Mobility Scale Research Articles

Stair-descent phenotypes in community-dwelling older adults determined using high-level balance tasks.

Falls on stairs are a major cause of severe injuries among older adults, with stair descent posing significantly greater risks than ascent. Variations in stair descent phenotypes may reflect differences in physical function and biomechanical stability, and their identification may prevent falls. This study aims to classify stair descent phenotypes in older adults and investigate the biomechanical and physical functional differences between these phenotypes using hierarchical cluster analysis. Eighty-two older adults participated in this study. Stair descent was measured using a three-dimensional motion analysis system. Physical function was assessed using measures of muscle strength, walking speed, the Timed Up and Go Test (TUG), and the Community Balance and Mobility Scale (CB&M). Hierarchical cluster analysis was performed on kinematic data obtained during stair descent. Three phenotypes were identified: neutral (N-type; 24%), extension (E-type; 52%), and rotation (R-type; 23%). There were no significant differences in lower limb muscle strength or walking speed among the different types, and TUG scores showed no differences in terms of mobility or balance abilities. However, CB&M scores were significantly lower for E-type and R-type compared to N-type. Sub-analyses revealed that while there were no differences in the mobility factor of CB&M between E-type and R-type, the strength factors were significantly lower compared to those for N-type. These results suggest that E-type and R-type stair-descent patterns may be influenced by declines in standing balance ability and muscle strength. These findings may inform fall-prevention training programs related to stair descent among older adults.

A mobile interactive cognitive self-assessment scale for screening cognitive impairment due to Alzheimer's disease.

A mobile cognition scale for community screening in cognitive impairment with rigorous validation is in paucity. We aimed to develop a digital scale that overcame low education for community screening for mild cognitive impairment (MCI) due to Alzheimer's disease (AD) and AD. A mobile cognitive self-assessment scale (CogSAS) was designed through the Delphi process, which is feasible for the older population with low education. In Phase 1, 518 clinically diagnosed participants were subjected to optimise the items. In Phase 2, the scale was validated in 358 participants with cognitively unimpaired and 396 participants of clinically diagnosed MCI and dementia for reliability, validity and diagnostic accuracy. In Phase 3, specificity and sensitivity were tested for biologically diagnosed participants of 38 with cognitively unimpaired and 45 with MCI and dementia due to AD according to the amyloid, tau, neurodegeneration classification system. The CogSAS was a three-task mobile scale testing memory and executive function. In Phase 2, the internal consistency was 0.81, and the test-retest reliability was 0.82. The construct validity was 0.74, and the criterion validity was 0.77. The sensitivity and specificity for discriminating clinically diagnosed participants with MCI and dementia from cognitively unimpaired were 0.90 and 0.67, respectively. For discriminating biologically diagnosed MCI and dementia due to AD from cognitively unimpaired, the sensitivity and specificity were 1.00 and 0.78, respectively. The CogSAS has good reliability, validity and feasibility, showing a high sensitivity and specificity both in the community and the clinic, identifying biologically diagnosed MCI and dementia due to AD.

Psychometric evaluation of the elderly mobility scale in Indonesia.

The Elderly Mobility Scale (EMS) is widely used to identify mobility limitations in older adults, though it has not been validated in Indonesia. To evaluate the reliability and validity of the Indonesian version of the EMS (EMS-I). A cross-sectional design involving 230 older adults in South Tangerang City, Indonesia, was used. The EMS was translated and culturally adapted following a multistage process. Psychometric testing included content validity, exploratory, and confirmatory factor analysis. The participants had a mean age of 70, with 65.7 % female. Results demonstrated high internal consistency (Cronbach's alpha = .942) and item content validity index (I-CVI > .75). Exploratory factor analysis confirmed a unidimensional structure, with confirmatory factor analysis supporting a good model fit. The EMS-I shows high reliability and validity, enabling healthcare professionals to monitor mobility status and facilitate targeted interventions for enhancing well-being in community-dwelling older adults in Indonesia.

A Software Tool for Rapid and Automated Preprocessing of Large-Scale Serum Metabolomic Data by Multisegment Injection-Capillary Electrophoresis-Mass Spectrometry.

