Flight Of Stairs Research Articles

Lateralization of spontaneous behaviours in the domestic cat, Felis silvestris

Recent research has drawn attention to the link between lateral bias and cerebral functional asymmetry in animals. Most studies of animal laterality have focused on limb use arising from forced experimental challenges as opposed to spontaneous behaviours. This study explored, for the first time, the expression of lateralized spontaneous behaviour in the domestic cat, a species that exhibits motor bias in the form of paw preferences. The side used by 44 pet cats to perform three spontaneous behaviours (lying side, stepping down a flight of stairs, stepping over a raised object) was recorded. Paw preferences were also assessed using a more traditional forced food reaching challenge. Cats showed a significant lateral bias for food reaching, stepping down and stepping over. Those with a paw preference, however, did not differ significantly in their tendency towards left or right sidedness. The direction of the cats' side preferences was significantly correlated for most measures, whether forced or spontaneous. The strength of the cats' motor bias was significantly related to the task; animals displayed a weaker lateral bias for lying side than any other measure. The study revealed a sex split in the direction, although not the strength, of the cats' lateral bias for food reaching, stepping down and stepping over. Males showed a significant preference for using their left paw on these measures, while females were more inclined to use the right one. The study provides the first evidence that the domestic cat displays motor laterality on specific spontaneous behaviours, and that the direction, although not the strength, of these lateral biases is largely consistent with that of an experimental task. The results suggest that the more forced food-reaching test traditionally used to assess motor bias in the cat offers a biologically valid measure of limb use in this species.

Stair ascending–descending exercise accelerates the decrease in postprandial hyperglycemia more efficiently than bicycle exercise

ObjectiveStair climbing–descending exercise (ST-EX) is a convenient method to increase exercise intensity. We compared the acute effect of ST-EX on lowering postprandial hyperglycemia with that of constant bicycle exercise (BI-EX)...

Femoral artery plaque characteristics, lower extremity collaterals, and mobility loss in peripheral artery disease.

Little is known about the prognostic significance of specific characteristics of magnetic resonance imaging (MRI) measured plaque in the superficial femoral artery (SFA). Associations of MRI-measured plaque quantity, lumen area, and plaque composition in the SFA with subsequent mobility loss were studied in people with lower extremity peripheral artery disease (PAD). Participants with an ankle-brachial index (ABI) < 1.00 were identified from Chicago medical centers and underwent direct visualization of atherosclerotic plaque in the SFA using MRI. Participants were followed annually for up to 4 years. Mobility loss was defined as becoming unable to walk up and down a flight of stairs or walk one-quarter of a mile without assistance among participants without mobility impairment at baseline. Analyses adjusted for age, sex, race, comorbidities, ABI, physical activity, and other confounders. Of 308 PAD participants without baseline mobility impairment, 100 (32.5%) developed mobility loss during follow-up. Compared to the lowest mean plaque area tertile at baseline, participants in the highest (worst) plaque area tertile had a higher rate of mobility loss (hazard ratio (HR) = 2.08, 95% confidence interval (CI) = 1.14-3.79, p = 0.018). Compared to the highest mean lumen area tertile, the smallest (worst) mean lumen area tertile was associated with greater mobility loss (HR = 2.18, 95% CI = 1.20-3.96, p = 0.011). Neither lipid rich necrotic core nor calcium in the SFA were associated with mobility loss. In conclusion, greater plaque quantity and smaller lumen area in the proximal SFA, but not lipid rich necrotic core or calcium, were associated with higher mobility loss in people with PAD.

Predicting postoperative cardio-pulmonary complications by a test of stair climbing.

