Recovery Phase Research Articles

Digital Nomad and Analysis of Regional Economic Resilience of Tourism Sector in Bali Province After Covid-19 Pandemic

This study aims to analyze the impact of the pandemic on Bali's regional economic resilience and how the workcation trend brought by digital nomad tourists able to encourage tourism recovery in Bali. The research method used is descriptive-analytical, including examining documents and statements from experts that explained the response to the economic shocks that occurred in Bali Province. Data sources were obtained from tourism ministry performance reports, BPS data, news articles and accredited journals. The study revealed that the resistance phase is demonstrated by the disruption of the tourism sector when the COVID-19 pandemic broke out, causing economic Bali to decline. The reorientation phase is demonstrated by the ability of government and business actors to adjust and adapt from shocks. The workcation trend brought by digital nomads is suitable for application during the adaptation period. The recovery phase is demonstrated by the revival of tourism in Bali Province with an increase in the number of foreign tourists. One of them comes from digital nomad tourists who increase regional income. Based on analysis using the regional economic resilience model, Bali Province in 2023 will approach economically resilient status.

Risk assessment in equine anesthesia: a first evaluation of the usability, utility and predictivity of the two-part CHARIOT

IntroductionAn accurate risk score that can predict peri-anesthetic morbidity and mortality in equine patients could improve peri-operative management, outcome and client communication.Materials and methodsThree hunded horses underwent pre-anesthetic risk assessment using the American Society of Anesthesiologists-Physical Status augmented with equine-specific diseases (ASA-PS-Equine), a multifactorial 10-part rubric risk scale (10-RS), and a combination of both, the Combined horse anesthetic risk identification and optimization tool (CHARIOT). Intra-and post-anesthetic complications, the recovery phase and mortality were recorded over a period of 7 days following general anesthesia. To compare the utility and predictive power of the 3 scores, data were analyzed using binominal logistic regression (p ≤ 0.05) and receiver operating characteristic curve analysis. In addition, inter-observer reliability, speed, safety, ease of use and face validity of the ASA-PS-Equine and the 10-RS were analyzed based on five hypothetical patients.ResultsAll scores showed statistically significant associations with various intra-anesthetic complications and parameters of the recovery phase. The discriminant ability of the scores related to the occurrence of intra-anesthetic (AUC = 0.6093–0.6701) and post-anesthetic (AUC = 0.5373–0.6194) complications was only low. The highest diagnostic accuracy for all scores was observed for overall mortality (AUC = 0.7526–0.7970), with the ASA-PS-Equine differentiating most precisely (AUC = 0.7970; 95% CI 0.7199–0.8741). Inter-observer reliability was fair for the 10-RS (κ = 0.39) and moderate for the ASA-PS-Equine (κ = 0.52). Patient assignment to the CHARIOT was predominantly rated as rather easy and quick or very quick.Limitations and conclusionThe main limitations of the study are the monocentric study design and failure to obtain the full range of points. In conclusion, all 3 scores provide useful information for predicting the mortality risk of equine patients undergoing general anesthesia, whereas intra-and postoperative complications cannot be predicted with these scores.

#2529 The role of the circadian clock system in the transition from acute kidney injury to chronic kidney disease

Abstract Background and Aims Recent studies suggest that circadian rhythms are an important factor in maintaining healthy kidney functions; however, its role in acute kidney injury (AKI) remains unclear. Method To investigate the role of tubule-specific clock gene disturbance in hypoxic tubular injury, we created human proximal tubule-specific BMAL1 KO cells using CRISPR-Cas9 gene editing. In mice, we also determined whether time-restricted feeding (TRF), a dietary strategy to enhance circadian rhythm, can have beneficial effect on recovery of ischemia reperfusion injury (IRI) or its progression to chronic kidney disease (CKD). Results BMAL1 loss in tubule cells resulted in the upregulation of cell cycle regulatory gene (p21) and inflammatory genes (TNF-α and CCL4) mRNA expression, suggesting that BMAL1 is a critical regulator of these genes. Exposure to hypoxia for 48 h resulted in more increased expressions of p21 in BMAL 1 KO cells than in WT HK-2 cells, leading to higher expression of TGF-b. In addition, loss of BMAl-1 led to significantly increased vimentin and decreased E-cadherin expression upon TGF-b stimulation, suggesting an aggravated epithelial-mesenchymal transition upon BMAL1 deletion. To clarify the role of clock system in AKI, we also tested whether TRF can have a beneficial effect during recovery phase after IRI. Despite limited access to food, TRF for 4 weeks after IRI had no effect on the total intake or weight of mice. However, we observed that TRF significantly improved renal function on day 21 and reduced renal fibrosis on day 28, which suggests that enhancing clock gene oscillations through restoring fasting/feeding cycle has a protective effect in the AKI to CKD transition. Conclusion We identified an important role of clock system in hypoxic tubular injury and the effects of treatment targeting circadian rhythm in AKI. Our results can provide a new perspective for developing novel therapeutic strategies for AKI.

