Free Distance Research Articles

STABLE trial of spectacle provision and driving safety among myopic motorcycle users in Vietnam: study protocol for a stepped-wedge, cluster randomised trial

BackgroundTraffic crashes are the leading cause of death globally for people aged 5–29 years, with 90% of mortality occurring in low- and middle-income countries (LMICs). The STABLE (Slashing Two-wheeled Accidents by Leveraging Eyecare) trial was designed to determine whether providing spectacles could reduce risk among young myopic motorcycle users in Vietnam.MethodsThis investigator-masked, stepped-wedge, cluster randomised naturalistic driving trial will recruit 625 students aged 18–23 years, driving ≥ 50 km/week, with ≥ 1-year driving experience and using motorcycles as their primary means of transport, in 25 clusters of 25 students in Ho Chi Minh City, Vietnam. Motorcycles of consenting students who have failed self-testing on the WHOeyes app will be fitted with Data Acquisition Systems (DAS) with video cameras and accelerometers. Video clips (± 30 s) of events flagged by the accelerometer will be reviewed for crash and near-crash events per 1000 km driven (main outcome). Five clusters of 25 students will be randomly selected every 12 weeks to undergo ocular examination and an estimated 40% of these will have bilateral spherical equivalent < − 0.5 D, and better-eye presenting distance visual acuity < 6/12, correctable bilaterally to ≥ 6/7.5. They will be given free distance spectacles and their driving data before receiving spectacles will be analysed as the control condition and subsequent data as the intervention condition. Secondary outcomes include visual function, cost-effectiveness and self-reported crash events.DiscussionSTABLE will be the first randomised trial of vision interventions and driving safety in a LMIC.Trial registrationClinicalTrials.gov, NCT05466955. Initial registration: 20 July 2022, most recent update: 9 July 2024.

Interface-Confined nanocatalysts at hollow porous nanofibers for High-Performance cascaded remediation of radioactive wastewater

The evolution of efficient remediation technologies for radioactive wastewater is crucial for the sustainable development of nuclear energy. The cascade strategy that combines adsorption and photocatalysis has emerged as one of the most ground-breaking approaches. However, the current composite materials are undesirable in practical applications due to the low interface exposures of nanocatalysts with limited light utilization, undesirable mass transfer as well as long free radical diffusion distances from photocatalytic sites to adsorption sites. Herein, we present the fabrication of hollow porous composite nanofibers (HPN) with high interface exposures of nanocatalysts and reduced mass transfer resistances via the interface-confined engineering by integrating coaxial electrospinning with non-solvent-induced phase separation. The hollow porous architecture effectively diminishes mass transfer resistance, leading to rapid adsorption and providing sufficient uranyl ions for the subsequent cascade photoreduction. Meanwhile, the high interface exposure of the nanocatalysts enables efficient uranium reduction, which serves to regenerate the adsorption sites for higher adsorption capacity as well as durable stability. Such an elegant architecture allows the HPN to achieve an over 2-fold improvement in removal rates than that of conventional composite nanofibers and removal ratios as high as 98.86 % within 270 min. The design concept and outstanding performance make it a promising and practical technology for the remediation of radioactive wastewater.

Optimised GRS coded cooperation: sliding relay selection design and improved joint decoding

ABSTRACT In this paper, the novel optimised generalised Reed-Solomon coded cooperative (OGRSCC) scheme is developed with a flexible selection of the code length and information dimension. In the OGRSCC scheme, two GRS codes with different dimensions are deployed at the source and relay, respectively, where the information symbols of the relay are dependent on those of the source. At the relay, different symbol selections may contribute to distinct joint codes at the destination. As a result, to achieve a maximum free distance (FD) and the optimised weight distribution of the final code, the global search method is first proposed to obtain the optimal selection pattern. However, as the code grows longer, its complexity rises dramatically. To make the selection more practical, the low-complexity sliding search method is then investigated to obtain the local optimal symbol selection pattern. Monte-Carlo simulated results indicate the OGRSCC scheme with two selection methods demonstrates almost identical performance. Furthermore, based on this special selection method and the unique algebraic structure of GRS code, the improved joint decoding algorithm is first proposed to boost the overall system performance. In addition, the theoretical upper bound is analysed, verifying the effectiveness of the proposed OGRSCC scheme. Numerical simulations reveal that the proposed OGRSCC scheme outperforms its corresponding non-cooperative scheme by a gain of over 3.2 dB and its existing comparable schemes by a margin of approximately more than 4 dB at high signal-to-noise ratio (SNR), respectively.