To assess whether a test of stair climbing ability could be used to predict the risk of developing postoperative cardiopulmonary complications in patients undergoing general anesthesia. Cohort study. The Aga Khan University Hospital, Karachi. The duration of the study was from December 2003 to December 2004. This study was carried out on consecutive, adult patients presenting for elective thoracic or abdominal surgery under general anesthesia. Pre-operatively, patients were asked to climb a standard staircase. Number of steps climbed was recorded. Those unable to climb stairs due to debilitating cardiac, pulmonary or rheumatologic disease were categorized as 0 stairs climbed. Outcome variables were postoperative cardiopulmonary complications or mortality. Period of follow-up was until hospital discharge. Seventy-eight patients were enrolled, 59 (75.6%) climbed 1 flight of stairs, 19 (24.3%) climbed < 1 flight. All-cause cardiopulmonary complications rate was 26 %. The most frequent complication was lobar atelectasis, followed by bronchospasm and acute MI. The complication rate was 22.8% in those able to climb 1 flight and 40% in those patients who climbed < 1 flight. The group that climbed < 1 flight tended to have complications associated with poor reserves of the cardiopulmonary systems, i.e. pulmonary edema, exacerbation of underlying lung disease. The relative risk of developing complications, if unable to climb at least 1 flight of stairs, was calculated to be 1.8 (95% CI 0.7 - 4.6). Stair climbing can be a useful pre-operative tool to predict the risk of postoperative cardiopulmonary complications.

Patient-Reported Dyspnea Correlates Poorly with Aerobic Exercise Capacity Measured During Cardiopulmonary Exercise Testing.

Patient-reported dyspnea plays a central role in assessing cardiopulmonary disease. There is little evidence, however, that dyspnea correlates with objective exercise capacity measurements. If the correlation is poor, dyspnea as a proxy for objective assessment may be misleading. To compare patient's perception of dyspnea with maximum oxygen uptake (MaxVO2) during cardiopulmonary exercise testing (CPET). Fifty patients undergoing CPET for dyspnea evaluation were studied prospectively. Dyspnea assessment was measured by a metabolic equivalent of task (METs) table, Mahler Dyspnea Index, Borg Index, number of blocks walked, and flights of stairs climbed before stopping due to dyspnea. These descriptors were compared to MaxVO2. MaxVO2 showed low correlation with METs table (r=0.388, p=0.005) and no correlation with Mahler Index (r=0.24, p=0.093), Borg Index (r=-0.017, p=0.905), number of blocks walked (r=0.266, p=0.077) or flights of stairs climbed (r=0.188, p=0.217). When adjusted for weight (maxVO2/kg), there was significant correlation between MaxVO2 and METs table (r=0.711, p<0.001), moderate correlation with blocks walked (r=0.614, p<0.001), and low correlation with Mahler Index (r=0.488 p=0.001), Borg Index (r=-0.333 p=0.036), and flights of stairs (r=0.457 p=0.004). Subgroup analysis showed worse correlation when patients with normal CPET were excluded (12/50 excluded). Patients with BMI<30 had no correlation between Max VO2 and the assessment methods, while patients with BMI>30 had moderate correlation between MaxVO2 and METs table (r=0.568, p=0.002). Patient-reported dyspnea correlates poorly with MaxVO2 and fails to predict exercise capacity. Reliance on reported dyspnea may result in suboptimal categorization of cardiopulmonary disease severity.

Falling down a flight of stairs: The impact of age and intoxication on injury pattern and severity.

BackgroundFalling down a flight of stairs is a common injury mechanism in major trauma patients, but little research has been undertaken into the impact of age and alcohol intoxication on the injury patterns of these patients. The aim of this study was to compare the impact of age and alcohol intoxication on injury pattern and severity in patients who fell down a flight of stairs.MethodsThis was a retrospective observational study of prospectively collected trauma registry data from a major trauma centre in the United Kingdom comparing older and younger adult patients admitted to the Emergency Department following a fall down a flight of stairs between July 2012 and March 2015.ResultsOlder patients were more likely to suffer injuries to all body regions and sustained more severe injuries to the spine; they were also more likely to suffer polytrauma (23.6% versus 10.6%; p < 0.001). Intoxicated patients were more likely to suffer injuries to the head and neck (42.9% versus 30.5%; p = 0.006) and were significantly younger than sober patients (53 versus 69 years; p < 0.001).ConclusionOlder patients who fall down a flight of stairs are significantly different from their younger counterparts, with a different injury pattern and a greater likelihood of polytrauma. In addition, alcohol intoxication also affects injury pattern in people who have fallen down a flight of stairs, increasing the risk of traumatic brain injury. Both age and intoxication should be considered when managing these patients.

