Limited Mobility Research Articles

Successful mobility in a wheelchair and the health status of people with paraplegia

Introduction. Possession of a wheelchair allows disabled people with paraplegia to compensate for mobility limitations. In order to build the rehabilitation process, it is important to know what factors hinder and what factors facilitate the development of a wheelchair. Aim. To determine functional independence, quality of life and secondary health conditions in persons with lower paraplegia and to assess their relationships with the degree of difficulty when moving around in a wheelchair. Materials and methods. We examined 396 patients with spinal cord injury (SCI) and lower paraplegia who used a wheelchair. The level of independence of the patients was determined using Functional Independence Measure (FIM) and Spinal Cord Independence Measure (SCIM III), quality of life was assessed using the SF-36 questionnaire, secondary health conditions were determined using the SCI SCS scale and the presence of problems moving around in the wheelchair was assessed using category d465 «moving around using equipment» of the International Classification of Functioning, Disability and Health. Results. Half of the examined patients with SCI had a sufficiently high level of independence when performing daily activities. 43.5 % of the patients showed either moderate, severe or absolute problems moving around in the wheelchair and 65.4 % demonstrated the presence of more than three secondary health conditions. We found negative correlations between the degree of difficulty experienced by the patients when moving around in the wheelchair and the levels of independence in daily life and the indicators of quality of life such as vitality, social functioning and mental health. In binary logistic regression it was ascertained that the significant independent factors associated with difficulty when using the wheelchair were spasticity, contractures of the muscles of the lower limb and circulatory disorders. Conclusion. The success in using the wheelchair is limited by spasticity, contractures of the muscles of the lower limb and circulatory disorders.

Immediate Effects of the Mandibular Muscle Energy Technique in Adults with Chronic Temporomandibular Disorder

Background/Objectives: Temporomandibular disorders affect the muscles used for chewing, the temporomandibular joint, and other related tissues, resulting in pain, limited mobility, and dysfunction of the masticatory muscles. Physical therapy plays a critical role in treatment. Manual therapy can trigger neurophysiological mechanisms that contribute to pain relief and a reduction in muscle activation. Evaluations of different manual therapy techniques are needed on this topic. The main objective of this study was to evaluate the effects of a specific manual therapy technique (the mandibular muscle energy technique) in adults with temporomandibular disorders. Methods: A randomized, parallel clinical trial was conducted, and 31 participants were recruited into an experimental group and 30 were recruited into a control group in order to analyze its effects on outcomes such as pain, pain threshold to pressure, mandibular mobility, and kinesiophobia. Pre- and post-intervention assessments were performed, followed by statistical analyses to verify the intra- and intergroup changes. Results: The results showed that the mandibular muscle energy technique produced positive effects with significant differences in the intra- and intergroup comparisons for pain threshold to pressure, mandibular mobility, and kinesiophobia, demonstrating its efficacy and safety as a treatment option for adults with temporomandibular disorders, with proven effects in the short term. Conclusions: The effects obtained and the absence of side effects showed that this technique can be integrated into multimodal treatment along with other types of interventions in patients with temporomandibular disorders.

Healthcare access in humanitarian settings: Mobile services successes and limits in Afghanistan

With an ever-increasing number of humanitarian emergencies being declared around the globe, identifying effective methods to provide healthcare access to affected communities is all the more relevant to health practitioners. Mobile health services have been widely implemented by international and national actors to reach underserved communities in humanitarian contexts. Nonetheless, little rigorous evidence exists on the effects of such services. Our work contributes to filling the knowledge gap by studying the role of mobile health teams (MHTs) in Afghanistan after the institution of the Taliban De Facto Authority in 2021. We conduct correlational and quasi-experimental analysis of country-wide survey data and matched with geo-localised information on MHTs and their related service delivery points (SDPs) – at least in part of the country – from WHO and UNICEF. Our findings show mobile services enhance recent access to health care by about 11 percentage points (about 14% over comparison) based on our preferred model. We also identify a decreasing effect of number of MHTs and SDPs on healthcare access. Our results indicate that higher number of mobile services do not necessarily translate to better access, although strong differences exist between underserved and better served areas within the country.

