Lower Fall Research Articles

Timed Up and Go Test With a Cognitive Task: Correlations With Neuropsychological Measures in People With Parkinson's Disease.

BackgroundThe Timed Up and Go (TUG) test is a simple and widely used clinical test for the assessment of lower extremity function, balance, mobility, and fall risk in various populations. The TUG has been found as a valid and reliable measure in people with Parkinson’s disease (PD). Besides, the addition of a cognitive task to the TUG (TUG-cognitive) enhances predictive validity related to fall risk in people with PD. However, further investigation is needed about the correlations of the TUG-cognitive test with neuropsychological measures in people with PD.MethodsThirty-three people with PD [modified Hoehn and Yahr scale, median (min-max)=2.5 (1.0-3.0)] participated in this cross-sectional study. The TUG was administered in the traditional way and with a cognitive task (counting backward by three from any number between 20 and 100). Neuropsychological measures included the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), and the Simple Reaction Time (SRT) test for stepping. The self-reported number of falls in the last six months was also recorded.ResultsThe TUG-cognitive [13.1 (SD=8.5) seconds] was significantly longer than the TUG-traditional [12.2 (SD=8.1) seconds] (p<0.01). The TUG-cognitive significantly correlated with the MoCA [(rho=-0.712), TMT part A (TMT-A; rho=0.722), TMT part B (TMT-B; rho=0.694), SRT (rho=0.794), and number of falls (rho=0.960)] (p<0.01). The TUG-traditional also significantly correlated with the MoCA (rho=-0.682), TMT-A (rho=0.684), TMT-B (rho=0.746), SRT (rho=0.755), and number of falls (rho=0.702) (p<0.01).ConclusionBoth the TUG-cognitive and TUG-traditional strongly correlated with neuropsychological measures; while the correlations were slightly stronger for the TUG-cognitive, the difference was not significant. The TUG-cognitive can be used in the clinical practice as a simple and more informative alternative to the TUG-traditional in people with PD.

Artificial Intelligence-Powered Digital Health Platform and Wearable Devices Improve Outcomes for Older Adults in Assisted Living Communities: Pilot Intervention Study.

BackgroundWearables and artificial intelligence (AI)–powered digital health platforms that utilize machine learning algorithms can autonomously measure a senior’s change in activity and behavior and may be useful tools for proactive interventions that target modifiable risk factors.ObjectiveThe goal of this study was to analyze how a wearable device and AI-powered digital health platform could provide improved health outcomes for older adults in assisted living communities.MethodsData from 490 residents from six assisted living communities were analyzed retrospectively over 24 months. The intervention group (+CP) consisted of 3 communities that utilized CarePredict (n=256), and the control group (–CP) consisted of 3 communities (n=234) that did not utilize CarePredict. The following outcomes were measured and compared to baseline: hospitalization rate, fall rate, length of stay (LOS), and staff response time.ResultsThe residents of the +CP and –CP communities exhibit no statistical difference in age (P=.64), sex (P=.63), and staff service hours per resident (P=.94). The data show that the +CP communities exhibited a 39% lower hospitalization rate (P=.02), a 69% lower fall rate (P=.01), and a 67% greater length of stay (P=.03) than the –CP communities. The staff alert acknowledgment and reach resident times also improved in the +CP communities by 37% (P=.02) and 40% (P=.02), respectively.ConclusionsThe AI-powered digital health platform provides the community staff with actionable information regarding each resident’s activities and behavior, which can be used to identify older adults that are at an increased risk for a health decline. Staff can use this data to intervene much earlier, protecting seniors from conditions that left untreated could result in hospitalization. In summary, the use of wearables and AI-powered digital health platform can contribute to improved health outcomes for seniors in assisted living communities. The accuracy of the system will be further validated in a larger trial.

