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Background: This study examined the after-school activities of Japanese elementary school children in which little information is available for understanding the process by which participation in organized activities leads to the decrease in children's independent mobility. Methods: One thousand eight hundred and twenty-four mothers of elementary school children participated in an online survey. The mothers responded to the questions on the number of lessons (or cram schools) their children attended weekdays, as well as their children's behavior after classes, and parents providing transportation when their children go out to play. Results: The proportion of children attending lessons and/or cram schools increased as their grades progressed. A significant interaction existed between the degree of parental transportation and grade in terms of whether or not the children attended lessons and/or cram schools. Parental involvement included pick up or drop-off for a large percentage of younger children without lessons, whereas the degree of parental involvement was greater for older children attending lessons. In other words, parents of children without attending lessons or cram schools tended to allow children to engage in independent activities when they reached the higher grades, whereas parents of children who frequently attended lessons and cram schools tended to remain involved in transporting their children, even when they reached the higher grades. Conclusions: The results suggested that the participation of children in organized activities leads to a routine of parental pickup and/or drop-off, which renders difficult the facilitation of opportunities for children to independently participate in play activities. [ABSTRACT FROM AUTHOR]

Fast carrier dynamics in organic thin-film transistors (OTFTs) was investigated by time-resolved electrostatic force microscopy (tr-EFM). We found that the carrier diffusion in the OTFTs proceeded in two stages: fast diffusion and slow diffusion. By applying the instantaneous frequency method to EFM, the temporal evolution of the spatial distribution of fast carriers in the channel region of the OTFTs, which took place on the timescale of several hundreds of nanoseconds, was evaluated. The inhomogeneous distribution of the local decay time constant showed that the carrier diffusion of the OTFTs was limited by the grain boundaries between each crystalline region. The quantitative capability of the method was verified by comparing the values of the carrier mobility estimated by the tr-EFM measurement and a numerical simulation. The mobility estimated from the experiment and the simulation showed good agreement, showing the possibility of the tr-EFM to evaluate the time evolution of dynamic phenomena in semiconductor devices. [ABSTRACT FROM AUTHOR]

We deal here with a general 2-commodity flow model over a time expanded network designed for the management of a shared mobility systems. The model involves an integral flow vector that represents carriers together with an integral flow vector that represents the items transported by those carriers. It simultaneously copes with temporal and resource issues, and is difficult to handle in the practice. So we propose here a Project and Lift approach to handle it. We start by projecting the time expanded network model on the original transit network to obtain a simpler two-commodity flow projected model. In order to make this projected model consistent with the original problem, we introduce some complex constraints, prove that these constraints can be separated in polynomial time and discuss the experimental behavior of the related Branch-and-Cut algorithm. Next, we introduce the Lift issue about the way one may turn an optimal solution of our projected model into a solution of the original problem. Finally, we thoroughly study a somewhat restrictive Strong Lift setting of this Lift issue, design and test an exact mixed integer programming Strong Lift model, and discuss some flexible alternative approaches. [ABSTRACT FROM AUTHOR]

Background: Globally, the population is rapidly ageing, stemming from a recent decline in mortality, and an increase in life expectancy. About 727 million people globally were aged ≥65 in 2020, and 1 in 6 people will be ≥65 years by 2050. About 7% of Ghana's population was over 60 years in 2010, and projected to be 12% by 2050. However, the aged are confronted with degenerative conditions that translate into difficulty with mobility. The study was conducted to investigate the difficulty with mobility among the aged in Ghana. Methods: The study utilised a cross-sectional dataset of the 2014/2015 (wave 2) Study on Global Ageing and Adult Health and included 1,856 participants aged ≥50 years. The survey command was applied to adjust for sampling biases and the design of the study. At 5% alpha level, a chi-square test of independence was conducted to determine the association between dependent and independent variables. At 95% confidence interval and 5% alpha level, three-level multilevel logistic regression models were performed. The fixed-effects were presented in odds ratio and the random effects were presented using the Intra-Class Correlation. All analysis were performed using STATA statistical software version 16.0. Results: Out of the 1,856 participants, 40.3% had difficulty with mobility. Additionally, age (80 and above) [AOR = 3.05, 95%CI = 1.78–5.22], self-reported poor/bad health status [AOR = 2.39, 95%CI = 1.35–4.23], having severe/extreme difficulty performing household activities [AOR = 25.12, 95%CI = 11.49–44.91], experienced severe/extreme bodily pains [AOR = 4.56, 95%CI = 2.16–9.64], severe/extreme sleep problems [AOR = 4.15, 95%CI = 1.68–10.29], and participants with difficulty with sight/vision [AOR = 1.56, 95%CI = 1.16–2.10] had higher odds of difficulty with mobility. Conclusion: The aged in Ghana had relatively higher prevalence (40.3%) of difficulty with mobility which is influenced by demographics, health status, and degeneration associated with ageing. This highlights the need to provide social support and strengthen social capital for the aged in Ghana, especially those with difficulty with vision, experiencing bodily pains and had poor health status. Additionally, the Government and stakeholders should provide assistive devices for the aged and geriatric care including recreational fields and care homes to address the health and physical needs of the aged in Ghana. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility of implementing a self-management intervention to improve mobility in the community for stroke survivors. Methods: A two-phase sequential mixed methods design was used (a pilot randomised controlled trial and focus groups). Participants were adult stroke survivors within six months post discharge from hospital with functional and cognitive capacity for self-management. The intervention included education sessions, goal setting and action planning, group sessions, self-monitoring and follow up. The control group received usual care and both groups enrolled for 3 months in the study. Feasibility outcomes (recruitment and retention rates, randomisation and blinding, adherence to the intervention, collection of outcome measures, and the fidelity and acceptability of the intervention). Participants assessed at baseline, 3 months and 6 months for functional mobility and walking, self-efficacy, goal attainment, cognitive ability, and general health. A descriptive analysis was done for quantitative data and content analysis for the qualitative data. Findings of quantitative and qualitative data were integrated to present the final results of the study. Results: Twenty-four participants were recruited and randomised into two groups (12 each). It was feasible to recruit from hospital and community and to deliver the intervention remotely. Randomisation and blinding were successful. Participants were retained (83%) at 3 months and (79.2%) at 6 months assessments. Adherence to the intervention varied due to multiple factors. Focus groups discussed participants' motivations for joining the programme, their perspectives on the intervention (fidelity and acceptability) and methodology, perceived improvements in mobility, facilitators and challenges for self-management, and suggestions for improvement. Conclusion: The self-management intervention seems feasible for implementation for stroke survivors in the community. Participants appreciated the support provided and perceived improvement in their mobility. The study was not powered enough to draw a conclusion about the efficacy of the program and a future full-scale study is warranted. [ABSTRACT FROM AUTHOR]

Sit-to-walk (STW) is a crucial daily task that impacts mobility, independence, and thus quality of life. Existing repositories have limited STW data with small sample sizes (n = 10). Hence, this study presents a STW dataset obtained via the time-up-and-go test, for 65 healthy adults across three age groups – young (19–35 years), middle (36–55 years) and older (above 56 years). The dataset contains lower body motion capture, ground reaction force, surface electromyography, inertial measurement unit data, and responses for the knee injury and osteoarthritis outcome score survey. For validation, the within subjects intraclass correlation coefficients for the maximum and minimum lower body joint angles were calculated with values greater than 0.74, indicating good test-retest reliability. The joint angle trajectories and maximum voluntary contractions are comparable with existing literature, matching in overall trends and range. Accordingly, this dataset allows STW biomechanics, executions, and characteristics to be studied across age groups. Biomechanical trajectories of healthy adults serve as a benchmark in assessing neuromusculoskeletal impairments and when designing assistive technology for treatment or rehabilitation. [ABSTRACT FROM AUTHOR]

Older adults have higher rates of emergency department (ED) admissions when compared to their younger counterparts. Mobility is the ability to move around, but also encompasses the environment and the ability to adapt to it. Walking aids can be used to improve mobility and prevent falls. According to international guidelines, they must be available in Geriatric EDs. This study aims to evaluate the efficacy of a program of training and provision of walking aids (WA), associated or not with telemonitoring, on fear of falling, mobility, quality of life and risk of falls up to 3 and 6 months in older adults cared for in an ED. A randomized controlled trial will be carried out in the ED. Participants will be randomized and allocated into three groups, as follows: A) walking aid group will be trained for the use of a walking aid and receive guidance on safe gait; B) walking aid and telemonitoring group will receive training for the use of a walking aid, guidance on safe gait, and telemonitoring (every two weeks for first three months); C) Control group will receive only guidance on safe gait. Patients will undergo a baseline evaluation encompassing sociodemographic and clinical data, mobility in life spaces, gait speed, muscle strength, functionality, quality of life, fear of falling, history of falls, cognition and mood before the intervention. Gait time and fear of falling will be assessed again after the intervention in ED. Finally, mobility in life spaces, functionality, quality of life, fear of falling, history of falls, cognition, and mood will be assessed 3 and 6 months after discharge from the geriatric ED through a telephone interview. Provision of walking aids in the geriatric ED is currently recommended. This study will be the first randomized controlled trial that will evaluate the impact of training and provision of these devices in the ED. Trial registration number: NCT05950269. [ABSTRACT FROM AUTHOR]

