. D. (2023). Design considerations for an exergame-based training intervention for older adults with mild neurocognitive disorder: Qualitative study including focus groups with experts and health care professionals and individual semistructured in-depth patient interviews. JMIR Serious Games, 11, Article e37616. https://doi.org/10.2196/37616 Manser, P., & de Bruin, E. D. (2021). Making the best out of it: Design and development of exergames for older adults with mild neurocognitive disorder - A methodological paper . Front in Aging Neuroscience, 13, Article 734012. https://doi.org/10.3389/fnagi.2021.734012 Manser, P., Michels, L., Schmidt, A., Barinka, F., & de Bruin, E. D. (2023). Effectiveness of an individualized exergame-based motor-cognitive Training concept targeted to improve cognitive functioning in older adults with mild neurocognitive disorder: Study protocol for a randomized controlled trial. JMIR Resarch Protocols, 12, Article e41173. https://doi.org/10.2196/41173 Manser, P., Poikonen, A., & de Bruin, E. D. (2023). Feasibility, usability, and acceptance of “Brain-IT”—A newly developed exergame-based training concept for the secondary prevention of mild neurocognitive disorder: A pilot randomized controlled trial [Original Research]. Frontiers in Aging Neuroscience, 15, Article 1163388. https://doi.org/10.3389/fnagi.2023.1163388 Min, J., Rouanet, J., Martini, A. C., Nashiro, K., Yoo, H. J., Porat, S., Cho, C., Wan, J., Cole, S. W., Head, E., Nation, D. A., Thayer, J. F. & Mather, M. (2023). Modulating heart rate oscillation affects plasma amyloid beta and tau levels in younger and older adults. Scientific Reports, 13(1), Article 3967. https://doi.org/10.1038/s41598-023-30167-0 Thayer, J. F. (2009). Heart rate variability: A neurovisceral integration model. In L. R. Squire (Ed.), Encyclopedia of Neuroscience (pp. 1041-1047). https://doi.org/10.1016/B978-008045046-9.01991-4 Veronese, N., Soysal, P., Demurtas, J., Solmi, M., Bruyère, O., Christodoulou, N., Ramalho, R., Fusar-Poli, P., Lappas, A. S., Pinto, D., Steen Frederiksen, K., Corbi, G. M., Karpenko, O., Georges, J., Durães, J., Schlögl, M., Yilmaz, O., Sieber, C., Shenkin, S. D., Smith, L., Reginster, J.-Y., … & World Psychiatry Association-Preventive Psychiatry Section. (2023). Physical activity and exercise for the prevention and management of mild cognitive impairment and dementia: a collaborative international guideline. European Geriatric Medicine, 14(5), 925-952. https://doi.org/10.1007/s41999-023-00858-y

IntroductionPhysical activity and exercise are crucial to counteract physical and cognitive decline in old age. Home-based exergame training can be a solution to overcome physical inactivity. This systematic review aims to provide a comprehensive overview of home-based exergame interventions and evaluate their effectiveness in improving cognitive and physical functions through physical activity enhancement in older adults.Methods and analysisWe are conducting a systematic literature search including studies examining (1) community-dwelling older adults aged 60 years and older without any specific disease, (2) exergame-based exercise programs that take place at least partially in a home setting, and (3) intervention-related physical and/or cognitive outcomes. We will include randomized controlled trials and any other type of pre-post study published in English. There are no restrictions in terms of control group type and publication date. A search string was created and used in PubMed, Web of Science, Embase, Scopus and CINAHL. In addition, a hand search is carried out. This involves checking the references of the included studies and searching Google Scholar for further studies. The included studies will be summarized and, if homogeneity is sufficient, a random-effects meta-analysis will be performed. We will assess the risk of bias using RoB 2.0 and ROBINS-I.ConclusionThe findings of this systematic review will help to define the most suitable exergame programs to counteract cognitive and physical decline in older adults. Additionally, they will inform the development of effective home-based exergame systems and point to future pathways of digital rehabilitation in older adults.RegistrationProspero (ID: CRD42023374234).

BackgroundTelerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs). ObjectiveThis study aims to analyze the usability, acceptance, and enjoyment of the COCARE system from the perspective of primary (older adults [OAs]) and secondary (HPs) end users. MethodsAt 3 trial sites (located in Switzerland, Italy, and Cyprus), participants engaged in a single-session trial of the COCARE system, including testing of exergames and assessments. Mixed methods encompassing qualitative approaches (eg, think aloud) and quantitative measures (eg, Exergame Enjoyment Questionnaire [EEQ], System Usability Scale [SUS], and Unified Theory of Acceptance and Use of Technology [UTAUT] questionnaire) were used to analyze participants’ perceptions of the system and identify potential barriers to its implementation in a home setting. In addition, the associations of performance during gameplay and assessments, demographics, and training motivation (Behavioral Regulation in Exercise Questionnaire–3 [BREQ-3]) with usability, acceptance, and enjoyment were explored. ResultsA total of 45 OAs and 15 HPs participated in this study. The COCARE system achieved good acceptance ratings (OAs: 83%, range 36%-100% and HPs: 81%, range 63.8%-93.3% of the maximum score), and OAs indicated high enjoyment (mean 73.3, SD 12.7 out of 100 points in the EEQ) during the exergame session. The system’s usability, assessed with the SUS, received scores of 68.1 (SD 18.8; OAs) and 70.7 (SD 12.3; HPs) out of 100 points, with substantial differences observed between the trial sites. Several requirements for improvement were identified. Commonly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties in understanding certain instructions for assessments and games. Performance in games and assessments showed the highest significant correlations with the SUS (Spearman ρ=0.35, P=.02 to ρ=0.52, P

Abstract Background Cognitive impairment is a critical aspect of our aging society. Yet, it receives inadequate intervention due to delayed or missed detection. Dual-task gait analysis is currently considered a solution to improve the early detection of cognitive impairment in clinical settings. Recently, our group proposed a new approach for the gait analysis resorting to inertial sensors placed on the shoes. This pilot study aimed to investigate the potential of this system to capture and differentiate gait performance in the presence of cognitive impairment based on single- and dual-task gait assessments. Methods We analyzed demographic and medical data, cognitive tests scores, physical tests scores, and gait metrics acquired from 29 older adults with mobility limitations. Gait metrics were extracted using the newly developed gait analysis approach and recorded in single- and dual-task conditions. Participants were stratified into two groups based on their Montreal Cognitive Assessment (MoCA) global cognitive scores. Statistical analysis was performed to assess differences between groups, discrimination ability, and association of gait metrics with cognitive performance. Results The addition of the cognitive task influenced gait performance of both groups, but the effect was higher in the group with cognitive impairment. Multiple dual-task costs, dual-task variability, and dual-task asymmetry metrics presented significant differences between groups. Also, several of these metrics provided acceptable discrimination ability and had a significant association with MoCA scores. The dual-task effect on gait speed explained the highest percentage of the variance in MoCA scores. None of the single-task gait metrics presented significant differences between groups. Conclusions Our preliminary results show that the newly developed gait analysis solution based on foot-worn inertial sensors is a pertinent tool to evaluate gait metrics affected by the cognitive status of older adults relying on single- and dual-task gait assessments. Further evaluation with a larger and more diverse group is required to establish system feasibility and reliability in clinical practice. Trial registration ClinicalTrials.gov (identifier: NCT04587895)

This study aims to develop a learning medium documentary film based on material on the Catholic Church's role in maintaining Indonesia's independence, which is suitable to be used by the XII grade senior high school students in history subjects specializing in basic competence 3.11 concering responeses to Indonesia independence. The conducted research is the type of R&D (Research and Development) using the Borg & Gall model modified by Nana Syodih Sukmadinata The product has gone through the validation stage by two material experts, two media experts, and two film expert. Field trials were conducted trough response interviews with one History teacher and two grade XII students. Data were collected using interviews, observation, and questionnaires with quantitative and qualitative data analysis techniques. The results of the material expert validation 1 obtained a score of 4.6 with the "Very Good" criterion. The results of the material expert validation 2 obtained a score of 4.5 with the "Very Good" criterion. The validation results of film experts 1 obtained a score of 4.5 with the "Very Good" criterion. The validation results of film experts 2 obtained a score of 3.8 with the "Good" criteria. The results of the validation of learning media experts 1 obtained a score of 4.7 with the "Very Good" criterion. The results of the validation of learning media experts 1 obtained a score of 4.9 with the "Very Good" criterion. The results of interviews with teachers' and students' responses concluded that the product was good and feasible to use.