Breeding together, wintering an ocean apart: Foraging ecology of the northern Bering Sea thick-billed and common murres in years of contrasting sea-ice conditions

Assessing impacts of environmental change on Arctic-breeding seabirds requires a better understanding of their year-round movement and foraging ecology. Here we examined the post-breeding movements and diving behavior of thick-billed (Uria lomvia) and common murres (U. aalge) breeding on St. Lawrence Island, northern Bering Sea, by using geolocators deployed in 2016 (n = 3, per species). During 2016–2019, we examined foraging niches and exposure to nutritional stress by using stable isotope signatures and corticosterone titers of blood and feather tissues (n = 60–96, per species). We found that thick-billed murres migrated to the Chukchi Sea in the fall and wintered in the western North Pacific, whereas common murres stayed in the eastern Bering Sea in the fall and wintered in the eastern North Pacific. Nutritional stress levels of breeding common murres were higher in 2017–2019, the period of historic low winter sea-ice extent, than in 2016. Higher nutritional stress levels of post-breeding thick-billed murres were associated with lower fall sea-ice extent in the Chukchi Sea. These results indicate that the loss of sea-ice might negatively affect murres breeding in the Pacific Arctic. Divergent migratory connectivity between the two murre species might also lead to different conservation threats both inside and outside the Arctic.

The Design and Development of Sit to Stand Trainer for the Elderly

Strengthening exercise for lower limbs is required in elderly. Repeated sit to stands could improve lower limbs strength, reduce limitations, and fall. The researchers developed a Sit to Stand Trainer, a device that assists and offers variable levels of weight support for users to stand. It was validated by comparing the kinematics and the kinetics between 2 experimental conditions; the movement that was assisted by Sit to Stand Trainer (STST) and the natural movement that was unassisted by Sit to Stand Trainer (No STST). This study is an Experimental Design using Pearson Correlation Coefficient. The time span of the observed movement was 2.5 s for all trials. The results in kinematics showed significant similarity in trunk, hip, knee, ankle angles and angular velocities including speed and distance of head between No STST to STST (P = 0.000). However, in kinetics, the maximum of vGRFs showed significant decrease in STST compared to No STST (P = 0.000). This represent that this device produces natural movement and speed. It also supports and helps to reduce the body weight that contacted to the ground in order to stand up easier. Thus, therapists could possibly consider this device for training in clinical practice. This research was studied within 6 weeks into training with Sit to Stand Trainer. This part of the study is a Quasi-Experimental Designs using Paired Samples T-tests. The results of the T-tests were compared before and after the training. The results showed a significant improvement in physical outcomes measurement tests; Berg Balance Scale (P = 0.000), 30-second Chair Stand (P = 0.001) and 4-meter Gait Speed (P = 0.000) among the elderly.

Energy level gradient trapping based on different work functions of ZnO enhancing response and stablity for lateral photodetectors

Abstract The slow response speed and instability of the lateral photodetectors (L-PDs), often caused by the persistence of the excess minority carriers in the long channel after the termination of the illumination (called Persistent Photoconductivity effects) are the main factors that hinder the practical application of this type of device. In this research, two types of ZnO with different work functions, including ZnO nanoparticles (ZnO-NPs) doped in bulk heterojunction (BHJ) and thermal annealed ZnO nanocrystalline film (ZnO–NF), are incorporated into the L-PDs to construct an energy gradient, which could facilitate the quick transfer of the minority carriers and restrict their release into the active layer. The structure of L-PDs are optimized as quartz/ZnO–NF/PffBT4T-2OD:PC61BM:ZnO-NPs (component ratio = 5:6:1)/Au–Au electrodes. Compared with the control device, the test results show that the optimized L-PDs exhibit higher stability with much lower fall time (3.7 ms, boosted 200-fold) and gentler rise slope of dark current versus time (Kdark) (8.3 × 10−6 nA/s, reduced four orders of magnitude). Meanwhile, the very low dark current (

Physical Frailty and Fall Risk in Community-Dwelling Older Adults: A Cross-Sectional Study.

