Stability Changes in Fall-Prone Individuals With Parkinson Disease Following Reactive Step Training.

BACKGROUND AND PURPOSE: Poor reactive steps may lead to falls in people with Parkinson disease (PwPD). However, whether reactive steps can be improved in PwPD at risk for falls or whether step training reduces falls remains unclear. This study aimed to determine whether 2 weeks of reactive step training result in (1) immediate and retained improvements in stepping and (2) fewer prospective falls in PwPD at fall risk. METHODS: Twenty-five PwPD (70.52 years ± 7.15; Hoehn & Yahr range 1-3) at risk for falls completed a multiple baseline, open-label, uncontrolled pre-/postintervention study. Stepping performance was assessed at 2 baseline assessments (B1 and B2) followed by a 2-week, 6-session training protocol. Stepping was assessed immediately (P1) and 2 months after training (P2). Primary outcomes were anterior-posterior margin of stability (MOS), step length, and step latency during backward stepping. Fall frequency was measured for 2 months before and after training. RESULTS: MOS during backward steps was significantly larger (better) after training ( P < 0.001, d = 0.83), and improvements were retained for 2 months ( P = 0.04, d = 0.66). Step length was not statistically significant different after training ( P = 0.13, d = 0.46) or at follow-up ( P = 0.08, d = 0.62), although effect sizes were medium and large, respectively. Step latency improved after initial exposure ( P = 0.01, d = 0.60) but not following training ( P = 0.43, d = 0.35). Twelve participants experienced fewer falls after training than before (10 = no change, 5 = increase; P = 0.12). Greater improvements in MOS were related to fewer falls ( P = 0.04). DISCUSSION AND CONCLUSIONS: Two weeks of reactive step training resulted in immediate and retained improvements in some reactive stepping outcomes in PwPD at risk for falls and may reduce fall risk. Reactive step training may be a viable approach to reduce falls in PwPD.

Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease.

BACKGROUND AND PURPOSE: Reactive balance training improves reactive postural control in people with Parkinson disease (PwPD). However, the extent to which reactive balance training generalizes to a novel, unpracticed reactive balance task is unknown. This study aimed to determine whether reactive training stepping through support surface translations can be generalized to an unpracticed, instrumented tether-release task. METHODS: Twenty-five PwPD (70.52 years ± 7.15; Hoehn and Yahr range 1-3) completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Stepping was trained through a 2-week (6-session) intervention with repeated support surface translations. Performance on an untrained tether-release task (generalization task) was measured at 2 baseline assessments (B1 and B2, 2 weeks apart), immediately after the intervention (P1), and 2 months after training (P2). The tether-release task outcomes were the anterior-posterior margin of stability (MOS), step length, and step latency during backward and forward steps. RESULTS: After support surface translation practice, tether-release stepping performance improved in MOS, step length, and step latency for both backward and forward steps compared to baseline ( P < 0.05). Improvements in MOS and step length during backward and forward steps in the tether-release task, respectively, were related to stepping changes in the practiced task. However, the improvements in the generalization task were not retained for 2 months. DISCUSSION AND CONCLUSIONS: These findings support short-term generalization from trained balance tasks to novel, untrained tasks. These findings contribute to our understanding of the effects and generalization of reactive step training in PwPD. VIDEO ABSTRACT AVAILABLE: for more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A465 ).

Transcription Factors Evolve Faster Than Their Structural Gene Targets in the Flavonoid Pigment Pathway.

Dissecting the relationship between gene function and substitution rates is key to understanding genome-wide patterns of molecular evolution. Biochemical pathways provide powerful systems for investigating this relationship because the functional role of each gene is often well characterized. Here, we investigate the evolution of the flavonoid pigment pathway in the colorful Petunieae clade of the tomato family (Solanaceae). This pathway is broadly conserved in plants, both in terms of its structural elements and its MYB, basic helix-loop-helix, and WD40 transcriptional regulators, and its function has been extensively studied, particularly in model species of petunia. We built a phylotranscriptomic data set for 69 species of Petunieae to infer patterns of molecular evolution across pathway genes and across lineages. We found that transcription factors exhibit faster rates of molecular evolution (dN/dS) than their targets, with the highly specialized MYB genes evolving fastest. Using the largest comparative data set to date, we recovered little support for the hypothesis that upstream enzymes evolve slower than those occupying more downstream positions, although expression levels do predict molecular evolutionary rates. Although shifts in floral pigmentation were only weakly related to changes affecting coding regions, we found a strong relationship with the presence/absence patterns of MYB transcripts. Intensely pigmented species express all three main MYB anthocyanin activators in petals, whereas pale or white species express few or none. Our findings reinforce the notion that pathway regulators have a dynamic history, involving higher rates of molecular evolution than structural components, along with frequent changes in expression during color transitions.

Using the Instrumented Sway System (ISway) to Identify and Compare Balance Domain Deficits in People With Multiple Sclerosis.