Abstract Preserving functional health and quality-of-life in old age is a major goal and global challenge in public health. The high rate of sedentary behavior that is characteristic of the older adult population exacerbates impairments of physiological and structural systems that are typically seen in the aging process. Achieving an understanding of the profound influence of physical activity on all aspects of health in old age is the driving force behind the emergence of "physical activity in old age" as a growing area of research. Accumulated evidence implies that being physically active and exercising is far superior to other optimal aging facilitators. Yet this area of research faces numerous constraints and obstacles. This commentary addresses some of these challenges, primarily the heterogeneity of the aging process, which induces both inter- and intra-individual differences among aged individuals, heterogeneity in assessment tools, unjustified inclusion/exclusion criteria and insufficient recruitment strategies, difficulties in implementing research results in real-world conditions, and rudimentary exploitation of innovative technology. We explain the importance of establishing a network of multidisciplinary scientists and stakeholders to propose consensus-based goals and scientifically evidenced wide-ranging plans for dealing with these challenges. In addition, we suggest work directions for this network.

IntroductionTeam sports athletes need excellent perceptual-cognitive skills, particularly executive functions (EF) to strategically perform on the field. The transfer effect of cognitive training might be accomplished by the inclusion of cognitive stimuli into a physically active environment as these couplings are required in real game situations. A training approach that combines both components is exergaming. The primary objective of this study was to gain preliminary insights into the effects of exergaming on cognitive-motor functions in young team sports athletes. The secondary objective was to investigate participants' training experience and well-being over time.MethodsParticipants were assigned to the intervention or control group. In the intervention group, participants trained with the ExerCube—a mixed reality exergame. The training was planned for 10 weeks (two sessions per week à 25 min) but had to be shortened by 2 weeks due to COVID-19 restrictions. The control group had no additional training. Outcomes included a computer-based alertness test and a cognitive-motor test battery to assess different EF (flexibility, divided attention, and inhibition) via a FitLight Trainer setup.ResultsTwenty-four athletes [mean age (±SD) 15.0 ± 0.7 years], evenly split into the intervention group (N = 12; male N = 6; female N = 6; 14.7 ± 0.5 years) and the control group (N = 12; male N = 7; female N = 5; 15.3 ± 0.8 years), participated in the study. Participants in the intervention group performed on average 9.4 ± 3.3 training sessions over 8 weeks. Significant time x group interaction effects were evident for the cognitive-motor sub-tests flexibility (F = 12.176, p

BackgroundExergame-based motor-cognitive training in older adults has been associated with improvements in physical, cognitive, and psychological functioning. The novel Cocare system (Dividat GmbH), developed through a user-centered design process, allows motor-cognitive training in a telerehabilitation setting. It includes (1) a stationary stepping platform for supervised exergame training (Dividat Senso; Dividat GmbH), (2) a home-based version (Dividat Senso Flex, which is a rollable pressure-sensitive mat; Dividat GmbH), (3) an assessment system (including motor-cognitive tests), and (4) a rehabilitation cockpit for remote training supervision and management. ObjectiveThe aim of this study is to test the feasibility and effectiveness of this novel training system. MethodsA total of 180 older adults from Switzerland, Italy, and Cyprus aged ≥60 years with a prescription for rehabilitation are randomly allocated to an intervention group or a control group. Both groups continue with their usual care, whereas participants in the intervention group additionally perform a 2-week supervised exergame training program at rehabilitation centers, followed by a 10-week home training program under remote supervision. The assessment system is used to indicate the start level of each participant, and, in both intervention periods, standardized progression rules are applied. The measures of feasibility include adherence, attrition, exergame enjoyment, willingness to perform such a training program, and the number and types of help requests. Effectiveness is assessed in terms of cognitive and physical functioning, balance confidence, and quality of life. ResultsData collection started in February 2023 and is ongoing. Final measurements are expected to be performed in January 2024. ConclusionsOwing to the user-centered design approach, the Cocare system is expected to be user-friendly and offers several novel features to cover the whole continuum of care. This pragmatic trial will provide valuable information regarding final necessary adaptations and subsequent implementation efforts. Trial RegistrationClinicalTrials.gov NCT05751551; https://www.clinicaltrials.gov/study/NCT05751551 International Registered Report Identifier (IRRID)DERR1-10.2196/49377