Background: To examine the prevalence of toileting disability among older adults in India and its association with broad aspects of the physical and social environment. Methods: We use data from the inaugural wave of the Longitudinal Ageing Study in India and focus on adults aged 65 and older (N = 20,789). We draw on the disablement process model and existing frameworks to identify environmental factors and other risk factors that may be associated with toileting disability. Hierarchical logistic regressions are implemented to analyze the health impacts from physical and social environment characteristics. Results: One in five older Indian adults had difficulties with toileting, and the prevalence rate of this functional disability varied across sub-national regions. We find that low neighborhood trust was associated with an increased likelihood of toileting disability, as was the use of assistive mobility devices. The negative effects of these social and external environment characteristics hold when we stratified the sample by rural and urban residency. Also, older adults in urban areas without access to toilets and using shared latrines had higher odds of being disabled in terms of toileting. Other factors important in explaining toileting disability among older adults included poor self-rated health, arthritis, currently working, living in the East or West region, and having functional limitations. Conclusions: Poor person-environment fit can compromise older adults' ability to perform self-care tasks. Policymakers need to look beyond the physical environment (e.g., dedicating resources to construct toilet facilities) to adopt a more holistic, multi-faceted approach in their sanitation policies. Improving the safety of neighborhood surroundings in which shared latrines are located and the availability of accessible toilets that cater to those with mobility impairments can help improve independence in toileting among older adults. [ABSTRACT FROM AUTHOR]

Background: The ageing process is highly heterogeneous leading to diverse ageing trajectories. Such trajectories have been modelled to study trends and determinants of ageing and could potentially be used to inform the planning of rehabilitation services at population level. The objective of this paper was to explore whether healthy ageing trajectories are suitable to identify targets for rehabilitation interventions for the ageing population. Methods: Data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) harmonized cohort and the English Longitudinal Study of Ageing (ELSA), which is included in ATHLOS, were used. Growth mixture models were implemented to replicate healthy ageing trajectories modelled elsewhere as 'high stable', 'low stable', and 'rapid decline'. Regularized partial correlation networks were used to estimate expected-influence and bridge expected-influence centrality measures. Results: Healthy ageing trajectories modelled with ATHLOS (N = 131116) and ELSA (N = 14904) were consistent with previous work. At the first individual wave, prevalence of problems of respondents in the 'high stable' and 'rapid decline' trajectories were comparable; at the last individual wave, prevalence remained similar for the 'high stable' but increased substantially in all domains for the 'rapid decline' trajectory. Expected-influence centrality measures provided different results than prevalence estimates. For instance, in the first individual wave mobility and carrying, moving, and handling objects had highest impact on overall functioning for the 'rapid decline' and 'high stable' trajectories, while the most prevalent functioning problems concerned cognition, pain, as well as energy and drive functions. Conclusions: Our study stressed the relevance of healthy ageing trajectories for identifying functioning domains and categories that need to be targeted by rehabilitation services in a heterogeneous ageing population. The use of such trajectories at country level has the potential to make a meaningful contribution to the planning and delivery of rehabilitation interventions through health systems and to informed policy making. [ABSTRACT FROM AUTHOR]

Background: Neck pain is a prevalent global musculoskeletal issue, significantly contributing to the loss of years of healthy life due to disability. Chronic nonspecific neck pain (CNNP) involves diverse symptoms impacting mobility and quality of life. While therapeutic exercises demonstrate efficacy, the role of photobiomodulation therapy (PBMT) remains uncertain. This study aims to assess the additional effects of PBMT within a multimodal therapeutic intervention for CNNP. Methods: A randomized, two-arm, controlled, blind clinical trial follows CONSORT and SPIRIT guidelines. Participants diagnosed with CNNP will receive a stand-alone multimodal therapeutic intervention or the same program with additional PBMT. The primary outcomes will be assessed by the functional disability identified through applying the NDI (Neck Disability Index). Secondary outcomes will be pain intensity during rest and active neck movement, catastrophizing and kinesiophobia, functionality, and disability assessed at baseline, after 8 weeks, and at a 4-week follow-up. Both groups receive pain education before personalized interventions, including resistance exercises, neuromuscular activities, mobility, and body balance. The PBMT group undergoes low-level light therapy. Intention-to-treat analysis, using linear mixed models, employs data presented as mean, standard deviation, and differences with a 95% confidence interval. Non-normally distributed variables transform. Statistical significance is set at 5%. Discussion: This study addresses a critical gap in understanding the combined effects of PBMT and therapeutic exercises for CNNP. The findings aim to guide clinicians, researchers, and CNNP sufferers through rigorous methodology and diverse outcome assessments, offering valuable insights into evidence-based practices for CNNP management. Data confidentiality is maintained throughout, ensuring participant privacy during statistical analysis. Trial registration: Effects of adding photobiomodulation to a specific therapeutic exercise program for the treatment of individuals with chronic nonspecific neck pain, registration number: NCT05400473, on 2022-05-27. [ABSTRACT FROM AUTHOR]

Lower back pain (LBP) is a musculoskeletal condition that affects millions of people worldwide and significantly limits their mobility and daily activities. Appropriate ergonomics and exercise are crucial preventive measures that play a vital role in managing and reducing the risk of LBP. Individuals with LBP often exhibit spinal anomalies, which can serve as valuable indicators for early diagnosis. We propose an advanced machine learning methodology for LBP detection that incorporates data balancing and bootstrapping techniques. Leveraging the features associated with spinal anomalies, our method offers a promising approach for the early detection of LBP. Our study utilizes a standard dataset comprising 310 patient records, including spinal anomaly features. We propose an ensemble method called the random forest gradient boosting XGBoost Ensemble (RGXE), which integrates the combined power of the random forest, gradient boosting, and XGBoost methods for LBP detection. Experimental results demonstrate that the proposed ensemble method, RGXE Voting, outperforms state-of-the-art methods, achieving a high accuracy of 0.99. We fine-tuned each method and validated its performance using k-fold cross-validation in addition to determining the computational complexity of the methods. This innovative research holds significant potential to revolutionize the early detection of LBP, thereby improving the quality of life. [ABSTRACT FROM AUTHOR]

As age increases, a decline in lower extremity strength leads to reduced mobility and increased fall risks. This decline outpaces the age-related reduction in muscle mass, resulting in mobility limitations. Older adults with varying degrees of mobility-disability use different stepping strategies. However, the link between functional lower extremity strength and stepping strategy is unknown. Therefore, understanding how age-related reductions in functional lower extremity strength influence stepping strategy is vital to unraveling mobility limitations. Twenty participants (17F, 72 ± 6 years) were recruited and tested at a local community event. Participants were outfitted with inertial measurement units (IMU) and walked across a pressurized walkway under single and dual motor task conditions (walking with and without carrying a tray with water) at their usual and fast speeds. Participants were dichotomized into normal (11) or low functional strength groups (9) based on age-specific normative cutoffs using the instrumented 5-repetition Sit-to-Stand test duration. Our study reveals that older adults with normal strength prefer adjusting their step time during walking tasks, while those with reduced strength do not exhibit a preferred stepping strategy. This study provides valuable insights into the influence of functional lower extremity strength on stepping strategy in community-dwelling older adults during simple and complex walking tasks. These findings could aid in diagnosing gait deviations and developing appropriate treatment or management plans for mobility disability in older adults. [ABSTRACT FROM AUTHOR]

Emerging studies highlight chrononutrition's impact on body composition through circadian clock entrainment, but its effect on older adults' muscle health remains largely overlooked. To determine the associations between chrononutrition behaviors and muscle health in older adults. Dietary data from 828 older adults (76 ± 5 years) recorded food/beverage amounts and their clock time over the past 24 h. Studied chrononutrition behaviors included: (1) The clock time of the first and last food/beverage intake; (2) Eating window (the time elapsed between the first and last intake); and (3) Eating frequency (Number of self‐identified eating events logged with changed meal occasion and clock time). Muscle mass (D3‐creatine), leg muscle volume (MRI), grip strength (hand‐held dynamometer), and leg power (Keiser) were used as outcomes. We used linear regression to assess the relationships between chrononutrition and muscle health, adjusting for age, sex, race, marital status, education, study site, self‐reported health, energy, protein, fiber intake, weight, height, and moderate‐to‐vigorous physical activity. Average eating window was 11 ± 2 h/day; first and last intake times were at 8:22 and 19:22, respectively. After multivariable adjustment, a longer eating window and a later last intake time were associated with greater muscle mass (β ± SE: 0.18 ± 0.09; 0.27 ± 0.11, respectively, p < 0.05). The longer eating window was also marginally associated with higher leg power (p = 0.058). An earlier intake time was associated with higher grip strength (−0.38 ± 0.15; p = 0.012). Chrononutrition behaviors, including longer eating window, later last intake time, and earlier first intake time were associated with better muscle mass and function in older adults. [ABSTRACT FROM AUTHOR]