Introduction Frailty is a condition in older adults with decreased physical and cognitive performance that can affect health outcomes associated with fracture, disability, and falls. The aim of this study was to compare fall risk with different physical frailty statuses and investigate factors associated with fall risk in community-dwelling older adults. Methods The population studied included 367 older adults (mean age = 73.2 years ± 7.0; 237 females (64.6%) and 130 males (35.4%)) who live in Chiang Mai, Thailand. This study was of cross-sectional design. Fried's phenotype was used to screen the physical frailty status. The physiological profile assessment (PPA) was used to screen for fall risk. One-way ANOVA analysis was used to compare the fall risk between the different levels of frailty status. Linear regression analysis was used to assess the association between frailty status and fall risk. Results The prevalence of the frailty group was 8.7% and that of the prefrailty group was 76.8%. The three statuses of frailty identified were found to have different levels of risk of falling. The frailty group had a higher fall risk than the nonfrailty group and the prefrailty group. In addition, the nonfrailty group had a lower fall risk than the prefrailty group. Conclusion The frailty group had the highest fall risk in this cohort of older adults living in a community-dwelling facility. Therefore, it is important to assess the frailty status among older adults as it can be a predictor for fall risk. This assessment will therefore lead to a reduction in the rate of disability and death in the community.

Posterior single-stepping thresholds are prospectively related to falls in older women.

Falls are a leading cause of injury in older women. Stepping thresholds quantify balance-reaction capabilities. It is unclear how such evaluations predict falls in comparison to, or as a complement to, other objective measures of gait, standing postural control, strength, and balance confidence. The objective of this study was to determine if stepping thresholds are prospectively related to falls in older women. For this prospective cohort study, 125 ambulatory, community-dwelling women, age ≥ 65years were recruited. Using a treadmill to deliver perturbations to standing participants, we determined anteroposterior single- and multiple-stepping thresholds. Here, thresholds represent the minimum perturbation magnitudes that consistently evoke one step or multiple steps. In addition, gait kinematics, obstacle-crossing kinematics, standing sway measures, unipedal stance time, the functional reach, lower extremity isometric strength, grip strength, balance confidence, and fall history were evaluated. Falls were prospectively recorded for one year. Seventy-four participants (59%) fell at least once. Posterior single-stepping thresholds were the only outcome that predicted future fall status (OR = 1.50, 95% CI 1.01-2.28; AUC = .62). A multivariate approach added postural sway with eyes closed as a second predictive variable, although predictive abilities were not meaningfully improved. These results align with the previous evidence that reactive balance is a prospective indicator of fall risk. Unlike previous studies, strength scaled to body size did not contribute to fall prediction. Posterior single-stepping thresholds held a significant relationship with future fall status. This relationship was independent of, and superior to that of, other measures of standing balance, gait, strength, and balance confidence.

73 Exercise Habit is Associated with Lower Fall Risks among Elderly People Living in Urban Areas

Abstract In the present super aged society that has limited financial resources for efficient health care for the elderly population, fall prevention is an urgent issue. The present study examined the relationship between exercise habit and fall risks among elderly people living in an urban area. A total of 1,014 elderly people (age: 65–89 years) living in Osaka City were enrolled in this study and assigned to 5 different age groups. The motor abilities of the participants were evaluated by the Functional Reach Test (FRT) and the Timed Up and Go (TUG) test, with the cutoff value for fall risk set at 25 cm and 13.5 s, respectively. Exercise habit (≤1 h, 1–2 h, or ≥2 h per week), history of recent falls, and anxiety about falling were also assessed using a questionnaire modified from the checklist by the Ministry of Health, Labour and Welfare of Japan. The results of the FRT and TUG tests were increasingly poorer in higher age groups. History of recent falls and anxiety about falling were also more frequent in higher age groups (all p &amp;lt; .05). The prevalence of exercise habits was similar among the age groups. In the age groups &amp;gt;75 years, there was an association between exercise habit and a decrease in fall risks, based on the FRT results (all p &amp;lt; .05). The mean FRT value of the participants with the greatest exercise habit was equivalent to that of the generation 10 years younger with the lowest exercise habit. There was an association between exercise habit and decreased anxiety about falling (p = .003), but not with a history of recent falls. Our results suggest that exercise should be promoted among elderly people living in urban areas to contribute to fall prevention.