Impact of Sport and Physical Activity on Urinary Incontinence: Does Exercise Act as a Protective Factor or Increase Risk?

Introduction: Urinary incontinence is a health problem which affects women more often. The condition manifests itself as uncontrolled urine leakage. A basic distinction is made between stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI). Physical activity is commonly used in the treatment of UI. Interestingly, numerous studies show that athletes and especially female athletes are more likely to develop UI. In this study, we will try to answer the question of whether sport and physical activity have a protective effect or are a risk factor for the development of UI. In this review, we will focus on sports and physical activity that does not directly target pelvic floor muscle training.Aim of the study: A review of the literature on the impact of sport and physical activity on the prevalence of urinary incontinence in both sexes in different age groups and different health and fitness statusesMaterials and methods: A review of the recent literature available in PubMed and Google Scholar databases was conducted, using keywords such as ‘urinary incontinence’, ‘stress urinary incontinence’, ‘prostatectomy”. This review was enriched by urological guidelines on urinary incontinence.Conclusion: Urinary incontinence is a common ailment, especially among women. Particularly at risk are those who participate in high-intensity sports and do prolonged training, performing exercises such as jumping and sprinting. On the other hand, limited physical mobility is also a risk factor for incontinence. Keeping active in seniors can reduce symptoms. Exercises with positive effects include Pilates, which has very good efficacy in men after total prostatectomy surgery. Physical activity may also help to reduce body weight, as obesity is a recognised risk factor for urinary incontinence. Further research into the therapeutic use of exercises such as yoga and Pilates is warranted and may help treat patients with incontinence.

Paul Christian P. Pacquing, MD (1986-2024)

It is an honor to write this tribute to Dr. Paul Christian Pacquing, though I never imagined doing this for him. Given this opportunity to pay my last respects to a dear friend and colleague, I will try my best to recount and share the last 11 years of his life with you. Pax played a myriad of roles. He was a husband, a father, a son, a friend and a physician. Whichever role he played; he was exemplary at it. I first met Pax during pre-residency for the ORL-HNS program at the East Avenue Medical Center. He was cordial to everyone, even to his fellow pre residents, despite us being competitors. During residency, he stood out as Mr. Congeniality. He had an immensely infectious smile, and was literally friends with everyone in the hospital. He always had an amicable demeanor towards his patients. He would call patients like, "Mommy dear! Kumusta ka na?" Sometimes, proceeding to innocently and warmly hug our patients. He had a knack for handling conflicts and toxicities with his laid back nature. He would utter: "Chill. Relax lang tayo pare." Surprisingly, this worked and we would surmount our challenges unscathed most of the time. We had our sleep medicine and surgery fellowship training together in the same year at Chang Gung Medical Center. He excelled even in a foreign land and training institution. As a Fellow, he was sharp, studious and valued the time and experience there. Our mentors acknowledged his brilliance and he finished training with much approval. Back home, he established his practice in Isabela, Cagayan and Manila. However, due to the limited mobility brought about by the pandemic, he opted to stay in his hometown of Isabela and share his medical expertise there. As a physician, he was charitable and compassionate. Sharing a clinic together, our secretary would frequently tell me the incidents where Pax would treat financially-constrained patients for free. He would incessantly discuss his dream of establishing and providing sleep disorder services in the North to cater to his fellow Ilocanos. As a family man, he was affectionate, responsible and thoughtful. He loved his wife and was committed, despite numerous challenges. Our chats never ended without him talking about his daughter, the time they spent together and the dreams he had for her. Even during his last days, he only thought of his daughter and that he was determined to fight on so that he could see her grow up. In March 2023, after attending our annual PSSM convention, he was diagnosed with a rare type of B- lymphoblastic leukemia. This was extremely difficult and sad news to process by everyone close to Pax. How could a fit, sporty and healthy young man have leukemia? He underwent numerous grueling sessions of chemotherapy, but despite this, in a typical Pax manner of managing things, he remained calm, positive and relaxed. Never was there a negative word during the entirety of his treatment. Even in pictures where he was bedridden and attached to IV lines, he was still smiling. On the morning of September 4, 2024, the day prior to the first phase of his bone marrow transplant treatment, he asked for prayers and told me the next time I see him will be during recovery. Four days after, I received news from his wife that he was in critical condition with signs of multiple organ failure. Even prior to intubation, he was seen smiling and waving to his wife and brother and gesturing a thumbs up. Only a brave man would be capable of doing this while feeling the inevitable end nearing. Pax joined our Creator the following day. Paul Christian’s early passing remains a mystery and nagging question to family and friends. Why was this energetic, young and vibrant soul extinguished so early? Perhaps God has a plan. As mere humans, maybe we are not supposed to know the answers to the whys and whens of life and existence. To Pax: "Paalam, kapatid." We will miss you.I know you are smiling down at us from the heavens.