ENabling Reduction of Low-grade Inflammation in SEniors Pilot Study: Concept, Rationale, and Design.

To test two interventions to reduce interleukin (IL)-6 levels, an indicator of low-grade chronic inflammation and an independent risk factor for impaired mobility and slow walking speed in older adults. The ENabling Reduction of low-Grade Inflammation in SEniors (ENRGISE) Pilot Study was a multicenter, double-blind, placebo-controlled randomized pilot trial of two interventions to reduce IL-6 levels. Five university-based research centers. Target enrollment was 300 men and women aged 70 and older with an average plasma IL-6 level between 2.5 and 30 pg/mL measured twice at least 1 week apart. Participants had low to moderate physical function, defined as self-reported difficulty walking one-quarter of a mile or climbing a flight of stairs and usual walk speed of less than 1 m/s on a 4-m usual-pace walk. Participants were randomized to losartan, omega-3 fish oil (ω-3), combined losartan and ω-3, or placebo. Randomization was stratified depending on eligibility for each group. A titration schedule was implemented to reach a dose that was safe and effective for IL-6 reduction. Maximal doses were 100 mg/d for losartan and 2.8 g/d for ω-3. IL-6, walking speed over 400 m, physical function (Short Physical Performance Battery), other inflammatory markers, safety, tolerability, frailty domains, and maximal leg strength were measured. Results from the ENRGISE Pilot Study will provide recruitment yields, feasibility, medication tolerance and adherence, and preliminary data to help justify a sample size for a more definitive randomized trial. The ENRGISE Pilot Study will inform a larger subsequent trial that is expected to have important clinical and public health implications for the growing population of older adults with low-grade chronic inflammation and mobility limitations.

Fitness plus American Society of Anesthesiologists grade improve outcome prediction after endovascular aneurysm repair

Although the American Society of Anesthesiologists (ASA) grade was established for statistical purposes, it is often used prognostically. However, older patients undergoing elective surgery are typically ASA III, which limits patient stratification. We look at the prognostic effect on early complications and survival of using ASA and self-reported physical fitness to stratify patients undergoing endovascular repair of abdominal aortic aneurysms. Data were extracted from a trial database. All patients were assigned a fitness level (A (fit) or B (unfit)) based on their self-reported ability to walk briskly for 1 km or climb two flights of stairs. Fitness was used to stratify ASA III patients, with fitter patients assigned ASA IIIA and less fit patients ASA IIIB. Outcomes assessed included survival, reinterventions, endoleak, all early and late complications and early operative complications. A combined ASA/fitness scale (II, IIIA, IIIB and IV) correlated with 1- and 3-year survival (1-year P = 0.001, 3-year P = 0.001) and early and late complications (P = 0.001 and P = 0.05). On its own, ASA predicted early complications (P = 0.0004) and survival (1-year P = 0.01, 3-year P = 0.01). Fitness alone was predictive for survival (1-year P = 0.001, 3-year P = 0.001) and late complications (P = 0.009). This study shows that even a superficial assessment of fitness is reflected in surgical outcomes, with fitter ASA III patients showing survival patterns similar to ASA II patients. Physicians should be alert to differences in fitness between patients in the ASA III group, despite similarities based on preexisting severe systemic disease.