60 GHz millimeter-wave indoor propagation path loss models for modified indoor environments

The 60 GHz band has been selected for short-range communication systems to meet consumers’ needs for high data rates. However, this frequency is attenuated by obstacles. This study addresses the limitations of the 60 GHz band by modifying indoor environments with square loop (SL) frequency selective surfaces (FSSs) wallpaper, thereby increasing its utilization. The SL FSS wallpaper response at a 61.5 GHz frequency has been analyzed using both MATLAB and CST Studio Suite software. ‘Wireless InSite’ is also used to demonstrate enhanced wave propagation in a building modified with SL FSSs wallpaper. The demonstration is applied to multiple input multiple output system to verify the effectiveness of FSSs on such systems’ capacity, as well as the effect of the human body on capacity. Simulation results presented here show that modifying a building using SL FSS wallpaper is an attractive scheme for significantly improving the indoor 60 GHz wireless communications band. This paper also presents and compares two large-scale indoor propagation path loss models, the close-in (CI) free space reference distance model and the floating intercept (FI) model. Data obtained from ‘Wireless InSite’ over distances ranging from 4 to 14.31 m is analyzed. Results show that the CI model provides good estimation and exhibits stable behavior over frequencies and distances, with a solid physical basis and less computational complexity when compared to the FI model.

A comparative analysis of alpha-beta-gamma and close-in path loss models based on measured data for 5G mobile networks

Mobile coverage is crucial for the fifth-generation (5G) network since it affects the network's accessibility and dependability in various locations. With a wider coverage, more people and devices will access the 5G network, allowing them to experience the benefits and capabilities of this important technology. However, the development and construction of the networks need a lot of time and effort to maximize network coverage and service delivery while utilizing the fewest possible infrastructure components. Path loss models are commonly employed to predict network coverage. Therefore, it is expedient to adopt a path loss model that is suitable for the specified geographical area. In this paper, we investigated and analysed two empirical models: the Close-in free space reference distance (CI) model and the alpha-beta-gamma (ABG) model at the low- and mid-spectrum bands. Secondly, the path loss parameters were derived to characterize the two empirical models based on data from the measurement campaign. Finally, Root Mean Square Error (RMSE) was employed for the comparison of the models. It was found that at frequencies 0.9 and 1.8 GHz, the CI model's least RMSE values were 3.6 and 4.1 at location 1 and 4.7 and 4.2 dB at location 2, respectively, outperforming the ABG. However, at 3.4 GHz, the ABG with 3.25 and 1.75 dB outperformed the CI at both locations. For future work, the integration of machine learning techniques to dynamically predict and adapt path loss models in real time based on continuous data collection will be appropriate.

Bounds on the Free Distance of Periodically Time-Varying SC-LDPC Codes

Bounds on the Free Distance of Periodically Time-Varying SC-LDPC Codes

Conditions for Energetic Electrons and Gamma Rays in Thunderstorm Ground Enhancements