Effective phonon dispersion and low field transport in AlxGa1−xN alloys using supercells: An ab initio approach

To investigate the transport properties in random alloys, it is important to model the alloy disorder using supercells. Although computationally expensive, the local disorder in the system is accurately captured as translational symmetry that is imposed on the system over larger length scales. Additionally, in supercells, the error introduced by self-image interaction between the impurities is reduced. In this work, we have investigated the Effective Phonon Dispersion (EPD) and transport properties, from first principle calculations using supercells in AlxGa1−xN alloy systems. Using an in-house developed code for phonon-band unfolding, the EPD of AlGaN is obtained and the individual phonon modes are identified with good agreement with experimental values. Moreover, we report an in-house developed method to calculate low-field transport properties directly from supercells without phonon band unfolding. First, to validate our methods, we have solved the Boltzmann transport equation using Rode’s method to compare the phonon limited mobility in the 4 atom GaN primitive cell and 12 atom GaN supercell. Using the same technique, we have investigated the low field transport in random AlxGa1−xN alloy systems. The quadrupole interaction is included for transport properties of GaN and AlN to accurately capture the physics in these materials. Our calculations show that along with alloy scattering, electron–phonon scattering may also play an important role at room temperature and high-temperature device operation. This technique opens up the path for calculating phonon-limited transport properties in random alloy systems.

Anesthetic Challenges in a Patient with Nodular Sclerosing Classical Hodgkin’s Lymphoma complicated by Cervical Metastasis and SVC Syndrome: A Case Report

This case presents the anesthetic complexities involved in managing a patient with nodular sclerosing classical Hodgkin’s Lymphoma, who presented with severe airway compromise, limited neck mobility due to C7 vertebra involvement, and superior vena cava syndrome. The patient, with an extensive anterior neck mass extending into the mediastinum, post-auricular, and axillary areas, exhibited symptoms such as dyspnea, orthopnea, facial swelling, and upper extremity edema, complicating traditional airway management techniques. Faced with these challenges, the team anticipated significant difficulty with ventilation, direct laryngoscopy, and invasive airway access. To address the airway obstruction effectively before initiating radiotherapy, the anesthesiologists employed awake nasotracheal intubation using a fiberoptic scope with minimal sedation using Remifentanil. This approach successfully secured the airway and facilitated an extended tracheostomy. The patient tolerated the procedure well and was eventually discharged. This case underscores the critical role of fiberoptic intubation in managing complex airway scenarios, particularly in patients with complex malignancies and associated complications.