Mass spectrometry (MS)-based metabolomics often rely on separation techniques when analyzing complex biological specimens to improve method resolution, metabolome coverage, quantitative performance, and/or unknown identification. However, low sample throughput and complicated data preprocessing procedures remain major barriers to affordable metabolomic studies that are scalable to large populations. Herein, we introduce PeakMeister as a new software tool in the R statistical environment to enable standardized processing of serum metabolomic data acquired by multisegment injection-capillary electrophoresis-mass spectrometry (MSI-CE-MS), a high-throughput separation platform (<4 min/sample) which takes advantage of a serial injection format of 13 samples within a single analytical run. We performed a rigorous validation of PeakMeister by analyzing 47 cationic metabolites consistently measured in 5,000 serum and 420 quality control samples from the Brazilian National Survey on Child Nutrition (ENANI-2019) comprising a total of 224,983 metabolite peaks acquired in 40 days across three batches over an eight-month period. A migration time index using a panel of 11 internal standards was introduced to correct for large variations in migration times, which allowed for reliable peak annotation, peak integration, and sample position assignment for serum metabolites having two flanking internal standards or a single comigrating stable-isotope internal standard. PeakMeister accelerated data preprocessing times by 30-fold compared to manual processing of MSI-CE-MS data by an experienced analyst using vendor software, while also achieving excellent peak annotation fidelity (median accuracy >99.9%), acceptable intermediate precision (median CV = 16.0%), consistent metabolite peak integration (mean bias = -2.1%), and good mutual agreement when quantifying 16 plasma metabolites from NIST SRM-1950 (mean bias = -1.3%). Reference ranges are also reported for 40 serum metabolites in a national nutritional survey of Brazilian children under 5 years of age from the ENANI-2019 study. MSI-CE-MS in conjunction with PeakMeister allows for rapid and automated processing of large-scale metabolomic studies that tolerate nonlinear migration time shifts without complicated dynamic time warping or effective mobility scale transformations.

Reliability and validity of the community balance and mobility scale in individuals with multiple sclerosis.

This study aims to evaluate the reliability and validity of the Community Balance and Mobility Scale (CB&M) in people with multiple sclerosis (PwMS). A total of 65 PwMS (Expanded Disability Status Scale (EDSS) ≤ 5.5) were included in the study. Test-retest, internal consistency (item-total score correlation, Cronbach's alpha coefficient) intra-rater, and inter-rater reliability were investigated for the reliability of the CB&M. For intra-rater and inter-rater reliability, CB&M measurements of 34 PwMS were videotaped. The validity of the CB&M was assessed through criterion (predictive and concurrent validity) and construct validity. Construct validity was evaluated using hypothesis testing which included examining correlations with EDSS, Timed Up and Go Test (TUG), and Dynamic Gait Index (DGI). Test-retest reliability demonstrated a good to excellent correlation (ICC = 0.995, p < 0.001). Cronbach's alpha was 0.971 (p < 0.001). Intra-rater (ICC = 0.993, p < 0.001) and inter-rater reliability (ICC = 0.986, p < 0.001) of the CB&M were also good to excellent. Cohen's kappa range values ​​of the scale vary between 0.958 - 0.665, and the percentage agreement varies between 97% and 75%. For the convergent validity of CB&M, strong correlations were observed with EDSS (r=-0.831, p < 0.001), TUG (r=-0.854, p < 0.001), and DGI (r = 0.865, p < 0.001). Additionally, the CB&M demonstrated an excellent correlation with the BBS (r = 0.907, p < 0.001). The scale exhibited no floor-ceiling effect. CB&M is a reliable and valid tool for assessing balance and mobility in PwMS and offers significant advantages for evaluating balance in PwMS, as it provides comprehensive information about the balance and mobility requirements essential for community living.

Self-Management Support Apps for Spinal Cord Injury: Results of a Systematic Search in App Stores and Mobile App Rating Scale Evaluation.