AbstractThe role of free passage distance (FPD: the distance between the avalanche region and surface detectors) in influencing the relative numbers of energetic electrons and gamma rays in Thunderstorm Ground Enhancements (TGEs) is reconsidered and focuses on the contrast between long (&gt;100 m) versus short (&lt;100 m) FPDs, respectively. Estimates of FPD are based on information from published balloon soundings of the electric field, from published profiles of radar reflectivity in TGEs, and from analyses of Japan winter storms. All these data sources support typical values of FPD &gt;100 m. Neither the shortcomings of present particle detectors in distinguishing electrons from gamma rays, nor the dominance of gamma rays over electrons, are sufficient evidence to deny the robust presence of Compton electrons at FDP values greater than 100 m that have also been shown in earlier simulations as well as the present Comment. Problems with having sustained electric fields of breakeven magnitude within 100 m of the Earth's surface (in relatively rare TGEs) are identified. The resolution of these problems, and the prominent nocturnal presence of these rare events, may possibly be explained by the descent of a strong field region in a collapsing storm, and by a low cloud base that intercepts and immobilizes fast corona ions, thereby preserving the intense electric field.

Multi-stage damping plate-restrained bearings: Concepts, experimental validation, and numerical analysis

This paper presents a novel damping plate-restrained isolation bearing (DP-bearing) that exhibits a range of advantages such as multi-stage energy dissipation, multi-directional restraining effect, and easily assembled/dismountable. The study commences with introducing the fundamental working principle of the proposed DP-bearing, followed by an investigation into the material properties of the damping plates using monotonic tensile and quasi-static cyclic tests. Subsequently, full-scale DP-bearing specimens, considering different numbers and orientations of the inserting damping plates as well as various free traveling distances (“predetermined gaps”), are tested. The test results confirm the multi-function of the damping plates which serve as energy dissipation sources and restrainers simultaneously. Prior to the predetermined gap, the load-displacement curves exhibit a rectangular shape that results from Coulomb friction. Once the gap is reached, the damping plates are activated and provide damping and restraint through shear or tension. The shear and tensile damping plates contribute to over 90% of the total horizontal peak resistance, with the former contributing to more than 70% of the energy dissipation. The study then presents a simplified numerical modeling approach, followed by design recommendations based on the simulation results. Furthermore, the numerical investigations provide supplementary evidence illustrating the effectiveness of the DP-bearing in different loading directions. The variations in the loading angle may induce a combined shear-tensile damage mode that differs from the modes observed in the tests.

Propagation channel characterization for mobile communication based on measurement campaign and simulation

Predicting the coverage area of mobile networks across various frequency bands is a critical concern in wireless communication. Each frequency band exhibits distinct propagation characteristics that directly influence the network coverage. Therefore, the use of the appropriate propagation models, whether through simulation or measurement-based approaches, is essential for accurate signal strength prediction in different environments and scenarios. In this study, we focus on the analysis and comparison of propagation channel characterization for mobile communication within the sub-6GHz frequency range. Our research involved outdoor measurement campaigns and ray-tracing simulations conducted at the Botswana International University of Science and Technology, covering distances up to 213 m. We then conducted an in-depth investigation and comparative analysis of the measured and simulated data for the propagation channel. Additionally, we derived a characterization model for the closed-in free space reference distance (CI) model based on measured and simulated data. Finally, we employed the root-mean-square error (RMSE) as a quantitative assessment of the performance of the characterized models. Notably, our findings revealed that the derived Close-in model based on measured data outperformed that of the simulations, exhibiting the lowest RMSE values of 3.56 dB, 4.20 dB, and 7.87 dB for location-1 line-of-sight, location-2 line-of-sight, and non-line-of-sight scenarios, respectively. These results hold significant potential for the development of precise path loss models that can effectively predict and optimize the coverage area of mobile communication systems across various real-world scenarios and environments.

Path Loss Characterization in an Outdoor Corridor Environment for IoT-5G in a Smart Campus University at 850 MHz and 3.5 GHz Frequency Bands.

