Trail Design Research Articles

An Update on Recent Clinical Trial Data in Bloodstream Infection

Bloodstream infections (BSIs) remain a significant source of morbidity and mortality globally, exacerbated by an ageing population and rising antimicrobial resistance (AMR). This review offers an updated evaluation of randomized clinical trials (RCTs) in BSI management from 2018 onwards, focusing on the evolving landscape of diagnostics and treatment. New rapid diagnostic technologies and shorter antimicrobial courses have transformed clinical practice, reducing the time to appropriate therapy and hospital stays. Several RCTs demonstrated that rapid phenotypic and genotypic tests shorten the time to optimal therapy, especially when paired with antimicrobial stewardship. Ongoing trials are investigating novel antimicrobial regimens and the safety of early oral switch strategies, particularly for Gram-positive and Gram-negative BSIs. Recent RCTs on Staphylococcus aureus BSI (SAB) and multidrug-resistant Gram-negative bacteria highlight advances in treatment but emphasize the need for further study into the efficacy of combination therapies and the utility of rapid diagnostics in different healthcare settings. The review also explores challenges in trail design, with adaptive and pragmatic appropriates improving the efficacy of clinical trials. Finally, this paper identifies gaps in the research, including the need for further investigation into oral step-down therapy, optimal durations, and the role of rapid diagnostics in resource-limited settings.

Designing for human-nature connectedness: A case study of the Barefoot Path Spalt, Germany

There is a need to bridge the disconnection between humans and nature through conscious landscape architectural designs. Recreation infrastructure can be a tool to guide humans towards a stronger connection with nature, improving health, welfare, and care for environmental issues. Considering Haraway's (2016) work on making kin with the more-than-human other and being with the trouble through cognisant presence of the self within a natural world, it appears that progress towards human-nature connectedness is stunted by commodification of the natural environment. This is reflected in nature discourse, and a risk perception driven by fear of nature which has become the unknown. A mixed methods study of the Barefoot Path Spalt, Germany, implementing document analysis, interviews, and criticism incorporating autoethnography and expert field assessments, generated knowledge on how trail designs can improve human-nature connectedness. The study based its findings on three major trail attributes, environmentally conscious trail design, the barefoot component, and interactive equipment and art. Results show that an intrinsic connection with the environment can be targeted with intentional trail design that entices curiosity, gradually guiding participants to build human-nature connectedness, contesting false risk perception. Management implicationsResults show that well designed trails have the potential to enhance human-nature connectedness with relatively cost-effective implementations. Future trail development and upgrades should consider (1) Conscious integration of a trail into the natural environment through a low-impact approach. (2) Using a creative feature that delivers a unique, nature-centric experience, for example through sensory immersion. (3) Installing both play equipment and art to mask the border between trail and context environment makes use of, and encourages more traffic to a trail, generating positive nature-contextual experiences.

Assessing the Environmental Impacts, Condition and Sustainability of Mountain Biking Trails in an Urban National Park.

Mountain biking is a popular recreational activity in natural areas, with thousands of formal trails designed, constructed and maintained by land managers. Increasingly, there are also rising numbers of informal trails created by riders. A challenge for land managers is identifying, assessing, and then mitigating environmental impacts created by trails, including in protected areas. Here we assessed mountain biking trails in a large, popular national park on the Gold Coast, Australia, addressing the currently limited research comparing the extent, environmental impacts, condition and sustainability of these trails. Impacts from the 31.4 km of formal and 33.7 km of informal trails through the forests in Nerang National Park (1659 ha) included soil erosion (16.48 m3) and loss of vegetation along and adjacent to the trails (90,955 m2). Formal trails were six times more popular and wider on average (1.1 m vs 0.7 m) than informal trails, but less incised than informal trails (4.6 cm deep vs 6.3 cm). Generalised Linear Models showed that Trail Grade, slope and alignment best-predicted trail condition, highlighting the importance of good trail design in minimising trail impacts. It is recommended most of the informal trails are closed and rehabilitated, as they were not well-designed, increase fragmentation and have environmental impacts, with some traversing ecologically sensitive areas. In addition, some formal trails need to be upgraded to deal with erosion and other impacts. More broadly, the increasing demand for mountain biking must be addressed, including exploring opportunities to promote areas outside of national parks while minimising environmental impacts and other challenges associated with the creation and use of informal mountain bike trails in protected areas.