Functional Outcome after Clinical Recovery from Moderate to Critical COVID-19 among Patients Admitted to the Philippine General Hospital: A Prospective Cohort Study

Background and Objective. COVID-19 is a novel disease primarily affecting the respiratory system. Of those infected, approximately 20% require management in a hospital-setting which may lead to deconditioning. Measures implemented to control spread of the virus also restricted mobility both in the hospital and community setting. The goal of this study was to describe the patient characteristics (age, sex, comorbidities), hospitalization (length of hospital stay, ICU stay, referral to Rehabilitation Medicine), and long-term functional outcome of patients who have clinically recovered from moderate to critical COVID-19 in terms of participation in activities of daily living. Methods. This was a descriptive prospective cohort study conducted at a tertiary government hospital with participant recruitment from September 2020 to February 2021 consisting of clinically recovered adult patients managed as COVID-19 Confirmed via rRT-PCR with moderate, severe, or critical risk status. Descriptive statistics were obtained and multiple regression analysis was done to determine associations between patient demographics and their Barthel Index Scores on follow-up at discharge, one month post-discharge, and six months post-discharge. Results. A total of 63 patients were recruited to our study with an average age of 52.4 years. More recovered patients had fulfilled the criteria of moderate illness (46%), with the most common comorbidity being chronic lung disease (42.1%) and diabetes (42.1%). Almost all had total independence pre-morbidly with better baseline functional scores for the COVID-19 severe population. Majority of the patients (63.5%) were not referred for Rehabilitation services. Across all patients, Barthel Index Score at discharge indicated a significant decline from slight dependence to moderate dependence in performing activities of daily living with the pre-morbid status significantly predicting scores at discharge (β = 0.621, p = 0.001) on multiple regression analysis. Patient demographics, hospitalization and ICU stay and outcome, and referral to Rehabilitation Medicine were not found to be significant factors. In the course of follow up, a high dropout rate was observed across the population and by the end of the study, 57.1% of the participants were alive while among those lost to follow up, 20.6% had expired and the remaining 22.2% had an unknown status. Conclusion. COVID-19 significantly affects the functional outcome of patients in terms of activities of daily living as measured by the Barthel Index. Preliminary data gathered from our study and the high dropout rate supports the need for better follow-up and selecting a tool that is better able to describe the non-demographic factors affecting functionality and participation in activities of daily living.

Management of Smith-Lemli-Opitz Syndrome Type II associated with Cleft Palate

Rationale: This case report presents the management of a patient with the rare occurrence of SmithLemli-Opitz Syndrome (SLOS) and complete cleft palate Patient Concerns: The patient's cleft palate repair was not done in infancy, and she reported to the dental institution complaining of difficulty with proper food intake and speech. A clinical examination revealed muscle deformity, limited neck mobility, scoliosis, malocclusion, and inadequate oral health. The patient exhibited facial and limb anomalies characteristic of SLOS, in tandem with substantial challenges in speech and nutrition due to the cleft palate. Diagnosis: The patient was referred to the dental wing to manage the cleft palate defect. On dental examination a complete cleft of the hard and soft palate, which had not been surgically corrected during infancy, was confirmed through clinical and radiological investigation. Additional musculoskeletal complications, including scoliosis and muscle deformity, were also identified. Interventions: The treatment plan addressed both SLOS and cleft palate. A prosthodontic appliance was prepared to assist with palatal function and speech therapy. Comprehensive care for SLOS included genetic counselling, nutrition management, and targeted physical therapy. The patient was also referred to an orthodontist, oral surgeon and a speech-language therapist further intervention. Conclusion: This case emphasizes the importance of early diagnosis and intervention in congenital disorders. It advocates for proactive, multidisciplinary care from infancy to enhance the quality of life for individuals with complex syndromes, underscoring the need for ongoing support and resources

Perspectives of Palestinian physicians on the impact of the Gaza War in the West Bank