The use of mobile technology to meet health needs, widely referred to as mobile health (mHealth), has played a critical role in providing self-management support for chronic health conditions. However, despite its potential benefits, mHealth technologies such as self-management support apps for spinal cord injury (SCI) have received little research attention, and an understanding of their public availability is lacking. Therefore, an overview of these apps is needed to complement findings from the literature for a complete understanding of mHealth self-management support tools for SCI to support the selection and improvement of existing apps and the development of new ones. This study aimed to identify and describe quantity, quality, focus, strengths, and weaknesses of self-management support apps for SCI available on major mobile app digital distribution platforms. A systematic search of the Google Play Store and Apple App Store was conducted to identify and summarize apps for SCI that have been updated since 2017. A supplementary systematic literature review was conducted across 11 bibliographic databases to identify publications that provided more detailed descriptions of the identified apps than what is typically available in app stores. The data synthesis was guided by self-management tasks and skills taxonomies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines informed the reporting. The 13 apps included in the final synthesis were launched between 2013 and 2021, mostly originating in the United States, with availability in 72 countries and support for 14 languages. Most apps used the Android operating system (10/13, 77%), while 31% (4/13) used iOS. The identified apps mainly focused on activities of daily living, physical activity promotion, health literacy, and therapeutic exercise. All 3 self-management tasks (medical, role, and emotional management) and most self-management skills and support activities were supported by the apps. The mean Mobile App Rating Scale score was 3.86 (SD 0.54), indicating good overall quality. No publications were found describing these apps. Despite their good overall quality, as measured by the Mobile App Rating Scale assessment, the 13 identified apps, alone or combined, do not appear to offer a comprehensive self-management approach that incorporates theory-based strategies. Besides working to improve comprehensiveness, future research and practice should consider adopting new technologies, such as artificial intelligence, to enhance future self-management support apps for SCI. Furthermore, adopting new app development methods, such as low-code development platforms, could help reduce barriers to development, such as time, cost, and securing scarce expertise.

Mobility scale for acute stroke patients (MSAS): construct validity and reliability of the Italian scale.

The Mobility Scale for Acute Stroke Patients (MSAS) was developed to discriminate between the lower levels of mobility in acute stroke patients in the first two weeks post-onset. The present study aims to develop and validate an Italian version of the MSAS. The English version of the MSAS was translated into Italian according to international guidelines. We recruited 58 patients admitted to a rehabilitation facility within 14 days of the stroke onset and administered the MSAS to test the internal consistency, concurrent validity, reliability, and responsiveness of the scale. As for internal consistency, Cronbach's alpha showed values equal to 0.96, and the alpha deleted analysis indicated that all the items have reason to exist. Concurrent validity showed statistically significant data for all sub-scales. The Italian version of the MSAS showed significant and high inter-rater reliabilities (all ICCs ≥ 0.75). The MSAS also showed excellent test-retest reliabilities (all ICCs ≥ 0.90). The reactivity of the scale, evaluated through the Student's t-test for paired samples on a sub-sample of 32 patients, showed statistically significant improvements over time for all items and the total scale. The results show that the scale is stable and reliable both in the evaluation after 24h and between different operators. High internal consistency and a strong concurrent validity were found. The scale also proved able to detect the improvement obtained by patients following the rehabilitation treatments.

Adaptation of problematic mobile phone usage scale (PMPUS) among students from countries of the commonwealth of independent states in Russian university

An aim of this study was to evaluate the precision and reliability of the problematic mobile phone use scale in the context of Russia and to investigate the frequency and associated factors of problematic mobile phone use among university students. The survey included a random sample of 481 university students from Moscow, Russia. The dataset was randomly split into two groups in order to support exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). An EFA helped to build the five-component framework including social dissonance, emotional impact, cognitive impact, psychosomatic impact, and loss of control. The CFA validated this structure by obtaining favorable model fit indices. Both Cronbach’s alpha and McDonald’s (2013) omega coefficients for all subscales demonstrated a high level of dependability. The application of latent profile analysis revealed three clearly defined user profiles: high-risk users, moderate users with social concerns, and low-risk users. This study presents a reliable and valid instrument for evaluating problematic mobile phone usage in the Russian setting and provides significant insights into the complex and multifaceted nature of this phenomena. The results emphasize the need to implement focused intervention measures, especially for vulnerable populations, and add to the expanding repository of research on problematic cell phone usage in many cultural settings.