BackgroundExergames provide a promising new approach to implement simultaneous motor–cognitive training, which may support preventing the decline in cognitive functioning in older adults who have a mild neurocognitive disorder (mNCD).ObjectivesTo evaluate feasibility, system usability, and acceptance of “Brain-IT”, a newly developed training concept combining exergame-based motor-cognitive training and heart rate variability (HRV) guided resonance breathing for the secondary prevention of mNCD.MethodsA pilot randomized controlled trial (RCT) with an allocation ratio of 2:1 (i.e., intervention:control) was conducted. The control group proceeded with usual care. The intervention group performed a 12-week training according to the “Brain-IT” training concept implemented with the “Senso Flex” (Dividat AG) exergaming system in addition to usual care. Feasibility and usability outcomes were analyzed using descriptive statistics. User acceptance was analyzed qualitatively and using Friedman analysis of variance (ANOVA), as well as Wilcoxon signed-rank tests.ResultsEighteen participants (77.3 ± 9.8 years; 44.4% females) were included. On average, we recruited 2.2 participants per month, and 35.3% of the individuals contacted were included. The intervention group had an attrition rate of 20% and mean adherence and compliance rates of 85.0 and 84.1%, respectively. The mean system usability score, measured with the system usability scale, was 71.7. High levels of exergame enjoyment, an increase in exergame enjoyment, and internalization of training motivation with large effect sizes (p = 0.03, r = 0.75 and p = 0.03, r = 0.74, respectively), as well as acceptable perceived usefulness, were observed. Preliminary data on the effects of the “Brain-IT” training are promising.ConclusionThe feasibility and usability of the “Brain-IT” training are acceptable. However, frequent occurrences of technical problems and difficulties in using the exergame training system were identified as barriers to performing the “Brain-IT” training. To optimize feasibility, either improvements or alternative solutions are required in the hardware and software of the exergame used to implement the “Brain-IT” training. The “Brain-IT” training itself was well-accepted by older adults who have mNCD. Therefore, the effectiveness of the “Brain-IT” training concept should be investigated in future studies.Trial registrationclinicaltrials.gov/ct2/show/NCT04996654.

Abstract Background People with Parkinson`s disease (PD) often suffer from both motor and cognitive impairments. Simultaneous motor and cognitive training stimulates neurobiological processes which are important especially for people with PD. The aim of this study is to test the feasibility and effects of simultaneous cognitive–motor training in form of exergames in the setting of inpatient rehabilitation of persons with PD. Methods Forty participants (72.4 ± 9.54 years; Hoehn and Yahr stage 1–4) were randomly assigned to either the intervention group, which trained five times a week in addition to the conventional rehabilitation program, or the control group, which underwent the standard rehabilitation treatment only. Primary outcome was feasibility (measured by adherence rate, attrition rate, occurrence of adverse events, system usability scale (SUS), and NASA TLX score). In addition, various cognitive (Go/No-Go test, reaction time test (RTT), color word interference test (D-KEFS) and Trail Making Test A and B (TMT)) and motor (preferred gait speed, maximum gait speed, dual-task gait speed, Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) and 5 times Sit-to-Stand (5xStS)) tests were conducted before and after the intervention phase in order to determine training effects Results Adherence rate was 97%, there were just two dropouts due to reasons unrelated to the study and there were no adverse events. The mean NASA TLX value was 56.2 and the mean value of the SUS was 76.7. Significant time–group interaction effects were observed for the 5xStS, the SPPB, the RTT, the Go/No-Go test and the D-KEFS 2. Discussion Exergaming, as applied in this study, showed to be feasible, safe and likely effective for the improvement of cognitive and motor functions of PD inpatients. Because of this future randomized controlled trials with a main focus on testing the efficacy of this new intervention are warranted. Trial registration: The study has been registered at ClinicalTrials.gov (ID: NCT04872153).