Fingerprinting enhanced floodplain reworking during the Paleocene–Eocene Thermal Maximum in the Southern Pyrenees (Spain): Implications for channel dynamics and carbon burial

Abstract The sedimentary record of the Paleocene–Eocene Thermal Maximum (PETM, ca. 56 Ma) allows the study of feedback mechanisms over the entire duration of a climatic event, from carbon release to the subsequent recovery phase. Clay sedimentation increase in the oceans during the PETM is linked to enhanced terrestrial erosion. Fluvial channel mobility has been invoked to explain this increase in fine sediment export based on more frequent transitional avulsions. In this study, we test whether the reworking of Microcodium (prismatic calcite concretions) from the floodplain to marine environments can serve to fingerprint floodplain reworking due to channel mobility. We quantified the abundance of floodplain-sourced Microcodium grains reworked in fluvial to marine sandstones pre-dating and coeval to the PETM in the Southern Pyrenees (Tremp Basin, Spain). Laser ablation–inductively coupled plasma–mass spectrometry U-Pb ages on calcite confirm the Thanetian age of the Microcodium grains. Our data show a four-fold increase in the export of floodplain sediments to the marine domain during the PETM. Moreover, we show that this is predominantly due to enhanced channel mobility, reworking channel banks and interfluves, with increased erosion in the hinterland as a secondary factor. This increase in floodplain reworking would correspond to an increase in biospheric carbon burial flux by a factor of 2.2. Therefore, enhanced channel mobility and fine-grain sediment transport to the oceans during a climatic perturbation such as the PETM may constitute an important negative feedback mechanism.

#2997 Characterising the natural history of renal recovery after AKI in a prospective cohort—does timing matter?

Abstract Background and Aims Acute kidney injury (AKI) is associated with an increased risk of chronic kidney disease (CKD). Failure of recovery of serum creatinine by 90 days after AKI strongly associates with subsequent long-term reductions in renal function, however there is no consensus agreement on the definition of renal recovery. Further, detailed prospective descriptions of the ‘renal recovery phase’ between AKI and 90 days are lacking. Here we describe outcomes at serial timepoints (days 30, 60 and 90) for a prospective cohort of hospitalised patients with AKI. Method Single centre, prospective cohort study of participants with all stages of AKI. Each participant was characterised in detail, including AKI aetiology, co-morbidities and frailty. Baseline blood and urine samples were obtained at the time of consent. Participants were then followed up at days 30, 60 and 90 with clinical measurements and blood and urine sample collection. Blood tests included serum creatinine and GFR measured by the CKD-EPI equation. The proportion of participants with renal recovery at different creatinine above baseline thresholds as well as major adverse kidney events (MAKE) a composite outcome of death, new dialysis, and persistent renal dysfunction, defined as a 25% or greater decline in GFR was determined at day 30, 60 and 90. Where data was missing, last creatinine / GFR was carried forward for day 60 and 90, or discharge creatinine for day 30. Results A total of 124 participants were recruited. 63% of patients had AKI on hospital admission. The median baseline creatinine was 88 (IQR 70–117) μmol/L and median GFR was 68 (46–87) mL/min/1.73 m2. Median peak creatinine of 306 (IQR 177–458) μmol/L. The majority of AKI was severe (stage 1 (24%) vs stages 2 & 3 (76%)). The most common primary aetiology of AKI was dehydration (46%) followed by sepsis (22%). Table 1 demonstrates the number of participants with ‘recovered’ renal function as defined by a creatinine above baseline of 10%, 20% and 50% from baseline (the latter being reversal of KDIGO AKI stage 1) across the timepoints. Non-recovery of renal function was common across all time points, ranging from 22% to 59% at day 90 depending on which definition of recovery was applied. Table 2 summarises the rate of major adverse kidney events (MAKE) for day 30, 60 and 90, that was predominantly driven by persistent renal dysfunction. Conclusion This study is one of the few prospective descriptions of the AKI recovery from time of AKI to day 90. Whilst it is known that failure to recover creatinine by day 90 is predictive of future renal dysfunction, these data suggest that there is little dynamic change after day 30 and suggests that interventions to prevent the AKI to CKD transition should be targeted in the first 30 days after AKI in order to have the biggest impact. These data also highlight the need for a consensus definition of non-recovery of renal function. Future work on this cohort will therefore include relating different thresholds of renal recovery to outcomes.