Design of an orchid conservation trail in Ixtaczoquitlán, Veracruz, Mexico

Objective: To raise awareness about the ecological importance of orchids and to promote the species commercialized by a company focused on their production through the design of a trail. Design/Methodology/Approach: A diagnosis of the plot was carried out to identify its characteristics and points of interest. A trail was designed to connect the most outstanding points. Native trees, which are the habitat of orchids, were subsequently planted to establish the outdoor collections. Results: The appeal of the place and the established phorophytes were taken into consideration to design the trail. Likewise, recommendations were made on what species of orchids should be planted in each station along the trail. Study Limitations/Implications: Evaluating visitor experience is pending. The trail lacks infrastructure for people with disabilities. The trail is located in an area subjected to anthropization and it will take several years before orchids can be established on the trees planted in July 2023. Findings/Conclusions: Trails are a useful tool to promote the conservation of native orchids; however, under anthropization conditions, it should be subjected to a systematized implementation to provide the climate and phorophyte conditions necessary for the survival of orchids.

Effect of feeding time on womens satisfaction after caesarean section a randomized control study.

Trail design A quazi randomizedd controlled trial Methods Particpaints A total of 226 parous women with singleton vaginal delivery at term pregnancy 37 to 42 weeks of gestation with cephalic presentation. Study participants who had undergone the use of tocolytics drugs for delivery, or caesarian section performed under general anaesthesia were excluded from the study. Moreover, participants with intra-operative complications bowel injury, bowel adhesions, post-partum haemorrhage and anaesthetic complications and postoperative complications postpartum haemorrhage, shock, fever, eclampsia, and use of MgSo4 were excluded from the study. The participants with pre-existing medical conditions like hypertension, diabetes and gastrointestinal diseases were screened off and removed from the study. Additionally, obstructed labour and the use of butrophanone as labour analgesia or postoperative analgesia were excluded. Intervention The study participants were divided into two groups based on the intervention considered. After the participants were selected as per inclusion criteria, an informed consent was taken from all the respondents. The early feeding group was allowed for intake of food after 6 hours of delivery starting with liquid diet followed by solid diet. Similarly delayed feeding group was allowed for intake of food after complete reversal of anaesthesia i.e. 12 hours of delivery starting with liquid diet followed by solid diet.

Recreation specialization: Resource selection functions as a predictive tool for protected area recreation management

Widespread and ongoing increases in park and protected area (PPA) visitation presents managers with the imminent challenge of preserving ecological conditions while also maintaining accessibility in the open spaces that are fundamental to the health and wellness needs of society. In the field of recreation resource management, recreation specialization, the selective channeling of interests and abilities into a specific recreational activity, has contributed to a more comprehensive understanding of recreation behavior, site preference, management perceptions and conservation support. Contributing to historical understandings of specialization can inform recreation planning on the diversity of uses occurring in urban-proximate PPAs. In this study, survey and GPS data collected in urban and peri-urban parks in the Nature Reserve of Orange County, CA, USA, were used to classify recreationists into three specialization types based on empirically derived dimensions of involvement, commitment and skill. For each survey participant, thirteen spatio-temporal metrics (STM) were calculated. A principle component analysis (PCA) reduced STMs into 3 factors representing expressions of spatial behavior and a one-way analysis of variance indicated unique patterns between specialization types and time spent recreating, elevation gained, speed traveled and stopping behavior. Additionally, GPS point data were analyzed with an analytical approach adopted from the field of wildlife movement ecology; a resource selection function (RSF). The RSF assisted in quantifying spatial distribution patterns specific to each specialization type across activity types at four park locations and demonstrated a landscape-based statistical analysis of probability of use in relation to change in elevation, distance to starting points and park amenities. Committed hikers and mountain bikers largely demonstrated longer trip durations, more elevation gain, less overall stopping, faster overall speeds and farther total distances, while e-bikers in this study demonstrated unintuitive specialization dynamics; casual specialization types travelling farther from starting points and dispersing more across trail systems. Further spatial results revealed spatial behavior to be inherently complex and influenced by numerous confounding factors (i.e. activity type/bike type, starting points, park topography and trail design). This novel spatial examination of recreation specialization according to activity type and park location, is useful in understanding recreation behavior and park use in a spatial context. This ability is helpful in a predictive managerial context when reviewed in correspondence with historical evidence identifying behaviors with increased potential for ecological impact.