USE OF WEARABLE MOTION SENSORS TO ASSESS THE BEHAVIOUR OF ALZHEIMER'S PATIENTS IN SIMULATED DOMESTIC ENVIRONMENTS

It has been postulated that the development of a dementia-friendly environment can enhance autonomy in Alzheimer's Disease. However, there a few studies that have investigated this in a controlled way. Data from wearable sensors can provide continuous objective measures of performance of task activity. Therefore, we have created controlled simulated real-world environments, using wearable sensors to evaluate activity. Three groups of participants were studied: patients with either Posterior Cortical Atrophy or Alzheimer's Disease, and age-matched controls. Simulated controlled environments were created within the Pedestrian Accessibility and Movement Environment Laboratory (PAMELA) to assess performance of different tasks: navigation along corridors, ascending and descending stairs, navigating rooms to an open door, and reaching for objects. Conditions within the environment could be varied systematically, by altering lighting levels, providing visual cues, or adding clutter to the environment. Depending on the specific task, inertial measurement units (IMUs) were placed on the feet, head and hands to assess performance. For some data series, simultaneous recordings from an opto-electronic motion capture system were performed. Foot movement was calculated from accelerations of the foot sensors, by double integration and correcting for sensor drift by identifying zero-velocity periods. This allowed calculation of spatio-temporal parameters of gait, in addition to being able to track participants moving within the environment. Locations of hesitation can then be identified. Tracking of foot movement has also shown abnormal activity with stair climbing in some patients (Figure1). Analysis of head movement has also shown that a number of Alzheimer's participants scan the environment when performing some tasks to a greater degree compared with controls (Figure 2). Use of the controlled environment of PAMELA to simulate a number of domestic environments allowed conditions to be varied in a reproducible way, and enabled the identification of situations where environmental factors may be beneficial or otherwise. The technology used for the assessment of performance is completely transferable, requiring no specific infrastructure to perform the measurement. This would allow follow-up studies to be performed within the home, day centre or care home, in order to improve design, evaluate aids or assess risk. Examples of movement of the heel measured by IMUs for control subject (left) and participants with PCA (right) when ascending a short flight of stairs. The PCA participant shows considerable uncertainty in performing this task. Examples of head orientation for a control participant (left) and an Alzheimer's subject (right) when crossing a room from one side to an open door on the other side. Compared with the control, the Alzheimer's subject takes much longer to complete the task, and shows considerably more side-to-side movement of the head in completing the task.

Special report : Can we copy the brain? - The brain as computer

Painful exercises in basic arithmetic are a vivid part of our elementary school memories. A multiplication like 3,752 × 6,901 carried out with just pencil and paper for assistance may well take up to a minute. Of course, today, with a cellphone always at hand, we can quickly check that the result of our little exercise is 25,892,552. Indeed, the processors in modern cellphones can together carry out more than 100 billion such operations per second. What's more, the chips consume just a few watts of power, making them vastly more efficient than our slow brains, which consume about 20 watts and need significantly more time to achieve the same result. Of course, the brain didn't evolve to perform arithmetic. So it does that rather badly. But it excels at processing a continuous stream of information from our surroundings. And it acts on that information-sometimes far more rapidly than we're aware of. No matter how much energy a conventional computer consumes, it will struggle with feats the brain finds easy, such as understanding language and running up a flight of stairs.