Abstract Postural sway and eye movements are potential biomarkers for dementia screening. Assessing the two movements comprehensively could improve the understanding of complicated syndrome for more accurate screening. The purpose of this research is to evaluate the effects of comprehensive assessment in healthy older adults (OA), using a novel concurrent comprehensive assessment system consisting of stabilometer and virtual reality headset. 20 healthy OA (70.4 ± 4.9 years) were recruited. Using a cross-sectional study design, this study investigated the effects of various dual-tasking paradigms with integrated tasks of visuospatial memory (VM), spatial orientation (SO), and visual challenge on posture and saccades. Dual-task paradigms with VM and SO affected the saccadic eye movements significantly. Two highly intensive tests of anti-saccade with VM task and pro-saccade with SO task also influenced postural sway significantly. Strong associations were seen between postural sway and eye movements for the conditions where the two movements theoretically shared common neural pathways in the brain, and vice versa. This study suggests that assessing posture and saccades with the integrated tasks comprehensively and simultaneously could be useful to explain different functions of the brain. The results warrant a cross-sectional study in OA with and without dementia to explore differences between these groups.

The coastal area is a complex and interconnected system of diverse ecosystems, with mangrove ecosystems standing out as one of the most productive. However, global mangrove ecosystems, including those in Langsa City, face multiple threats from human activities and natural hazards. This study focuses on examining the various threats impacting the mangrove ecosystem in Langsa City, including tourism and urban development, climate change, regional development, human activities, and sedimentation. Mangrove ecosystems have specific requirements for survival, making these threats particularly concerning. Through field observations and analysis, this study explores the impact of these threats on the mangrove ecosystem's well-being and its correlation with the overall coastal biodiversity. Additionally, the research delves into the management practices implemented by the local government to preserve the mangrove ecosystems. The findings reveal the severity of threats to the mangrove ecosystem's viability and its implications for coastal biodiversity sustainability. The study also sheds light on the local government's mangrove management system, providing valuable insights into current conservation efforts. By understanding the threats faced by the mangrove ecosystem and the management practices in place, this research contributes to the preservation and sustainable use of this vital coastal resource.

Patiënten met Mild Cognitive Impairment (MCI) lopen een hoger risico op het ontwikkelen van een dementie. Een gestoord ziekteinzicht is een symptoom bij dementie en zou bij de vroegdiagnostiek voorspellend kunnen zijn voor het ontwikkelen van een dementie. Ziekte-inzicht kan worden onderzocht door middel van de discrepantie in de beoordeling van geheugenachteruitgang door patiënt en partner. In deze studie is het ziekte-inzicht bij patiënten met MCI onderzocht met behulp van de Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-N). De resultaten laten zien dat de discrepantiescore (het verschil tussen de IQCODE-Nscore van de patiënt en de IQCODE-Nscore van de partner) bij de 61 MCI-patiënten significant hoger was dan bij de 40 gezonde ouderen (p=0,01). Dit suggereert een verminderd ziekte- inzicht bij MCI-patiënten. Een analyse van de spreiding binnen de groep laat echter zien dat dit voor 60% van de MCI-patiënten geldt. Patiënten met een gestoord ziekte-inzicht hebben lagere MMSE scores ( p < 0,01) dan patiënten met inzicht in de geheugenproblemen.

Objective Stepping exergames designed to stimulate physical and cognitive skills can provide important information concerning individuals’ performance. In this study, we investigated the potential of stepping and gameplay metrics to assess the motor-cognitive status of older adults. Methods Stepping and gameplay metrics were recorded in a longitudinal study involving 13 older adults with mobility limitations. Game parameters included games’ scores and reaction times. Stepping parameters included length, height, speed, and duration, measured by inertial sensors placed on the shoes while interacting with the exergames. Parameters measured on the first gameplay were correlated against standard cognitive and mobility assessments, including the Montreal Cognitive Assessment (MoCA), gait speed, and the Short Physical Performance Battery. Based on MoCA scores, patients were then stratified into two groups: cognitively impaired and healthy controls. The differences between the two groups were visually inspected, considering their within-game progression over the training period. Results Stepping and gameplay metrics had moderate-to-strong correlations with cognitive and mobility performance indicators: faster, longer, and higher steps were associated with better mobility scores; better cognitive games’ scores and reaction times, and longer and faster steps were associated with better cognitive performance. The preliminary visual analysis revealed that the group with cognitive impairment required more time to advance to the next difficulty level, also presenting slower reaction times and stepping speeds when compared to the healthy control group. Conclusion Stepping exergames may be useful for assessing the cognitive and motor status of older adults, potentially allowing assessments to be more frequent, affordable, and enjoyable. Further research is required to confirm results in the long term using a larger and more diverse sample.