The importance of user perspective in the evolution of MaaS

The rapid emergence of Mobility as a Service (MaaS) into the transport sector’s lexicon has brought with it an air of expectation that suggests a future mobility revolution. This paper focusses on the user perspective and offers a deepening of socio-technical thinking about MaaS and its prospects. It first provides an examination of what is understood to date about MaaS in what is a new but rapidly evolving body of literature. This highlights the concept of MaaS as a ‘mobility system beyond the private car’ and the new centrality of a ‘mobility intermediary’ layer in that system. The paper then focuses and elaborates upon its contention that MaaS is neither new nor revolutionary but is rather an evolutionary continuation in terms of transport integration. Emerging from an era of unimodal travel information systems becoming multimodal and then integrated multimodal information services, MaaS is now about adding seamless booking, payment and ticketing to the integration offer. The paper puts forward a ‘Levels of MaaS Integration (LMI) taxonomy’ analogous to the level 0-5 SAE taxonomy for automation of road vehicles. This taxonomy, designed around the user perspective (including cognitive user effort), concerns operational, information and transactional integration that it is suggested reflect a hierarchy of user need. From a synthesis of insights from the ‘pre-MaaS’ literature concerning choice making for travel and the role of information, a MaaS behavioural schema is provided to illustrate potential consideration and adoption of MaaS from the user perspective. In concluding, the paper considers what a user perspective reveals for the future prospects of MaaS and in particular for the mobility intermediaries

New wine, new wine-skins: Revisiting Catholic Sacramentality through the Eyes of a child's Spiritual Being

This theoretical paper discusses the spirituality of childhood within the context of Catholic sacramentality, specifically the child’s experience of the Sacrament of Eucharist. The authors argue that readiness for a child’s reception of the Eucharist needs to take into account the spiritual being of the child, as well as the child’s cognitive capacity to grasp the meaning of the Eucharist. Future research directions arising from this theoretical paper are discussed in the conclusion

Reduced Cardiorespiratory Fitness after Stroke: Biological Consequences and Exercise-Induced Adaptations

Evidence from several studies consistently shows decline in cardiorespiratory (CR) fitness and physical function after disabling stroke. The broader implications of such a decline to general health may be partially understood through negative poststroke physiologic adaptations such as unilateral muscle fiber type shifts, impaired hemodynamic function, and decrements in systemic metabolic status. These physiologic changes also interrelate with reductions in activities of daily living (ADLs), community ambulation, and exercise tolerance, causing a perpetual cycle of worsening disability and deteriorating health. Fortunately, initial evidence suggests that stroke participants retain the capacity to adapt physiologically to an exercise training stimulus. However, despite this evidence, exercise as a therapeutic intervention continues to be clinically underutilized in the general stroke population. Far more research is needed to fully comprehend the consequences of and remedies for CR fitness impairments after stroke. The purpose of this brief review is to describe some of what is currently known about the physiological consequences of CR fitness decline after stroke. Additionally, there is an overview of the evidence supporting exercise interventions for improving CR fitness, and associated aspects of general health in this population

The effect of a cognitive or motor task on the gait parameters of those with diabetes, with and without neuropathy

Aims: To compare the gait parameters of older people with diabetes (DM) and people with diabetes and diabetic peripheral neuropathy (DPN) and to investigate the effect of a secondary motor or cognitive task on their gait. Methods: Thirty subjects were recruited; 15 with DPN (mean age 69 ±3.0years) and 15 with diabetes and no neuropathy (70 ± 2.9years). The temporal and spatial parameters of gait were evaluated using the GAITRite walkway. Subjects undertook four walks under normal walking conditions (single task); four times while simultaneously undertaking an additional motor task, carrying a tray with cups of water (dual task); and four times whilst undertaking a cognitive dual task, counting backwards in sevens. This arithmetic task was also completed in sitting. Results: For all gait variables there was a statistically significant difference between the groups. Subjects with DPN walked slower and with smaller steps compared to those with diabetes. In general the secondary task had a significant and adverse effect on the gait parameters and this effect was greater for those with DPN in both absolute and relative terms. Both groups had poorer arithmetic ability when walking compared to sitting. Discussion: Patients with DPN have different gait parameters to diabetic patients without neuropathy. Problems with divided attention when walking were more evident in the DPN group and may increase their risk of falls

State and parameter estimation using Monte Carlo evaluation of path integrals

Transferring information from observations of a dynamical system to estimate the fixed parameters and unobserved states of a system model can be formulated as the evaluation of a discrete time path integral in model state space. The observations serve as a guiding potential working with the dynamical rules of the model to direct system orbits in state space. The path integral representation permits direct numerical evaluation of the conditional mean path through the state space as well as conditional moments about this mean. Using a Monte Carlo method for selecting paths through state space we show how these moments can be evaluated and demonstrate in an interesting model system the explicit influence of the role of transfer of information from the observations. We address the question of how many observations are required to estimate the unobserved state variables, and we examine the assumptions of Gaussianity of the underlying conditional probability.Comment: Submitted to the Quarterly Journal of the Royal Meteorological Society, 19 pages, 5 figure