Findings from the Study of Muscle, Mobility and Aging (SOMMA) in this issue of Aging Cell show that several biological pathways in skeletal muscle cells play an important role in determining mobility in older adults. These are based on assays in skeletal muscle biopsies obtained from participants, aged 70 years and older in SOMMA tested for association with assessments related to mobility, including muscle mass, strength, power, cardiopulmonary fitness, and 400 m walking speed. The papers show that, using mass spectrometry, oxidative modifications of proteins essential to myocellular function are associated with poorer mobility. Using RNA‐seq to quantify gene expression, lower levels of expression of antioxidant enzymes located in mitochondria, autophagy, patterns of expression of genes involved in autophagy, and higher levels of RNA transcripts that increase with denervation were associated with poorer performance on tests of mobility. These results extend previous research from the Baltimore Longitudinal Study of Aging and recent studies from SOMMA showing the importance of mitochondrial energetics in mobility. Together, these findings are painting a picture of how fundamental cellular processes influence the loss of mobility with aging. They may also be a window on aging in other cells, tissues, and systems. The data collected in SOMMA are publicly available and SOMMA welcomes collaborations with scientists who are interested in research about human aging. [ABSTRACT FROM AUTHOR]

Aim: Although diabetes is a risk factor for walking speed decline in older adults, it remains unclear how glycaemic control [assessed by glycated haemoglobin (HbA1c)] might affect the long‐term trajectories of walking speed. We investigated whether the glycaemic control status accelerates the walking speed decline and whether this decline differs depending on previous mobility conditions. Materials and Methods: In total, 3202 individuals aged ≥60 years from the English Longitudinal Study of Ageing (ELSA) were classified at baseline and after 4 and 8 years of follow‐up according to glycaemic control status as 'without diabetes' (no self‐reported diabetes and HbA1c <6.5%), 'good glycaemic control' (self‐reported diabetes and HbA1c ≥6.5% and <7.0%) and 'poor glycaemic control' (PGC) (self‐reported diabetes and HbA1c ≥7.0%). The generalized linear mixed models verified the walking speed trajectories in m/s. A second analysis was performed, including only participants without slowness at baseline (>0.8 m/s). Results: Compared with the status 'without diabetes', the annual walking speed decline was −0.015 m/s for PGC and −0.011 m/s for good glycaemic control, totalling −0.160 and −0.130 m/s, respectively, over 8 years. Among those without slowness at baseline, only PGC had a significant walking speed decline, corresponding to −0.014 m/s per year and −0.222 m/s over 8 years. Conclusions: Poor glycaemic control is a discriminator of walking speed decline in older adults, regardless of previous mobility conditions. It may serve as an early screening tool for those at risk of decreased functional performance later in life. [ABSTRACT FROM AUTHOR]

We report on the overall health status of persons suffering from spinal cord injury paralysis (SCI) after their initial participation in a supervised post-rehabilitative exercise program and their continued participation in specific health programs over the past decade. A follow up survey was performed in the summer of 2023 on 29 current or former clients who trained at the original Project Walk program (now Perfect Step) (N = 29 average age = 32.59 ± 12.52; Men = 22, 31.82 ± 14.5 years, Women = 7, 25.86 ± 3.75 years) to ask questions regarding their mobility, medical status, and physical function. The survey was completed either in person or through phone interviews, where questions were asked to assess current health and mobility status, necessary medical interventions, current exercise programs, and quality of life. Five participants (17.2%) stated that they had the ability to be 100% mobile after their participation while 10 participants improved their mobility to at least 10% of their day. Nine of the participants eliminated their need for pain medications during their exercise program, while 15 others had a reduction in dosages or number of medications (86% reduced their use of total medications during exercise). No person who participated in the exercise program used the emergency room or hospital physician visits during their exercise program for complications related to their injury. Twenty-five of the participants saw an improvement in their activities for daily living score (86%) at an average of 4.68 on The Perfect Step FMA. These findings indicate that persons suffering from paralysis who engage in at least six months of supervised exercise will have higher functional movement scores and fewer medical interventions over time than traditional SCI programs. [ABSTRACT FROM AUTHOR]

The tourism sector plays a crucial role in the global economy, encompassing both physical infrastructure and cultural engagement. Indonesia has a wide range of attractions and has experienced remarkable growth, with Bali as a notable example of this. With the rapid advancements in technology, travelers now have the freedom to explore independently, while online travel agencies (OTAs) serve as important resources. Reviews from tourists significantly impact the service quality and perception of destinations, and text mining is a valuable tool for extracting insights from unstructured review data. This research integrates multiclass text classification and a network analysis to uncover tourists' behavioral patterns through their perceptions and movement. This study innovates beyond conventional sentiment and cognitive image analysis to the tourists' perceptions of cognitive dimensions and explores the sentiment correlation between different cognitive dimensions. We find that destinations generally receive positive feedback, with 80.36% positive reviews, with natural attractions being the most positive aspect while infrastructure is the least positive aspect. We highlight that qualitative experiences do not always align with quantitative cost-effectiveness evaluations. Through a network analysis, we identify patterns in tourist mobility, highlighting three clusters of attractions that cater to diverse preferences. This research underscores the need for tourism destinations to strategically adapt to tourists' varied expectations, enhancing their appeal and aligning their services with preferences to elevate destination competitiveness and increase tourist satisfaction. [ABSTRACT FROM AUTHOR]

Two-plus-one (2+1) highways are a special configuration of two-lane two-way (TLTW) highways with a continuous center lane that is used to alternate passing lanes. The main objective of this paper is, therefore, to evaluate the suitability of the 2+1 design for Middle East conditions as a replacement for traditional TLTW roads with higher traffic volumes or as an interim solution before transforming TLTW roads into four-lane highways. In our analysis, we considered both safety and mobility performances by comparing the 2+1 and TLTW designs. The new suggested 2+1 designs were evaluated, with the first design prohibiting overtaking in the opposite direction, while the second design permitted it. Additionally, two-speed-limit strategies, uniform speed limit (USL), and differential speed limit (DSL) were also evaluated. The results showed that the 2+1 design, which prohibited overtaking in the opposite direction, was superior to TLTW in terms of mobility and safety, while the other design compromised safety compared to TLTW. The results provide valuable information to policymakers, urban planners, and transport authorities to guide evidence-based decisions on the integration of the 2+1 design as a viable solution for sustainable and efficient transportation. [ABSTRACT FROM AUTHOR]

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Public space auditing is an efficient tool for urban planning of active mobility infrastructures. It enables real estate developers and urban planners to judge the level of comfort their design of sidewalks and public places can provide. Most of the research focus on the methodology to characterize the satisfaction of a public space, but there is a lack of knowledge about inter-cultural aspects of such methods. Our main research question is whether there is consistency in the way in which French and Spanish auditors perceived an urban streetscape: would they rate a public space the same and what features would be differently audited. We selected three urban identities of a modern district representing a variety of urban form: a public place with a tramway station, a commercial street designed as a strip mall, and green residential area with leisure activities. Each of these points of view were audited by a pool of French and Spanish participants according to criteria related to buildings' architecture and sidewalks' design for walkability and cyclability purposes. Both virtual reality and real scenes of the public spaces were recorded in videos and provided to participants for rating purposes. Architectural ambiances were measured with qualitative scales, quality of public space was measured with two integrated indicators of pedestrian level of service, and the accordance of infrastructures for active mobility was probed with individual scales. Results from the audit suggest that some streetscape impressions may be quite similar when assessed with various types of measurement, in different cultural contexts: scale, size and architectural style stimulate the same kind of feelings, and the quality of public spaces were perceived equivalently by the two communities as well as bikeability. Dissimilarities in perception occurred for the perception of materials and general feelings of the areas, and in the rating of walkability and in preferences for walking. [ABSTRACT FROM AUTHOR]

Persistent dizziness and balance deficits are common, often with unknown etiology. Persistent Postural-Perceptual Dizziness (3PD) is a relatively new diagnosis with symptoms that may include dizziness, unsteadiness, or non-vertiginous dizziness and be persistent the majority of time over a minimum of 90 days. The purpose of this case series was to investigate short-term outcomes of reducing dizziness symptoms using a manual therapy intervention focused on restoring mobility in the fascia using a pragmatically applied biomechanical approach, the Fascial Manipulation® method (FM®), in patients with 3PD. The preliminary prospective case series consisted of twelve (n = 12) patients with persistent complaints of dizziness who received systematic application of manual therapy to improve fascial mobility after previously receiving vestibular rehabilitation. The manual therapy consisted of strategic assessment and palpation based on the model proposed in the FM® Stecco Method. This model utilizes tangential oscillations directed toward the deep fascia at strategic points. Six males (n = 6) and females (n = 6) were included with a mean age of 68.3 ± 19.3 years. The average number of interventions was 4.5 ± 0.5. Nonparametric paired sample t-tests were performed. Significant improvements were observed toward the resolution of symptoms and improved outcomes. The metrics included the Dizziness Handicap Inventory and static and dynamic balance measures. The Dizziness Handicap Inventory scores decreased (i.e., improved) by 43.6 points (z = −3.1 and p = 0.002). The timed up and go scores decreased (i.e., improved) by 3.2 s (z = −2.8 and p = 0.005). The tandem left increased (i.e., improved) by 8.7 s (z = 2.8 and p = 0.005) and the tandem right increased (i.e., improved) by 7.5 s (z = 2.8 and p = 0.005). Four to five manual therapy treatment sessions appear to be effective for short-term improvements in dizziness complaints and balance in those with 3PD. These results should be interpreted with caution as future research using rigorous methods and a control group must be conducted. [ABSTRACT FROM AUTHOR]

