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Exercise has become increasingly relevant in the treatment of people with Parkinsons Disease (PD), especially for gait and balance impairments where pharmacological and surgical therapy does not fully alleviate symptoms. Split-belt treadmill (SBT) is a tool which can introduce artificial asymmetry and motor switches through belts running at different velocities and has been used to study motor control or as exercise intervention. This narrative review summarizes the current literature of SBT as a therapeutic tool for people with PD. Studies have shown that walking on an SBT is safe and feasible for people with PD and results suggest that training should best be carried out under antiparkinsonian medication. Compared to healthy adults, people with PD adapt their gait in a similar manner during and after SBT walking, but effects are smaller. One session of SBT training improved gait adaptation as well as gait during dual tasking, with results being partially retained for 24 hours. With regard to endurance, tendencies are visible that SBT training has generic health benefits similiar to aerobic exercise.Further studies are ongoing investigating long term training interventions of SBT in people with PD, including the study of retention effects. However, the clinical relevance of the above-mentioned benefits remains unclear. Finally, the aerobic benefit of the training and the potential for alleviation of fall risk in the PD population need to be investigated.Key Words: Rehabilitation, Gait Disorder, Neurological Disease, Exercise Therapy

Abstract Background The purpose of this paper is to report on the process for developing an online RE-AIM evaluation toolkit in partnership with organizations that provide physical activity programming for persons with disabilities. Methods A community-university partnership was established and guided by an integrated knowledge translation approach. The four-step development process included: (1) identify, review, and select knowledge (literature review and two rounds of Delphi consensus-building), (2) adapt knowledge to local context (rating feasibility of outcomes and integration into online platform), (3) assess barriers and facilitators (think-aloud interviews), and (4) select, tailor, implement (collaborative dissemination plan). Results Step 1: Fifteen RE-AIM papers relevant to community programming were identified during the literature review. Two rounds of Delphi refined indicators for the toolkit related to reach, effectiveness, adoption, implementation, and maintenance. Step 2: At least one measure was linked with each indicator. Ten research and community partners participated in assessing the feasibility of measures, resulting in a total of 85 measures. Step 3: Interviews resulted in several recommendations for the online platform and toolkit. Step 4: Project partners developed a dissemination plan, including an information package, webinars, and publications. Discussion This project demonstrates that community and university partners can collaborate to develop a useful, evidence-informed evaluation resource for both audiences. We identified several strategies for partnership when creating a toolkit, including using a set of expectations, engaging research users from the outset, using consensus methods, recruiting users through networks, and mentorship of trainees. The toolkit can be found at et.cdpp.ca. Next steps include disseminating (e.g., through webinars, conferences) and evaluating the toolkit to improve its use for diverse contexts (e.g., universal PA programming).

Abstract Freezing of gait (FOG) is a debilitating problem that markedly impairs the mobility and independence of 38-65% of people with Parkinson’s disease. During a FOG episode, patients report that their feet are suddenly and inexplicably “glued” to the floor. The lack of a widely applicable, objective FOG detection method obstructs research and treatment. To address this problem, we organized a 3-month machine-learning contest, inviting experts from around the world to develop wearable sensor-based FOG detection algorithms. 1,379 teams from 83 countries submitted 24,862 solutions. The winning solutions demonstrated high accuracy, high specificity, and good precision in FOG detection, with strong correlations to gold-standard references. When applied to continuous 24/7 data, the solutions revealed previously unobserved patterns in daily living FOG occurrences. This successful endeavor underscores the potential of machine learning contests to rapidly engage AI experts in addressing critical medical challenges and provides a promising means for objective FOG quantification.