Acalabrutinib monotherapy in patients with Waldenström macroglobulinemia: a single-arm, multicentre, phase 2 study

Chemoimmunotherapy is typically the standard of care for patients with Waldenström macroglobulinemia; however, infectious and hematologic toxic effects are problematic. Acalabrutinib is a selective, potent Bruton tyrosine-kinase inhibitor. The aim of this trial was to evaluate the activity and safety of acalabrutinib in patients with Waldenström macroglobulinemia. This single-arm, multicentre, phase 2 trial was done in 19 European academic centres in France, Italy, Greece, the Netherlands, and the UK, and eight academic centres in the USA. Eligible patients were 18 years or older and had treatment naive (declined or not eligible for chemoimmunotherapy) or relapsed or refractory (at least one previous therapy) Waldenström macroglobulinemia that required treatment, an Eastern Cooperative Oncology Group performance status of 2 or less, and received no previous Bruton tyrosine-kinase inhibitor therapy. Patients received 100 mg oral acalabrutinib twice per day in 28-day cycles until disease progression or unacceptable toxicity. The primary endpoint was investigator-assessed overall response (at least a minor response) according to the 6th International Workshop for Waldenström Macroglobulinemia (IWWM) and the modified 3rd IWWM workshop criteria. The primary outcome and safety were assessed in all patients who received at least one dose of treatment. This study is registered with ClinicalTrials.gov, number NCT02180724, and is ongoing, but no longer enrolling. Between Sept 8, 2014, and Dec 24, 2015, 122 patients were assessed for eligibility, of which 106 (87%) patients were given acalabrutinib (14 were treatment naive and 92 had relapsed or refractory disease). With a median follow-up of 27·4 months (IQR 26·0-29·7), 13 (93% [95% CI 66-100]) of 14 treatment naive patients achieved an overall response and 86 (93% [86-98]) of 92 relapsed or refractory patients per both the modified 3rd and 6th IWWM criteria. Seven (50%) of 14 treatment naive patients and 23 (25%) of 92 relapsed or refractory patients discontinued treatment on study. Grade 3-4 adverse events occurring in more than 5% of patients were neutropenia (17 [16%] of 106 patients) and pneumonia (7 [7%]). Grade 3-4 atrial fibrillation occurred in one (1%) patient and grade 3-4 bleeding occurred in three (3%) patients. The most common serious adverse events were lower respiratory tract infection (n=7 [7%]), pneumonia (n=7 [7%]), pyrexia (n=4 [4%]), cellulitis (n=3 [3%]), fall (n=3 [3%]), and sepsis (n=3 [3%]). Pneumonia (n=5 [5%]) and lower respiratory tract infection (n=4 [4%]) were considered treatment related. One treatment-related death was reported (intracranial hematoma). This study provides evidence that acalabrutinib is active as single-agent therapy with a manageable safety profile in patients with treatment-naive, or relapse or refractory Waldenström macroglobulinemia. Further studies are needed to establish its efficacy against current standard treatments and to investigate whether outcomes can be improved with combination therapies. Acerta Pharma.

Lumbar Forces While Making a Bed With and Without an Instant Tuck™ Mat

Introduction: Conventional wisdom to avoid back pain while making your bed recommends not to lean across your bed to tuck in the sheets, and to keep your back straight and use Core Muscles. This is not practical or possible with any of the many different designs currently available. At present, there is no safe way to make your bed, which can significantly increase the risk of injury and create lifelong disabilities for both individuals and certain professional bedmakers such as house keepers, and caregivers. Objective: It was hypothesized that the use of an Instant Tuck™ Mat can significantly lower the Back-Compression Force (BCF) on the Lower Back and fall far below the risk threshold level stated by the NIOSH. The Instant Tuck™ Mat addresses this major health problem of back pain and injuries by eliminating the need to ever lift a mattress when making the bed. Method: A sample of 35 subjects performed the task of making a bed with a queen-sized mattress with and without the Instant Tuck™ Mat in a random order. BCF, the number of lifts to make the bed as well as the length of time for each lift, and the number of times each individual bent forward was measured during each trial. Results: There were significant differences for all the measured variables. Regarding the BCF, there was an approximately 85% reduction of pressure on the lower back when using the Instant Tuck™ Mat vs. not using it, which was a highly significant decrease (p&lt;.001). Also, the number of times the mattress was lifted was lower by 12 times when using the Instant Tuck™ Mat vs. not using it (p&lt;.001). Finally, the times each individual bent down was approximately 9 times less when using the Instant Tuck™ Mat vs. not using it (p&lt;.001). Conclusion: BCF’s making a bed in its current form is by a wide margin out of compliance with NIOSH standards and as a result it poses a significant risk of injury especially for those who are required to perform this for their occupation, such as hotel housekeepers and hospital, nursing home, and in-home caregivers. Making a bed using the Instant Tuck™ Mat reduced the BCF’s by 85% and is in line with NIOSH standards. The Instant Tuck™ Mat has that it can make the repetitive act of making a bed safe and that it can significantly reduce the risk of injury based on NIOSH standards.