Introduction: The effects of vitamin B12 metabolism on musculoskeletal health and the exact mechanism have not been fully determined. Our study aimed to assess the association of vitamin B12 and its biomarkers with musculoskeletal health in middle-aged and older adults. Methods: The data from the National Health and Nutrition Examination Survey 2001–2002 were used to investigate the effects of serum vitamin B12 and its biomarkers (homocysteine and methylmalonic acid) on skeletal muscle health. Bone mineral density (BMD), lean mass, gait speed and knee extensor strength were used as indicators for musculoskeletal health. Results: Serum vitamin B12 level was positively correlated with the total and appendicular lean mass (β = 584.83, P = 0.044; β = 291.65, P = 0.043) in older adults over 65 years of age. In the full population, plasma homocysteine was associated with total lean mass, appendicular lean mass, gait speed, and knee extensor strength (all P < 0.05). Among older adults over 65 years of age, homocysteine level was significantly negatively correlated with gait speed and knee extensor strength (β = -12.75, P = 0.019; β = -0.06, P <0.001). Plasma methylmalonic acid was negatively associated with total BMD and femur BMD in the full population (β = -0.01, P = 0.018; β = -0.01, P = 0.004). In older adults, methylmalonic acid significantly affected total BMD, femur BMD and knee extensor strength (β = -0.01, P = 0.048; β = -0.01, P = 0.025; β = -7.53, P = 0.015). Conclusions: Vitamin B12 and its biomarkers are closely related to BMD, body composition, muscle strength and physical function in middle-aged and older adults. Vitamin B12 may be an important indicator of musculoskeletal health in the elderly. [ABSTRACT FROM AUTHOR]

Sustainable Urban Mobility Plans (SUMPs) or similar documents from 17 European capitals (published between 2010 and 2021) and the European SUMP guidelines have been analysed to understand how cities shape mobility and their transport systems. Text analysis is applied to identify development tendencies in a time- and cost-effective manner, without relying on traditional deep semantic analysis techniques. In addition to traditional statistical indicators, we introduce Category Term Frequency (CTF) as a new measure in text analysis. CTF reveals the number and proportion of words belonging to the same content group, namely specific mobility-related categories. The results indicate that categories describing general aspects such as the future, general transport, environment, and society are more prominently represented compared to more forward-looking categories like automation, electromobility, and sharing. The aggregated CTF of categories describing these emerging aspects is highest in the mobility plans of Copenhagen, Helsinki, Luxembourg, and Vienna, which are considered forerunners in their implementation. In general, the analysis concludes that despite recent technological developments and new business models, the examined mobility plans barely mention terms that would imply radical changes by the 2030s. Strategic documents and, thus, urban mobility developments suggest only a slow transition towards the expected levels of sustainable and smart urban mobility. These findings may contribute to understanding and (re)considering urban and transport development strategies in Europe. Furthermore, this text analysis framework provides planners and other experts with a novel tool to identify the focal areas of mobility-related (or other) documents. [ABSTRACT FROM AUTHOR]

Biochar is widely used for sediment remediation owing to its excellent adsorption properties and low carbon footprint. However, the impacts of biochar capping on phosphorus (P) bioavailability and mobility in the sediment are little known. In this study, the P mobilization processes in sediments capped with biochar were investigated by combining advanced high-resolution sampling techniques and microbiome analysis. The results showed that biochar is a double-edged sword for the sediment P release, depending on the application dosage and the capping time. In the short term (30 days), 2-cm biochar capping decreased the release flux of soluble reactive phosphorus (SRP) by 73.1%, whereas the 1-cm biochar capping significantly increased the release flux of SRP by 51.0%. After aging of biochar (80 days), the resupply capacity of sediment P was improved, resulting in increases of more than 33.7% and 121.5% in the release fluxes of SRP in the 1-cm and 2-cm capping groups, respectively, compared to the control group. Chemisorption played a pivotal role in regulating the levels of SRP, particularly during the short-term capping period. And more biochar can provide more adsorption sites on P. The P mobilization increase could be attributed to P desorption from biochar after biochar aging. Furthermore, biochar capping intensified the microbial-mediated iron reduction and organic matter decomposition, which enhanced P mobility. Our study highlights the importance of biochar application dosage and the capping time in sediment remediation, providing a scientific basis for the optimization of biochar capping techniques. Highlights: Biochar capping caused a sudden increase in organic matter and P concentration. Aging biochar enhanced the bioavailability and release flux of P. Biochar capping enhanced the P mobility by altering the microbial community. [ABSTRACT FROM AUTHOR]

Gait and balance have emerged as a critical area of research in health technology. Gait and balance studies have been affected by the researchers' slow follow-up of research advances due to the absence of visual inspection of the study literature across decades. This study uses advanced search methods to analyse the literature on gait and balance in older adults from 1993 to 2022 in the Web of Science (WoS) database to gain a better understanding of the current status and trends in the field for the first time. The study analysed 4484 academic publications including journal articles and conference proceedings on gait and balance in older adults. Bibliometric analysis methods were applied to examine the publication year, number of publications, discipline distribution, journal distribution, research institutions, application fields, test methods, analysis theories, and influencing factors in the field of gait and balance. The results indicate that the publication of relevant research documents has been steadily increasing from 1993 to 2022. The United States (US) exhibits the highest number of publications with 1742 articles. The keyword "elderly person" exhibits a strong citation burst strength of 18.04, indicating a significant focus on research related to the health of older adults. With a burst factor of 20.46, Harvard University has made impressive strides in the subject. The University of Pittsburgh displayed high research skills in the area of gait and balance with a burst factor of 7.7 and a publication count of 103. The research on gait and balance mainly focuses on physical performance evaluation approaches, and the primary study methods include experimental investigations, computational modelling, and observational studies. The field of gait and balance research is increasingly intertwined with computer science and artificial intelligence (AI), paving the way for intelligent monitoring of gait and balance in the elderly. Moving forward, the future of gait and balance research is anticipated to highlight the importance of multidisciplinary collaboration, intelligence-driven approaches, and advanced visualization techniques. [ABSTRACT FROM AUTHOR]

Stroke can impair mobility, with deficits more pronounced while simultaneously performing multiple activities. In this study, common clinical tests were instrumented with wearable motion sensors to study motor–cognitive interference effects in stroke survivors (SS). A total of 21 SS and 20 healthy controls performed the Timed Up and Go (TUG), Sit-to-Stand (STS), balance, and 10-Meter Walk (10MWT) tests under single and dual-task (counting backward) conditions. Calculated measures included total time and gait measures for TUG, STS, and 10MWT. Balance tests for both open and closed eyes conditions were assessed using sway, measured using the linear acceleration of the thorax, pelvis, and thighs. SS exhibited poorer performance with slower TUG (16.15 s vs. 13.34 s, single-task p < 0.001), greater sway in the eyes open balance test (0.1 m/s2 vs. 0.08 m/s2, p = 0.035), and slower 10MWT (12.94 s vs. 10.98 s p = 0.01) compared to the controls. Dual tasking increased the TUG time (~14%, p < 0.001), balance thorax sway (~64%, p < 0.001), and 10MWT time (~17%, p < 0.001) in the SS group. Interaction effects were minimal, suggesting similar dual-task costs. The findings demonstrate exaggerated mobility deficits in SS during dual-task clinical testing. Dual-task assessments may be more effective in revealing impairments. Integrating cognitive challenges into evaluation can optimize the identification of fall risks and personalize interventions targeting identified cognitive–motor limitations post stroke. [ABSTRACT FROM AUTHOR]