David Ashbaugh reminisces

In 1964, while I was working as codirector of the University of Colorado's (Boulder, CO, USA) first intensive care unit (ICU), I saw my first case of what turned out to be acute respiratory distress syndrome. At the time, I was puzzled about a number of symptoms that I hadn't previously recognised. If the patient had been admitted in the time before intensive care wards and respirators, they would have died without the attending physician knowing why and how. This particular patient was one of the first admitted to a new ICU set up by Dr Thomas Petty and myself. We had just finished residencies in medicine and surgery, respectively, and had lobbied for and obtained the necessary funds and space. We had one primitive respirator to use on patients with respiratory failure. The patient was admitted as a surgical trauma patient to my service, with multiple fractures after an automobile accident. Despite major blood loss, he soon stabilised and had a normal chest x-ray despite a few broken ribs. Over the course of 48 h, he developed respiratory distress and was intubated and put on the respirator, which was run from the hospital wall oxygen supply on a pressure-controlled basis. Despite 100% oxygen and maximum pressure, his condition worsened and fluffy infiltrates appeared in both lungs. He proceeded to die of respiratory failure. The rapid onset fluffy infiltrates, increasing pressures that required us to ventilate the patient, and falling oxygenation puzzled me as I had not seen this in patients before. Over the following months I saw a couple of similar cases, and went to the library to see what I could find. At the time there was only one reported case of congestive atelectasis following trauma. I consulted with our pathologists and infectious disease specialists and we did find hyaline membranes and alveolar haemorrhage in our patient. Some months later I had borrowed an Engstrom respirator from our anaesthesia department. It was a volume-controlled device and superior to anything we had on our ICU. When a 12-year-old boy presented in the emergency room on a Saturday morning, I was called to come down as he was in severe respiratory distress and coughing up blood after being backed over by a pickup truck. I did an immediate tracheostomy and transferred him to the paediatric care unit. Tom Petty had recently obtained a new blood gas analyser and I learned how to operate it. I spent the morning running up and down four flights of stairs and watching the patient's arterial blood gas deteriorate as we suctioned more and more blood from his tracheotomy. He was attached to the new respirator and I noticed, off to the right hand side, a red dial labelled “end expiratory pressure”. I wondered if this might help and dialled in a moderate amount. Within minutes the bleeding slowed and then stopped and the arterial blood gas returned to normal limits. Over the next few days he was weaned from the respirator and made a complete recovery. While this was obviously a case of traumatic pulmonary contusion, it was still a case of severe respiratory distress and positive end expiratory pressure was clearly an effective treatment. Within 2 years we had collected 12 cases, which included three patients treated with positive end expiratory pressure. Getting the paper published was a struggle, and after four rejections from US-based journals, we submitted it to The Lancet, which not only accepted the paper, but published it on the basis of in-house review within 6 weeks. For the first description of ARDS see Lancet 1967; 290: 319–23 For the first description of ARDS see Lancet 1967; 290: 319–23

Racial differences in functional decline in peripheral artery disease and associations with socioeconomic status and education

ObjectiveThe objective of this study was to determine whether blacks with lower extremity peripheral artery disease (PAD) have faster functional decline than whites with PAD. MethodsParticipants with ankle-brachial index <0.90 were identified from Chicago medical centers and observed longitudinally. Mobility impairment and the 6-minute walk were assessed at baseline and every 6 to 12 months. Mobility loss was defined as becoming unable to walk up and down a flight of stairs or to walk ¼ mile without assistance. ResultsOf 1162 PAD participants, 305 (26%) were black. Median follow-up was 46.0 months. Among 711 PAD participants who walked 6 minutes continuously at baseline, black participants were more likely to become unable to walk 6 minutes continuously during follow-up (64/171 [37.4%] vs 156/540 [28.9%]; log-rank, P = .006). Black race was associated with becoming unable to walk 6 minutes continuously, adjusting for age, sex, ankle-brachial index, comorbidities, and other confounders (hazard ratio, 1.45; 95% confidence interval, 1.05-1.99; P = .022). This association was attenuated after adjustment for income and education (P = .229). Among 844 participants without baseline mobility impairment, black participants had a higher rate of mobility loss (64/209 [30.6%] vs 164/635 [25.8%]; log-rank, P = .009). Black race was associated with increased mobility loss, adjusting for potential confounders (hazard ratio, 1.42; 95% confidence interval, 1.04-1.94; P = .028). This association was attenuated after additional adjustment for income and education (P = .392) and physical activity (P = .113). There were no racial differences in average annual declines in 6-minute walk, usual-paced 4-meter walking velocity, or fast-paced 4-meter walking velocity. ConclusionsBlack PAD patients have higher rates of mobility loss and becoming unable to walk for 6 minutes continuously. These differences appear related to racial differences in socioeconomic status and physical activity.