Patient and caregiver benefit-risk preferences for non-metastatic castration-resistant prostate cancer treatment (nmCRPC).

196 Background: Second-generation androgen receptor inhibitors (SGARIs) have been recently approved for the management of nmCRPC based on documented improvements in metastasis-free survival. We used a discrete choice experiment (DCE) to examine how nmCRPC patients (pts) and caregivers perceive the benefits versus risks of SGARIs. Methods: nmCRPC pts and caregivers were invited to complete an online DCE survey of 14 treatment choice questions, each comparing 2 hypothetical medication profiles varying in terms of 5 safety attributes (frequency or severity of adverse events [AEs]: fatigue, skin rash, cognitive problems, serious falls, and serious fractures) and 2 efficacy attributes (duration of overall survival [OS] and time to pain progression). These attributes were selected based on in-depth qualitative interviews with pts, caregivers, and physicians. We used random parameters logit models to estimate preference weights and relative importance scores for each attribute. Results: 143 nmCRPC pts and 149 caregivers were included in the analysis. Both pts and caregivers viewed safety attributes in the following decreasing order of importance: fractures, falls, cognitive problems, fatigue, and rash. Compared to a reduction in rash severity from moderate to none, a similar reduction in cognitive problems severity was considered nearly as important by patients but twice as important by caregivers. On average, pts were willing to trade 5.8 and 4.0 months of OS to reduce the risks of serious fractures and falls, respectively, from 3% to 0%; the corresponding figures caregivers were willing to trade were 6.6 and 5.4 months of OS. Of note, 8.4% of pts and 14.8% of caregivers consistently chose the treatment profile with the lowest fall or fracture risk, regardless of the other attributes' values. Conclusions: nmCRPC pts and caregivers preferred treatments with lower AE burdens and were willing to trade substantial amounts of OS to avoid AEs. They viewed the reduction of fractures, falls, and cognitive problems as most important. In this relatively asymptomatic population, carefully balancing risks and benefits when selecting SGARI treatments is important to optimizing quality of survival.

Insufficient Balance Recovery Following Unannounced External Perturbations in Persons With Stroke

Background. Persons with stroke (PwS) are at increased risk of falls, especially toward the paretic side, increasing the probability of a hip fracture. The ability to recover from unexpected loss of balance is a critical factor in fall prevention. Objectives. We aimed to compare reactive balance capacity and step kinematics between PwS and healthy controls. Methods. Thirty subacute PwS and 15 healthy controls were exposed to forward, backward, right, and left unannounced surface translations in 6 increasing intensities while standing. Single step threshold, multiple step threshold, and fall threshold (ie, perturbation intensity leading to a fall into harness system) were recorded as well as reactive step initiation time, step length, and step velocity. Results. Twenty-five PwS fell into harness system during the experiment while healthy controls did not fall. Fourteen out of 31 falls occurred in response to surface translations toward the nonparetic side, that is, falling toward the paretic side. Compared with healthy controls, PwS demonstrated significantly lower fall threshold and multiple step threshold in response to forward, backward, and lateral surface translations. Impairments were more pronounced in response to forward surface translation and toward the nonparetic side (ie, loss of balance toward the paretic side). A trend toward significant shorter step length in response to lateral surface translations was found in PwS compared with healthy controls. Conclusions. Findings highlight the importance of assessing reactive balance capacity in response to perturbations in different directions and intensities in addition to the routine assessment in PwS.