Introduction: Although COVID-19 has entered the endemic phase, individuals infected with COVID-19 are required to adhere to home quarantine measures. By exploring the public's knowledge and attitude towards recommended home quarantine measures, their readiness in containing potential COVID-19 outbreak can be determined. This study aimed to assess the public knowledge and attitude towards home quarantine instructions and their association with history of COVID-19 infections. Methods: This was a web-based cross-sectional study conducted among the public in Malaysia between August to October 2022. All Malaysian adults over 18 years of age were included. Knowledge on home quarantine instructions and COVID-19 warning signs were measured using "True," "False," or "I'm not sure", while attitude towards home quarantine instructions was measured using a five-point Likert Scale. The questionnaire was initially constructed in English and then translated into the national language, Bahasa Malaysia. Face and content validation were performed. The internal consistency of the questionnaire was found to be satisfactory. Results: 1,036 respondents were analyzed, comprised mostly of females (743, 71.6%) with a history of COVID-19 (673, 64.9%). In the knowledge domain, more than 80% of the respondents answered 9 out of 11 home quarantine instructions statements correctly. 457 (44.1%) were unaware or unsure about the minimum distance of the infected individual's bed from the rest of the occupants in a shared bedroom. The respondents reported relatively weaker knowledge in identifying uncommon warning signs of COVID-19 deterioration, including anuria (162, 44.5%), ingestion problems (191, 52.5%), and immobility (195, 53.6%). In the attitude domain, more than 90% of respondents answered correctly in 8 out of 9 questions. Respondents with a previous history of COVID-19 infections had better knowledge than COVID-19 infection-naïve individuals towards both home quarantine instructions and COVID-19 warning signs. Conclusion: Most respondents had good knowledge and attitude towards home quarantine instructions, with those previously infected with COVID-19 showing greater awareness of uncommon warning signs. However, there was a notable lack of awareness regarding physical distancing within shared rooms, appropriate disinfectant use and mobility limitation within the household. This study highlights the knowledge gaps to be improved in future educational campaigns. [ABSTRACT FROM AUTHOR]

Objective: To co-create expert guidelines for the management of pregnancy, birth, and postpartum recovery in the context of hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD). Design: Scoping Review and Expert Co-creation. Setting: United Kingdom, United States of America, Canada, France, Sweden, Luxembourg, Germany, Italy, and the Netherlands. Sample: Co-creators (n = 15) included expertise from patients and clinicians from the International Consortium on the Ehlers-Danlos syndromes and Hypermobility Spectrum Disorders, facilitated by the Ehlers-Danlos Society. Methods: A scoping review using Embase, Medline, the Cochrane Central Register of Controlled Trials and CINHAL was conducted from May 2022 to September 2023. Articles were included if they reported primary research findings in relation to childbearing with hEDS/HSD, including case reports. No language limitations were placed on our search, and our team had the ability to translate and screen articles retrieved in English, French, Spanish, Italian, Russian, Swedish, Norwegian, Dutch, Danish, German, and Portuguese. The Mixed Methods Appraisal Tool was used to assess bias and quality appraise articles selected. The co-creation of guidelines was based on descriptive evidence synthesis along with practical and clinical experience supported by patient and public involvement activities. Results: Primary research studies (n = 14) and case studies (n = 21) including a total of 1,260,317 participants informed the co-creation of guidelines in four overarching categories: 1) Preconceptual: conception and screening, 2) Antenatal: risk assessment, management of miscarriage and termination of pregnancy, gastrointestinal issues and mobility, 3) Intrapartum: risk assessment, birth choices (mode of birth and intended place of birth), mobility in labor and anesthesia, and 4) Postpartum: wound healing, pelvic health, care of the newborn and infant feeding. Guidelines were also included in relation to pain management, mental health, nutrition and the common co-morbidities of postural orthostatic tachycardia syndrome, other forms of dysautonomia, and mast cell diseases. Conclusions: There is limited high quality evidence available. Individualized strategies are proposed for the management of childbearing people with hEDS/HSD throughout pregnancy, birth, and the postpartum period. A multidisciplinary approach is advised to address frequently seen issues in this population such as tissue fragility, joint hypermobility, and pain, as well as common comorbidities, including dysautonomia and mast cell diseases. [ABSTRACT FROM AUTHOR]

Drawing from trauma-informed interviews with women undergraduate students, this article examines the ripple effects of sexual violence on student (in)security and mobility. Campus sexual violence is exceedingly common, with 1 in 5 women experiencing sexual assault during college. Young women and women of color also experience the highest rates of sexual harassment and fear of sexual violence. Yet, it is still not well understood how such experiences collectively impact women students' notions of security, spatial mobility, and independence. Focusing on a small, diverse set of women undergraduate students at the University of Arizona in the Southwest U.S., I analyze how perceptions of sexual violence impact behavior and safety strategies. I describe the variety of prevention and safety methods women undergraduates utilize and how they shoulder the burden of safety and care in lieu of university action. Findings suggest that participants often built their spatial behavior around avoiding 'danger spots' or places they feared, regardless of whether those were places they had ever experienced harassment or violence. Some students of color also found themselves at the crossroads of experiencing sexual harassment and racial microaggressions and expressed an emotional drain of straddling multiple cultural worlds. Findings further complicate notions that women's fear of public space is 'irrational'. This article builds on and extends work in geographies of fear to demonstrate how women students' safety behavior in the U.S. is informed by harassment, perceived crime, and secondary trauma. [ABSTRACT FROM AUTHOR]

Children's active travel to and from school (AST) and children's independent mobility (CIM) are consistently positively associated with physical activity (PA); however, few researchers have investigated associations between objective measures of the environment and indicators of AST and CIM in national samples. A national sample of 2,067 Canadian parents of 7- to 12-year-old children was recruited in December 2020. Regression analyses were used in 2023 to assess the association between geographic information system measures of park density, blue space, population density, greenspace, intersection density, and CIM and AST to and from school. Children in areas with high versus low park density (>0.025 vs. ≤0.025) had higher odds of travel to school via active modes (OR: 1.47 [1.14, 1.91], p =0.003). Children in neighborhoods in the highest quartile for neighborhood greenspace (Normalized Difference Vegetation Index) were more likely to travel to home actively than those in areas of lower greenspace (OR: 1.70 [1.18, 2.45], p =0.004). On average, children living in areas in the highest versus the lowest quartile for intersection density were more likely to engage in AST to (OR: 2.43 [1.58, 3.75], p <0.001) and from (OR: 2.77 [1.80, 4.29], p <0.001) school. The observed associations underscore a need for city planners and policymakers to ensure sufficient access to parks and neighborhood greenspace, especially if findings are confirmed in longitudinal studies. More research is needed to investigate the role of intersection density in supporting AST and CIM. [ABSTRACT FROM AUTHOR]

In the United States and worldwide, food insecurity continues to plague underserved communities. At-risk populations experiencing other barriers to health, such as homelessness and poverty, will further suffer from food insecurity to a greater degree. Locally, public housing facilities can be improved by implementing community gardens. This will not only address food insecurity but also provide health benefits that can uniquely benefit the older adult and disabled population. Benefits include improvements in physical mobility, decreasing fall risk, and preventing vitamin D deficiency. Cruciferous vegetables grown in gardens can support the gastrointestinal system's microbiome, improving cardiovascular function. Because food insecurity is linked to depression, improving mental health through gardening can notably benefit vulnerable populations. Growing food together as a community will also reduce stress levels, increase social connectedness, and improve individual-level psychosocial outcomes. By directing efforts against food insecurity, community members can receive the vital aid needed to protect their right to health. [ABSTRACT FROM AUTHOR]

Purpose: Independence in activities of daily living (ADLs) is associated with quality of life (QoL) in individuals with dementia. However, the contribution of physical and cognitive functions to this relationship needs further examination. This study aims to examine the mediating effect of physical fitness and cognitive function in the relationship between independence in basic ADLs and QoL among older adults with dementia. Methods: This cross-sectional study included 107 older adults with dementia (74.8% women; age 78.21 ± 7.70 years). Independence in basic ADL and QoL were evaluated using the Barthel Index (BI) and QoL- Alzheimer's Disease Scale, respectively. The Alzheimer's Disease Assessment Scale–Cognitive Subscale and the Mini-Mental State Examination were applied to assess cognitive function. Physical fitness was evaluated using the 30-s chair stand, 2-min step and the Timed-Up and Go tests. A structural equation modelling (SEM) with bootstrapping estimation was conducted to determine the relationship between all variables. Results: Independence in basic ADL positively affected QoL and this association was mediated by physical fitness (β = 0.242, p = 0.011). No statistically significant results were observed when testing cognitive function as a mediator between BI and QoL (β = 0.009, p = 0.345). Conclusions: Physical fitness (i.e., lower body strength, aerobic capacity, and mobility) plays a role in the relationship between basic ADL independence and QoL of older adults with dementia, reinforcing the need to improve and monitor these parameters throughout the disease progression. Future longitudinal studies should explore the temporal relationship between physical and cognitive function and its contribution to basic ADL independence and QoL. [ABSTRACT FROM AUTHOR]