Rationale and design of the SPRING trail: effectivity and safety of Pfo closuRe vs medIcine in alleviatiNg migraine, a multicenter, randomized and open-label trail

BackgroundMigraine is a leading cause of disability worldwide. Several retrospective studies have suggested that the closure of the Patent Foramen Ovale (PFO) may provide relief from migraines. However, three randomized controlled trials did not meet their primary endpoints regarding migraine cessation, reduction in monthly migraine days, and responder rates.MethodsThe SPRING study is a multicenter, prospective, randomized, and open-label trial designed to compare the effectiveness and safety of PFO closure versus medication in the relief of migraines. The primary endpoint is the total cessation of migraines, as recorded in patient headache diaries during the follow-up period. Additional diagnostic tools include echocardiography with agitated saline contrast, transcranial Doppler, and routine laboratory measurements.ConclusionThe SPRING trial aims to assess the effectiveness and safety of PFO closure versus medication in mitigating migraines in real-world settings. (Clinical Trails ID: NCT04946734).

Design of an interpretive trail and conservation of native orchids (Orchidaceae) in an anthropized landscape

Objective: to design an interpretive trail of native orchids in the gardens of Campus Cordoba, Colegio de Postgraduados.Design/Methodology/Approach: this study is descriptive and field based. First, the feasibility of the trail wasvalidated through an online survey. Afterwards, several field trips were conducted; the script was created, andfinally the interpretive script of the trail was validated.Results: of the respondents, 95% considered the orchid interpretive trail as feasible. The inventory of thetrail area allowed to verify that the orchids are accessible at all stations along the route. The design of theinterpretive trail has nine thematic stations: 0. Introduction, 1. The Catasetum trail, 2. In vitro germination, 3.Acclimatization of orchids, 4. Miniature orchids, 5. Establishing orchids in phorophytes, 6. The Laelias trail,7. The “May Flowers” trail, and 8. The “Donkey ears” (Thricocentrum luridum). The interpretive trail allowsanyone to know and appreciate the diversity of wild orchids, 28 species and their phorophytes, along 700 m ofwalking trails for a 2.5-hours route.Limitations of the study/Implications: it is a guided interpretive trail.Findings/Conclusions: The interpretive trail allows us to appreciate the importance of the Orchidaceaefamily; which is one of the largest families in Mexico and the world through environmental and ornamentalimportance.

Effectiveness of planned health education on knowledge regarding HIV-TB co-infection among HIV patients

Abstract: BACKGROUND: In various parts of the world, mainly in developing nations, co-infection with HIV and tuberculosis (TB) is a significant public health concern. Commonly HIV-TB co-infection is related to a lack of knowledge on TB among people surviving with HIV. Hence, the particular research study is done to know the effectiveness of planned health education on HIV-TB co-infection among HIV patients. MATERIALS AND METHODS: “Nonrandomized controlled trail design” (before and after trial) was used for the study. Written permission was granted from hospital authorities and written consent was obtained from HIV patients after explaining the study and its objectives. Data were collected from 80 HIV-positive patients using a purposive sampling technique. These patients were interviewed for their knowledge of HIV-TB co-infection, followed by health teaching was delivered. After 8 days of health education, a posttest was carried out using the same tool. RESULTS: It was showed that pretest mean knowledge scores were 4.18 with a 1.97 standard deviation (SD), whereas posttest mean knowledge scores were 7.58 with a 2.12 SD. The obtained paired t-value was 10.31, which at the 0.05 level was statistically significant and revealed that health education was effective in improving HIV patients’ knowledge scores. CONCLUSION: The present research study concluded that the health teaching program was effective in improving knowledge scores regarding HIV-TB co-infection among HIV patients. Hence, there is an urgent need to educate HIV patients on the prevention of HIV-TB co-infection.