There is an urgent need for valid and reliable measures of physical activity (PA) participation for use among people with physical and/or sensory disabilities. This study involved adapting the Leisure Time PA Questionnaire for People with Spinal Cord Injury for use in individuals with disabilities (i.e., the LTPAQ-D) and performing a preliminary evaluation of its content validity, construct validity, and same-day test–retest reliability in people with disabilities. User interviews assessed the content validity (n = 5). A cross-sectional study assessed the construct validity and same-day test–retest reliability (n = 27, 45 ± 21 years). Participants completed the LTPAQ-D, other self-report measures of aerobic and strength training PA, as well as tests of cardiorespiratory fitness (i.e., peak oxygen consumption (V˙O2peak)) and muscular strength. LTPAQ-D measures of min/week of aerobic LTPA, aerobic moderate-to-vigorous PA (MVPA), and strength training shared medium-to-large correlations with other self-report measures of aerobic and strength training PA (r = 0.458–0.942, ps < 0.01). After controlling for age, aerobic LTPA and MVPA shared moderate partial correlations with V˙O2peak (r = 0.341 and 0.356, respectively). Min/week of strength training, measured by the LTPAQ-D, was associated with predicted maximal strength on the chest press (r = 0.621, p = 0.009). All LTPAQ-D measures demonstrated good-to-excellent test–retest reliability (intraclass correlations = 0.709–0.948, ps < 0.01). This study provides preliminary evidence of the validity and reliability of the LTPAQ-D as a measure of LTPA among people with disabilities.

Abstract Background Health, fitness and lifestyle professionals can play important roles in promoting physical activity in groups at risk of developing an inactive lifestyle, such as people with spinal cord injury (SCI). Tailored counselling is a promising tool to promote and improve physical activity levels. To support professionals to effectively have a conversation about physical activity with clients with SCI, evidence-based training and resources are needed. This project aimed to (1) co-develop an e-learning course on best practices for SCI physical activity counselling and, (2) examine the effectiveness and usability of this course. Methods Guided by the technology-enhanced learning (TEL) evaluation framework, we used a systematic, multistep approach to co-develop and evaluate an e-learning course. The development process was informed by input and feedback from a diverse group of end-users and experts (n > 160) via online surveys and (think-aloud) interviews. A randomized controlled trial was used to compare learning outcomes (post-knowledge and self-efficacy) between participants who completed the course (intervention group) and the wait-listed control group. Usability, learning experiences, and satisfaction were assessed among all participants. Results Forty-one participants (21 intervention-group; 20 control-group) with various backgrounds (e.g., lifestyle counsellors, physiotherapists, occupational therapists, recreation therapists, fitness trainers) enrolled in the randomized controlled trial. After completing the course, participants in the intervention group showed significantly improved knowledge on the best practices for SCI physical activity counselling and higher self-efficacy for using these best practices in conversations with clients with SCI compared to the control group (p

Abstract Super Typhoon Mangkhut, which traversed the North Equatorial Current (NEC; 8–17 °N) in the western North Pacific in 2018, was the most intense Category-5 tropical cyclone (TC) with the longest duration in history—3.5 days. Here we show that the combination of two factors—high ocean heat content (OHC) and increased stratification — makes the NEC region the most favored area for a rapid intensification (RI) of super typhoons, instead of the Eddy Rich Zone (17–25 °N), which was considered the most relevant for RI occurrence. The high OHC results from a northward deepening thermocline in geostrophic balance with the westward-flowing NEC. The stratification is derived from precipitation associated with the Inter-Tropical Convergence Zone in the summer peak typhoon season. These factors, which are increasingly significant over the past four decades, impede the TC-induced sea surface cooling, thus enhancing RI of TCs and simultaneously maintaining super typhoons over the NEC region.