OBJECTIVE: To develop a multiple sclerosis (MS)-specific model of balance and examine differences between (1) MS and neurotypical controls and (2) people with MS (PwMS) with (MS-F) and without a fall history (MS-NF). DESIGN AND SETTING: A cross-sectional study was conducted at the Gait and Balance Laboratory at the University of Kansas Medical Center. Balance was measured from the instrumented sway system (ISway) assessment. PARTICIPANTS: In total, 118 people with relapsing-remitting MS (MS-F=39; MS-NF=79) and 46 age-matched neurotypical controls. INTERVENTION: Not applicable. OUTCOME MEASURES: A total of 22 sway measures obtained from the ISway were entered into an exploratory factor analysis to identify underlying balance domains. The model-derived balance domains were compared between (1) PwMS and age-matched, neurotypical controls and (2) MS-F and MS-NF. RESULTS: Three distinct balance domains were identified: (1) sway amplitude and velocity, (2) sway frequency and jerk mediolateral, and (3) sway frequency and jerk anteroposterior, explaining 81.66% of balance variance. PwMS exhibited worse performance (ie, greater amplitude and velocity of sway) in the sway velocity and amplitude domain compared to age-matched neurotypical controls (P=.003). MS-F also exhibited worse performance in the sway velocity and amplitude domain compared to MS-NF (P=.046). The anteroposterior and mediolateral sway frequency and jerk domains were not different between PwMS and neurotypical controls nor between MS-F and MS-NF. CONCLUSIONS: This study identified a 3-factor, MS-specific balance model, demonstrating that PwMS, particularly those with a fall history, exhibit disproportionate impairments in sway amplitude and velocity. Identifying postural stability outcomes and domains that are altered in PwMS and clinically relevant (eg, related to falls) would help isolate potential treatment targets.

The effect of shoe cushioning on gait and balance in females with multiple sclerosis.

Gait and balance deficits are significant concerns for people with multiple sclerosis (MS). Shoe cushioning can influence mobility and balance, but its effect on walking and balance remains unknown in MS. This study aimed to determine how shoe cushioning affects gait and balance in females with MS (FwMS). We hypothesized that extra cushioning would improve gait but reduce balance performance. FwMS performed gait (n = 18) and balance (n = 17) assessments instrumented using inertial sensors in two different shoe conditions: a standard-cushioned and an extra-cushioned shoe. Care was taken to ensure minimal differences between shoe types other than midsole cushioning, but shoe construction was not identical between conditions. Spatiotemporal gait parameters were assessed during a 2-min walk test, while postural sway measures were evaluated using the modified Clinical Test of Sensory Interaction and Balance. In the extra-cushioned shoe, FwMS spent less time in the double support and stance phase with more time in the single support and swing phase. No differences in stride length, gait speed, or elevation at midswing were observed between shoe conditions. Decreased path length, RMS sway, and sway velocity were observed in the extra-cushioned shoe. No differences were observed in the gait cycle's spatial composition between shoe conditions, but FwMS demonstrated improvements in the gait cycle's temporal parameters and postural sway in the extra-cushioned shoe. This may suggest a less cautious walking strategy and improved balance when wearing a shoe with extra cushioning.

Consensus and uncertainty in the geographic range of Aedes aegypti and Aedes albopictus in the contiguous United States: Multi-model assessment and synthesis.

Aedes (Stegomyia) aegypti (L.) and Ae. (Stegomyia) albopictus (Skuse) mosquitoes can transmit dengue, chikungunya, yellow fever, and Zika viruses. Limited surveillance has led to uncertainty regarding the geographic ranges of these vectors globally, and particularly in regions at the present-day margins of habitat suitability such as the contiguous United States. Empirical habitat suitability models based on environmental conditions can augment surveillance gaps to describe the estimated potential species ranges, but model accuracy is unclear. We identified previously published regional and global habitat suitability models for Ae. aegypti (n = 6) and Ae. albopictus (n = 8) for which adequate information was available to reproduce the models for the contiguous U.S. Using a training subset of recently updated county-level surveillance records of Ae. aegypti and Ae. albopictus and records of counties conducting surveillance, we constructed accuracy-weighted, probabilistic ensemble models from these base models. To assess accuracy and uncertainty we compared individual and ensemble model predictions of species presence or absence to both training and testing data. The ensemble models were among the most accurate and also provided calibrated probabilities of presence for each species. The quantitative probabilistic framework enabled identification of areas with high uncertainty and model bias across the U.S. where improved models or additional data could be most beneficial. The results may be of immediate utility for counties considering surveillance and control programs for Ae. aegypti and Ae. albopictus. Moreover, the assessment framework can drive future efforts to provide validated quantitative estimates to support these programs at local, national, and international scales.

Virtual time-to-contact identifies balance deficits better than traditional metrics in people with multiple sclerosis.