Introductions:This study assessed the effects of telehealth-delivered exercise interventions on physical functioning for older adults and explored implementation measures related to program delivery. Methods:We conducted a systematic review of studies investigating effects of exercise interventions delivered through telehealth in adults 60+ years of age with frailty, mobility, or cognitive disability on mobility, strength, balance, falls, and quality of life (QoL). Electronic databases (MEDLINE, CINAHL, SPORTSDiscus, and Physiotherapy Evidence Database) were searched from inception until May 2022. Evidence certainty was assessed with Grading of Recommendations, Assessment, Development, and Evaluation and meta-analysis summarized study effects. Results:A total of 11 studies were included, 5 randomized controlled trials, 2 pilot studies, and 4 feasibility studies. The overall certainty of evidence was rated as "low" or "very low." Pooled between-group differences were not statistically significant, but effect sizes suggested that telehealth produced a moderate improvement on mobility (n = 5 studies; standardized mean difference [SMD] = 0.63; 95% confidence interval [CI] = −0.25 to 1.51; p = 0.000, I2 = 86%) and strength (n = 4; SMD = 0.73; 95% CI = −0.10 to 1.56; p = 0.000, I2 = 84%), a small improvement on balance (n = 3; SMD = 0.40; 95% CI = −035 to 1.15; p = 0.012, I2 = 78%), and no effect on QoL. Analysis of implementation measures suggested telehealth to be feasible in this population, given high rates of acceptability and adherence with minimal safety concerns. Discussion:Telehealth may provide small to moderate benefits on a range of physical outcomes and appears to be well received in aged care populations. [ABSTRACT FROM AUTHOR]

The mobile lifestyle of digital nomads mingles remote work, international travel, and multi-local living in ways that both submit to and resist state-based mobility regimes. In this article, we examine this apparent paradox by asking how digital nomads move both with the state and against it. Employing the metaphor of 'friction', the analytical lens of 'governmobility' and ethnographic fieldwork with digital nomads, the article illustrates how nomads leverage state-imposed constraints into creative forms of 'border artistry' that allow them to achieve their lifestyle goals in the shadow of the state. At the same time, however, the article suggests that states are also border artists, an argument developed through an analysis of governments' recently established special visa programs. The findings suggest that mobility regimes do not merely determine who can or cannot move, enter, or stay, but rather exercise a kind of governmobility that encourages mobile individuals to discipline themselves according to desirable qualities such as self-sufficiency, consumer citizenship, and depoliticised mobility. In this sense, mobility regimes emerge as the mutual interface between digital nomads' individual strategies to stay on the move and states' institutional strategies to codify and commodify their legal status. [ABSTRACT FROM AUTHOR]

This research analyzes immunological response patterns to SARS-CoV-2 infection in blood and urine in individuals with serum cotinine-confirmed exposure to nicotine. Samples of blood and urine were obtained from a total of 80 patients admitted to hospital within 24 h of admission (tadm), 48 h later (t48h), and 7 days later (t7d) if patients remained hospitalized or at discharge. Serum cotinine above 3.75 ng/mL was deemed as biologically significant exposure to nicotine. Viral load was measured with serum SARS-CoV-2 S-spike protein. Titer of IgG, IgA, and IgM against S- and N-protein assessed specific antiviral responses. Cellular destruction was measured by high mobility group box protein-1 (HMGB-1) serum levels and heat shock protein 60 (Hsp-60). Serum interleukin 6 (IL-6), and ferritin gauged non-specific inflammation. The immunological profile was assessed with O-link. Serum titers of IgA were lower at tadm in smokers vs. nonsmokers (p = 0.0397). IgM at t48h was lower in cotinine-positive individuals (p = 0.0188). IgG did not differ between cotinine-positive and negative individuals. HMGB-1 at admission was elevated in cotinine positive individuals. Patients with positive cotinine did not exhibit increased markers of non-specific inflammation and tissue destruction. The blood immunological profile had distinctive differences at admission (MIC A/B↓), 48 h (CCL19↓, MCP-3↓, CD28↑, CD8↓, IFNγ↓, IL-12↓, GZNB↓, MIC A/B↓) or 7 days (CD28↓) in the cotinine-positive group. The urine immunological profile showed a profile with minimal overlap with blood as the following markers being affected at tadm (CCL20↑, CXCL5↑, CD8↑, IL-12↑, MIC A/B↑, GZNH↑, TNFRS14↑), t48h (CCL20↓, TRAIL↓) and t7d (EGF↑, ADA↑) in patients with a cotinine-positive test. Here, we showed a distinctive immunological profile in hospitalized COVID-19 patients with confirmed exposure to nicotine. [ABSTRACT FROM AUTHOR]

Several small studies have associated exposure to elevated average temperature with specific vision problems. However, no large-scale studies have examined the relationship between vision impairment and average area temperature in the general population. We conducted a cross-sectional analysis of a large nationally representative sample of older adults to further explore this relationship. Secondary analysis of the American Community Survey (ACS). The survey was conducted through mail, telephone and in-person interviews. Data from six consecutive years of the cross-sectional survey were analysed (2012–2017). The subsample analysed included community-dwelling and institutionalized older adults aged 65 and older in the coterminous US who lived in the same state in which they were born (n = 1,707,333). The question on severe vision impairment was "Is this person blind or does he/she have serious difficulty seeing even when wearing glasses?". Average annual temperature data from the National Oceanic and Atmospheric Administration was combined into a 100-year average and mapped to corresponding US Census Bureau's public use microdata areas from the ACS. Higher average temperature is consistently associated with increased odds of severe vision impairment across all cohorts (i.e. age, sex, race, income, and educational attainment cohorts) with the exception of Hispanic older adults. Compared to those who lived in counties with average temperature of < 50 °F (< 10 °C) , the odds of severe vision impairment were 44% higher in counties with average temperature of 60 °F (15.5 °C) or above (OR 1.44; 95% CI 1.42–1.46). If the association is found to be causal, the predicted rise in global temperatures could impact the number of older Americans affected by severe vision impairment and the associated health and economic burden. [ABSTRACT FROM AUTHOR]

Background Appropriate conceptualization and measurement of disability are critical for population-focused resource allocation and policy development. Self-reported and performance-based measures of functioning have been used to represent disability. Variation in environmental context or self-perception of ability may influence self-reports; however, performance-based measures that attempt to control environmental context may not accurately capture real-world aspects of functioning. This study examined the agreement between self-report and performance-based measures of functioning within 4 domains among older adults. Methods Cross-sectional data from the 2021 National Health and Aging Trends Study was used. Self-reported and performance-based measures of functioning were assessed for vision, hearing, mobility, and memory domains. We examined the diagnostic characteristics of performance-based versus self-reported measures using sensitivity, specificity, and receiver operating characteristics curves. Differences in the agreement of these measures across sociodemographic groups were investigated using logistic regression. Results Among 2 442 respondents 71 years and older (mean 78.5 ± 5.3, 56% female participants), performance measures of hearing and mobility had high sensitivity (89% and 91%, respectively) and low/moderate specificity (36% and 63%, respectively). The sensitivity and specificity of vision measures were 71%. Memory measures had high specificity (89%) and low sensitivity (28%). Performance-based discrimination ranged from 0.59 (memory) to 0.78 (mobility). Agreement varied across sociodemographic factors. Conclusions Performance measures diverge from self-reported functioning among older adults. Discordance may reveal opportunities for environmental intervention where participants' performance does not capture the full extent of barriers in their daily lives. Additional research is needed to investigate individual and environmental factors which could explain the observed differences. [ABSTRACT FROM AUTHOR]

Background: Tracking gait and balance impairment in time is paramount in the care of older neurological patients. The Minimal Detectable Change (MDC), built upon the Standard Error of the Measurement (SEM), is the smallest modification of a measure exceeding the measurement error. Here, a novel method based on linear mixed-effects models (LMMs) is applied to estimate the standard error of the measurement from data collected before and after rehabilitation and calculate the MDC of gait and balance measures. Methods: One hundred nine older adults with a gait impairment due to neurological disease (66 stroke patients) completed two assessment sessions before and after inpatient rehabilitation. In each session, two trials of the 10-meter walking test and the Timed Up and Go (TUG) test, instrumented with inertial sensors, have been collected. The 95% MDC was calculated for the gait speed, TUG test duration (TTD) and other measures from the TUG test, including the angular velocity peak (ωpeak) in the TUG test's turning phase. Random intercepts and slopes LMMs with sessions as fixed effects were used to estimate SEM. LMMs assumptions (residuals normality and homoscedasticity) were checked, and the predictor variable ln-transformed if needed. Results: The MDC of gait speed was 0.13 m/s. The TTD MDC, ln-transformed and then expressed as a percentage of the baseline value to meet LMMs' assumptions, was 15%, i.e. TTD should be < 85% of the baseline value to conclude the patient's improvement. ωpeak MDC, also ln-transformed and expressed as the baseline percentage change, was 25%. Conclusions: LMMs allowed calculating the MDC of gait and balance measures even if the test-retest steady-state assumption did not hold. The MDC of gait speed, TTD and ωpeak from the TUG test with an inertial sensor have been provided. These indices allow monitoring of the gait and balance impairment, which is central for patients with an increased falling risk, such as neurological old persons. Trial registration: NA. [ABSTRACT FROM AUTHOR]