Chronic Dyspnea - Running

HISTORY: 63 year-old male presented to clinic with complaint of continued severe shortness of breath status-post left total shoulder arthroplasty. Surgery was performed under general anesthesia with interscalene nerve block for regional anesthesia. Previously, patient had been running 3 miles per day and golfing regularly without issues. Immediately after the surgery, he began to notice a significant decrease in his functional status due to SOB. He now has difficulty walking up one flight of stairs, cutting the grass, or golfing more than 9 holes because of the SOB he experiences with activity. Denies fevers, chills, cough, hemoptysis, chest pain, palpitations, and calf pain. He is otherwise very happy with the improvements in pain, ROM, and overall functionality of his left shoulder s/p left TSA. PHYSICAL EXAMINATION: VS: BP 132/76, P 66, Temp 36.7 C, Resp 18, SpO2 96%; Gen: Awake, alert, cooperative, NAD; Lungs: No increased work of breathing, good air exchange, CTAB, No rales or wheezing; CV: RRR, +S1S2, no S3 or S4, no murmurs noted; Neuro: AOx3, sensation to light touch intact throughout LUE, no focal deficits; Skin: Surgical incisions clean, dry, and intact DIFFERENTIAL DIAGNOSIS: 1. Atelectasis 2. Pulmonary Embolism 3. Underlying pulmonary condition (COPD vs. pulmonary fibrosis vs. lung carcinoma) 4. Congestive heart failure 5. Diaphragmatic paralysis from phrenic nerve injury TEST AND RESULTS: CTA Chest: significant pleural effusion, negative for PE; CXR: elevated left hemi-diaphragm FINAL WORKING DIAGNOSIS: Left diaphragmatic paralysis secondary to phrenic nerve injury associated with interscalene block TREATMENT AND OUTCOMES: 1. Patient initially on Aspirin and encouraged to ambulate for DVT prophylaxis 2. Provided with an incentive spirometer to prevent post-op atelectasis 3. Extensive outpatient Cardiology and Pulmonology evaluations without findings of underlying medical condition to explain symptoms 4. Suspected phrenic nerve injury associated with pre-operative interscalene block 5. Pulmonary rehabilitation performed with minimal improvement symptoms 6. We have discussed the possibility of further pulmonary rehabilitation vs. neurosurgical consultation for possibility of phrenic nerve decompression with possible nerve graft

Stair-Climbing Capacity as a Marker of Improvement Following Pulmonary Rehabilitation.

The aim of this study was to explore the potential and safety of a stair-climbing test as a tool to monitor improvement following pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). Stair-climbing capacity was assessed in 139 patients with COPD before and after a comprehensive 8-week PR program, which included stair-climbing training. Stair-climbing capacity was assessed as the total number of flights of stairs climbed without stopping. A constant work rate endurance test (CET) was also performed before and after PR. Change in stair-climbing after PR (Δstairs) was compared and correlated to the change in endurance time (ΔCET) and, for 40 patients, to the change in COPD assessment test (ΔCAT) score. Most patients had moderate to severe COPD (mean forced expiratory volume in 1 second = 54% ± 20% predicted). Stair-climbing capacity, endurance time, and CAT score improved after PR (2.8 ± 1.4 vs 8.3 ± 3.3 flights, 408 ± 272 vs 717 ± 415 seconds, and 20.0 ± 6.4 vs 17.6 ± 6.6 units, respectively; P value for all < .001). Δstairs was moderately correlated to ΔCET (r = 0.49; P < .001) and well correlated to ΔCAT (r = -0.71; P < .001). Patients with greater change in Δstairs had better baseline resting lung function and aerobic capacity. No adverse events were reported during stair-climbing. Stair-climbing is responsive to training in patients with COPD and is correlated to the change in CAT score following PR. Although the test requires further standardization, it could eventually be used as a simple and safe way to assess improvement following interventions in COPD.

Changes in physical activity following total hip or knee arthroplasty: a matched case-control study from the EPIC-Norfolk cohort