Health Service Impacts and Risk Factors for Severe Trauma in Mountain Biking: A Narrative Review.

Mountain biking is growing in participation but carries risk for severe injury and burden on health systems. Little is known about the impact of these injuries on emergency medical services, definitive healthcare, and factors contributing to accidents. This review aimed to determine the health service impacts of severe mountain bike trauma and risk factors, with a view to understanding critical gaps and needs. A systematic online search was conducted using the databases PubMed and MEDLINE complete and grey literature relating to mountain bike injury since the databases' inception to July 2023. The results show that although mountain biking has relatively high injury rates that are increasing, the impacts on health services were rarely documented, with some evidence indicating that even small increases in injuries from race events can overwhelm local health services. Severe injuries were more common in downhill disciplines. However, the definitions of what constitutes severe injury were variable. Severe injuries were more common in downhill disciplines, influenced by the rider skill level, demographics, participation in competitive events, trail design, environmental factors, and healthcare availability. Further research in these areas is needed, along with the more consistent reporting of injury severity.

Placebo and nocebo responses in painful diabetic neuropathy: systematic review and meta-analysis (P9-6.002)

<h3>Objective:</h3> The present study examined both the magnitude of placebo and nocebo responses and the factors contributing to placebo response in randomized, double-blind, placebo-controlled clinical trials of painful diabetic neuropathy (PDN) that: i) had parallel group design, ii) were conducted over the past twenty years, iii) were aimed at evaluating the efficacy of oral medications recommended for the treatment of neuropathic pain and, more specifically, PDN. <h3>Background:</h3> Systematic reviews over last decade support the hypothesis that a relevant part of patients’ response to PDN treatments may be due to nonspecific drug effects. <h3>Design/Methods:</h3> Electronic databases PubMed, Cochrane Controlled Trial Register, EMBASE, and Scopus were searched from January 2000 to December 2020, without any restriction of countries. The protocol was registered a priori on the international Prospective Register for Systematic Reviews (PROSPERO) under the ID CRD42021223379. <h3>Results:</h3> In the eligible 20 studies (2,302 patients in the placebo arms) the magnitude of placebo and nocebo responses was comparable to previous literature. The overall mean pooled placebo response was −1.56 change in pain intensity from baseline [95% CI: −1.54, −1.58], with a mean Cohens’ d effect size of 0.73, while the pooled placebo 50% Response Rate was 25.3% (from 21.7% to 29.0%). The overall percentage of patients with adverse events (AEs) in the placebo arms was 27.2% [95% CI: 25.4%, 28.9%], while the overall percentage of patients dropping out due to AEs was 5.1% [95% CI: 4.2%, 6.0%]. Regarding possible moderators, the year of study initiation confirmed to be significantly associated with placebo response, whereby more recent — and thus longer and bigger — trials showed higher placebo response −0.06 [95% CI: −0.10, −0.02, P=0.008]. Neither trail design nor demographic and baseline characteristics showed significant effects on placebo response. <h3>Conclusions:</h3> This knowledge would benefit clinical trials, clinical practice, and placebo research. <b>Disclosure:</b> Dr. Frisaldi has received publishing royalties from a publication relating to health care. Dr. Vollert has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Casquar. Dr. Vollert has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Embody Orthopedics . Dr. Vollert has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vertex Pharmaceuticals. Husam Al Sultani has nothing to disclose. Ms. Hafuth has nothing to disclose. Prof. Benedetti has nothing to disclose. Dr. Shaibani has nothing to disclose.

CDIEA: Chaos and DNA Based Image Encryption Algorithm

A proposal for an image encryption algorithm called Chaos and DNA Based Image Encryption Algorithm (CDIEA) has been put forward. CDIEA is a combination of block cipher algorithms, permutations, chaotic keys, and DNA operations. It leverages the strong structures of modern cryptography and the properties of chaotic systems, rather than relying solely on chaos. The permutations used in CDIEA are constructed using a strategy called the wide trail design, which makes it resilient to many forms of cryptanalysis. CDIEA operates as a byte-oriented SP-network and has been confirmed to have high security for practical image encryption through both theoretical analysis and computer experiments.