BackgroundThe West Bank has been under military occupation since 1967. When the Israeli army attacked Gaza after October 7th, 2023, the situation in the occupied West Bank became much worse. We interviewed Palestinian physicians about practicing under occupation and how the Gaza War has impacted their professional and personal lives. MethodsThis qualitative study was conducted from December 2023 to February 2024 and involved 15 individual interviews by reaching out to networks of practicing physicians across the West Bank, purposefully sampling physicians in different geographic locations in hospital and clinic-based practices. The data were analyzed with inductive coding and organized into themes. ResultsViolence and the threat of violence affected many elements of life and health. Restricted mobility, financial hardship, educational challenges, and fear about safety and the future affected physical and psychological health, making patients sicker and physicians' jobs harder. Lack of medications and treatments worsened chronic medical conditions. Mental health care was in demand due to acute stress and persistent trauma. Physicians struggle fulfilling their professional commitment to care for patients. They worried about the future and struggled to care for their families. ConclusionLife under occupation on the West Bank has become harsher and more violent with the Gaza War. The chronic exposure to trauma and ongoing uncertainty about the future impact physicians and the next generation of healthcare professionals who will care for their traumatized population. Despite the violations of international codes physicians continued to “honor their duties” to their patients and students.

Gender Differences in the Functional Limitations of Frail Older People Ageing in Place Alone in Italy.

The study presents findings from the IN-AGE ("Inclusive ageing in place") study carried out in 2019 in this country assessing the ability of seniors aged 65 years and over to carry out basic and instrumental activities of daily living (ADLs and IADLs), in addition to two mobility limitations (going up/down the stairs and bending to pick up an object) and sensory limitations (hearing and eyesight). Qualitative/semi-structured interviews were administered to 120 older people living in three Italian regions (Lombardy, Marche, and Calabria). Quantitative and qualitative analyses were performed by differentiating between genders and among activities carried out autonomously, with help, or not performed (i.e., the senior is "not able"). Possible sources of support were also explored. The main results revealed that cleaning the house, shopping, bathing/showering, and washing the laundry are particularly difficult, with men reporting greater difficulties than women. Moreover, for both genders, the family-especially children-represents the main source of help, in addition to public and private services, but the results differ between males and females. These results can offer insights for policymakers in the development of adequate gender-sensitive policies.

Comparative assessment of the quality of life in patients with bronchial asthma and chronic obstructive pulmonary disease before and after COVID-19

Objective. To compare the quality of life of patients with bronchial asthma and chronic obstructive pulmonary disease (COPD) before and after COVID-19. Materials and methods. 73 patients diagnosed with bronchial asthma and 78 patients with COPD who were treated at Sechenov University Clinical Hospital №4, participated in the retrospective dynamic comparative study based on the principle «from cause to effect». Assessment of the quality of the patients` life was carried out before and after COVID-19 using a visual analogue scale from 0 to 100 points and the universal EuroQol-5D questionnaire. Mobility, self-care abilities, habitual activity, severity of pain/discomfort, the presence of anxiety/depression in the post-COVID period were assessed. Results. In patients with COPD before COVID-19, the average total score on the visual–analogue scale was 89,5 [83,8; 95], and after COVID-19 it was 70 [64,5; 80] points. In the post-covid period, 91 % of people with COPD noted some mobility limitations, 33.3 % experienced difficulties with self-care, 65.4 % of patients could not engage in habitual activities, 60.3 % suffered pronounced pain or discomfort, and 29.5 % of patients had severe anxiety or depression. In patients with asthma before COVID-19, the average total score was 90 [88,4; 91] points, and after COVID-19 it was 75 [70,2; 80,2]. In the post-ovarian period, mobility limitations were noted by 71.2 % of patients, and 64.4 % had difficulties with taking care of themselves, 54.8 % could not engage in habitual activities. At the same time, 78.1 % of patients experienced pain or discomfort, and 58.9 % had moderate anxiety or depression. Conclusions. COVID-19 has led to a significant decrease in the quality of life in patients with asthma and COPD. This may be associated with a worsening of the course of the disease and increase in the number of exacerbations of these pulmonary pathologies, resulting in significant limitation of mobility, growing pain or discomfort, as well as the occurrence of severe anxiety or depression.