Experimental study on CO2 flooding within a fractured low-permeability reservoir: Impact of high injection rate

The rapid decay of reservoir energy in the late development of fractured low-permeability reservoir leads to poor development benefit. Injecting CO2 into such reservoir at high pressure and rate can rapidly replenish reservoir energy and fully utilize the advantages of CO2 flooding, which is an efficient approach for CCUS-EOR. Previous laboratory studies have mainly been conducted under conventional low injection rate, with little discussion on the impact of high injection rate (above 20 times the conventional low injection rate) on CO2 flooding, especially regarding the limited reports on the effect of high injection rate on CO2 flooding within a fractured low-permeability reservoir. In this paper, microscopic visualization and fractured-core experiments of CO2 flooding at different injection rates were conducted. The variations in microscopic displacement front and sweep characteristics under different injection rates were clarified. The influence of CO2 injection rate on the macroscopic and pore scale oil production characteristics in fractured low-permeability cores under different injection modes were analyzed. The results indicate that injection rate significantly influences the microscopic displacement characteristics. The final sweep coefficient at 10 μL/min was 25.07 %, and the pre-breakthrough sweep coefficient accounted for approximately 90 %. While for 200 μL/min, the final sweep coefficient was 34.83 %, and the post-breakthrough sweep coefficient accounted for above 50 %. During CO2 flooding in fractured low-permeability core, the oil production before CO2 channeling dominates the final oil recovery. Compared to 0.1 mL·min−1, oil recovery increases by above 20 % at a CO2 injection rate of 4 mL·min−1 at 6 PV. The high-pressure gradient formed by high injection rate enhances CO2 diffusion, promoting the oil mobilization in near-fracture and deep matrix. And it results to a decrease in the minimum pore scale of oil mobilization. Soaking enhances the interaction between CO2 and oil as well as the fluid exchange between fracture and matrix. It further reduces the minimum pore scale of oil mobilization, and the enhancing effect of soaking gradually strengthens with increasing injection rate. The results can provide theoretical reference for application of CO2 flooding within a fractured low-permeability reservoir.

Different impact of chronic kidney disease in older patients with heart failure according to frailty.

Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the association of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF METHODS: Our data come from the FRAGIC study ("impacto de la FRAGilidad y otros síndromes Geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio con Insuficiencia Cardíaca"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Renal function was assessed according to CKD-EPI formula. A comprehensive geriatric assessment was performed and frailty was identified according to visual mobility scale (frail if VMS≥2). Survival rates were analyzed by Cox regression model. We included 499 patients, mean age 81.4 ± 4.3 years, 38 % women. Mean estimated glomerular filtration rate (eGFR) was 52.1 ± 17.5 ml/min/1.72 m2. Patients were classified in normal renal function (eGFR≥60 ml/min/1.72m2, 182 patients, 36 %), moderately impaired (eGFR 30-59 ml/min/1.72m2, 261 patients, 52.7 %) and severely impaired (eGFR<30 ml/min/1.72m2, 56 patients, 11.3 %). Patients with severe CKD were older, more often female, and presented a worse clinical profile, with higher comorbidity burden and frailty. After a median follow up of 371 days, 58 patients (11.6 %) died. Mortality was higher in patients with worse renal function (8.8 %, 11 % and 21 % according to renal function subgroups, respectively, p = 0.036) and frailty in the univariate analysis. However, only frailty, according to VMS, but not severe renal dysfunction, was independently associated with one year mortality. Most HF patients≥75 years have renal dysfunction. CKD is a marker of worse prognosis in elderly patients with chronic HF, but it does not independently associate one-year mortality in the presence of frailty.

The Impact of an Early Mobility Protocol on Recovery Outcomes in Patients Undergoing Abdominal Surgeries.