Background Chronic pain among athletes is often misinterpreted as tissue damage resulting from sport. While researchers have started to examine neuropathic pain among athletes with spinal cord injury (SCI), there is a need to develop a deeper understanding of their neuropathic pain symptoms and experiences, to support the development of evidence-based pain management protocols.Objectives The primary purpose of this study was to describe neuropathic pain experienced by athletes with SCI. A secondary purpose was to compare athletes’ neuropathic pain symptoms when measured by two different clinical pain assessment tools and describe their experiences when trying to communicate their neuropathic pain.Methods 47 athletes with SCI completed the International Spinal Cord Injury Pain Basic Data Set (V.2.0), Douleur Neuropathique 4 (DN4), and two open-ended pain questions over the telephone.Results 66% of participants reported experiencing moderate-intensity neuropathic pain (Mpain intensity=5.32±1.78) and mild-to-moderate pain interference with activities of daily living (Mpain interference=3.55±2.11) and sleep (Mpain interference4.68±2.92). Overall, participants reported significantly more neuropathic pain symptoms in response to DN4 questions (M=4.62±1.38) versus open-ended pain questions (M=2.13±1.08), p

Abstract Background Freezing of gait (FOG) is an episodic and highly disabling symptom of Parkinson’s Disease (PD). Traditionally, FOG assessment relies on time-consuming visual inspection of camera footage. Therefore, previous studies have proposed portable and automated solutions to annotate FOG. However, automated FOG assessment is challenging due to gait variability caused by medication effects and varying FOG-provoking tasks. Moreover, whether automated approaches can differentiate FOG from typical everyday movements, such as volitional stops, remains to be determined. To address these questions, we evaluated an automated FOG assessment model with deep learning (DL) based on inertial measurement units (IMUs). We assessed its performance trained on all standardized FOG-provoking tasks and medication states, as well as on specific tasks and medication states. Furthermore, we examined the effect of adding stopping periods on FOG detection performance. Methods Twelve PD patients with self-reported FOG (mean age 69.33 ± 6.02 years) completed a FOG-provoking protocol, including timed-up-and-go and 360-degree turning-in-place tasks in On/Off dopaminergic medication states with/without volitional stopping. IMUs were attached to the pelvis and both sides of the tibia and talus. A temporal convolutional network (TCN) was used to detect FOG episodes. FOG severity was quantified by the percentage of time frozen (%TF) and the number of freezing episodes (#FOG). The agreement between the model-generated outcomes and the gold standard experts’ video annotation was assessed by the intra-class correlation coefficient (ICC). Results For FOG assessment in trials without stopping, the agreement of our model was strong (ICC (%TF) = 0.92 [0.68, 0.98]; ICC(#FOG) = 0.95 [0.72, 0.99]). Models trained on a specific FOG-provoking task could not generalize to unseen tasks, while models trained on a specific medication state could generalize to unseen states. For assessment in trials with stopping, the agreement of our model was moderately strong (ICC (%TF) = 0.95 [0.73, 0.99]; ICC (#FOG) = 0.79 [0.46, 0.94]), but only when stopping was included in the training data. Conclusion A TCN trained on IMU signals allows valid FOG assessment in trials with/without stops containing different medication states and FOG-provoking tasks. These results are encouraging and enable future work investigating automated FOG assessment during everyday life.

Freezing of gait (FOG) is an episodic and highly disabling symptom of Parkinson’s disease (PD). Although described as a single phenomenon, FOG is heterogeneous and can express as different manifestations, such as trembling in place or complete akinesia. We aimed to analyze the efficacy of deep learning (DL) trained on inertial measurement unit data to classify FOG into both manifestations. We adapted and compared four state-of-the-art FOG detection algorithms for this task and investigated the advantages of incorporating a refinement model to address oversegmentation errors. We evaluated the model’s performance in distinguishing between trembling and akinesia, as well as other forms of movement cessation (e.g., stopping and sitting), against gold-standard video annotations. Experiments were conducted on a dataset of eighteen PD patients completing a FOG-provoking protocol in a gait laboratory. Results showed our model achieved an F1 score of 0.78 and segment F1@50 of 0.75 in detecting FOG manifestations. Assessment of FOG severity was strong for trembling (ICC=0.86, [0.66,0.95]) and moderately strong for akinesia (ICC=0.78, [0.51,0.91]). Importantly, our model successfully differentiated FOG from other forms of movement cessation during 360-degree turning-in-place tasks. In conclusion, our study demonstrates that DL can accurately assess different types of FOG manifestations, warranting further investigation in larger and more diverse verification cohorts.