COVID-19 compliance among urban trail users: Behavioral insights and environmental implications.

As both trail width and visitor density impacted physical distancing, a combination of trail design that accommodates distancing requirements and density management practices that provide sufficient trail user spacing is essential to retain safe and active trail use.Off-trail movement was influenced by both trail width and density, so ensuring safe off-trail spaces exist and using durable off-trail materials can minimize disturbance and protect visitors.Signage is inconsistently significant to influence trail-compliant distancing behavior, but optimizing its placement and content may improve effectiveness.Compliant trail behavior varied by trail width, visitor density, and trail location; therefore, site-specific information is necessary to understand possible visitor behavior and design/implement mitigation strategies.

Outdoor walking better? environmental elements of cardiorespiratory fitness training trails.

In metropolitan areas where land resources are scarce, trails are a more suitable environment for cardiorespiratory fitness training for modern people. Previous studies have demonstrated that cardiorespiratory fitness is an important factor in assessing individual health and have focused on individual training performance, but the relationship between environment and cardiorespiratory fitness training participants has rarely been investigated. The purpose of this study was to investigate the demands for outdoor cardiorespiratory fitness training and a favorable trail environment by comparing the differences in exercise intensity and perceptions between outdoor and indoor environments. In this study, information on physical data, psychological feedback, and visual atmosphere was collected from nine participants during each phase of moderate intensity cardiorespiratory fitness training in indoor and outdoor environments. The results revealed that outdoor cardiorespiratory fitness training provided participants with lower training intensity during the active exercise phase and higher heart rate during the stretching phase compared to indoor training. The participants paid more attention to the slope, length, pavement, Spaciousness, and width of the trails and the circuitous route. The change of the visual atmosphere and the scenery for the environmental factors were the important factors to motivate the participants to train. The results of the study could assist participants to understand a favorable cardiorespiratory training environment and design a suitable training program, as well as provide a model for trail planning and design for government.

Edible fungi for local and sustainable development in the Patagonian Andes forests of Argentina: A review

Wild fungi are one of the most characteristic and diverse non-wood forest products from native and planted forest environments and grasslands in the Patagonian Andes. Through the technological and scientific platform “Patagonia Fungi, trails and tastes®”, we work to promote mycotourism and mycogastronomy as sustainable identity and inclusive economic and educational activities that promote local development, taking advantage of the outstanding regional tourist profile. We also work on the development of functional foods and promote the cultivation of edible and medicinal fungi. The main objectives of this research were to define novel edible species and evaluate them for sustainable uses, including: environmental characterizations of their fruiting niches and ‘mycosilvicultural’ managements to increase their productivity; documentation and analysis of the ancestral uses and their processes of change; determination of the nutritional and nutraceutical profiles; studies of molecular genetic diversity of various genera; protocols for the domestication of wild species; evaluation and selection of lignocellulosic substrates for cultivation from available residues in Patagonian Andes; economic aspects related to the marketing and use in local gastronomy; evaluation of postharvest preservation techniques. Most relevant actions include the design and implementation of mycotourism trails, the promotion of an identity mycogastronomy; the inter-institutional management of protocols for sustainable harvesting and food safety practices; the incorporation of 21 new species in the Argentinean Food Code. We also work for food sovereignty through a spawn production laboratory fostering edible and medicinal fungi cultivation through courses and assistance to producers from family to productive scales.

Construction of a National Trail Research Framework under a Natural Protected Area System

National Trail is an integral component of the system of natural reserves. China’s study on the creation of National Trail is scattered and lacks theory and policy at present. Here, the theoretical framework, technical procedure, and construction management of National Trail are examined based on the national conditions of China and the building experience of foreign National Trail. A research framework for National Trail is then established. The research framework encompasses a theoretical framework of policy and related theories, a technical process of analyzing National Trail resource management and public recreation, and construction management, which includes planning and management as well as laws and regulations. This research framework provides a theoretical foundation and policy basis for the future establishment of National Trail as well as general guidance for the planning and design of trails and facilitates the integration of diverse natural space resources.

Minimal Impact of a Long-Distance Hiking Trail on the Plant Community in the Adirondack Park, New York State, U.S.A.