Online travel searches: From pandemic to endemicity

This research paper presents the core findings of a study on the impact of stringency of government policies on online travel search behaviour between 2020 and 2022, and how these measures were perceived by potential travellers concerning different destinations. This study also includes isolated effects, deaths, and vaccinations, which are representative of the level of risk of COVID-19. Results show that online travel searches do not cease during a health crisis, but fluctuate in response to perceived risks and travel friction factors until the recovery phase. It highlights the influence of online search engines as liminal systems that provide travel consumers with a transient means of contact with destinations in an unstable market environment, but which can materialize into consumption at any given moment perceived by consumers as viable. Findings also reveal that risk factors and stringency of policies among destinations were perceived unevenly by potential tourists.

New findings on retinal microvascular changes in patients with primary COVID-19 infection: a longitudinal study.

To investigate the longitudinal alterations of retinal microvasculature in patients with primary coronavirus disease 2019 (COVID-19) infection. A cohort of participants, who had never been infected with COVID-19, was recruited between December 2022 and May 2023 at Peking Union Medical College Hospital in Beijing, China. Participants underwent comprehensive ophthalmologic examinations and fundus imaging, which included color fundus photography, autofluorescence photography, swept-source optical coherence tomography (SS-OCT) and SS-OCT angiography (SS-OCTA). If participants were infected with COVID-19 during the study, follow-ups with consistent imaging modality were conducted within one week and two months after recovery from the infection. 31 patients (61 eyes), with a mean age of 31.0 ± 7.2 years old, were eligible for this study. All participants contracted mild COVID-19 infection within one month of baseline data collection. The average period was 10.9 ± 2.0 days post-infection for the first follow-up and 61.0 ± 3.5 days for the second follow-up. No clinical retinal microvasculopathy features were observed during the follow-ups. However, SS-OCTA analysis showed a significant increase in macular vessel density (MVD) from 60.76 ± 2.88% at baseline to 61.59 ± 3.72%(p=0.015) at the first follow-up, which subsequently returned to the baseline level of 60.23 ± 3.33% (p=0.162) at the two-month follow-up. The foveal avascular zone (FAZ) remained stable during the follow-ups with areas of 0.339 ± 0.097mm2, 0.342 ± 0.093mm2, and 0.344 ± 0.098mm2 at the baseline, first follow-up (p=0.09) and second follow-up (p=0.052), respectively. Central macular thickness, cube volume and ganglion cell-inner plexiform layer showed a transient decrease at the first follow-up(p<0.001, p=0.039, p=0.002, respectively), and increased to baseline level at the two-month follow-up(p=0.401, p=0.368, p=0.438, respectively). Mild COVID-19 infection may temporarily and reversibly impact retinal microvasculature, characterized by a transient increase in retinal blood flow during the early recovery phase, which returns to the pre-infection level two months post-infection.

Comparative Study of Predictive Classification Models on Data with Severely Imbalanced Predictors

Analysing pre-COVID-19 unemployment in West Java is vital for comprehending and tackling Indonesia’s economic challenges. This significance arises not only due to the region’s high unemployment rate, but also from the need to understand unemployment patterns before COVID-19, which has become more relevant now during the country’s post-pandemic recovery phase. This study evaluates four machine learning models (Random Forest, Linear SVM, RBF SVM, and Polynomial SVM) to classify employment status using demographic and job-related variables. The objective is to find the most suitable model, particularly considering the imbalanced nature of the study-case data. Data from the National Labor Force Survey (SAKERNAS) in August 2019 is utilized, comprising 54,429 respondents across districts in West Java. The four models are evaluated using holdout validation with a 70:30 stratified proportion, repeated for 100 times. Results indicate that the random forest model outperforms others in balanced accuracy, F1-score, and computational time. The random forest model also underscores the importance of gender and age in classifying employment status in West Java, suggesting a need for targeted intervention, especially for female citizens and individuals in productive age groups.