The usage scenarios defined in the ITU-M2150-1 recommendation for IMT-2020 systems, including enhanced Mobile Broadband (eMBB), Ultra-reliable Low-latency Communication (URLLC), and massive Machine Type Communication (mMTC), allow the possibility of accessing different services through the set of Radio Interface Technologies (RITs), Long-term Evolution (LTE), and New Radio (NR), which are components of RIT. The potential of the low and medium frequency bands allocated by the Federal Communications Commission (FCC) for the fifth generation of mobile communications (5G) is described. In addition, in the Internet of Things (IoT) applications that will be covered by the case of use of the mMTC are framed. In this sense, a propagation channel measurement campaign was carried out at 850 MHz and 5.9 GHz in a covered corridor environment, located in an open space within the facilities of the Pedagogical and Technological University of Colombia campus. The measurements were carried out in the time domain using a channel sounder based on a Universal Software Radio Peripheral (USRP) to obtain the received signal power levels over a range of separation distances between the transmitter and receiver from 2.00 m to 67.5 m. Then, a link budget was proposed to describe the path loss behavior as a function of these distances to obtain the parameters for the close-in free space reference distance (CI) and the floating intercept (FI) path loss prediction models. These parameters were estimated from the measurements made using the Minimum Mean Square Error (MMSE) approach. The estimated path loss exponent (PLE) values for both the CI and FI path loss models at 850 MHz and 3.5 GHz are in the range of 2.21 to 2.41, respectively. This shows that the multipath effect causes a lack of constructive interference to the received power signal for this type of outdoor corridor scenario. These results can be used in simulation tools to evaluate the path loss behavior and optimize the deployment of device and sensor network infrastructure to enable 5G-IoT connectivity in smart university campus scenarios.

Eight Years Experience of Transanal Endoscopic Microsurgery

Abstract Introduction Transanal Endoscopic Microsurgery (TEM) is a minimally invasive method for management of different proctologic conditions. Despite widespread use of this method, it is not used widely in Iran. This report is about to describe the application of TEM in managing different proctologic conditions in a tertiary colorectal referral center in Iran regarding methods and complications. Methods All of the patients' documents such as procedure, method, early postop complications and further operations were actively reviewed and the data were entered in to the database. Results Since 2012 till the end of 2020 chart review was done and 150 cases of TEM operation were found. The most frequent procedure that was done was resection procedure. Using different energy devices during surgery or suturing versus not suturing the defect were not associated with complication. There was a case of in hospital mortality and one case delayed perianal fistula following TEM. Measurement of lesion distance from anal verge was not significantly different using TEM or colonoscopy. Villous adenomas detected in colonoscopy were mostly associated with malignancy. In evaluated resected lesions most of cases had free base and distance from anal verge or using different energy devices were not associated with obtaining free base. Conclusion TEM is a safe minimal invasive procedure with acceptable complications that could be helped in managing different proctologic conditions and the results of reviewing our patients revealed the same results that is reported from other colorectal centers.

An Investigation on Filler Particle Size and Its Distribution in Glass-Epoxy Hybrid Composites Using Image Processing

Analysis of filler particle size and distribution plays a vital role in achieving a good balance of polymer composites’ electrical, thermal, and mechanical properties. Such assessments help understand the relationship between microstructure and the physical nature of polymer composites reinforced with fillers. In this investigation, glass epoxy composites with different nano and micro-sized fillers, namely SiO <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> , Al <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> O <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">3</sub> , MoS <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> , graphite and cenosphere, are fabricated by hand-lay technique with bagging. Particle analysis is carried out by employing image processing techniques using ImageJ. To understand the nature of hybrid filler size distribution, a comprehensive assessment of the micro and nanofiller particle distribution and the average shortest and longest separation distance between the nano and micron particles is estimated. From the particle size distribution analysis, it is observed that the micron particles are more evenly distributed than nanoparticles. The average distance between micron and nanofiller particles is observed depending on the type of filler used. The microparticles tend to surround the nanoparticles, which is desirable for decreasing the free space distances between the filler particles. Also, statistical analysis is carried out to study the experimental and estimated micron and nanofiller particle sizes used in the composites.