ER stress-induced YAP upregulation leads to chondrocyte phenotype loss in age-related osteoarthritis.

Osteoarthritis (OA) is a common degenerative joint disease, leading to pain and restricted mobility. Age-related endoplasmic reticulum (ER) stress has been implicated in the pathogenesis of OA, but the underlying mechanisms remain unclear. This study aims to explore the relationship between age-related ER stress, YAP overexpression, and chondrocyte phenotype loss in the development of OA. Cartilage samples were collected from patients undergoing amputation, and age-related ER stress markers and YAP expression were assessed using immunohistochemical staining and qPCR. Transgenic mice with cartilage-specific YAP overexpression (YAPOE) were created, and Pamrevlumab was administered to evaluate its therapeutic effects. Higher expression of ER stress markers and YAP were showed in aged tissues compared to younger tissues. YAP overexpression led to decreased levels of cartilage phenotype markers and increased osteogenesis-related proteins. In vivo, YAPOE mice exhibited OA-like cartilage degeneration, which was mitigated by Pamrevlumab treatment. Age-related ER stress induces YAP overexpression, contributing to OA pathogenesis. Pamrevlumab effectively prevents this phenotype loss in YAPOE mice, suggesting its potential as a therapeutic agent for OA. These findings provide new insights into the molecular mechanisms of OA and highlight the importance of targeting the ER stress-YAP-CTGF signaling pathway in OA treatment and prevention.

Comparisons in Limited Mobility: Exploring the Shaping of Travel Experience for Individuals with Physical Disabilities

Tourism emerges as a focal point under the “new mobilities” paradigm. Current research, however, needs to address how groups with limited mobility navigate their travel experiences. This study delves into the tourism patterns of tourists with physical disabilities—a prominent mobility-limited demographic. Utilizing constructivist grounded theory through interviews, participatory observation, and online data collection, we discern that the tourism experience of those with physical disabilities is shaped dynamically by “comparison” across four orientations: time, space, self, and others. This multidimensional comparison transitions from tangible tourism to profound experiential realms, defining their unique travel experiences. “Comparison” is identified as a core microgenetic mechanism, challenging existing psychological theories and potentially reshaping our understanding of the experiential processes for all tourist groups, not just those with mobility limitations. The findings enrich our understanding of mobility-constrained tourism within the “new mobilities” paradigm, offering insights and practical implications for the tourism industry. This article is also available in [Chinese]. See supplemental material for details.

Empowerment and Sustainability: Investigating Barriers to Women’s Transition from Higher Education to Empowerment in Brazil

Gender equality continues to be a global issue, with significant disparities in attention and action between developed and developing nations. Women, in particular, face unique challenges when transitioning from higher education (HE) to empowerment compared to their male counterparts. In many developing countries, barriers to accessing formal education are prevalent, while, in others, despite access to education, women struggle to leverage their learning for societal advancement. This paper adopts the development theory approach by exploring the role of gender equality in fostering sustainable development, emphasizing how women’s empowerment is integral to overall societal progress. This study focuses on Brazil, where, despite high levels of female educational attainment, women still encounter substantial obstacles in transforming their education into meaningful societal empowerment. These challenges include restricted freedom and mobility, deeply ingrained gender norms, violence and harassment, cultural and societal expectations, economic limitations, and family obligations. Survey data were collated from 192 students, alumni, and staff at three academic higher education (HE) institutions in Brazil, utilizing a range of descriptive and inferential statistical analyses to uncover the most significant barriers. This study concludes with policy recommendations aimed at various stakeholders, including government bodies, employers, and other organizations, to support a smoother transition for women from higher education to empowerment. These recommendations include improving workplace policies, enhancing legal protections, and promoting gender equality in leadership roles, all of which are essential to narrowing the gender gap in Brazil.

