Search Results (17)

Traumatic injuries are a major cause of disability in adults, with long-term consequences that extend beyond acute survival. Understanding the longitudinal trajectory of quality of life (QoL) following trauma is essential for optimising recovery pathways. This study aimed to evaluate changes in QoL over a six-month period after injury and to characterise the most affected health domains. Methods: A longitudinal observational study was conducted including 136 adult trauma patients. QoL was assessed using the EQ-5D-5L at three time points: retrospectively for the pre-trauma state, and prospectively at one and six months post-injury. Statistical analysis included Paired T-Tests and Cohen’s d to evaluate the significance and magnitude of changes across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Results: The sample was predominantly male (57.4%), and falls were the most common mechanism of injury (57.4%). One month after trauma, a significant decline was observed across all EQ-5D dimensions (p < 0.001), with large effect sizes particularly in usual activities (d = 0.89) and self-care (d = 0.86). At six months, significant improvement was noted in all domains compared to the one-month assessment (p < 0.001). However, only mobility returned to pre-trauma levels (p = 0.137), while persistent impairments remained in pain/discomfort and anxiety/depression. The EQ-VAS score declined from a pre-trauma mean of 82.74 to 69.00 at one month and partially recovered to 77.29 at six months. Notably, only 15.4% of patients received specialized rehabilitation services. Conclusions: Trauma results in a profound immediate reduction in QoL. Although physical mobility tends to recover by six months, functional autonomy and psychological well-being remain compromised. The findings highlight the need for multidisciplinary post-discharge interventions, focusing on pain management and psychological support to bridge the gap in long-term recovery. Full article

Objectives: We aimed to explore foot condition and toe strength in older adults undergoing heart valve surgery. Materials and Methods: This exploratory pilot study included nine older adults undergoing heart valve surgery. Subjective data on foot-related symptoms, self-care status, nail care, footwear, exercise habits, and fall history were collected. Preoperative foot and nail conditions were assessed using observation and photography. Toe strength was measured preoperatively in all participants and postoperatively in a subset of participants when feasible. Descriptive analyses were primarily conducted, with exploratory group comparisons. Results: Participants frequently reported foot-related symptoms and difficulties with foot self-care prior to hospitalization. Lower toe strength appeared to be related to greater difficulties in foot self-care, whereas higher toe strength was more commonly observed in those reporting regular exercise habits. Postoperative toe strength was reassessed in six participants. In a participant with prolonged intensive care unit (ICU) stay, delayed recovery of toe strength was observed. Conclusions: These preliminary findings suggest that foot condition and toe strength may be relevant to physical function and fall prevention-related factors in older a dults undergoing cardiac surgery. Reduced toe strength may be related to self-care difficulties, and prolonged ICU stay may influence the recovery of toe strength. However, due to the small sample size, these findings should be interpreted as exploratory and hypothesis-generating. Full article

Background: Traumatic spinal injuries (TSI) are often associated with substantial physical burden and potential psychological consequences. Early detection of depressive symptoms may be important for improving quality of life during recovery. Despite the high prevalence of injury, unique sociocultural factors affecting mental health, and the need to optimize long-term rehabilitation outcomes, there is a lack of longitudinal assessments of depression in TSI patients in this region of the MENA (Middle East and North Africa). This study aimed to examine the occurrence of depressive symptoms following TSI over a 3-month period. Methods: A prospective cohort study was conducted to assess the occurrence of depression in TSI patients admitted between 2019 and 2022 at the Hamad Trauma Center. Conscious patients aged 18–65 years diagnosed with TSI were included. Perceived social support was assessed using the RAND Social Support Survey (Medical Outcomes Study Social Support Survey), a validated instrument measuring multiple dimensions of social support. Patient Health Questionnaire-9 (PHQ-9), a widely validated self-administered screening tool for depressive symptoms, was utilized twice: at 2 weeks and at 3 months post-trauma to evaluate early-onset depressive symptoms and their persistence or resolution over time. Results: A total of 189 TSI were included. The cohort was predominantly young individuals. The most common mechanisms of injury included falls (42.1%) and motor vehicle crashes (31.1%). The mean Injury Severity Score was 16.5 ± 8.2 and the spine Abbreviated Injury Scale score was 2.4 ± 0.7. Injuries involved cervical (32.8%), thoracic (38.1%), and lumbo-sacral (6.9%) regions. A total of 32.6% underwent spinal surgery, and 9.0% experienced neurological deficits. Most patients reported emotional and informational support (69%), and 62% reported caregiving support. At 2 weeks post-trauma, patients demonstrated mild depressive symptoms, with a mean PHQ-9 score of 4.6 ± 5.1, which decreased to 2.5 ± 4.2 at 3 months. The proportion of patients screening positive for depressive symptoms (PHQ-9 ≥ 5) decreased from 39.1% (52/133) at 2 weeks to 19.5% (26/133) at 3 months, corresponding to a 19.6% absolute reduction over the follow-up period. A subset of patients reported increased feelings of depression or hopelessness and sleep disturbances at three months compared with two weeks post-trauma. Conclusions: Patients with TSIs experience psychological distress in the early post-injury period, with a subset screening positive for depressive symptoms. Although depressive symptom scores declined over 3 months, continued psychological screening and follow-up care remain important components of comprehensive TSI management during recovery and rehabilitation. Our results should be considered cautiously because of gender-biased findings, single center data and potential attrition bias. Full article