Pectoral Fin Propulsion Performance Analysis of Robotic Fish with Multiple Degrees of Freedom Based on Burst-and-Coast Swimming Behavior Stroke Ratio

The pectoral fin propulsion of a bionic robotic fish always consists of two phases: propulsion and recovery. The robotic fish moves in a burst-and-coast swimming manner. This study aims to analyze a pair of bionic robotic fish with rigid pectoral fin propulsion with three degrees of freedom and optimize the elliptical propulsion curve with the minimum recovery stroke resistance using computational fluid dynamics methods. Then, the time allocated to the propulsion and recovery phases is investigated to maximize the propulsion performance of the bionic robotic fish. The numerical simulation results show that when the time ratio of the propulsion and recovery phases is 0.5:1, the resistance during the movement of the robotic fish is effectively reduced, and the drag-reducing effect is pronounced. According to a further analysis of pressure clouds and vortex structures, the pressure difference between the upstream and downstream fins of the pectoral fin varies with different stroke ratios. The increase in recovery phase time helps to prevent premature damage to the vortex ring structure generated during the propulsion process and improves propulsion efficiency.

Supporting post-pandemic recovery: a qualitative study of the capabilities, opportunities and motivations to deliver oral health behaviour change messages to parents of young children in community settings.

The COVID-19 pandemic exacerbated vulnerabilities and inequalities in children's oral health, and treatment activity virtually ceased during periods of lockdown. Primary care dentistry is still in the post-pandemic recovery phase, and it may be some years before normal service is resumed in NHS dentistry. However, opportunities to support the dental workforce through offering some preventative care in outreach settings may exist. This has the additional benefit of potentially reaching children who do not routinely see a dentist. The aim of this research was therefore to explore views around upskilling practitioners working in early years educational and care settings to support families of pre-school aged children to adopt and maintain preventative oral health behaviours. Using the Capability, Opportunity and Motivation model of behaviour (COM-B) to structure our data collection and analysis, we conducted semi-structured interviews with 16 practitioners (dental and non-dental) and analysed the data using deductive framework analysis. The data were a good fit with the COM-B model, and further themes were developed within each construct, representing insights from the data. Early years practitioners can reach vulnerable children who are not usually brought to see a dentist, and have the capability, opportunity and motivation to support the oral health behaviours of families of children in their care. Further research is needed to identify training needs (oral health and behaviour change knowledge and skills), acceptability to parents, and supporting dental practice teams to work in partnership with early years settings.

Intermittent sequential pneumatic compression reduces post-exercise hemodilution and enhances perceptual recovery without improving subsequent cycling performance

Abstract Purpose The present study aims to evaluate the effects of intermittent sequential pneumatic compression (ISPC) in the short-term recovery of a repeated sprint interval exercise, including the assessment of power output performance, hematocrit, legs water, and perceptual recovery. Methods A randomized, counterbalanced, crossover design was conducted. Sixteen healthy trained individuals (F=7, M=9; 27.7 ± 9.4 years; BMI 22.3 ± 2.9) performed two trials of a cycling fatiguing exercise, followed by a recovery phase (ISPC or Sham), and a subsequent performance assessment exercise to evaluate the effects of ISPC in post-exercise recovery. Results There were no significant differences in cycling performance comparing both recovery modes. However, the decrease in the hematocrit levels after the recovery phase was less exacerbated in the ISPC condition compared to Sham (44.03 ± 1.33 vs. 42.38 ± 1.33 %; p = 0.047; d = 0.310). Likewise, the total quality recovery (TQR) was higher after the recovery in the ISPC condition (15.94 ± 0.16 vs. 14.75 ± 0.12 points; p = 0.045; d = 2.125), although no differences were shown previously in power output performance (371.8 ± 22.2 [46.5] vs. 372.4 ± 21.8 [47.2] W; p = 0.986) and rating of perceived exertion (RPE) (17.69 ± 0.41 vs. 17.56 ± 0.31; p = 0.700). Conclusions Contrary to our hypothesis, the application of intermittent sequential pneumatic compression after high-intensity exercise reduces the post-exercise hemodilution response and increases perceptual recovery. However, power output was similar between conditions, challenging the effectiveness of this recovery method in a short-term intervention.

Comparative analysis of oropharyngeal microbiota in healthcare workers post-COVID-19.