Intelligent Transmit Antenna Selection Schemes for High-Rate Fully Generalized Spatial Modulation

The sixth-generation (6G) network is supposed to transmit significantly more data at much quicker rates than existing networks while meeting severe energy efficiency (EE) targets. The high-rate spatial modulation (SM) methods can be used to deal with these design metrics. SM uses transmit antenna selection (TAS) practices to improve the EE of the network. Although it is computationally intensive, free distance optimized TAS (FD-TAS) is the best for performing the average bit error rate (ABER). The present investigation aims to examine the effectiveness of various machine learning (ML)-assisted TAS practices, such as support vector machine (SVM), naïve Bayes (NB), K-nearest neighbor (KNN), and decision tree (DT), to the small-scale multiple-input multiple-output (MIMO)-based fully generalized spatial modulation (FGSM) system. To the best of our knowledge, there is no ML-based antenna selection schemes for high-rate FGSM. SVM-based TAS schemes achieve ∼71.1% classification accuracy, outperforming all other approaches. The ABER performance of each scheme is evaluated using a higher constellation order, along with various transmit antennas to achieve the target ABER of 10−5. By employing SVM for TAS, FGSM can achieve a minimal gain of ∼2.2 dB over FGSM without TAS (FGSM-NTAS). All TAS strategies based on ML perform better than FGSM-NTAS.

High-Data-Rate and Wide-Steering-Range Optical Wireless Communication via Nonuniform-Space Optical Phased Array

The silicon photonic optical phased array (OPA) featured by high integration and agile beam steering exhibits greatly potential application in optical wireless communication (OWC). In this paper, we demonstrate high-data-rate and long-range OWC using an integrated Silicon-Silicon Nitride OPA chip with 12 mm <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> large aperture. The OPA chip constituted by 128 waveguide grating antennas at nonuniform spacing is employed for wide-steering and small-divergence solid beam steering. In the experiment, we demonstrated 100° wide range communications in horizontal direction via antenna phase tuning. To our best knowledge, 100° is the widest cover range in the reported OPA-based OWC systems. Moreover, the OPA chip is also utilized to achieve up to 32 Gb/s low BER transmission of non-return-to-zero (NRZ) signal over 54 m free space distance. In addition, we also successfully demonstrated more than 50 Gb/s PAM4 signal transmission by measuring clear eye diagrams at the horizontal direction of 0° and 50° over 10 m. Thanks to agile beam steering of the OPA, switching time among arbitrary positions in multi-targets communication can be less than 27 μs. By virtue of tiny beam divergence 0.021° × 0.029° emitted from the OPA, data transmission switching between two targets spaced at 3.5 cm over 20 m can be achieved accurately. The experimental measurement shows the sidelobe crosstalk from the adjacent target channel is less than -25.2 dB. Our demonstrations validate the feasible implementation of the silicon-based OPA in the high-data-rate and wide-steering-range OWC system.

Land Suitability for Chili and Tomato Crops in Wayamiga Village East Bacan Sub-District South Halmahera District, Indonesia

Chili (Capsicum annum L.) and tomato (Solanum lycopersicum) crops are two vegetable horticultural commodities with high economic value and market demand and it’s becomes extremely important to consider land suitability and environmental sustainability factors to reduce losses and increase the probability of success. This research aimed to identify land suitability, land limiting factors, and land management for the development of chili and tomato crops in Wayamiga Village East Bacan Sub-district. The research uses a land survey method with a free survey observation distance system. The land characteristics identification employs the Boring Technique on 13 land units and land sampling of 7 samples. Land suitability analysis refers to the FAO’s land suitability classification system (1976) up to the sub-class of land suitability using a matching method. The research results indicate that the land is actually suitable for chili in Wayamiga Village with the analysis result suggesting a suitable land and S3(write this in full since it is the first time it appears) for chili and tomato is 1.940,7 ha (42,1%) and not suitable (N) is 2.666,3 ha (57,9%). Suitable land for chili and tomato crops is usually moderately suitable land (S2) (do same as foe S3) and marginally suitable land (S3). The land limiting factors that affect the land suitability for chili and tomato crops include rainfall during the growth period, humidity, soil drainage, base saturation, soil pH, organic C, soil salinity, total nitrogen nutrients (N-total), phosphorus (P2O5), potassium (K2O), flood hazard class, land average temperature, soil effective depth, surface rocks, and slope. Land management applied to maintain the sustainability of chili and tomato farming in Wayamiga Desa consists of the improvement of environmental humidity conditions, tillage, construction of drainage channels, application of lime and organic fertilizers, application of nitrogen, phosphorus, and potassium fertilizers, and flood prevention.