Background: Reserve Officer Training Corps (ROTC) Cadets undergo biannual Field Training Exercises (FTX) that impose substantial physiological demands, necessitating adequate nutritional intake to support performance and recovery. Methods: Energy Expenditure (EE) measured by actigraphy and self-reported nutritional intake (NI) of ROTC Cadets during a Fall FTX were obtained and compared to Military Dietary Reference Intake (MDRI) guidelines. Energy balance and nutrient adequacy were assessed using paired sample t-tests. Results: Cadets demonstrated significant caloric deficits, consuming fewer kilocalories than both their active metabolic rate (t = −12.07, df = 42, p < 0.001) and Low Energy Availability thresholds (t = 6.47, df = 57.54, p < 0.001). Macronutrient analysis revealed widespread deficiencies. Neither male nor female cadets met minimum carbohydrate gram recommendations. Protein intake in grams was significantly below MDRI guidelines for 94% of males (t = −10.03, p < 0.001) and 90% of females (t = −4.62, p = 0.001). Fat intake was generally adequate for all cadets, with 94% of males (t = 6.50, p < 0.001) and 90% of females (t = 4.19, p = 0.002) meeting or exceeding recommended fat intake. Conclusions: These findings underscore the prevalence of under-fueling during FTX and highlight the need for improved nutritional strategies to mitigate energy deficits and support cadet performance and health. Full article

Cascading link failures continue to imperil power grids, transport networks, and cyber-physical systems, yet the relationship between a network’s robustness at the moment of attack and its subsequent resiliency remains poorly understood. We introduce a dynamic framework in which connectivity-based cascades and distributed self-healing act concurrently within each time-step. Failure is triggered when a node’s active-neighbor ratio falls below a threshold $\phi$; healing activates once the global fraction of inactive nodes exceeds trigger $T$ and is limited by budget $B$. Two real data sets—a 332-node U.S. airport graph and a 1133-node university e-mail graph—serve as testbeds. For each graph we sweep the parameter quartet ($\phi ,\hspace{0.17em}B,\hspace{0.17em}T,attackmode$) and record (i) immediate robustness $R$, (ii) 90% recovery time T₉₀, and (iii) cumulative average damage. Results show that targeted hub removal is up to three times more damaging than random failure, but that prompt healing with $B\ge 0.12$ can halve T₉₀. Scatter-plot analysis reveals a non-monotonic correlation: high-$R$ states recover quickly only when $B$ and $T$ are favorable, whereas low-$R$ states can rebound rapidly under ample budgets. A multiplicative fit $T_{90}\propto B^{-\beta }g\left(T\right)h\left(R\right)$ (with $\beta \approx 1$) captures these interactions. The findings demonstrate that structural hardening alone cannot guarantee fast recovery; resource-aware, early-triggered self-healing is the decisive factor. The proposed model and data-driven insights provide a quantitative basis for designing infrastructure that is both robust to failure and resilient in restoration. Full article