To date, more than 770 million individuals have become coronavirus disease 2019 (COVID-19) convalescents worldwide. Emerging evidence highlights the influence of COVID-19 on the oral microbiome during both acute and convalescent disease phases. Front-line healthcare workers are at an elevated risk of exposure to viral infections, and the effects of COVID-19 on their oral microbiome remain relatively unexplored. Oropharyngeal swab specimens, collected one month after a negative COVID-19 test from a cohort comprising 55 healthcare workers, underwent 16S rRNA sequencing. We conducted a comparative analysis between this post-COVID-19 cohort and the pre-infection dataset from the same participants. Community composition analysis, indicator species analysis, alpha diversity assessment, beta diversity exploration, and functional prediction were evaluated. The Shannon and Simpson indexes of the oral microbial community declined significantly in the post-COVID-19 group when compared with the pre-infection cohort. Moreover, there was clear intergroup clustering between the two groups. In the post-COVID-19 group, the phylum Firmicutes showed a significant increase. Further, there were clear differences in relative abundance of several bacterial genera in contrast with the pre-infection group, including Streptococcus, Gemella, Granulicatella, Capnocytophaga, Leptotrichia, Fusobacterium, and Prevotella. We identified Gemella enrichment in the post-COVID-19 group, potentially serving as a recovery period performance indicator. Functional prediction revealed lipopolysaccharide biosynthesis downregulation in the post-COVID-19 group, an outcome with host inflammatory response modulation and innate defence mechanism implications. During the recovery phase of COVID-19, the oral microbiome diversity of front-line healthcare workers failed to fully return to its pre-infection state. Despite the negative COVID-19 test result one month later, notable disparities persisted in the composition and functional attributes of the oral microbiota.

Effect of olfactory stimulation from aromatherapy on the autonomic nervous activity during aerobic exercises

Variations in the autonomic nervous system activity during exercise therapy in patients with cardiovascular diseases may lead to adverse events. Aromatherapy may reduce these adverse events by enhancing parasympathetic nervous activity (PNA). However, the effects of aromatherapy during exercise remain relatively unknown. This study aimed to evaluate the effect of aromatherapy on autonomic nervous activity during exercise and recovery. This randomized crossover study included 20 healthy men subjected to both aroma and placebo conditions which involved rest and moderate-intensity aerobic exercise on a cycle ergometer, followed by recovery. Blood pressure, heart rate variability indices, and SpO2 were measured during the rest, exercise, and recovery phases. Moreover, aroma preferences and emotional changes in response to the aroma were assessed. Under the placebo condition, high frequency (HF), root mean square of successive differences indices, and heart rate showed delayed recovery (P < 0.05). Furthermore, a moderate positive correlation was identified between aroma preference, pleasant emotions induced by aromatherapy, and the HF index (P < 0.05). These results indicate that aromatherapy facilitates the recovery of PNA after exercise. Furthermore, these effects were more pronounced among individuals who exhibited a stronger preference for and more positive emotions toward aromas.

Thermospheric nitric oxide energy budget during extreme geomagnetic storms: a comparative study

We selected three superstorms (disturbance storm time [Dst] index less than −350 nT) of 2003–04 to study the thermospheric energy budget with a particular emphasis on the thermospheric cooling emission by nitric oxide via a wavelength of 5.3 μm. The nitric oxide radiative emission data are obtained from the Sounding of the Atmosphere by Broadband Emission Radiometry (SABER) instrument onboard the Thermosphere Ionosphere Mesosphere Energetics and Dynamics (TIMED) satellite and the thermosphere ionosphere electrodynamic general circulation model (TIEGCM) simulation. Different energy sources for the magnetospheric energy injection and the thermospheric/ionospheric dissipation processes are calculated using empirical formulations, model simulations, and space-borne and ground-based measurements. The Joule heating rates calculated from different sources showed similar variations but significant differences in the magnitude. The nitric oxide cooling power is calculated by zonally and meridionally integrating the cooling flux in the altitude range of 100–250 km. The satellite observed that cooling flux responds faster to the energy input, as compared to the modeled results. The cooling power increases by an order of magnitude during storm time with maximum radiation observed during the recovery phase. Both the satellite-observed and modeled cooling powers show a strong positive correlation with the Joule heating power during the main phase of the storm. It is found that the maximum radiative power does not occur during the strongest storm, and it strongly depends on the duration of the main phase. The model simulation predicts a higher cooling power than that predicted by the observation. During a typical superstorm, on average, a cooling power of 1.87 × 105 GW exiting the thermosphere is estimated by the TIEGCM simulation. On average, it is about 40% higher than the satellite observation.