Dementias Platform UK (DPUK) Data Portal - World-leading infrastructure facilitating innovative multi-modal research

Introduction Modern team science requires effective sharing of data and skills. The DPUK Data Portal is a collection of tools, datasets and networks that allows for epidemiologists and specialist researchers alike to access, analyse and investigate cohort and different modalities of routine data across UK and international sources. Objectives and Approach The Portal is housed on an instance of UKSeRP (UK Secure eResearch Platform), that allows customisable infrastructure to be used for multi-modal research (thus far live in genetics, imaging and clinical data) for researchers across the world using remote access technology whilst allowing governance to remain with the data provider. A central team at Swansea University is responsible for data curation and processing, and runs an access procedure for researchers to apply to use data from multiple sources to be analysed in a central analysis environment. Other modalities are similarly hosted, with input from partner sites in Cardiff and Oxford. Results DPUK facilitates data access and research on 49 cohorts, 40 UK-based and 9 international. The centralised repository model including remote access and ability to store and make available different modalities of data, from phenotypic data, to genetic and imaging data, has allowed DPUK to begin to support research of varying topics, from those studying cognitive decline and Dementia as a disease, to those maturing analytical models. By providing access to data platforms specialising in genetics, imaging and routine clinical data, as well as to specialists in disease and biology to aid with its understanding, DPUK has realised a large-scale research exercise combining major data modalities on a central platform, and allow access to such rich data across the world under an umbrella of robust governance. Conclusion/Implications Globally, cohorts are pooling data, expertise and desire to enrich their own aims in partnership with a federated research community to enable in-depth scrutiny of the biological origins of dementia and the development and evaluation of novel approach to disease prevention and cure

Exercise-Based Stroke Rehabilitation: Clinical Considerations Following the COVID-19 Pandemic

Background. The COVID-19 pandemic attributable to the severe acute respiratory syndrome virus (SARS-CoV-2) has had a significant and continuing impact across all areas of healthcare including stroke. Individuals post-stroke are at high risk for infection, disease severity, and mortality after COVID-19 infection. Exercise stroke rehabilitation programs remain critical for individuals recovering from stroke to mitigate risk factors and morbidity associated with the potential long-term consequences of COVID-19. There is currently no exercise rehabilitation guidance for people post-stroke with a history of COVID-19 infection. Purpose. To (1) review the multi-system pathophysiology of COVID-19 related to stroke and exercise; (2) discuss the multi-system benefits of exercise for individuals post-stroke with suspected or confirmed COVID-19 infection; and (3) provide clinical considerations related to COVID-19 for exercise during stroke rehabilitation. This article is intended for healthcare professionals involved in the implementation of exercise rehabilitation for individuals post-stroke who have suspected or confirmed COVID-19 infection and non-infected individuals who want to receive safe exercise rehabilitation. Results. Our clinical considerations integrate pre-COVID-19 stroke (n = 2) and COVID-19 exercise guidelines for non-stroke populations (athletic [n = 6], pulmonary [n = 1], cardiac [n = 2]), COVID-19 pathophysiology literature, considerations of stroke rehabilitation practices, and exercise physiology principles. A clinical decision-making tool for COVID-19 screening and eligibility for stroke exercise rehabilitation is provided, along with key subjective and physiological measures to guide exercise prescription. Conclusion. We propose that this framework promotes safe exercise programming within stroke rehabilitation for COVID-19 and future infectious disease outbreaks

Interventions for behaviour change and self-management in stroke secondary prevention: protocol for an overview of reviews