Objective: To assess self-reported physical activity changes pre- compared to post-operatively in patients undergoing total hip or knee arthroplasty, and to compare this to an age- and gender-matched cohort of people who have not undergone arthroplasty. Design: Population-based prospective cohort study. Setting: Norfolk, United Kingdom. Subjects: People who had undergone hip or knee arthroplasty, compared to an age- and gender-matched non-arthroplasty cohort. Intervention: Primary total hip or knee arthroplasty. Main measures: Physical activity, measured using the EPIC Physical Activity Questionnaire (EPAQ2). Results: A total of 400 people from the EPIC-Norfolk community cohort were identified who had undergone hip or knee arthroplasty. In all, 767 people were identified to form an age- and gender-matched non-arthroplasty cohort. Mean post-operative follow-up was 43 months post-total hip and 41 months post-total knee arthroplasty. There was a statistically significant reduction from pre- to post-arthroplasty in the number of flights of stairs climbed weekly (hip: mean difference (MD): 6.8; P < 0.01; knee: MD: 10.2; P < 0.01), duration of walking (hip: MD: 1.4 hours/week; P = .02; knee: MD: 2.2 hours/week; P < 0.01) and duration of total recreational activity (hip: MD: 1.1 hours/week; P = 0.02). Compared to the non-arthroplasty cohort, duration of physical activity was lower post-total hip arthroplasty (MD: 1.8 hours/week; P = 0.01). The number of flights of stairs climbed weekly (MD: 12.0; P < 0.01), total recreational activity (MD: 1.7 hours/week; P = 0.04) and physical activity energy expenditure (MD: 5.7 Mets-hours/week; P = 0.05) were lower for people post-total knee arthroplasty compared to the matched controls. Conclusions: Physical activity did not increase, and in some instances decreased, following total hip or knee arthroplasty.

Reliability, Validity, and Minimal Detectable Change of Four-Step Stair Climb Power Test in Community-Dwelling Older Adults.

Stair climb power is an important clinical measure of lower-extremity power. The stair climb power test (SCPT) was validated by requiring individuals to climb a full flight of stairs. A 4-step SCPT (4SCPT) would be more clinically feasible and easier to perform, yet its reliability and validity are unknown. To evaluate reliability, validity, and minimal detectable change of 4SCPT among community-dwelling older adults. This study is a cross-sectional analysis of baseline data from a clinical trial. Fifty older adults ≥65 years of age, at risk for mobility decline, consented to participate in this ancillary study. Test-retest reliability was derived from 2 measurements within each participant measured by a single assessor. Pearson correlation analyses among leg power measures (4SCPT, SCPT, single leg press power at 40% and 70% of the 1-repetition maximum [SLP40, SLP70]) were performed. Separate multivariate linear regressions were conducted evaluating the associations between each leg power measure and 2 mobility outcomes, the Short Physical Performance Battery (SPPB) and habitual gait speed (HGS). Minimal detectable change was based on a 90% confidence interval (MDC 90 ). The 4SCPT had excellent test-retest reliability (ICC(2,1) = 0.951), and strong correlation with SCPT, SLP40, and SLP70 ( r = 0.85-0.96). The 4SCPT explained a greater amount of variance in the SPPB (R 2 = 0.31) than other leg power measurements (R 2 = 0.23-0.25). The 4SCPT (R 2 = 0.41) and SCPT (R 2 = 0.42) described equivalent amounts of variance in HGS, and greater than that with SLP40 (R 2 = 0.28) and SLP70 (R 2 = 0.30). The MDC 90 for 4SCPT was 44.0 watts. This was a cross-sectional analysis within a small, nonrepresentative sample. Interrater reliability was not evaluated. The 4SCPT shows scientific promise as a valid and reliable leg power measurement among community-dwelling older adults.

Basement wall under earth pressure loading with low surcharge

AbstractThe structural verification of basement walls under earth pressure loading with low surcharge is often a difficult part of the everyday work of engineers. This situation is often encountered for basement walls under terrace doors, stair flights, masonry light wells etc., where the theoretically necessary surcharge loading is lacking. In this case, it is possible to transfer the acting forces from earth pressure with an arch model. One constructively possible measure to resist the resulting arch thrust is the provision of a sufficiently stiff reinforced concrete beam at the head of the basement wall. The article explains the verification of this method according to current standards.

Diffuse Idiopathic Skeletal Hyperostosis (DISH) and Impaired Physical Function: The Rancho Bernardo Study.