This investigation aimed to scrutinise the kinematic and spatio-temporal characteristics of free and Nordic walking (NW) in older adults, utilising both traditional and biosensor-integrated mechatronic poles. The hypothesis was that including biosensors for gait analysis in NW poles would not disrupt the walking pattern of older adults compared to standard poles. The study involved seniors aged 65–74 who were amateur Nordic Walking (NW) practitioners. They were instructed to traverse a 100-m distance three times: without poles, with traditional NW poles, and with mechatronic poles. The MyoMOTION MR3 system was used to gather biomechanical data. The study revealed differences in eight kinematic parameters and stride time between free walking and walking with poles. However, no statistically significant differences were observed in any of the parameters, regardless of the pole type used. The findings suggest that older NW practitioners tend to employ free walking patterns even when using poles. [ABSTRACT FROM AUTHOR]

In the context of the electrification of the mobility sector, smart algorithms have to be developed to control battery packs. Smart and reconfigurable batteries are a promising alternative to conventional battery packs and offer new possibilities for operation and condition monitoring. This work proposes a reinforcement learning (RL) algorithm to balance the State of Charge (SoC) of reconfigurable batteries based on the topologies half-bridge and battery modular multilevel management (BM3). As an RL algorithm, Amortized Q-learning (AQL) is implemented, which enables the control of enormous numbers of possible configurations of the reconfigurable battery as well as the combination of classical controlling approaches and machine learning methods. This enhances the safety mechanisms during control. As a neural network of the AQL, a Feedforward Neuronal Network (FNN) is implemented consisting of three hidden layers. The experimental evaluation using a 12-cell hybrid cascaded multilevel converter illustrates the applicability of the method to balance the SoC and maintain the balanced state during discharge. The evaluation shows a 20.3% slower balancing process compared to a conventional approach. Nevertheless, AQL shows great potential for multiobjective optimizations and can be applied as an RL algorithm for control in power electronics. [ABSTRACT FROM AUTHOR]

Accessibility in today's reality is becoming an increasingly important issue as it affects every individual. We are observing the progressive ageing of the Polish population. By applying the principles of universal design, all needs related to mobility, vision, hearing, and other issues are met, thereby creating inclusive spaces that eliminate social exclusion and enhance the quality of life. This article aims to demonstrate the usefulness of BIM in building urban accessibility. For this purpose, a point cloud acquired from laser scanning of a single-family building was utilised. Based on this, a digital BIM model of the actual building was created in Revit and subsequently modernised. This modernisation aimed to remove barriers from the building, as stipulated in the relevant regulation. The paper refers to the theory of ageing in place, a response to the steady increase in average age. The BIM model is not merely a geometric representation of the building, but a digital reconstruction of the object using elements equivalent to those used in reality, allowing for efficient data management. [ABSTRACT FROM AUTHOR]

Background: Adrenoleukodystrophy (ALD) is a multifaceted, X-linked, neurodegenerative disorder that comprises several clinical phenotypes. ALD affects patients through a variety of physical, emotional, social, and other disease-specific factors that collectively contribute to disease burden. To facilitate clinical care and research, it is important to identify which symptoms are most common and relevant to individuals with any subtype of ALD. Methods: We conducted semi-structured qualitative interviews and an international cross-sectional study to determine the most prevalent and important symptoms of ALD. Our study included adult participants with a diagnosis of ALD who were recruited from national and international patient registries. Responses were categorized by age, sex, disease phenotype, functional status, and other demographic and clinical features. Results: Seventeen individuals with ALD participated in qualitative interviews, providing 1709 direct quotes regarding their symptomatic burden. One hundred and nine individuals participated in the cross-sectional survey study, which inquired about 182 unique symptoms representing 24 distinct symptomatic themes. The symptomatic themes with the highest prevalence in the overall ALD sample cohort were problems with balance (90.9%), limitations with mobility or walking (87.3%), fatigue (86.4%), and leg weakness (86.4%). The symptomatic themes with the highest impact scores (on a 0–4 scale with 4 being the most severe) were trouble getting around (2.35), leg weakness (2.25), and problems with balance (2.21). A higher prevalence of symptomatic themes was associated with functional disability, employment disruption, and speech impairment. Conclusions: There are many patient-relevant symptoms and themes that contribute to disease burden in individuals with ALD. These symptoms, identified by those having ALD, present key targets for further research and therapeutic development. [ABSTRACT FROM AUTHOR]

Objective. Full immersive virtual reality (VR) technology shows potential for reducing the risks of falls in older adults. There is yet little evidence to support the usability and acceptance on using VR technology application in community aged care service. The study reports on research that aims to address that gap by evaluating the usefulness and acceptance of using an innovative VR application among Chinese older adults from Hong Kong. Methods. A single-arm exploratory study was conducted to evaluate how the participants experienced the use of a fully immersive cave automatic virtual environment (CAVE) VR program on fall prevention. Thirty-one participants were recruited by convenience sampling based on their fall concerns and potential risk of falls. The participants completed 16 training sessions over eight weeks using the VR CAVE application. They were asked to complete a VR usability questionnaire (HK-version) based on the Technology Acceptance Model and previous research, and they took fall risk assessments at the pretest, posttest, and follow-up. Results. The participants' group significantly showed improvements in reducing the risk factors of falls including balance, functional mobility, walking speed, and fear of falling after VR intervention. Perceived usefulness (PU), perceived enjoyment (PE), user experience (UE), and intention to use (IU) had an overall significant change at different time points. These are important factors to influence the participants' acceptance of the use of VR technology applications. Perceived ease of use (PEOU) and social norms (SNs) had an inconsistent result, and some items had low validity. The findings indicated a positive training effect on fall prevention and high acceptance of the adoption of the VR technology application. Conclusion. This study supports the growing evidence on the usefulness and acceptance of using full immersive VR training on fall prevention among Chinese older adults. They perceived that the VR CAVE application was useful and innovative as an effective fall prevention training. Technically, the application of VR CAVE technology faces many challenges and is not easily manageable under COVID-19 restrictions and the limitation on technological adaptation for older adults. However, investment in full immersive VR technology application is supported for future adoption in aged care and rehabilitation services. [ABSTRACT FROM AUTHOR]

Background: Decubitus ulcers are prevalent among the aging population due to a gradual decline in their overall health, such as nutrition, mental health, and mobility, resulting in injury to the skin and tissue. The most common technique to prevent these ulcers is through frequent repositioning to redistribute body pressures. Therefore, the main goal of this study is to facilitate the timely repositioning of patients through the use of a pressure mat to identify in-bed postures in various sleep environments. Pressure data were collected from 10 healthy participants lying down on a pressure mat in 19 various in-bed postures, correlating to the supine, prone, right-side, and left-side classes. In addition, pressure data were collected from participants sitting at the edge of the bed as well as an empty bed. Each participant was asked to lie in these 19 postures in three distinct testing environments: a hospital bed, a home bed, and a home bed with a foam mattress topper. To categorize each posture into its respective class, the pre-trained 2D ResNet-18 CNN and the pre-trained Inflated 3D CNN algorithms were trained and validated using image and video pressure mapped data, respectively. Results: The ResNet-18 and Inflated 3D CNN algorithms were validated using leave-one-subject-out (LOSO) and leave-one-environment-out (LOEO) cross-validation techniques. LOSO provided an average accuracy of 92.07% ± 5.72% and 82.22% ± 8.50%, for the ResNet-18 and Inflated 3D CNN algorithms, respectively. Contrastingly, LOEO provided a reduced average accuracy of 85.37% ± 14.38% and 77.79% ± 9.76%, for the ResNet-18 and Inflated 3D CNN algorithms, respectively. Conclusion: These pilot results indicate that the proposed algorithms can accurately distinguish between in-bed postures, on unseen participant data as well as unseen mattress environment data. The proposed algorithms can establish the basis of a decubitus ulcer prevention platform that can be applied to various sleeping environments. To the best of our knowledge, the impact of mattress stiffness has not been considered in previous studies regarding in-bed posture monitoring. [ABSTRACT FROM AUTHOR]