According to the World Health Organization (WHO), early mobilization is a critical component of healthcare that significantly impacts patient recovery and outcomes. Despite evidence supporting the benefits of early mobilization for abdominal surgery patients, standardized protocols remain scarce across many healthcare environments. This study evaluates the feasibility and impact of an early mobility protocol (EMP) on improvement in mobility and patient satisfaction in abdominal surgery patients. This feasibility study, conducted in the surgical intensive care unit at Health World Hospital in West Bengal, involved 20 participants who underwent abdominal surgery. Data were collected via demographic questionnaires, the Modified Johns Hopkins Highest Level of Mobility scale, and a patient satisfaction scale. Statistical analysis was performed using IBM Statistical Package for the Social Sciences Statistics, version 28.0, Armonk, NY. The EMP significantly enhanced recovery outcomes among patients undergoing abdominal surgery. By day 6, sixout of 10 participants in the experimental group(EG; 60%) achieved independence in mobility, compared to five out of 10 participants (50%) in the control group. Additionally, the protocol led to substantially higher mobility scores (p = 0.0001) and patient satisfaction levels, with the EG reporting an average satisfaction score of 4.40, markedly higher than the 0.70 observed in the control group (p < 0.05), thus underscoring the protocol's effectiveness. This study demonstrates that an EMP significantly enhances recovery outcomes for abdominal surgery patients, with 60% (six out of 10) of the EG achieving independence by day 6. However, the lack of standardized early mobilization protocols in healthcare settings remains a critical gap. These results align with the WHO's recommendations, underscoring early mobilization as a cornerstone of postoperative recovery and emphasizing the need for standardized approaches to optimize patient outcomes.

Early Mobility After Cardiac Surgery: A Quality Improvement Project.

Coronary artery bypass graft surgery is one of the most common cardiac procedures performed worldwide. The longer these patients remain in bed, the greater their risk of postoperative complications and prolonged length of stay. At the authors' institution, the average length of stay after coronary artery bypass graft surgery was 7.27 days, longer than the national average of 6.9 days. This quality improvement project was undertaken to increase these patients' postoperative mobility and thereby reduce their length of stay. Data on mobility and length of stay of patients with isolated coronary artery bypass graft surgery during an 8-week period were collected retrospectively to establish preintervention values. These values were compared with postintervention values for an equivalent period. An evidence-based nurse-driven early mobility protocol was used to mobilize appropriate patients from bed to chair on postoperative day 0. This level of mobility was documented as a score of 4 on the Johns Hopkins Highest Level of Mobility Scale. From before to after protocol implementation, the postoperative length of stay decreased by 1.04 days. None of the 103 patients in the preintervention group scored a 4 on the Johns Hopkins Highest Level of Mobility Scale, compared with 36 of 134 patients in the intervention group. The difference in postoperative length of stay was clinically but not statistically significant (2-sided P = 1.95). Early mobility may help improve patient outcomes by reducing hospital length of stay and minimizing complications associated with prolonged immobility.

Depressive syndrome, cognitive impairment, and associated factors among community-dwelling aged persons in Cameroon.

Background: Depressive syndrome (DS) and cognitive impairment (CI) are associated with unsuccessful aging. However, little is known about Cameroon. This study aimed to assess the factors associated with DS and CI among older adults in Cameroon. Methods: A representative sample of 599 individuals aged ≥ 60 years was selected for this cross-sectional study. Sociodemographic and health data were also collected. DS and CI were assessed using the Center for Epidemiologic Studies-Depression Scale (CES-D) and Mini-Mental State Examination (MMSE), respectively. The Rosow Mobility Scale, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) scales were used to evaluate functional abilities. Chi-2, ANOVA, and multiple regression analyses were performed to assess the factors associated with DS and CI. The threshold of statistical significance was 5%. Results: The average age was 68.9±7.2 years, sex ratio M/F=0.93, and weight 68.5±14.7 kg. DS affected 14.5% of the population and the CI was 21.4%. In the multivariate analysis, DS was positively associated with male gender (Odds Ratio (OR)=1.7 [95% Confidence Interval (CI):1.1-2.7], p=0.031) and inactivity (OR=1.7 [95% CI:1.0-3.0], p=0.043). CI was positively associated with lack of education (OR=6.5 [95% CI:3.5-12.2], p<0.001), inactivity (OR=5.3 [95% CI:1.6-17.9], p=0.008), single (OR=3.7 [95% CI:1.2-11.3], p=0.023), and widowhood (OR=3.3 [95% CI:1.6-6.5], p=0.001), and negatively associated with no IADL (OR=0.3 [95% CI:0.2-0.6], p=0.001) and ADL disability (OR=0.5 [95% CI:0.2-0.9], p=0.032) limitations. Conclusions: The associated factors suggest that it might be of interest to fight inactivity and encourage early and long-term education to prevent DS and/or CI among older adults.