Subclinical Cardiovascular Disease and Fall Risk in Older Adults: Results From the Atherosclerosis Risk in Communities Study.

Falls are frequent and often devastating events among older adults. Cardiovascular disease (CVD) is associated with greater fall risk; however, it is unknown if pathways that contribute to CVD, such as subclinical myocardial damage or wall strain, are related to future falls. We hypothesized that elevations in high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), measured in older adults, would be associated with greater fall risk. Prospective cohort study. Atherosclerosis Risk in Communities Study participants without known coronary heart disease, heart failure, or stroke. We measured hs-cTnT or NT-proBNP in 2011 to 2013. Falls were identified from hospital discharge International Classification of Diseases, Ninth Revision (ICD-9), codes or Centers for Medicare and Medicaid Services claims. We used Poisson models adjusted for age, sex, and race/study center to quantify fall rates across approximate quartiles of hs-cTnT (less than 8, 8-10, 11-16, and 17 or greater ng/L) and NT-proBNP (less than 75, 75-124, 125-274, and 275 or greater pg/mL). We used Cox models to determine the association of cardiac markers with fall risk, adjusted for age, sex, race/center, and multiple fall risk factors. Among 3973 participants (mean age = 76 ± 5 years, 62% women, 22% black), 457 had a subsequent fall during a median follow-up of 4.5 years. Incidence rates across quartiles of hs-cTnT and NT-proBNP were 17.1, 20.0, 26.2, and 36.4 per 1000 person-years and 12.8, 22.2, 28.7, and 48.4 per 1000 person-years, respectively. Comparing highest vs lowest quartiles of either hs-cTnT or NT-proBNP demonstrated a greater than two-fold higher fall risk, with hazard ratios of 2.17 (95% confidence interval {CI} = 1.60-2.95) and 2.34 (95% CI = 1.73-3.16), respectively. In a joint model, the relationships of hs-cTnT and NT-proBNP with falls were significant and independent. Subclinical elevations of cardiac damage and wall strain were each associated with a higher fall risk in older adults. Further research is needed to determine whether interventions that lower hs-cTnT or NT-proBNP also lower fall risk. J Am Geriatr Soc 67:1795-1802, 2019.

Development and validation of Comprehensive Gait Assessment using InerTial Sensor score (C-GAITS score) derived from acceleration and angular velocity data at heel and lower trunk among community-dwelling older adults

BackgroundAlthough some gait parameters from inertial sensors have been shown to be associated with important clinical issues, because of controversial results, it remains uncertain which parameters for which axes are clinically valuable. Following the idea that a comprehensive score obtained by summing various gait parameters would sensitively reflect declines in gait performance, we developed a scoring method for community-dwelling older adults, the Comprehensive Gait Assessment using InerTial Sensor score (C-GAITS score). The aim of this study was to examine the internal consistency and the construct validity of this method.MethodsIn this cross-sectional study, the gait performance of 378 community-dwelling older people (mean age = 71.7 ± 4.2 years, 210 women) was assessed using inertial sensors attached to the heel and lower trunk. Participants walked along a 15-m walkway, and accelerations, angular velocity, and walking time were measured. From these data, walking speed, mean stride time, coefficients of variation of stride time and swing time, and autocorrelation coefficients and harmonic ratios of acceleration in vertical, mediolateral, and anteroposterior directions at the lower trunk were calculated. Scoring was performed based on quartile by gender (i.e., scored from 0 to 3) for each of the 10 gait parameters. The C-GAITS score was the sum of these scores (range: 0–30). Lower extremity strength, balance function, fall history, and fear of falling were also assessed.ResultsAn exploratory factor analysis revealed that the C-GAITS score yielded four distinct factors explaining 57.1% of the variance. The Cronbach’s alpha coefficient was 0.77. A single linear regression analysis showed a significant relationship between total C-GAITS score and walking speed (adjusted R2 = 0.28). Results from bivariate comparisons using unpaired t-tests showed that the score was significantly related to age (p = 0.002), lower extremity strength (p = 0.007), balance function (p < 0.001), fall history (p = 0.04), and fear of falling (p < 0.001).ConclusionsGood internal consistency and appropriate construct validity of the C-GAITS score were confirmed among community-dwelling older adults. The score might be useful in clinical settings because of ease of use and interpretation and capability of capturing functional decline.