Background/Objectives: Older adults (ages ≥ 65) have experienced longer recovery, decreased independence in self-care, and reduced quality of life after diagnosis of mild traumatic brain injury (mTBI). Although the sequela following mTBI has also generated higher healthcare costs in older adults, the research on associations returning to the emergency department (ED) has been limited. This study explored subsequent mild traumatic brain injury (mTBI-S) ED visit relationships among older adult populations, fall injuries, payors, and discharge outcomes. Methods: The design was a population-based cross-sectional study using data from the 2018 Nationwide Emergency Department Sample (NEDS). The study sample size was 4932. Descriptive analysis and correlation analysis described characteristics of people with subsequent mTBI visits. Logistic regressions and odds ratios ascertained the relationship between subsequent mTBI visits and the predictor variables of age, fall injury, payors (Medicare, Medicaid, Private, and other), and the outcome variable of healthcare services. Results: Falls and referrals to healthcare service associations were significant (p < 0.001, X²₁ = 123.6). The association between Medicare and referral to healthcare service visits was also significant (p < 0.001, X²₃ = 1059.9). The odds ratio in populations aged ≥65 (OR 4.172, p < 0.001, CI 95% 3.427, 5.079), falls (OR 3.847, p < 0.001, CI 95% 2.649, 5.587), and Medicare (OR 4.492, p < 0.001, CI 95% 1.273, 2.106) had an increased probability of referral to healthcare services. Conclusions: Geriatric populations, falls, and Medicare carriers had an increased probability of healthcare service referral upon readmission to the ED for persistent symptoms after mTBI. Research on geriatric populations and post-mTBI medical monitoring may inform ED discharge models. Full article

Purpose: This study aims to assess how fractures and fear of falling affect health-related quality of life (HRQoL) in men (≥50 years) across different domains. Methods: Design: Observational study. Setting: Primary care. Subjects: 237 men aged 50–90 years. Outcome measures: Age, frac-tures, fear of falling, EQ-5D. Results: A total of 122 men (51.47% of the male cohort) participated, the mean age was 69 ± 5 (≥65–74 years 26.2%, ≥75–84 years 21.3%, ≥85 years 9.8%). Poorer EQ-5D scores were observed in men ≥ 65 years with fractures in the pain domain (p = 0.04), while men < 65 showed better scores in mobility (p = 0.04), self-care (p = 0.04), daily activities (p = 0.04), and anxiety/depression (p = 0.01). Fear of falling significantly impacted HRQoL across all ages, with men ≥ 65 reporting worse mobility (p = 0.02) and higher anxiety/depression (p = 0.01), while men < 65 experienced less pain (p = 0.00). Conclusions: This study shows a relationship between frac-tures, fear of falling, and the perception of the various dimensions of HRQoL in older men. It highlights the need for targeted interventions and follow-up systems to monitor recovery and address fears of falling in men aged 65 and above post-fracture. Full article

The selective control and manipulation of nanoparticles require developing and researching new methods for designing optical tweeters, mainly based on a photonic hooks (PHs) effect. This paper first proposes a tunable PH in which a structured beam illuminates an anisotropic cutting liquid crystal microcylinder based on the Finite-DifferenceTime-Domain (FDTD) method. The PHs generated by plane wave, Gaussian, and Bessel beam are analyzed and compared. The impact of beams and LC particle parameters on the PHs are discussed. Where the influence of the extraordinary refractive index ($n_{\mathrm{e}}$) on PHs is emphasized. Our results reveal that introducing birefringence can change the bending direction of PH. Besides, the maximum intensity of the PHs increases as $n_e$ increases regardless of the beam type. The PH generated by a plane wave has a higher maximum intensity and smaller FWHM than that generated by the Gaussian and Bessel beams. The smallest FWHM and maximum intensity of the PHs generated by the Gaussian falls between that generated by the plane wave and the Bessel beam. The PH generated by a Bessel beam has the minor maximum intensity and the largest FWHM. Still, it exceeds the diffraction limit and exhibits bending twice due to its self-recovery property. This paper provides a new way to modulate PH. This work offers novel theoretical models and the degree of freedom for the design of PHs, which is beneficial for the selective manipulation of nanoparticles. It has promising applications in Mesotronics and biomedicine. Full article