Obtaining Symmetrical Gradient Structure in Copper Wire by Combined Processing

Traditionally, structural wire is characterized by a homogeneous microstructure, where the average grain size in different parts of the wire is uniform. According to the classical Hall–Petch relationship, a homogeneous polycrystalline metal can be strengthened by decreasing the average grain size since an increase in the volume fraction of grain boundaries will further impede the motion of dislocations. However, a decrease in the grain size inevitably leads to a decrease in the ductility and deformability of the material due to limited dislocation mobility. Putting a gradient microstructure into the wire has promising potential for overcoming the compromise between strength and ductility. This is proposed a new combined technology in this paper in order to obtain a gradient microstructure. This technology consists of deforming the wire in a rotating equal-channel step die and subsequent traditional drawing. Deformation of copper wire with a diameter of 6.5 mm to a diameter of 5.0 mm was carried out in three passes at room temperature. As a result of such processing, a gradient microstructure with a surface nanostructured layer (grain size ~400 nm) with a gradual increase in grain size towards the center of the wire was obtained. As a result, the microhardness in the surface zone was 1150 MPa, 770 Mpa in the neutral zone, and 685 MPa in the central zone of the wire. Such a symmetrical spread of microhardness, observed over the entire cross-section of the rod, is a direct confirmation of the presence of a gradient microstructure in deformed materials. The strength characteristics of the wire were doubled: the tensile strength increased from 335 MPa to 675 MPa, and the yield strength from 230 MPa to 445 MPa. At the same time, the relative elongation decreased from 20% to 16%, and the relative contraction from 28% to 23%. Despite the fact that the ductility of copper is decreased after cyclic deformation, its values remain at a fairly high level. The validity of all results is confirmed by numerous experiments using a complex of traditional and modern research methods, which include optical, scanning, and transmission microscopy; determination of mechanical properties under tension; and measurement of hardness and electrical resistance. These methods allow reliable interpretation of the fine microstructure of the wire and provide information on its strength, plastic, and electrical properties.

Community Leaders’ Perceptions of the Unique Service Barriers and Facilitators Among Immigrant Families With Young Children in the Rural U.S.–Mexico Border Region

The present descriptive phenomenological study examines the unique service access barriers and facilitators of immigrant families along the rural U.S.–Mexico border from the perspectives of agency and government representatives. Twenty-three semi-structured interviews were conducted with nine local/state government officials and 14 community agency leaders using purposive and snowball sampling. A phenomenological thematic analysis approach was utilized to analyze data from individual interviews. Findings reveal that unique barriers experienced by immigrant families in the U.S.–Mexico border region include rurality, border checkpoints, and U.S. Customs and Border Patrol presence, which have placed mobility limitations on immigrant families, cutting them off from central service providers. Programs and policies aimed at engagement of mixed-status families in areas along the U.S.–Mexico border need to create mechanisms to better reach these families.

A live online exercise program for older adults improves depression and life-space mobility: A mixed-methods pilot randomized controlled trial.