Analysis of Sound Field Distribution in Architecturally Diverse Temples

The results of the research, which aimed to analyze the acoustic properties of selected sacred buildings located in the city of Czestochowa, Poland are presented in the paper. Three architecturally unusual and completely different from each other churches were selected for the study. The churches differed in shape of their buildings, cubic volume, years of construction, interior furnishings, etc. Nine different objective parameters were used to describe the physical properties of acoustical field in the studied churches. Various factors characterizing the acoustic properties of each building were determined, such as the distribution of sound pressure level (SPL), reverberation time T30, definition D50. Next, they were thoroughly analyzed, so as to ultimately obtain distributions of individual acoustic parameters in the space of the tested building. It allowed to evaluate the quality of the received verbal or musical message depending on the place where the listener was. Further research on speech intelligibility and the musical quality of churches was performed by determining the averaged values of next four objective acoustic parameters: centre time Ts, speech clarity C50, music clarity C80, and speech transmission index (STI). A new approach to analyzing the objective physical parameters describing the sound field was presented in Sec. 4. Mean free path length and critical distance were determined for the investigated acoustic fields in each church and they were associated with a general geometric factor characterizing the complexity of the room shape. The final part of the work presents a comparative analysis of the obtained results of acoustic quality tests of the temples, and thus their usefulness in terms achieving a maximum intelligibility of speech and music. The interesting similarities were found in the spatial distribution of individual acoustic parameters characterizing the distribution of the acoustic field in temples with completely different architecture.

Perencanaan Penggunaan Lahan Berbasis Kemampuan Lahan di Kelurahan Kulaba, Kecamatan Ternate Barat, Kota Ternate

Land use planning is the process of inventorying and assessing the status, potential and limitations of a given area and its resources, which local people interact with or with people who care about the area to determine their needs, wants and aspirations. for the time. Kulaba sub-district is a small part of Ternate City which is located in West Ternate sub-district, which has a characteristic sloping to steep topographic area. The purpose of this study is to plan land use based on land capability, which is in the Kulaba Village, so that it becomes information in farming and other businesses. Determination of sampling points using a map then carried out a land survey with a free survey observation distance system, the approach used is analytic. Classification of land capability is categorized based on the characteristics that are potential and obstacles in its use. This analysis uses the LCLP (Land Classification and Landuse Planning) application. The results showed land use planning based on land capability that the land at the research location in Kulaba Village had four land capability classes namely III, IV, VI and VIII with the limiting factor of surface slope (L), soil permeability (P) and erosion sensitivity (KE). and subsoil texture with an area of 259.4 Ha. The alternative is that C-organic must have an important role in determining the soil's ability to support plants.

Near-Infrared Fluorescence Imaging With Indocyanine Green to Predict Clinical Outcome After Revascularization in Lower Extremity Arterial Disease.

Contemporary quality control methods are often insufficient in predicting clinical outcomes after revascularization in lower extremity arterial disease (LEAD) patients. This study evaluates the potential of near-infrared fluorescence imaging with indocyanine green to predict the clinical outcome following revascularization. Near-infrared fluorescence imaging was performed before and within 5days following the revascularization procedure. Clinical improvement was defined as substantial improvement of pain free walking distance, reduction of rest- and/or nocturnal pain, or tendency toward wound healing. Time-intensity curves and 8 perfusion parameters were extracted from the dorsum of the treated foot. The quantified postinterventional perfusion improvement was compared within the clinical outcome groups. Successful near-infrared fluorescence imaging was performed in 72 patients (76 limbs, 52.6% claudication, 47.4% chronic limb-threatening ischemia) including 40 endovascular- and 36 surgical/hybrid revascularizations. Clinical improvement was observed in 61 patients. All perfusion parameters showed a significant postinterventional difference in the clinical improvement group (P-values <.001), while no significant differences were seen in the group without clinical improvement (P-values .168-.929). Four parameters demonstrated significant differences in percentage improvement comparing the outcome groups (P-values within .002-.006). Near-infrared fluorescence imaging has promising additional value besides clinical parameters for predicting the clinical outcome of revascularized LEAD patients.

