Effects of Evidence-Based Fall Reduction Programing on the Functional Wellness of Older Adults in a Senior Living Community: A Clinical Case Study.

BACKGROUND: Older adults at a high risk of falls may be referred to a physical therapist. A physical therapy episode of care is designed for the transition of an older adult from a high fall risk to a moderate to low fall risk. However, these episodes of care are limited in time and duration. There is compelling evidence for the efficacy of group-based exercise classes to address risk, and transitioning an older adult from physical therapy to a group-based program may be an effective way to manage risk through the continuum of care. OBJECTIVES: The purpose of this study was to translate research findings into a real world setting, and demonstrate the efficacy of integrating evidence-based fall prevention exercises into pre-existing exercise classes at a senior living facility as a proof of concept model for future programing. METHODS: Twenty-four participants aged 65 years and older living in a senior living community and the community were stratified into group-based exercise classes. Cutoff scores from functional outcome measures were used to stratify participants. Exercises from The Otago Exercise Program were implemented into the classes. Functional outcome measures collected included the 10-Meter Walk Test, 30-Second Sit to Stand, and Timed Up and Go (TUG). Number of falls, hospitalizations, and physical therapy episodes of care were also tracked. Data were compared to a control group in a different senior living community that offered classes with similar exercises aimed at improving strength and mobility. The classes were taught by an exercise physiologist and were of equal duration and frequency. RESULTS: Participants demonstrated significant improvements in all functional outcome measures. TUG mean improved from 13.5 to 10.4 s (p = 0.034). The 30-Second Sit to Stand mean improved from 10.5 to 13.4 (p = 0.002). The 10-Meter Walk Test improved from 0.81 to 0.98 m/s (p \u3c 0.0001). Participants did not experience any falls or hospitalizations, and two participants required physical therapy episodes of care. CONCLUSION: Implementing an evidence-based fall reduction program into a senior living program has a positive effect on strength, balance, fall risk, gait speed, fall rate, hospitalizations, and amount of physical therapy intervention

Density of States in Landau Level Tails of GaAs-AlxGa1-xAs Heterostructures

From an analysis of the thermally activated resistivity as a function of the magnetic field in the quantum Hall regime we deduced the position of the Fermi energy in the mobility gap as a function of the filling factor and therefore the density of states. The measured density of states is best described by a Gaussian like profile superimposed on a constant background

Why Transcortical Reflexes?

Experiments in humans and in monkeys have indicated that load perturbations, occurring during voluntary movements and postural activity, may be automatically compensated for. Overall muscle stiffness opposing load changes is determined by the viscoelastic properties of the muscle, by segmental reflex actions and finally by long-loop reflexes. Under certain circumstances, for instance when the subject or the experimental monkey is "prepared” to counteract perturbations which are unpredictable in time, the long-loop "reflexes” appear to be responsible for most of the corrective muscle tension. Experiments in anaesthetized monkeys revealed that signals from stretch afferents reach neurons of the motor cortex, possibly via a relay in the cortical area 3a. The latencies of these responses to well controlled muscle stretches were in the same range as motor cortical cell discharges recorded in alert monkeys subjected to load perturbations. Furthermore, these responses of cells in the motor cortex also had the appropriate timing to indicate a causal relationship with the long-latency electromyographic responses to load changes referred to above. These experimental results therefore strongly support the hypothesis, first proposed by Phillips (1969), of a transcortical servoloop adjusting motor cortical output according to the load conditions in which movements are performed. The major advantage of transcortical regulations as opposed to segmental regulations, seems to be a powerful gain control acting at the cortical level; it was repeatedly shown that the long-loop reflexes are strongly modifiable and under voluntary control. It is suggested that an adaptive gain control at the cortical level is a prerequisite to preserve the complex capabilities of the motor cortex as the chief "executive" for skilled, preprogrammed movements. A loss of this adaptive gain control may be, at least partly, the cause of motor disorders such as rigidity in Parkinsonian patients, as reported by Tatton and Lee (1975). It is suggested that further investigations of the control of transcortical reflexes may aid in the understanding of the pathophysiology of motor disabilitie

Sequelae of premature birth in young adults

Background and Purpose Qualitative studies about the abnormalities appreciated on routine magnetic resonance imaging (MRI) sequences in prematurely born adults are lacking. This article aimed at filling this knowledge gap by (1) qualitatively describing routine imaging findings in prematurely born adults, (2) evaluating measures for routine image interpretation and (3) investigating the impact of perinatal variables related to premature birth. Methods In this study two board-certified radiologists assessed T1-weighted and FLAIR-weighted images of 100 prematurely born adults born very preterm (VP <32 weeks) and/or at very low birth weight (VLBW <1500 g) and 106 controls born at full term (FT) (mean age 26.8 ± 0.7 years). The number of white matter lesions (WML) was counted according to localization. Lateral ventricle volume (LVV) was evaluated subjectively and by measurements of Evans’ index (EI) and frontal-occipital-horn ratio (FOHR). Freesurfer-based volumetry served as reference standard. Miscellaneous incidental findings were noted as free text. Results The LVV was increased in 24.7% of VP/VLBW individuals and significantly larger than in FT controls. This was best identified by measurement of FOHR (AUC = 0.928). Ventricular enlargement was predicted by low gestational age (odds ratio: 0.71, 95% CI 0.51–0.98) and presence of neonatal intracranial hemorrhage (odds ratio: 0.26, 95% CI 0.07–0.92). The numbers of deep and periventricular WML were increased while subcortical WMLs were not. Conclusion Enlargement of the LVV and deep and periventricular WMLs are typical sequelae of premature birth that can be appreciated on routine brain MRI. To increase sensitivity of abnormal LVV detection, measurement of FOHR seems feasible in clinical practice

Spacetime Emergence and General Covariance Transmutation

Spacetime emergence refers to the notion that classical spacetime "emerges" as an approximate macroscopic entity from a non-spatio-temporal structure present in a more complete theory of interacting fundamental constituents. In this article, we propose a novel mechanism involving the "soldering" of internal and external spaces for the emergence of spacetime and the twin transmutation of general covariance. In the context of string theory, this mechanism points to a critical four dimensional spacetime background.Comment: 11 pages, v2: version to appear in MPL

The measurement and determinants of skill acquisition in young workers' first job

The article analyses participation in five types of training (formal on-site, formal off-site, informal co-worker training, learning by watching and learning by doing) and self-assessed skill acquisition in young Flemish workers' first job. A skill production function is estimated whereby the simultaneity of participation in the different types of training and skill acquisition is taken into account. The results clearly demonstrate the importance of informal training. Formal training participation is found to be only a fraction of total training participation. Moreover, the determinants of total training participation and skill acquisition differ from those of formal training participation. While some training types are complementary, others are clearly substitutes. Finally, most types of training generate additional skills. Nonetheless, learning by doing is found to be complementary to formal education in the production of both specific and general skills, whereas formal training serves as a substitute