Abstract Background Individuals with spinal cord injury (SCI) report high levels of neuropathic pain. Current treatment options are primarily pharmaceutical, despite their limited effectiveness. Exercise may reduce neuropathic pain among persons with SCI; however, the optimal dose of exercise required to elicit analgesic effects remains unknown. The purpose of this study was to compare neuropathic pain intensity, pain catastrophizing, use of coping strategies, and positive affect and well-being among Paralympic versus recreational athletes with SCI who experience chronic neuropathic pain. Forty-seven athletes with SCI (25 Paralympic, 27 recreational) completed the International SCI Pain Basic Data Set, Douleur Neuropathique-4, coping strategies questionnaire, pain catastrophizing scale, and SCI-quality of life assessment. Results Paralympic athletes reported significantly greater neuropathic pain (p = 0.032) and positive affect and well-being (p = 0.047) than recreational athletes. No other comparisons were significant (ps > 0.09). Significant, medium-sized positive correlations were observed between neuropathic pain and total minutes of moderate-intensity exercise (r = 0.335, p = 0.023) and average minutes per day of moderate-intensity exercise (r = 0.375, p = 0.010) over the past week. Conclusions The results suggest that frequent moderate- to high-intensity exercise may exacerbate neuropathic pain sensations for persons with SCI. Research should investigate psychosocial and physiological mechanisms by which exercise may influence neuropathic pain to explain how Paralympic athletes with SCI are able to continue exercising while maintaining positive affect despite neuropathic pain.

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.

No Spanish-language tool exists to assess physical activity in people with spinal cord injuries. This work aimed to provide a valid Spanish version of the Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI). It was conducted in three phases. First, translation and cross-cultural adaptation. Second, a reliability assessment through inter-rater reliability (n = 25) and test -- retest reliability (n = 50). Third, validity assessment, comparing PARA-SCI-Spanish and wearable sensors (n = 13), as well as analyzing PARA-SCI-Spanish results between known groups (n = 235). Intraclass correlation coefficients ranged from 0.36 to 0.95. The correlations between the wearable sensors and the PARA-SCI-Spanish were r = 0.67, p = 0.005 (moderate to vigorous physical activity) and r = 0.62, p = 0.01 (total activity). The known-groups analyses demonstrated differences in accord with previous research and not differing according to the interview mode. The PARA-SCI-Spanish was a reliable and valid tool in telephone and face-to-face interviews.

Introduction: There are limited data regarding the characteristics and management of drug hypersensitivity reactions (DHR) in hospitalized children. This study aims to determine the prevalence, clinical features, and management of DHRs in pediatric inpatients. Methods: Children who had pediatric allergy consultation for suspected DHR during hospitalization in Ankara Bilkent City Hospital between August 1, 2020, and July 30, 2021, were included. Patient and reaction characteristics, culprit drugs, and management strategies were recorded. When possible, diagnostic tests (skin or provocation tests) were performed after discharge. Results: Among the 14,090 hospitalized children, 165 (72% male, median age: 106 months) underwent consultation for 192 suspected DHRs with 246 drugs. Cutaneous eruptions were the most common (94.3%). There was anaphylaxis in 40 patients and severe cutaneous adverse drug reaction in 4 patients (drug rash with eosinophilia and systemic symptoms in 3, acute generalized exanthematous pustulosis in 1). Antimicrobials were the leading cause (78.4%, n = 193/246). In 48 reactions, 60 (24%) culprit drugs could be readministered with close follow-up or desensitization (n = 12). In total, 186 suspected drugs were discontinued, and 115 were replaced with alternative drugs. After discharge, 38 provocation tests (2 positives) and 36 skin tests (1 positive prick test, 1 positive intradermal test, and 1 positive patch test) were performed. Discussion/conclusions: The incidence of suspected DHR among pediatric inpatients was approximately 1.1%. Skin symptoms were the most common manifestation. Twenty-four percent of suspected drugs could be continued during hospitalization. Patients with DHR during hospitalization should be evaluated with a drug allergy work-up unless there are contraindications to testing.