IMMEDIATE EFFECT OF THREE METHODS OF NEURODYNAMIC TISSUE MOBILIZATION EXERCISES ON THE WALKING CAPACITY AMONG PATIENTS HAVING NEUROGENIC CLAUDICATION

Purpose: Neurogenic claudication presents itself as leg pain, paresthesia or cramp reproduced by walking and reduced by rest. It occurs more commonly in spinal canal Stenosis and the surgical decompression of the spine in this condition is rarely required. Nerve tissue may develop dynamic dysfunction such as adhesion and neural fibrosis can impair nerve mobility. Neurodynamic mobilization methods may enhance the neural tissue mobility and enhance physical function. The aim of this study was to explore the role of neural mobilization on the pain free walking distance (PFWD) and walking time among cases of spinal canal Stenosis presenting with neurogenic claudication. Methods: Forty eight patients diagnosed with neurogenic claudication were randomly and equally divided into any of the four groups: the “tensioner neural mobilization”; the “one ended slider neural mobilization” group; the “two ended slider neural mobilization” group; and the placebo group. The distance walked before pain onset and this pain-free walking time was recorded immediately before and after the neural mobilization intervention as per group’s protocol. Result: The “two ended slider method” of neural mobilization was more superior to the “one ended slider” or the “tensioner method” for improving walking capacity. Neither “single ended” slider neural mobilization nor placebo intervention caused any statistically significant improvement in the walking capacity among patients of neurogenic claudication. Conclusion: The “double slider method” of neural mobilization is most appropriate followed by “slider method” of neural mobilization and the “single ended slider method” for enhancing the walking distance and walking time among patients suffering from neurogenic claudication.

How German vascular surgeons and angiologists judge walking exercise for patients with PAD.

Background: To determine the physician's perspective and perception on walking exercise as well as barriers in guideline-directed best medical treatment of patients with lower extremity peripheral arterial disease (PAD). Patients and methods: All members of the German Society for Vascular Surgery and Vascular Medicine and of the German Society for Angiology - Society for Vascular Medicine with valid email address were invited to participate in an electronic survey on walking exercise for treatment of intermittent claudication that was developed by the authors. Results: Amongst 3910 invited participants, 743 (19%) provided valid responses (33% females, 84% vascular surgery, 15% angiology). Thereof, 65% were employed by non-university hospitals, 16% by university institutions, and 18% by outpatient facilities. A mean of 14 minutes were spent per patient to counsel and educate, while only 53% responded they had enough time in everyday clinical practice. While 98% were aware of the beneficial impact of structured exercise training (SET) on pain free walking distance and 90% advise their patients to adhere to SET, only 44% provided useful guidance to patients to find local SET programmes and merely 42% knew how to prescribe SET as service that can be reimbursed by medical insurances. Approximately 35% knew a local SET programme and appropriate contact person. Health-related quality of life was assessed in a structured way by only 11%. Forty-seven percent responded that medical insurances should be responsible to implement and maintain SET programmes, while only 4% held hospital physicians responsible to achieve this task. Conclusions: This nationwide survey study amongst vascular specialists illustrates the current insufficient utilisation of SET as an evidence-based therapeutic cornerstone in patients with lower extremity PAD in Germany. The study also identified several barriers and flaws from the physician's perspectives which should be addressed collectively by all health care providers aiming to increase the SET use and eventually its' impact on patients with PAD.