Human safety is paramount in flood disasters. Current research indicates that the majority of fatalities in such disasters are due to people moving in water. Existing studies on human stability in floods have primarily focused on the static resistance of a standing posture against water flow, neglecting the realistic scenario where people need to move and attempt self-rescue in the aftermath of destabilization. This paper introduces an analysis of the stability during the self-rescue process following a fall in floodwaters, providing insights into the baseline risks of human impact in floods. The self-rescue process is defined as the recovery to a standing position after a fall, segmented into four postures: sitting, kneeling, squatting, and standing. Additionally, considering the significant variability of the current method ($D\times v$ water depth multiplied by flow velocity) used to assess human stability in floods, this research thoroughly investigates previously undefined parameters, including submerged volume, frontal area, wet friction coefficient, and flow resistance coefficient. This leads to the development of a physically meaningful self-rescue risk assessment formula, which is validated against previous studies for accuracy, with the aim of contributing new insights to flood risk management and public education. Full article

A double-edge-triggered digital low dropout regulator (DLDO) is proposed with a built-in adaptive voltage-controlled oscillator (VCO) clock (AVC) for a system-on-chip (SoC) application. To achieve a fast transient response, the main comparator generates the comparison result at the rising edge of the AVC, and this result is sampled by the coarse or fine bidirectional shifter register at the falling edge of the AVC. Furthermore, the clock frequency can be boosted from 8 MHz at the steady state to 50 MHz by the AVC when the output current suffers from a sudden change, and it can also be adjusted in real-time according to the output voltage, which avoids the oscillation phenomenon and decreases the power consumption during the recovery process. To further lower the power consumption, the self-clock comparator replaces the conventional static comparator in the transient detector. The post-simulation results show that the proposed DLDO consumes a quiescent current of 95.13 μA in the steady state, and drives a maximum load current of 25 mA at the supply power of 0.6 V with an active area of 0.053-mm² in a 180 nm CMOS process. When the load current jumps from 0.5 mA to 25 mA at the edge of 100 ps, the undershoot voltage and overshoot voltage are only 335 mV with the recovery time of 2.7 μs and 47.6 mV with the recovery time of 2.1 μs at the total on-chip capacitor of 50 pF, respectively, resulting in two competitive figures of merits (FoMs) than the previous works. Full article

When a quadruped robot is climbing stairs, due to unexpected factors, such as the size of the differing from the international standard or the stairs being wet and slippery, it may suddenly fall down. Therefore, solving the self-recovery problem of the quadruped robot after falling is of great significance in practical engineering. This is inspired by the self-recovery of crustaceans when they fall; the swinging of their legs will produce a resonance effect of a specific body shape, and then the shell will swing under the action of external force, and self-recovery will be achieved by moving the center of gravity. Based on the bionic mechanism, the kinematics model of a one-leg swing and the self-recovery motion model of a falling quadruped robot are established in this paper. According to the established mathematical model, the algorithm training environment is constructed, and a control strategy based on the reinforcement learning algorithm is proposed as a controller to be applied to the fall self-recovery of quadruped robots. The simulation results show that the quadruped robot only takes 2.25 s to achieve self-recovery through DDPG on flat terrain. In addition, we compare the proposed algorithm with PID and LQR algorithms, and the simulation experiments verify the superiority of the proposed algorithm. Full article

Background: Wilson’s disease (WD) is an autosomal-recessive disorder of copper deposition caused by pathogenic variants in the copper-transporting ATP7B gene. There is not a clear correlation between genotype and phenotype in WD regarding symptom manifestations. This is supported by the presentation of genetically identical WD twins with phenotypic discordance and different response behavior to WD-specific therapy. Case Presentation: One of the female homozygous twins (age: 26 yrs) developed writing, speaking, swallowing and walking deficits which led to in-patient examination without conclusive results but recommended genetic testing. Both sisters were tested and were heterozygous for the C.2304dupC;p(Met769Hisf*26) and the C.3207C>A;p(His1069Gln) mutation. Self-medication of the affected sibling with 450 mg D-penicillamine (DPA) did not prevent further deterioration. She developed a juvenile parkinsonian syndrome and became wheelchair-bound and anarthric. A percutaneous endoscopic gastrostomy was applied. Her asymptomatic sister helped her with her daily life. Despite the immediate increase of the DPA dose (up to 1800 mg within 3 weeks) in the severely affected patient and the initiation of DPA therapy (up to 600 mg within 2 weeks) in the asymptomatic patient after the first visit in our institution, liver function tests further deteriorated in both patients. After 2 months, the parkinsonian patient started to improve and walk again, but experienced several falls, broke her right shoulder and underwent two necessary surgical interventions. With further consequent copper elimination therapy, liver dysfunction improved in both patients, without need for orthotopic liver transplantation (LTX) in the severely affected patient. Her excellent recovery of liver and brain dysfunction was only transiently interrupted by the development of a nephrotic syndrome which disappeared after switching to Cuprior^®. Unfortunately, she died from fulminant pneumonia. Conclusion: Despite identical genetic disposition, WD symptom presentations may develop differently in monozygotic twins, and they may need to be placed on a very different therapeutical regimen. The underlying gene-environment interaction is unclear so far. Full article