Background: Hypophosphatasia (HPP) is a rare inherited disease caused by deficient activity of tissue-nonspecific alkaline phosphatase. Many adults with HPP have a high burden of disease, experiencing chronic pain, fatigue, limited mobility, and dental issues, contributing to decreased health-related quality of life (HRQoL). HPP may be treated with the enzyme replacement therapy asfotase alfa though real-world data in adults are limited. This analysis was conducted to assess the clinical effectiveness of asfotase alfa among adults in the Global HPP Registry. Methods: The Global HPP Registry is an observational, prospective, multinational study. Adults ≥ 18 years of age were included in this analysis if they had serum alkaline phosphatase (ALP) activity below the age- and sex-adjusted reference ranges, and/or ALPL variant(s), and received asfotase alfa for ≥ 6 months. Mobility was assessed with the 6-Minute Walk Test (6MWT), and patient-reported outcomes tools were used to assess pain (Brief Pain Inventory-Short Form), quality of life (36-item Short Form Health Survey, version 2 [SF-36v2]), and disability (Health Assessment Questionnaire-Disability Index) at multiple time points from baseline through Month 36. Data were collected as per usual standard of care; patients may not have contributed data at all time points. Results: A total of 190 patients met the inclusion criteria. For patients with ≥ 1 follow-up measurement, the mean distance achieved on 6MWT increased from 404 m (range 60–632 m) at baseline (n = 31) to 484 m at Month 12 (range 240–739 m; n = 18) and remained above baseline through Month 36 (n = 7). Improvements in mean self-reported pain severity scores ranged from − 0.72 (95% CI: − 1.23, − 0.21; n = 38) to − 1.13 (95% CI: − 1.76, − 0.51; n = 26) and were observed at all time points. Improvements in the Physical Component Summary score of SF-36v2 were achieved by Month 6 and sustained throughout follow-up. There was a trend toward improvement in the Mental Component Summary score of SF-36v2 at most time points, with considerable fluctuations from Months 12 (n = 28) through 36 (n = 21). The most frequent adverse events were injection site reactions. Conclusions: Adults with HPP who received asfotase alfa for ≥ 6 months experienced improvements in mobility, physical function, and HRQoL, which were maintained over 3 years of follow-up. Registration: NCT02306720; EUPAS13514. [ABSTRACT FROM AUTHOR]

In around 716 AD, the city of Santarém, Portugal, was conquered by the Berber and Arab armies that swept the Iberian Peninsula and went on to rule the region until the 12th century. Archaeological excavations in 2007/08 discovered an Islamic necropolis (Avenida 5 de Outubro #2–8) that appears to contain the remains of an early Muslim population in Santarém (8th– 10th century). In this study, skeletal material from 58 adult individuals was analysed for stable carbon (δ13Ccol; δ13Cap), nitrogen (δ15N) and sulphur (δ34S) isotope ratios in bones, and stable oxygen (δ18O), carbon (δ13Cen) and radiogenic strontium (87Sr/86Sr) isotopes in tooth enamel. The results of this study revealed a dietary pattern of predominantly C3-plant and domestic C3-fed herbivore consumption during adulthood (δ13Ccol and δ15N, respectively) but a higher proportion of C4-plant input during childhood (δ13Cen) for some individuals—interpreted as possible childhood consumption of millet porridge, a common practice in North Africa—in those with unorthodox burial types (Groups 1 and 2) that was not practiced in the individuals with canonical burials (Group 3). In this first mobility study of a medieval Muslim population in Portugal, δ18ODW values revealed greater heterogeneity in Groups 1 and 2, consistent with diverse origins, some in more humid regions than Santarém when compared to regional precipitation δ18O data, contrasting the more homogenous Group 3, consistent with the local precipitation δ18O range. Ancient DNA analysis conducted on three individuals revealed maternal (mtDNA) and paternal (Y-chromosome) lineages compatible with a North African origin for (at least) some of the individuals. Additionally, mobility of females in this population was higher than males, potentially resulting from a patrilocal social system, practiced in Berber and Arab communities. These results serve to offer a more detailed insight into the ancestry and cultural practices of early Muslim populations in Iberia. [ABSTRACT FROM AUTHOR]

The mobility and activity restrictions imposed in Spain due to the COVID-19 pandemic caused a significant improvement in the urban noise pollution that could be objectively measured in those cities with acoustic sensor networks deployed. This significant change in the urban soundscapes was also perceived by citizens who positively appraised this new acoustic scenario. In this work, authors present a comparative analysis between different noise indices provided by 70 sound sensors deployed in Barcelona, both during and before the lockdown, and the results of a perceptual test conducted in the framework of the project Sons al Balcó during the lockdown, which received more than one hundred contributions in Barcelona alone. The analysis has been performed by clustering the objective and subjective data according to the predominant noise sources in the location of the sensors and differentiating road traffic in heavy, moderate and low-traffic areas. The study brings out strong alignments between a decline in noise indices, acoustic satisfaction improvement and changes in the predominant noise sources, supporting the idea that objective calibrated data can be useful to make a qualitative approximation to the subjective perception of urban soundscapes when further information is not available. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the impact of microwave ablation (MWA) on pain relief, quality of life, mobility, and local tumour progression in adult patients with pelvic osteolytic bone metastasis and to test the safety of MWA. Methods This study retrospectively analysed the data from 20 patients with pelvic osteolytic metastases who received MWA combined with percutaneous osteoplasty (POP). The visual analogue scale (VAS), musculoskeletal tumour society system (MSTS), and Quality of Life Questionnaire-Bone Metastases 22 (QLQ-BM22) were used to evaluate the pain, limb function, and quality of life. The intraoperative and postoperative complications were recorded. The tumour recurrence and survival time were analysed during the follow-up period (range 3-26 months). Results All (n  = 20) MWA and POP operations were completed successfully. Four patients (20%; 95% CI, 6%-44%) had mild bone cement leakage from surrounding tissues, and there were no obvious symptoms or serious complications. There were significant differences in VAS, MSTS, and QLQ-BM22 scores before and after the operation (P  < .001). During the postoperative follow-up period, 9 patients died. The median survival time was 8 months (range 3-26 months; IQR: 4.5-13; 95% CI, 4.2-15.3 months), and the 1-year survival rate was 65% (13/20; 95% CI, 41%-85%). Tumour recurrence occurred in 4 cases (20%; 95% CI, 6%-44%) after the operation, and the median time of recurrence was 12 months (range 8-16 months; IQR: 8.25-12.75; 95% CI, 5.5-18.5 months). Conclusions MWA combined with POP is an effective and safe treatment for pelvic osteolytic metastases. It can significantly relieve local pain, reconstruct limb function, improve patients' quality of life, and effectively control local tumour progression. Advances in knowledge So far, the experience of using microwave in the treatment of pelvic metastases is still limited. MWA combined with POP in the treatment of pelvic osteolytic metastases can provide significant clinical benefits in acceptable low-risk minimally invasive situations and should be provided to patients with appropriate pelvic metastases in a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the prognostic factors associated with clinical outcomes in CV2/Collapsin response‐mediator protein 5 (CRMP5)‐IgG paraneoplastic neurologic disorders (PND). Methods: This is a retrospective study of patients with CV2/CRMP5‐IgG PND evaluated between 2002–2022. We examined the association of clinical variables (including age, clinical phenotype [autoimmune encephalopathy, myelopathy, polyneuropathy/radiculopathy, MG, cerebellar ataxia, chorea, optic neuropathy], cancer) with three clinical outcomes (wheelchair dependence, modified Rankin Scale [mRS], mortality) using univariate logistic regression and Cox proportional hazards modeling. Kaplan–Meier estimates were used to determine the probability of survival. Results: Twenty‐seven patients (56% female) with CV2/CRMP5‐IgG PND were identified with a median follow‐up of 54 months (IQR = 11–102). An underlying tumor was identified in 15 patients (56%) including small cell lung cancer (SCLC) (8, [53%]), thymoma (4, [27%]), and other histologies (3, [20%]). At last follow‐up, 10 patients (37%) needed a wheelchair for mobility and this outcome was associated with myelopathy (HR = 7.57, 95% CI = 1.87–30.64, P = 0.005). Moderate–severe mRS = 3–5 was associated with CNS involvement (encephalopathy, myelopathy, or cerebellar ataxia) (OR = 7.00, 95% CI = 1.18–41.36, P = 0.032). The probability of survival 4 years after symptom onset was 66%. Among cancer subtypes, SCLC (HR = 18.18, 95% CI = 3.55–93.04, P < 0.001) was significantly associated with mortality, while thymoma was not. Interpretation: In this retrospective longitudinal study of CV2/CRMP5‐IgG PND, patients with CNS involvement, particularly myelopathy, had higher probability of disability. SCLC was the main determinant of survival in this population. [ABSTRACT FROM AUTHOR]

This study examines how mobility-challenged persons (MCPs) navigate the limitations of transportation systems, using an integrated choice and latent variable (ICLV) model. Building on the experience of MCPs in a South Asian megacity context, that of Dhaka, Bangladesh, the empirical strategy accounts for perceptions of mode-specific challenges, which arguably vary by mobility impairment. These perceptions are posited as latent variables. Drawing on survey data collected from 400 MCPs living in Dhaka, the latent variables were constructed via a factor analysis of 18 statements about the experienced severity (ranked on a scale from 1 to 5) of mode-specific challenges. Holding socio-demographic and travel-related factors constant, we find that perceptions of mode-specific challenges significantly influence mode choices – while the degree of impairment alone, and related mobility aid needed, do not. Perceived limitations of the walking infrastructure shift MCPs' travel demand towards the bus, whereas bus fare-related issues encourage the use of non-motorized and powered three-wheelers. We recommend that mode choice models include latent variables related to MCPs' perceptions of various modes to more accurately inform universal access policies. • Mode-specific challenges significantly influence mode choices. • Perceived limitations of the walking infrastructure encourage MCP to use bus. • Bus fare-related issues encourage the use of rickshaw and auto-rickshaw. • Mobility aids have a significant relationship with mode-specific challenges. [ABSTRACT FROM AUTHOR]