Investigate associations of diffuse idiopathic skeletal hyperostosis (DISH) with self-reported and measured physical function in older adults. Cross-sectional analyses of data collected in 1992-96 from a longitudinal cohort. Research clinic within a community. Community-dwelling men (n = 630) and women (n = 961), mean age 71.5 years (SD = 10.8), from the Rancho Bernardo Study. DISH assessed from lateral thoracic and lumbar spine radiographs; self-reported difficulty bending over to the floor, walking 2-3 level blocks, or climbing 1 flight of stairs; performance-based measures of grip strength and chair-stand testing (ability to stand up and sit down in a chair 5 times without using chair arms). DISH was present in 25.6% of men and 5.5% of women. In age and sex-adjusted models, those with DISH had 1.72-fold increased odds (95% CI: 1.13, 2.62) of self-reported difficulty bending; this remained significant after further adjustment for Cobb angle, weight, stroke, arthritis, and exercise, OR = 1.69, (95% CI: 1.07, 2.66). In fully adjusted multivariate models, those with DISH had worse grip strength, -1.08 kg, P = .01, but did not differ from those without DISH on walking or climbing stairs. In sex-stratified, fully adjusted models, among men only, those with DISH were 2.17-times (95% CI: 1.04, 4.52) more likely to be unable to complete 5 chair stands without using their arms. DISH was less prevalent in women but affected almost one-quarter of older white men. People with DISH are more likely to experience physical functional impairment, suggesting that DISH has clinical correlations and is not an incidental radiographic finding.

An Introduction to Concept and Evolution of the Guardstone and Its Architectural Visualization of the Contemporary Religious and Cultural Diversities

&lt;p&gt;This specific study deals with a unique piece of Buddhist architecture, the Guardstone found almost in every part of ancient kingdoms in Sri Lanka spanning from Anuradhapura to Kandy period significantly. The Guardstone is an excellent piece of structure placed on either side of the first step of the flight of stairs at the entrance of ancient religious buildings or palaces in Sri Lanka. The origin of this architectural masterpiece is still to determine. Nevertheless, it is widely accepted in an evolutionary point of view that the guardstone has passed through several developmental stages from a simple slab to a highly sophisticated artifact in its dimensions, complexity and artistry. The numerous inclusions as well as exclusions from time to time to this artifact still remain uncertain as to whether they were due to secular or ecclesiastical reasons or simply due to the creators own culture influenced imagination. This study will peruse all the possible evidence that are available architecturally and to develop a logical reasoning for any identifiable characteristic and to elucidate with reasonable legitimacy as to how and why such a character is present or absent in a particular guardstone. This study in no way has any intention of rejecting or amending any proposition available at present but will pursue its best to shed light only on the attributes of a guardstone and to concentrate on the diversities of this beautiful monastic artifact that deserves serious academic study and meticulous aesthetic evaluation.&lt;/p&gt;

Intersections of Multiple Oppressions: Racism, Sizeism, Ableism, and the “Illimitable Etceteras” in Encounters With Law Enforcement,

This think piece on the intersectionality of multiple oppressive markers incorporates critical race feminism, fat studies, body/embodiment studies, and dis/ability studies. It discusses the cases of two African Americans deemed irresolvable nuisances, treated as threats to police, and dealt with, with undue force, resulting in their untimely deaths. Eleanor Bumpurs, 66, was a black female of older age, ample size, with physical and mental disabilities; she was arthritic, fighting off hallucinations, and was economically disadvantaged. Eric Garner, 43, was a black male of ample size, with physical disabilities; he was diabetic, asthmatic, with sleep apnea and a heart condition, all of which made employment difficult for him. Intersectional identities determined what happened when each crossed paths with law enforcement. Intersecting oppressions of racism/classism/fat hatred/ageism/ableism/healthism resulted in the murder of Bumpurs in 1984 and Garner in 2014. Following Garner's execution, police supporters used multiple, intersecting forms of discrimination to sidestep the brutality: “Garner would've died going up a flight of stairs—he died because of preexisting medical conditions.” This article argues that besides perpetuating the long history of portraying African American men as hulking brutes or as genetically inferior, such justifications aim to divert attention away from structural racism, cloaking it in sizeism/ableism/healthism.