Repeated Sprint Training in Hypoxia Improves Repeated Sprint Ability to Exhaustion Similarly in Active Males and Females.

The aim of this study was to compare the physiological adaptations of males and females to repeated sprint training in hypoxia (RSH). Active males and females completed 7 wk of repeated sprint training in normoxia (RSN; F i O 2 = 0.209, males: n = 11, females: n = 8) or RSH (F i O 2 = 0.146, males: n = 12, females: n = 10). Before (Pre-) and after (Post-) training, a repeated sprint ability (RSA) test was performed (10-s cycle sprints with 20-s recovery between sprints, until exhaustion), and aerobic and anaerobic qualities were evaluated in normoxia. The number of sprints during RSA increased after training in HYP from 11 to 21 in males and from 8 to 14 in females ( P < 0.001, 95% confidence interval = 5-11), without significant changes after RSN (10 vs 14 and 8 vs 10 in males and females, respectively). No improvements in mean or peak power output were found in either group. Total work during RSA improved after training in all groups (+9 ± 2 kJ, P < 0.001). Tissue saturation index during the repeated sprints was higher in females than males (+10% ± 2%, P < 0.001). The difference in tissue saturation index between the recovery and sprint phases remained unchanged after training. O 2 peak during an incremental exercise test increased in all groups (+3 ± 1 mL·kg -1 ·min -1 , P = 0.039). Mean power output during a Wingate test also increased in both males and females in RSN and RSH (+0.38 ± 0.18 W·kg -1 , P = 0.036). No changes were observed in hematological parameters after training. Seven weeks of RSH further increased the number of repeated sprints performed to exhaustion compared with RSN in females, in the same order of magnitude as in males.

Attitudes of cardiac rehabilitation and stroke teams towards integration of stroke survivors into adapted cardiac rehabilitation: A focus group study

Objective To explore the attitudes and beliefs of cardiac rehabilitation and stroke teams towards adapted cardiac rehabilitation, and the broader topics of exercise, healthy lifestyles and health behaviour change, for people with mild-to-moderate severity stroke in the sub-acute phase of recovery. Design Qualitative focus group-based study. Setting Acute and community national health service trusts. Participants Stroke and cardiac rehabilitation team members. Intervention Adapted cardiac rehabilitation. Main measures Focus groups. Thematic analysis was applied to the transcribed data. Results Overall, 57 health professionals participated in 12 focus groups. Positive impacts for teams and stroke survivors were identified particularly confidence. However, there were negatives, barriers and adaptations identified. In addition, there was a lack of knowledge for cardiac rehabilitation teams in relation to stroke survivors and stroke teams in relation to cardiac rehabilitation, exercise and healthy lifestyles. Conclusions Cardiac rehabilitation and stroke staff attitudes to cardiac rehabilitation for stroke survivors showed a range of benefits, negatives, barriers and adaptations needed. Confidence and knowledge of the cardiac rehabilitation and stroke teams needs to be addressed. Registration ISRCTN65957980.

Correlations in abnormal synergies between the upper and lower extremities across various phases of stroke.

The flexion synergy and extension synergy are a representative consequence of a stroke and appear in the upper extremity and the lower extremity. Since the ipsilesional corticospinal tract (CST) is the most influential neural pathway for both extremities in motor execution, damage by a stroke to this tract could lead to similar motor pathological features (e.g., abnormal synergies) in both extremities. However, less attention has been paid to the interlimb correlations in the flexion synergy and extension synergy across different recovery phases of a stroke. We used results of the Fugl-Meyer assessment (FMA) to characterize those correlations in a total of 512 participants with hemiparesis after stroke from the acute phase to 1 year. The FMA provides indirect indicators of the degrees of the flexion synergy and extension synergy after stroke. We found that, generally, strong interlimb correlations (r > 0.65 with all P values < 0.0001) between the flexion synergy and extension synergy appeared in the acute-to-subacute phase (<90 days). However, the correlations of the lower-extremity extension synergy with the upper-extremity flexion synergy and extension synergy decreased (down to r = 0.38) 360 days after stroke (P < 0.05). These results suggest that the preferential use of alternative neural pathways after damage by a stroke to the CST enhances the interlimb correlations between the flexion synergy and extension synergy. At the same time, the results imply that the recovery of CST integrity or/and the fragmentation (remodeling) of the alternative neural substrates in the chronic phase may contribute to diversity in neural pathways in motor execution, eventually leading to reduced interlimb correlations.NEW & NOTEWORTHY For the first time, this article addresses the asynchronous relationships in the strengths of flexion and extension synergy expressions between the paretic upper extremity and lower extremity across various phases of stroke.