Outcomes associated with functional mobility and pain amelioration in 49 patients after sacroplasty: a single-center study

This study aimed to determine the predictive factors for analgesic reduction and amelioration of mobility following percutaneous sacroplasty in patients with insufficiency fractures or metastatic lesions. A single-center retrospective analysis of 49 patients who underwent percutaneous sacroplasty for insufficiency fractures and sacral pathological lesions was conducted. Visual analog scale (VAS), Functional Mobility Scale (FMS), and Oswestry Disability Index (ODI) were assessed. All data were accessed immediately before and 1month after the procedure. Thirty-one patients (63.3%) experienced a significant reduction in VAS score, 36 (73.5%) experienced amelioration of FMS, and 20 (40.8%) fell within the ODI at 1month. The mean VAS score was 7.8 (median [min-max]=8 [3-10]) preprocedure and 3.4 (median [min-max]=3 [0-8]) postprocedure. The mean ODI was 0.5 (median [min-max]=0.5 [0.3-0.8]) preprocedure and 0.3 (median [min-max]=0.3 [0-0.7]) postprocedure. The mean FMS was 2.6 (median [min-max]=3 [1-5]) preprocedure and 1.2 (median [min-max]=1 [0-4]) postprocedure. There was a statistically significant increase in VAS amelioration in patients without concomitant vertebroplasty (odds ratio=4.16, interval range [1.09; 15.79], P<0.05). Major complications were not observed. In terms of long-term satisfaction, only two patients reported that they would not undergo the same procedure again. Percutaneous sacroplasty was effective for pain relief, functional outcomes, and short-term satisfaction. The absence of concomitant vertebroplasty was significantly associated with VAS improvements.

Association Between Verbal Communication With Families and Delirium in Mechanically Ventilated Patients: A Retrospective Study.

Introduction Delirium in the intensive care unit (ICU) significantly impacts patient outcomes. While family involvement may help prevent delirium in ICU patients, its effect during mechanical ventilation remains unclear. This study investigated the association between verbal communication during family visits and early post-extubation delirium in mechanically ventilated ICU patients. Materials and methods This retrospective, analytical observational study used data from the hospital's standard electronic health record (EHR) system, which includes routine medical and nursing documentation. We conducted this study in a 10-bed emergency ICU at an academic hospital in rural Japan from April 1, 2019, to December 31, 2020. We included patients aged ≥18 years who received invasive positive pressure ventilation for >48 hours. We excluded patients who were discharged while intubated, required a tracheostomy, or were unable to be assessed using the intensive care delirium screening checklist (ICDSC). The primary outcome was the maximum ICDSC score within 24 hours post-extubation. We conducted multiple regression analyses with ICDSC as the outcome. Results A total of 110 patients were analyzed. The mean age was 64.7 years (standard deviation ± 14.3), and 73 patients were male (66.4%). The median duration of intubation was five days (interquartile range (IQR), 4-8), and the median sequential organ failure assessment (SOFA) score was 8 (IQR, 6-11). The median ICDSC within 24 hours post-extubation was 3 (IQR, 2-5). Of the total 110 patients, 28 (25.5%) could communicate verbally. Patients who could communicate verbally had lower SOFA scores, longer duration of intubation, more frequent family visits, and higher intensive care mobility scale (IMS) scores during intubation. Neither single nor multiple regression showed a significant association between verbal communication and post-extubation ICDSC. Conclusions We did not find a statistically significant association between verbal communication during family visits with patients and ICDSC within 24 hours post-extubation. Potential confounders and variations in care practices may have influenced the results. Further studies are needed to address these limitations.