Does severity of motor impairment affect reactive adaptation and fall-risk in chronic stroke survivors?

BackgroundA single-session of slip-perturbation training has shown to induce long-term fall risk reduction in older adults. Considering the spectrum of motor impairments and deficits in reactive balance after a cortical stroke, we aimed to determine if chronic stroke survivors could acquire and retain reactive adaptations to large slip-like perturbations and if these adaptations were dependent on severity of motor impairment.MethodsTwenty-six chronic stroke participants were categorized into high and low-functioning groups based on their Chedoke-McMaster-Assessment scores. All participants received a pre-training, slip-like stance perturbation at level-III (highest intensity/acceleration) followed by 11 perturbations at a lower intensity (level-II). If in early phase, participants experienced > 3/5 falls, they were trained at a still lower intensity (level-I). Post-training, immediate scaling and short-term retention at 3 weeks post-training was examined. Perturbation outcome and post-slip center-of-mass (COM) stability was analyzed.ResultsOn the pre-training trial, 60% of high and 100% of low-functioning participants fell. High-functioning group tolerated and adapted at training-intensity level-II but low-functioning group were trained at level-I (all had > 3 falls on level-II). At respective training intensities, both groups significantly lowered fall incidence from 1st through 11th trials, with improved post-slip stability and anterior shift in COM position, resulting from increased compensatory step length. Both groups demonstrated immediate scaling and short-term retention of the acquired stability control.ConclusionChronic stroke survivors are able to acquire and retain adaptive reactive balance skills to reduce fall risk. Although similar adaptation was demonstrated by both groups, the low-functioning group might require greater dosage with gradual increment in training intensity.

The effect of user variables on academic websites usability : An empirical study

The aim of the study is to delineate quantitative usability evaluation of 50-academic websites using System Usability Scale. 600-participants are enquired about usability of these academic websites using SUS a 10-question based survey created through Google form. The study utilizes one of different applications of SUS on academic websites in which, the users are not implored to execute particular tasks on these websites before giving the adjective rating for usability to specific website but are rather queried to gauge usability hinged on their experience with a given website. Results manifest that the end-users gave lower SUS scores for 38-websites, whereas experts gave lower SUS scores for only 10-websites. It is observed that female participants gave lower SUS scores for only 7-websites. Further, results show that the mobile and desktop users gave lower SUS scores for 35 and 9-websites respectively. The participants of age group 20-25 have rated 36-websites with lower SUS as compared to greater age groups. 8-websites fall into the low marginal section of acceptability range whereas 42-websites are rated at the lower level and fall into non-acceptability range. Results conclude that end-users and participants of age group 20-25 face more usability problems on websites which needs to be resolved. Female participants show more satisfaction with websites against male counterparts. Further, when websites have been evaluated on mobile phones then participants also face more usability problems. The study manifests explicit distinctions among websites and provides wholistic approach for presenting usability scores for academic websites while considering different user variables.

Bushen Yijing Fang Reduces Fall Risk in Late Postmenopausal Women with Osteopenia: A Randomized Double-blind and Placebo-controlled Trial

Falls in late postmenopausal women with osteopenia usually cause fractures with severe consequences. This 36-month randomized, double-blind and placebo-controlled trial with a 10-year observational follow-up study aimed to investigate the long-term effect of herbal formula Bushen Yijing Fang (BSYJF) on fall risk in the late postmenopausal women with osteopenia. 140 late postmenopausal women (Femoral neck T-score, −2.5~−2 SD) were recruited and randomized to orally receive calcium carbonate 300 mg daily with either BSYJF or placebo for 36 months. The effect was further investigated for another 10-year follow-up. During the 36-month administration, there were 12 falls in BSYJF group and 28 falls in placebo group, respectively, indicating 64% lower risk of falls (RR 0.36 [95% CI, 0.18 to 0.71]; P = 0.004) in BSYJF group. During the 10-year follow-up, 36% lower fall risk (RR 0.64 [95% CI, 0.46 to 0.89]; P = 0.009) was observed in BSYJF group. No significant difference was found in safety profile between two groups. Thirty-six-month administration of BSYJF reduced fall risk with an increase in bone mass, and its latent effect on fall risk was continually observed in the 10-year follow-up in late postmenopausal women with osteopenia. This clinical trial was registered at Chinese clinical trial registry (ChiCTR-IOR-16008942).