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.

Open data sharing of clinical research aims to improve transparency and support novel scientific discoveries. There are also risks, including participant identification and the potential for stigmatization. The perspectives of persons participating in research are needed to inform open data-sharing policies. The aim of the current study was to determine perspectives on data sharing in persons with spinal cord injury (SCI), including risks and benefits, and types of data people are most willing to share. A secondary aim was to examine predictors of willingness to share data. Persons with SCIs in the United States and Canada completed a survey developed and disseminated through various channels, including our community partner, the North American Spinal Cord Injury Consortium. The study collected data from 232 participants, with 52.2% from Canada and 42.2% from the United States, and the majority completed the survey in English. Most participants had previously participated in research and had been living with an SCI for ?5 years. Overall, most participants reported that the potential benefits of data sharing outweighed the negatives, with persons with SCI seen as the most trustworthy partners for data sharing. The highest levels of concern were that information could be stolen and companies might use the information for marketing purposes. Persons with SCI were generally supportive of data sharing for research purposes. Clinical trials should consider including a statement on open data sharing in informed consents to better acknowledge the contribution of research participants in future studies.

Abstract Introduction Integrated knowledge translation (IKT) is a partnered approach to research that aims to ensure research findings are applied in practice and policy. IKT can be used during diffusion and dissemination of research findings. However, there is a lack of understanding how an IKT approach can support the diffusion and dissemination of research findings. In this study, we documented and described the processes and outcomes of an IKT approach to diffusing and disseminating the findings of consensus recommendations for conducting spinal cord injury research. Methods Communication of the IKT Guiding Principles in two phases: a diffusion phase during the first 102 days from the manuscript’s publication, followed by a 1147 day active dissemination phase. A record of all inputs was kept and all activities were tracked by monitoring partnership communication, a partnership tracking survey, a project curriculum vitae, and team emails. Awareness outcomes were tracked through Google Analytics and a citation-forward search. Awareness includes the website accesses, the number of downloads, and the number of citations in the 29 month period following publication. Results In the diffusion period, the recommendations were viewed 60 times from 4 different countries, and 4 new downloads. In the dissemination period, the recommendations were viewed 1109 times from 39 different countries, 386 new downloads, and 54 citations. Overall, during dissemination there was a 17.5% increase in new visitors to the website a month and a 95.5% increase in downloads compared to diffusion. Conclusion This project provides an overview of an IKT approach to diffusion and dissemination. Overall, IKT may be helpful for increasing awareness of research findings faster; however, more research is needed to understand best practices and the the impact of an IKT approach on the diffusion and dissemination versus a non-partnered approach.

An air-sea interaction field campaign was conducted in September of 2017 within the warm and cold eddy region of the western Northwest Pacific (WNP) (17.5˚-20.5˚N, 127.5˚E-133.5˚E). Both near-surface oceanic and atmospheric conditions in addition to ocean heat content (OHC) were examined to better understand the mechanisms governing high heat flux magnitudes responsible for rapidly intensifying tropical cyclones. Observations from this experiment indicate that the latent heat flux (LHF) under modest wind conditions reached 400 W m-2 within the vicinity of a warm eddy, with OHC higher than 100 kJ cm-2 of warm eddy region being 2~3 times as large as that of cold eddy region. These high OHC and a resultant high LHF in the warm eddy, comparable to the magnitude of LHF in the North Equatorial Current, may explain the mechanism of why tropical cyclones over a warm eddy in eddy-rich zones often rapidly intensify in the WNP. A month later typhoon Lan rapidly intensified into a super typhoon, while passing over the boundary region of warm and cold eddies during the observation period. Results from this study illustrate that both the wind-normalized LHF and the difference (Qs-Qa) between the specific humidity at air (Qa) and at the sea surface (Qs), closely correlate with OHC patterns, which suggests that the ocean looks likely to control the spatial pattern of LHF. Overall, both the ocean and weather conditions govern the pattern of specific humidity difference between the air-sea interface, with large OHC over the warm eddy controlling higher Qs and the pattern of Qa depending on the pattern of wind direction. Qa as a factor impacting LHF magnitude is strongly linked to wind direction in the experimental area, that is, the drier northwesterly flow and southeasterly moist wind, resulting in the enhanced contrast of specific humidity at cold eddy region.