Sustaining spontaneous volunteer groups following their response to a disaster

PurposeThis research explores the drivers that determine the ability of spontaneous volunteer groups (SVGs) to sustain their operations. That sustainability aims to support those affected in the community beyond the response phases of a disaster and into the recovery and mitigation phases to build resilience to the next disaster.Design/methodology/approachTo investigate the sustainability of spontaneous volunteering that takes place in the aftermath of a disaster, we conducted qualitative interviews in three English locations where groups of spontaneous volunteers emerged following major floods. We analysed our qualitative data using thematic analysis.FindingsOur findings theorise the drivers of SVG sustainability and present these in four themes: (1) assessment of ongoing needs; (2) organisation of resources to address that need; (3) leadership and followership creating a weight of operational capability and (4) influence of political will. Through exploring these drivers, we uncover key factors to developing a sustainable SVG system including trusted leadership and social capital.Research limitations/implicationsWe show how the four drivers interact to support the continuity of SVGs and sustain their operations. This has implications for how leaders of SVGs create a volunteering environment that encourages ongoing involvement and has implications for officials to view SVGs as a support rather than a risk.Originality/valueThe novelty of our paper is in rejecting the argument of the temporal limit of SVGs to the response phase by theorising the drivers that make their operations sustainable for recovery and resilience building to mitigate the next disaster. This includes our examination of the interplay between those drivers.

Specific Salivary Neuropeptides Shift Synchronously during Acute Stress in Fire Recruits.

Once thought of as an immune-privileged site, we now know that the nervous system communicates in a bidirectional manner with the immune system via the neuroimmune axis. Neuropeptides constitute a component of this axis, playing critical roles in the brain and periphery. The function of salivary neuropeptides in the acute stress response is not well understood. The purpose of this study is to investigate salivary neuropeptide levels during acute stress. Salivary samples were collected from fire recruits engaged in a stress training exercise previously shown to induce acute stress, at three separate timepoints during the exercise and levels of oxytocin, neurotensin, Substance P, α-MSH, and β-Endorphin were measured using the Human Neuropeptide 5-Plex Custom Assay Eve Technologies. All neuropeptides increased throughout the acute stress simulation and during the recovery phase. Exploratory factor analysis (EFA) identified one factor contributing to baseline values across five neuropeptides and Pairwise Pearson Correlation Coefficient analysis showed positive correlations >0.9 for almost all neuropeptide combinations at the pre-stress timepoint. Further analysis identified negative and positive correlations between past-life trauma and self-assessed hardiness, respectively. Calculated neuropeptide scores showed an overall positive correlation to self-assessed hardiness. Altogether, our results suggest that salivary neuropeptides increase synchronously during acute stress and higher levels correlate with an increase in self-assessed hardiness. Further study is required to determine if interventions designed to enhance neuropeptide activity can increase stress resilience, especially in high-stress occupations such as firefighting.

Push the Limit of Highly Accurate Ranging on Commercial UWB Devices

Ranging plays a crucial role in many wireless sensing applications. Among the wireless techniques employed for ranging, Ultra-Wideband (UWB) has received much attention due to its excellent performance and widespread integration into consumer-level electronics. However, the ranging accuracy of the current UWB systems is limited to the centimeter level due to bandwidth limitation, hindering their use for applications that require a very high resolution. This paper proposes a novel system that achieves sub-millimeter-level ranging accuracy on commercial UWB devices for the first time. Our approach leverages the fine-grained phase information of commercial UWB devices. To eliminate the phase drift, we design a fine-grained phase recovery method by utilizing the bi-directional messages in UWB two-way ranging. We further present a dual-frequency switching method to resolve phase ambiguity. Building upon this, we design and implement the ranging system on commercial UWB modules. Extensive experiments demonstrate that our system achieves a median ranging error of just 0.77 mm, reducing the error by 96.54% compared to the state-of-the-art method. We also present three real-life applications to showcase the fine-grained sensing capabilities of our system, including i) smart speaker control, ii) free-style user handwriting, and iii) 3D tracking for virtual-reality (VR) controllers.