From the perspective of the sustainability of aviation demand, we investigated passenger perceptions with regards to whether or not Korean people will resume the use of air transport after COVID-19. Based on five factors—the prevalence of COVID-19, requirements for self-isolation, circumstances at the destination, social atmosphere with regards to overseas travel, and level of preventative measures employed in the aviation service sector—a structured questionnaire was developed using confirmatory factor analysis. Based on these, the main levels of determination per factor were derived and a structured path for the recovery of aviation demand via structural equation analysis between factors was analyzed. The five factors established above were found to have a significant impact on passenger perceptions with regards to the restart of using air transport. It was found that people may consider resuming overseas travel with air transport, prior to the development of a COVID-19 cure or vaccine, corresponding to relaxed requirements for self-isolation if there is a fall in the number of confirmed cases. In addition, it was determined that the unconditional lifting of self-isolation requirements without considerations for the hygienic conditions of the destination has limitations in how much it will lead to the resumption of air travel. We hope that this study will serve as a starting point for other studies monitoring passenger behavior in the future and that it will lead to the development of sustainable strategies for recovering aviation demand. Full article

Wearable electronics, such as sensors, actuators, and supercapacitors, have attracted broad interest owing to their promising applications. Nevertheless, practical problems involving their sensitivity and stretchability remain as challenges. In this work, efforts were devoted to fabricating a highly stretchable and sensitive strain sensor based on dip-coating of graphene onto an electrospun thermoplastic polyurethane (TPU) nanofibrous membrane, followed by spinning of the TPU/graphene nanomembrane into an intertwined-coil configuration. Owing to the intertwined-coil configuration and the synergy of the two structures (nanoscale fiber gap and microscale twisting of the fiber gap), the conductive strain sensor showed a stretchability of 1100%. The self-inter-locking of the sensor prevents the coils from uncoiling. Thanks to the intertwined-coil configuration, most of the fibers were wrapped into the coils in the configuration, thus avoiding the falling off of graphene. This special configuration also endowed our strain sensor with an ability of recovery under a strain of 400%, which is higher than the stretching limit of knees and elbows in human motion. The strain sensor detected not only subtle movements (such as perceiving a pulse and identifying spoken words), but also large movements (such as recognizing the motion of fingers, wrists, knees, etc.), showing promising application potential to perform as flexible strain sensors. Full article

Background. Stroke leads to physical problems, commonly paralysis, cognitive, sensory, perceptual and communication problem. Physical inactivity among stroke patients is high in the acute and chronic stage. The adherence of them towards exercise and rehabilitation therapy declined after discharge, thus lead to poor outcomes of recovery. Objective. To review the literature on the factors that influence stroke patients’ adherence to physical activity (PA) and to identify the intrapersonal, interpersonal and environmental factors that affect the adherence of stroke patients’ towards PA. Methods. Four electronic databases (EBSCO: CINAHL Plus with Full text, Willey Online Library, and ScienceDirect) from 2008 to 2019 reporting any factors that affecting stroke people participate in the physical activity. The methodological quality of the studies was appraised using McMaster critical appraisal tools and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for online searching strategy. Results. 10 articles met the inclusion criteria. The intrapersonal factors include physical impairment, balance, and mobility, fear of fall, aging, forgetful, reduce in self-efficacy and exercise benefits. Interpersonal factors were social support, lack of attendant and support from healthcare, physiotherapist or gym trainer. Economic factors, transportation, and exercise facility were the environmental factors that influence stroke patient adherence to PA. Conclusions. These three factors were interrelated to change the individual perception towards exercise among stroke patients. This review enables the development of an intervention to improve participation in PA among stroke patients. Full article