Abstract Background Stroke secondary prevention guidelines recommend medication prescription and adherence, active education and behavioural counselling regarding lifestyle risk factors. To impact on recurrent vascular events, positive behaviour/s must be adopted and sustained as a lifestyle choice, requiring theoretically informed behaviour change and self-management interventions. A growing number of systematic reviews have addressed complex interventions in stroke secondary prevention. Differing terminology, inclusion criteria and overlap of studies between reviews makes the mechanism/s that affect positive change difficult to identify or replicate clinically. Adopting a two-phase approach, this overview will firstly comprehensively summarise systematic reviews in this area and secondly identify and synthesise primary studies in these reviews which provide person-centred, theoretically informed interventions for stroke secondary prevention. Methods An overview of reviews will be conducted using a systematic search strategy across the Cochrane Database of Systematic Reviews, PubMed and Epistomonikas. Inclusion criteria: systematic reviews where the population comprises individuals post-stroke or TIA and where data relating to person-centred risk reduction are synthesised for evidence of efficacy when compared to standard care or no intervention. Primary outcomes of interest include mortality, recurrent stroke and other cardiovascular events. In phase 1, two reviewers will independently (1) assess the eligibility of identified reviews for inclusion; (2) rate the quality of included reviews using the ROBIS tool; (3) identify unique primary studies and overlap between reviews; (4) summarise the published evidence supporting person-centred behavioural change and self-management interventions in stroke secondary prevention and (5) identify evidence gaps in this field. In phase 2, two independent reviewers will (1) examine person-centred, primary studies in each review using the Template for Intervention Description and Replication (TIDieR checklist), itemising, where present, theoretical frameworks underpinning interventions; (2) group studies employing theoretically informed interventions by the intervention delivered and by the outcomes reported (3) apply GRADE quality of evidence for each intervention by outcome/s identified from theoretically informed primary studies. Disagreement between reviewers at each process stage will be discussed and a third reviewer consulted. Discussion This overview will comprehensively bring together the best available evidence supporting person-centred, stroke secondary prevention strategies in an accessible format, identifying current knowledge gaps

Effective Mechanical Advantage About the Ankle Joint and the Effect of Achilles Tendon Curvature During Toe-Walking

© Copyright © 2020 Harkness-Armstrong, Debelle, Maganaris, Walton, Wright, Bass, Baltzopoulos and O’Brien. Aim: To study the causes of locomotor dysfunction, estimate muscle forces, or understand the influence of altered sarcomere and muscle properties and behaviours on whole body function, it is necessary to examine the leverage with which contractile forces operate. At the ankle joint, current methods to quantify this leverage for the plantarflexors do not account for curvature of the Achilles tendon, and so may not be appropriate when studying equinus gait. Thus, novel methodologies need to be developed and implemented to quantify the Achilles tendon moment arm length during locomotion. Methods: Plantarflexor internal moment arm length and effective mechanical advantage of 11 typically developed young adults were calculated throughout stance, while heel-toe walking and voluntarily toe-walking on an instrumented treadmill. Achilles tendon moment arm was defined in two-ways: (1) assuming a straight tendon, defined between the gastrocnemius medialis myotendinous junction and Achilles tendon insertion point, and (2) accounting for tendon curvature, by tracking the initial path of the Achilles tendon from the calcaneal insertion. Results: When accounting for tendon curvature, Achilles tendon moment arm length and plantarflexor effective mechanical advantage did not differ between walking conditions (p > 0.05). In contrast, when assuming a straight tendon, Achilles tendon moment arm length (p = 0.043) and plantarflexor effective mechanical advantage (p = 0.007) were significantly greater when voluntary toe-walking than heel-toe walking in late stance. Discussion: Assuming a straight Achilles tendon led to a greater Achilles tendon moment arm length and plantarflexor effective mechanical advantage during late stance, compared to accounting for tendon curvature. Consequently, plantarflexor muscle force would appear smaller when assuming a straight tendon. This could lead to erroneous interpretations of muscular function and fascicle force-length-velocity behaviour in vivo, and potentially inappropriate and ineffective clinical interventions for equinus gait

High-intensity interval training vs. moderate-intensity continuous training in the prevention/management of cardiovascular disease

Moderate-intensity continuous training (MICT) has long been considered the most effective exercise treatment modality for the prevention and management of cardiovascular disease, but more recently high-intensity interval training (HIIT) has emerged into the clinical environment has been viewed as a potential alternative to MICT in accruing such benefits. HIIT was initially found to induce significant improvements in numerous physiological and health-related indices, to a similar if not superior extent to MICT. Since then, many studies have attempted to explore the potential clinical utility of HIIT, relative to MICT, with respect to treating numerous cardiovascular conditions such as coronary artery disease, heart failure, stroke, and hypertension. Despite this, however, the efficacy of HIIT compared to MICT with respect to in reversing the specific symptoms and risk factors of these cardiovascular pathologies for improved health and wellbeing as well as reduced morbidity and mortality is not well understood. In addition, HIIT is often perceived as very strenuous, which could potentially render it unsafe for those at risk of or afflicted with cardiovascular disease, but these issues are also yet to be reviewed. Furthermore, the optimal HIIT protocol for each of the cardiovascular disease cohorts has not been established. Thus, the purpose of this review article is to (i) evaluate the efficacy of HIIT relative to MICT in the prevention and management of cardiovascular conditions, and (ii) explore any potential safety issues surrounding the suitability and/or tolerability of HIIT for patients with cardiovascular disease, as well as the potential optimal prescriptive variables of HIIT for application in the clinical environment