Hiking trails provide the opportunity for people to access, experience, and appreciate natural areas, but they also pose the risk of damage by converting vegetated areas to trail, providing the opportunity for off-trail hiking, and increasing soil compaction. To assess the impact of hiking trails on the plant community of a northeastern forest ecosystem, trail width was measured, and understory vegetation was documented at the trail edge, 3 m from the trail, and 5 m from the trail every 4 km along the Northville–Placid Trail from Benson to Averyville Road in the Adirondack State Park of New York State in August 2018. Soil compaction, canopy cover, and the tree species in the canopy were documented, including from the trail itself. The mean trail width was 65.18 ± 6.06 cm. Within the 183.39 km of trail sampled, 119,533.60 ± 11,113.43 m2 of forest were replaced with trail. Soil compaction was greatest in the trail and significantly lower off the trail. None of the canopies of the tree species was more likely to occur away from the trail than adjacent to or directly above the trail. Canopy cover did not differ significantly among sample locations. Cover of understory species was not significantly different near to or away from the trail. Species richness in the understory was significantly higher adjacent to the trail than 5 m from the trail, but trail width, canopy openness above the trail, canopy openness adjacent to the trail, and soil compaction were not significantly related to species richness adjacent to the trail. Understory community composition was more similar among plots within a sample location than between plots 5 m from the trail at adjacent sample locations. Collectively, the plant community outside of the trail itself is not significantly affected by the presence of the trail. The major impact of the trail is the loss of the plant community at its margins as the trail width increases. Hikers should be further educated and encouraged to use trails in ways that minimize the width of the trail to protect the ecosystem, along with trail managers continuing to increase the sustainability of the trail design.

Особливості проєктування екологічних стежок Надслучанського регіонального ландшафтного парку за матеріалами дистанційних знімань та засобів ГІС

The purpose of this work is to design the routes of ecological trails according to modern technologies (for example, Nadsluchansky Regional Landscape Park) for recreational development and use of territories. The park itself is located in the Rivne region in the valley of the river Sluch, covers an area of over 17 thousand hectares and includes many sites of environmental, historical and recreational importance. Method. Preliminary design of ecological trails was performed on the basis of satellite imagery (radar images Sentinel-1 and multispectral Sentinel-2), which are distinguished by many important features, among which, above all, note the high frequency of imaging, global coverage, the availability of and free access to research. To perform this task, digital terrain models, thematic and index maps, composite images were obtained. At the final stage of modeling, specialized ArcGIS software was used. Results. As a result of the performed work, 5 routes of pedestrian and 2 equestrian health-cognitive ecological trails with corresponding maps, profiles, catalogs of coordinates, descriptions of routes and viewpoints, photos, etc. were designed. Scientific novelty and practical significance. To create routes of ecological trails, the proposed technique was implemented for the first time and proved its effectiveness. It allowed to achieve a significant reduction in the duration of work, the cost of field research and take into account the necessary features of the territory. Prior to that, there were no such trails in the Nadsluchansky Landscape Park. As the ecological tourist network in Ukraine has not yet been formed, the use of this approach at other sites of environmental importance will allow faster and more efficient development of this important segment, and it will help solve a number of environmental, cultural, social and economic problems. The information provided also provides an opportunity for those wishing to use such smartphones to make such trips on their own.

The Influence of Trail Design on the Impacts of Walkers, Mountain Bikers and Multi-use Trail Users: An Environmentally Responsible Approach

The Influence of Trail Design on the Impacts of Walkers, Mountain Bikers and Multi-use Trail Users: An Environmentally Responsible Approach

Effects of an Interaction and Cognitive Engagement-Based Blended Teaching on Obstetric and Gynecology Nursing Course.

An interaction and cognitive engagement-based blended teaching mode was applied to obstetrics and gynecology nursing course to examine the effects on nursing students’ competency, self-directed learning level. A randomized controlled trail design was designed. The experimental group engaged with the blended teaching, and the control group was assigned a usual teaching. The level of competency, self-directed learning was compared between two groups. The total score and scores of each dimension of core competence and self-induced learning ability in intervention group were all higher than those in control group (p < 0.05).