Tracking HFSE associated with high salinity fluid during HP metamorphism in the Zavkhan Terrane, Western Mongolia

Garnets often exhibit high concentrations of heavy rare-earth elements, which provide crucial insights into element mobility and fluid dynamics during metamorphism. This research reports on the distributions of trace and major elements in garnets from the Khungui eclogite of the Zavkhan Terrane in Western Mongolia. Within the eclogite sample, two types of garnets were identified, featuring dissimilar microstructures and compositional zoning: aggregate-type garnet with asymmetric zoning (Grt1) and euhedral garnet with concentric zoning (Grt2). Previous studies determined that Grt2 formation occurred in the pre-eclogite stage to eclogite facies (2.1–2.2 GPa and 580–610 °C), associated with the infiltration of high-saline fluids. The hexagonal-shaped pseudomorphs of Ti-bearing minerals associated with Grt1 suggest that the nucleation of titanite and garnet was simultaneously accelerated by the destabilization of Ti-augite during pre-eclogite metamorphism. This process could have contributed to the formation of aggregation textures, where Ti-bearing minerals are closely associated with Grt1 in the Khungui eclogite. Based on major divalent elemental composition zoning and trace element characteristics, both Grt1 and Grt2 in the Khungui eclogite are formed simultaneously from the pre-eclogite to eclogite stages. The cores (high Fe + Mg + Mn; Y + REE) of Grt1 and Grt2 are attributed to Rayleigh fractionation or a diffusion-limited uptake process. In contrast, the growth mechanisms of the Grt1 rim and Grt2 rim are distinct during the eclogite stage. The Grt1 rim is explained by a dissolution–reprecipitation, which resulted in the atoll texture observed in Grt1. The Grt2 rim (high Ca; low Y + REE) grew through a mechanism consistent with that of the Grt2 core. The major and trace element zonings of these garnets provide insights into element mobility related to Ti-bearing minerals and infiltration of high salinity fluids at different stages: (1) the mobilization of Ti and V increased under eclogite facies conditions (growth stage of garnet) compared to the pre-eclogite stage, with the mobility of Ti, Nb, Ta elements being pronounced under the exhumation stage (Rt–Ilm–Ttn2), possibly because of the infiltration of high-saline fluids and an increase in temperature, and (2) post-growth compositional modification of Grt1 was induced by a localized transport of Fe, Mg, Mn, and Ca elements in response to the replacement of ilmenite by titanite during decompression (0.1–0.5 GPa and 421–534 °C). The contrasting zoning of garnet in Khungui eclogite indicates dissimilar scales of element mobility under eclogite facies conditions (over a thin-section scale) and during decompression (up to several centimeters or beyond).

Labour mobility of medical specialists: attitudes and factors

Introduction. The healthcare sector characterized by low levels of labour mobility of medical specialists. In this regard, the purpose of the study is to identify the causes of the current scale of intra-firm and inter-firm mobility in the healthcare sector, which are associated with readiness for professional and qualification growth, as well as with external and internal employment conditions. Materials and methods. The study was based on regulatory documents of the Ministry of Health of the Russian Federation and the Government of Moscow. Data from Rosstat and statistics of the Moscow Healthcare Department, as well as materials from expert and questionnaire surveys of Moscow medical specialists, have compiled a statistical database. Results. The relatively small scale of inter-firm mobility of medical specialists in Moscow is largely due to the similarity of employment conditions in the public sector, which includes most healthcare institutions. This hinders the transfer of personnel to other institutions, although their specifics, such as a significant workload on staff and low wages, are unlikely to suit specialists. At the same time, a significant part of doctors and nursing staff have active attitudes towards professional and qualification growth. Such attitudes can be realized by the institute of certification for the qualification category. However, its imperfection does not allow coping with these functions. Research limitations. Due to the scarcity of official statistics, the study was mostly based on expert and questionnaire surveys of medical specialists, which, by definition, provide mainly subjective information and limited factual data. Conclusion. For the institute for certification of medical specialists for the qualification category to fulfill the functions assigned to it, its work should be supplemented with professional training programs by category, the additional payment for them should be increased, and categorical and job status should be linked. To curb the undesirable consequences of the outflow of personnel from the healthcare sector, it is also necessary to take measures to reduce the workload on staff and increase wages.