PurposeThis study investigated the accuracy of activity trackers in chronic lower limb lymphoedema (LLL) patients and in comparison to matched controls.Materials and methodsSeventeen LLL patients and 35 healthy subjects wore an activity tracker at the hip (Fitbit Zip/Inspire; hip-AT) and one at the wrist (Fitbit Alta/Inspire; wrist-AT) combined with a reference activity monitor (Dynaport Movemonitor; DAM), for 14 consecutive days. To analyze accuracy and agreement, mean daily step count from both AT's were compared to DAM. To evaluate the accuracy as coaching tool, day-by-day differences were calculated. The Kendall correlation coefficient was used to test consistency of ranking daily steps between the AT's and the DAM.ResultsThe wrist-AT significantly overestimated daily step count compared to DAM in the LLL group (+1221 ± 1754 steps per day, p = 0.011) while the hip-AT underestimated the step count, although not significantly. Similar results were found in the healthy control group. As a coaching tool, both wrist-AT and hip-AT showed a moderate correlation with the DAM (r = 0.507 and 0.622, respectively) in the LLL group regarding consistency of ranking from most to least active days.ConclusionWrist-AT's significantly overestimate daily step count in a LLL population. As a coaching tool, both trackers show moderate validity, indicating applicability to improve physical activity.

IntroductionPrevious studies have shown that anticipatory postural adjustments (APAs) are altered in people with Parkinson's disease but its meaning for locomotion is less understood. This study aims to investigate the association between APAs and gait initiation, gait and freezing of gait and how a dynamic postural control challenging training may induce changes in these features.MethodsGait initiation was quantified using wearable sensors and subsequent straight walking was assessed via marker-based motion capture. Additionally, turning and FOG-related outcomes were measured with wearable sensors. Assessments were conducted one week before (Pre), one week after (Post) and 4 weeks after (Follow-up) completion of a training intervention (split-belt treadmill training or regular treadmill training), under single task and dual task (DT) conditions. Statistical analysis included a linear mixed model for training effects and correlation analysis between APAs and the other outcomes for Pre and Post-Pre delta.Results52 participants with Parkinson's disease (22 freezers) were assessed. We found that APA size in the medio-lateral direction during DT was positively associated with gait speed (pConclusionsThe findings of this work revealed new insights into how APAs were not associated with first step characteristics and freezing and only baseline APAs during DT were related with DT gait characteristics. Training-induced changes in the size of APAs were related to training benefits in the first step ROM only in non-freezers. Based on the presented results increasing APA size through interventions might not be the ideal target for overall improvement of locomotion.