Inner-City Asthma in Children.

Asthma in inner-city children is often severe and difficult to control. Residence in poor and urban areas confers increased asthma morbidity even after adjusting for ethnicity, age, and gender. Higher exposure to household pests, such as cockroaches and mice, pollutants and tobacco smoke exposure, poverty, material hardship, poor-quality housing, differences in health care quality, medication compliance, and heath care access also contribute to increased asthma morbidity in this population. Since 1991, the National Institutes of Allergy and Infectious Diseases established research networks: the National Cooperative Inner-City Asthma Study (NCICAS), the Inner-City Asthma Study (ICAS), and the Inner-City Asthma Consortium (ICAC), to improve care for this at risk population. The most striking finding of the NCICAS is the link between asthma morbidity and the high incidence of allergen sensitization and exposure, particularly cockroach. The follow-up ICAS confirmed that reductions in household cockroach and dust mite were associated with reduction in the inner-city asthma morbidity. The ICAC studies have identified that omalizumab lowered fall inner-city asthma exacerbation rate; however, the relationship between inner-city asthma vs immune system dysfunction, respiratory tract infections, prenatal environment, and inner-city environment is still being investigated. Although challenging, certain interventions for inner-city asthma children have shown promising results. These interventions include family-based interventions such as partnering families with asthma-trained social workers, providing guidelines driven asthma care as well as assured access to controller medication, home-based interventions aim at elimination of indoor allergens and tobacco smoke exposure, school-based asthma programs, and computer/web-based asthma programs.

Impact of a Pilot Adaptive Sports Intervention on Residents at a Skilled Nursing Facility

The purpose of this pilot study was to measure the im-pact of an adaptive sports intervention on several out-comes including the components of self-determination (i.e., autonomy, competence, relatedness), loneliness, and mobility for residents of a skilled nursing facility (SNFs). This study employed a physician-prescribed, 4-week adaptive sports intervention specifically adapted for the residents of a SNF. The program was administered by Certified Therapeutic Recreation Specialists® (CTRS), and facilitated six participants in weekly practice (basket-ball, baseball, golf, shuffleboard) and competition against residents in other local facilities. This mixed-methods study employed pre-test/post-test outcome evaluation using the UCLA Loneliness Scale, Basic Psychological Needs Satisfaction Scale (BPNSS) (competence, autono-my, relatedness), Timed Up and Go Test, as well as struc-tured qualitative interviews. Results of this study showed improvements for all participants across most or all cog-nitive, physical, emotional, and/or social domains and all measures showed positive movement. Results also sug-gested improvements in identity, belonging, importance, and the potential for transfer of these benefits to greater social engagement, lower fall risk, and decreased depression. Practical recommenda-tions are provided. In addition, replication and expansion of this design is warranted. Subscribe to TRJ

Peer Effects on Vocabulary Knowledge: A Linear Quantile Mixed-Modeling Approach

Do your peers in the classroom have an effect on your vocabulary learning? The purpose of this study was to determine if group-level peer characteristics and group-level peer achievement account for individual-level differences in vocabulary achievement using a large sample of students in kindergarten through second grade (n = 389,917). We applied a mixed-modeling approach to control for students nested among peers, and used quantile regression to test if group-level peer effects functioned similarly across the range of conditional student ability in vocabulary knowledge. Group-level peer effects were more strongly related to vocabulary achievement for students at the low end of the conditional distribution of vocabulary. The difference in vocabulary achievement between children with and without an individualized education program increased as quantiles of the conditional vocabulary distribution increased. Children with lower relative fall scores had better spring scores when they were in homogenous classrooms (i.e., their peers had similar levels of achievement). The importance of classroom composition and implications for accounting for peer effects are discussed.