Aging is the primary risk factor for sarcopenia and mobility limitations. Exercise reduces these risks, but older adults have low levels of participation in physical activity and exercise. We investigated the preliminary effectiveness of a live, online exercise program on community-dwelling older adults' physical activity levels. A mixed-method pilot randomized controlled trial was conducted according to CONSORT 2010 statement: extension for pilot and feasibility trials. Sedentary older adults (65-80 years) were randomly assigned to the online exercise intervention (ACTIVE) or a waitlist control (CON) group. Outcomes were measured pre-randomization and following the 8-week intervention for ACTIVE and CON and two months following the end of the intervention for the ACTIVE group. Outcomes included habitual physical activity levels, depression, anxiety, loneliness, life-space mobility, nutrition risk, and feasibility. All participants were invited to participate post-intervention in individual semi-structured qualitative interviews. Reporting of the qualitative research followed the checklist for the Consolidated Criteria for Reporting research. Seventeen older adults (71% women) were allocated to ACTIVE group, while 15 were allocated to CON group (87% women). Following the intervention, participants in the ACTIVE group reported reduced symptoms of depression (ACTIVE: pre = 4.2 ± 2.5; post = 2.2 ± 1.9; CON: pre = 3.5 ± 2.1, post = 3.5 ± 2.1; p <0.001) and improved life-space mobility (ACTIVE: pre = 62.4 ± 14.7; post = 71.8 ± 16.0; CON: pre = 65.1 ± 19.0, post = 63.6 ± 22.0; p = 0.003) compared to waitlist control participants. The ACTIVE group had good adherence (97%) and acceptability (98%). Twenty-two participants participated in qualitative interviews. Five themes were identified, including (1) Feasibility of the online exercise program; (2) Perceived health benefits and improvements; (3) Registered Kinesiologists and Physiotherapists contributed to perceived safety; (4) Social connectivity associated with synchronous/live delivery; and (5) Growing old gracefully and preventing disability. Our online exercise program was acceptable to older adults, had good adherence, reduced depression, and increased life space. Participants reported improved functional and mental health benefits. Further research is warranted to expand on these findings. NCT04627493; 13/11/2020.

A Review of Algorithms and Platforms for Offloading Decisions in Mobile Cloud Computing

With the substantial growth of mobile applications and the emergence of cloud computing concepts, therefore mobile Cloud Computing (MCC) has been introduced as a potential mobile service technology. Mobile has limited resources, battery life, network bandwidth, storage, and processor, avoid mobile limitations by sending heavy computation to the cloud to get better performance in a short time, the operation of sending data, and get the result of computation call offloading. In this paper, a survey about offloading types is discussed that takes care of many issues such as offloading algorithms, platforms, metrics (that are used with this algorithm and its equations), mobile cloud architecture, and the advantages of using the mobile cloud. The trade-off between local execution of tasks on end-devices and remote execution on the cloud server for minimizing delay time and energy saving. In the form of a multi-objective optimization problem with a focus on reducing overall system power consumption and task execution latency, meta-heuristic algorithms are required to solve this problem which is considered as NP-hardness when the number of tasks is high. To get minimum cost (time and energy) apply partial offloading on specific jobs containing a number of tasks represented in sequences of zeros and ones for example (100111010), when each bit represents a task. The zeros mean the task will be executed in the cloud and the ones mean the task will be executed locally. The decision of processing tasks locally or remotely is important to balance resource utilization. The calculation of task completion time and energy consumption for each task determines which task from the whole job will be executed remotely (been offloaded) and which task will be executed locally. Calculate the total cost (time and energy) for the whole job and determine the minimum total cost. An optimization method based on metaheuristic methods is required to find the best solution. The genetic algorithm is suggested as a metaheuristic Algorithm for future work.

EyeWheel: Autonomous Wheelchair Mobility Through Eye Movement Control

This paper explores the advancements in assistive technology with gaze-controlled wheelchairs. These wheelchairs utilize eye-tracking sensors and intelligent algorithms to translate a user's gaze patterns into steering commands. This offers an intuitive control method for individuals with severe mobility limitations, such as those with ALS or quadriplegia. By simply looking in the desired direction, users can navigate their surroundings with improved independence and quality of life compared to traditional mobility aids. The paper highlights the benefits of smooth and precise control through eye movements. Additionally, it explores the integration of safety features like obstacle detection and customizable settings. These features contribute to enhanced user confidence and security, making gaze- controlled wheelchairs a transformative solution for individuals with diverse mobility needs. Keywords- eye-tracking, assistive technology, mobility impairment, gaze control, wheelchair navigation