Approximately 1·5 billion people worldwide live with a physical, mental, sensory, or intellectual disability, about 80% of which are in low-income and middle-income countries. This Series paper provides a global overview of the prevalence, benefits, and promotion policies for physical activity for people living with disabilities (PLWD). PLWD are 16-62% less likely to meet physical activity guidelines and are at higher risk of serious health problems related to inactivity than people without disabilities. Meta-analyses have shown that physical activity has beneficial effects on cardiovascular fitness (average standardised mean difference [SMD] 0·69 [95% CI 0·31-1·01]), musculoskeletal fitness (0·59 [0·31-0·87]), cardiometabolic risk factors (0·39 [0·04-0·75]), and brain and mental health outcomes (0·47 [0·21-0·73]). These meta-analyses also show that health benefits can be achieved even with less than 150 min of physical activity per week, and suggest that some physical activity is better than none. Meta-analyses of interventions to increase physical activity for PLWD have reported effect sizes ranging from SMD 0·29 (95% CI 0·17-0·41, k=10) to 1·00 (0·46-1·53, k=10). There is increasing awareness among policy makers of the needs of PLWD for full participation in physical activity. Physical activity action plans worldwide must be adequately resourced, monitored, and enforced to truly advance the fundamental rights of PLWD to fully participate in physical activity.

This study investigates the impact of warm core eddies (WCEs) on the ocean response and intensity of tropical cyclones (TCs) in the Northwest Pacific, focusing on three typhoons in 2018: Jebi, Trami, and Kong-rey. The research uses the Hurricane Weather Research and Forecast (HWRF) model coupled with the MPIPOM-TC ocean model. Idealized WCEs are embedded into the ocean model ahead of each TC. The impacts of WCEs are evaluated by comparing simulations with and without their presence. Uncoupled experiments with the fixed sea surface temperature (SST) serve as a reference for TC maximum potential intensity. To quantitatively assess the impact of WCEs on the SST, enthalpy fluxes, and TC intensity, a Maximum WCE Potential Index (MWPI) is introduced. Our findings indicate that for a WCE with a 200 km radius, the potential to reduce SST cooling ranges from 34 to 37%, while the potential to increase enthalpy fluxes varies between 25 and 39%. The influence of WCEs on TC intensity, as measured by minimum pressure, shows a larger variation from 27% to 48%, depending on the oceanic and atmospheric environmental conditions in each storm. Additional experiments reveal the sensitivity of the MWPI to WCE size, with TC Trami showing less sensitivity due to its slower translational speed. This study underscores the significant role of oceanic thermal conditions, particularly WCEs, in modulating TC intensity.

IntroductionPhysical Activity (PA) levels for individuals with spinal cord injury (SCI) peak during rehabilitation and sharply decline post-discharge. The ProACTIVE SCI intervention has previously demonstrated very large-sized effects on PA; however, it has not been adapted for use at this critically understudied timepoint. The objective is to evaluate the reach, effectiveness, adoption, implementation, and maintenance of the ProACTIVE SCI intervention delivered by physiotherapists and SCI peer coaches during the transition from rehabilitation to community.MethodsA single-group, within-subjects, repeated measures design was employed. The implementation intervention consisted of PA counseling training, champion support, prompts and cues, and follow-up training/community of practice sessions. Physiotherapists conducted counseling sessions in hospital, then referred patients to SCI peer coaches to continue counseling for 1-year post-discharge in the community. The RE-AIM Framework was used to guide intervention evaluation.ResultsReach: 82.3% of patients at the rehabilitation hospital were reached by the intervention. Effectiveness: Interventionists (physiotherapists and SCI peer coaches) perceived that PA counseling was beneficial for patients. Adoption: 100% of eligible interventionists attended at least one training session. Implementation: Interventionists demonstrated high fidelity to the intervention. Intervention strategy highlights included a feasible physiotherapist to SCI peer coach referral process, flexibility in timepoint for intervening, and time efficiency. Maintenance: Ongoing training, PA counseling tracking forms, and the ability to refer to SCI peer coaches at discharge are core components needed to sustain this intervention.DiscussionThe ProACTIVE SCI intervention was successfully adapted for use by physiotherapists and SCI peer coaches during the transition from rehabilitation to community. Findings are important for informing intervention sustainability and scale-up.

Resonators are key components in optics. In this work, the authors introduce a class of optical resonators with distinctly different properties from conventional resonators, allowing fundamental design trade-offs to be circumvented.