Is lateral external perturbation training more beneficial for protective stepping responses than voluntary stepping training in stroke? A pilot randomized control study

The study examined whether lateral perturbation training could improve stepping performance and balance in individuals post-stroke. Thirty-one participants with hemiparesis were randomly allocated to PERT (external perturbation) or VOL (voluntary stepping) step training. The PERT and VOL group consisted of 80 step trials predominantly in the lateral direction, with a small proportion of steps in the anterior/posterior direction. Outcome measures based on step type (medial and lateral) included step initiation time, step length, step clearance, step velocity during an induced waist pull perturbation and voluntary step, and clinical balance assessments. The PERT group initiated a lateral step faster with the non-paretic leg during the induced waist pull perturbation step (P = 0.044) than the VOL group after training. Both groups improved the non-paretic step length and step velocity during lateral steps. During the voluntary steps, the PERT group significantly initiated a voluntary step faster. No significant changes were observed in the paretic leg. Both groups significantly improved on the Community Balance & Mobility Scale and Activities Specific Balance Confidence Scale. Overall, we demonstrated that an exercise to improve stepping performance with external perturbations might provide more benefits in protective stepping responses than training with voluntary steps for individuals with a stroke.

Continuity and Disjuncture: The Translocal-Transnational Experiences of Chinese Skilled Trade Workers in Western Australia

Research on transnational migration from China since the 1990s has focused on stories about highly educated, skilled migrants. Little research has been done about the transnational migration of skilled trade workers who moved from China to Western countries. This article endeavors to analyze the experiences of this cohort through a case study of skilled trade workers who migrated to the state of Western Australia (WA) from China in the early 2000s. The life trajectories of these workers saw them migrate from villages to cities in China and then from Chinese cities to WA. By conducting semistructured in-depth interviews with eleven skilled trade workers, this study has found that trade workers’ translocal and transnational experiences should be viewed as a continuous process with both consistencies and discontinuities between the two scales of mobility. International migration strengthens the economic capital of these workers in their new context. Although the sense of social status disparity in internal migration is reduced, the language barrier becomes more salient. The workers have developed a dependence on bonding social capital by using social media to maintain their social networks in their host and home countries. These migration narratives demonstrate new modes of transnational mobility emerging from China’s rise on the global stage and the fluidity and mutability of class identities and personal capital in transnational migration.

Effect of early mobilization on functional recovery in ICU patients with post-COVID ARDS

Background. The COVID-19 pandemic has significantly increased the number of patients requiring intensive care unit (ICU) admissions due to severe complications such as acute respiratory distress syndrome (ARDS). Prolonged ICU stays, often associated with immobility, lead to muscle weakness, ICU-acquired weakness (ICU-AW), and reduced functional status, which impede recovery. Early mobilization in the ICU has been proposed as a beneficial intervention to mitigate these effects, but its impact on patients with post-COVID ARDS remains underexplored. Objective. This study aimed to evaluate the effect of early mobilization on functional recovery in ICU patients with post-COVID ARDS. Methods. A prospective, randomized controlled trial was conducted at Saveetha Medical College and Hospital, Chennai, from August 2021 to August 2024. Two hundred patients with post-COVID ARDS were randomly assigned to either an early mobilization or standard care group. The early mobilization group received structured physical therapy interventions within 48 hours of ICU admission. Functional status was measured using the ICU Mobility Scale (IMS) and Functional Status Scale ICU (FSS ICU) at baseline, weekly, and discharge. Secondary outcomes included the duration of ICU stay, mechanical ventilation, and incidence of ICU-AW. Results. Patients in the early mobilization group demonstrated significantly higher functional recovery, with a mean IMS score of 7.8 ± 1.2 compared to 4.3 ± 1.5 in the standard care group (p &lt; 0.001). The FSS ICU score was also significantly higher in the early mobilization group (90.6 ± 8.3) than in the standard care group (65.4 ± 10.7; p &lt; 0.001). Additionally, early mobilization reduced the mean ICU stay (14.5 ± 3.2 vs. 19.8 ± 4.1 days, p &lt; 0.001), shortened the duration of mechanical ventilation (10.1 ± 2.9 vs. 13.7 ± 3.6 days, p &lt; 0.001), and decreased the incidence of ICU-AW (20% vs. 45%, p = 0.002). Conclusion. Early mobilization significantly improves functional recovery, reduces ICU stay and mechanical ventilation duration, and lowers ICU-AW risk in post-COVID ARDS patients. These findings highlight the importance of integrating early mobility into standard ICU care to enhance patient outcomes.