Multiple sclerosis (MS) is a neurodegenerative disease that negatively affects the quality of electrical signaling throughout the central nervous system. Although impaired postural control is one of the most common symptoms in people with MS (PwMS), commonly reported metrics such as center of pressure (CoP) path length and velocity have not been great predictors of fall risk. A relatively new metric, known as virtual time-to-contact (VTC), is a measurement that uses the instantaneous position, velocity and acceleration of the CoP, to predict how long it would take the CoP to reach the boundary of the base of support for every data point in a trial. While the VTC metric has shown promising results in PwMS, there are still inconsistencies in how VTC is reported. Thus, the purpose of this work was to compare VTC to commonly reported measures of postural balance control to identify the most appropriate metric(s) for assessing balance impairments unique to PwMS. A group of patients with MS and a group of neurologically healthy controls performed a static balance task with both eyes open and eyes closed. The VTC minimum values (minima) were the best at detecting balance performance differences between conditions and between study groups. In addition, VTC minima was the best at detecting proprioceptive weaknesses in PwMS, assessed via the Romberg ratio. These results suggest that the VTC minima may be better than traditional metrics at detecting balance impairments unique to PwMS as well as proprioceptive deficits within this population.

Management of Pediatric Condyle Fractures.

INTRODUCTION: Mandibular condyle fractures are a common type of facial fracture in children. The authors aimed to examine the demographics, etiology, treatment, and outcomes of these fractures managed in a single pediatric trauma unit. MATERIALS AND METHODS: A retrospective review was performed of patients presenting to a pediatric hospital between 2003 and 2016 with mandibular condyle fractures. Initial data was extracted from a dedicated trauma database. Included patient's medical records and imaging were then reviewed. Data on demographics, etiology, fracture type, and treatment were recorded. Univariate statistical analysis was performed. RESULTS: Forty-four patients with 49 condyle fractures were included. The average age of patients was 11.4 years (range 3-15 years). A fall from a bicycle/scooter was the most common mechanism. Twenty-six fractures were isolated and 23 involved a further fracture of the mandibular arch. The condylar neck was the most common site of fracture (55%). There was no statistical significance between age (0-10 years, 10-16 years) and site of fracture or the presence of an associated arch fracture. The majority of isolated fractures (73%) were treated conservatively without inter-maxillary fixation. Thirty-nine patients attended the follow-up and the median follow-up period was 196 days (interquartile range 21-165 days). Two patients had a malocclusion at follow-up that required intervention. CONCLUSION: There was a broad range of presentations in our cohort. Conservative management in isolated fractures resulted in stable outcomes and this large case series supports the consensus that management of pediatric condyle fractures should be as conservative as possible.

Two methods for estimating limits to large-scale wind power generation.

Wind turbines remove kinetic energy from the atmospheric flow, which reduces wind speeds and limits generation rates of large wind farms. These interactions can be approximated using a vertical kinetic energy (VKE) flux method, which predicts that the maximum power generation potential is 26% of the instantaneous downward transport of kinetic energy using the preturbine climatology. We compare the energy flux method to the Weather Research and Forecasting (WRF) regional atmospheric model equipped with a wind turbine parameterization over a 10(5) km2 region in the central United States. The WRF simulations yield a maximum generation of 1.1 We⋅m(-2), whereas the VKE method predicts the time series while underestimating the maximum generation rate by about 50%. Because VKE derives the generation limit from the preturbine climatology, potential changes in the vertical kinetic energy flux from the free atmosphere are not considered. Such changes are important at night when WRF estimates are about twice the VKE value because wind turbines interact with the decoupled nocturnal low-level jet in this region. Daytime estimates agree better to 20% because the wind turbines induce comparatively small changes to the downward kinetic energy flux. This combination of downward transport limits and wind speed reductions explains why large-scale wind power generation in windy regions is limited to about 1 We⋅m(-2), with VKE capturing this combination in a comparatively simple way.

Vascular Lesions of the Head and Oral Cavity ­ Diagnosis and Management.

Vascular anomalies constitute a diffuse group of conditions which can range in their significance from being completely harmless and of little clinical relevance to being potentially life threatening. It is important that dentists have a good understanding of these conditions so that the risk of potential complications of dental treatment in affected patients is reduced as much as possible. This article focuses on the pathogenesis, diagnosis and treatment of these conditions, with explanation on their relevance to the practising dentist. Clinical relevance: The paper describes several vascular anomalies that may be encountered in clinical practice with information that is relevant to their diagnosis and management.

Awareness and support of release of genetically modified "sterile" mosquitoes, Key West, Florida, USA.

After a dengue outbreak in Key West, Florida, during 2009-2010, authorities, considered conducting the first US release of male Aedes aegypti mosquitoes genetically modified to prevent reproduction. Despite outreach and media attention, only half of the community was aware of the proposal; half of those were supportive. Novel public health strategies require community engagement.

Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana (REACCTING): study rationale and protocol.

BACKGROUND: Cooking over open fires using solid fuels is both common practice throughout much of the world and widely recognized to contribute to human health, environmental, and social problems. The public health burden of household air pollution includes an estimated four million premature deaths each year. To be effective and generate useful insight into potential solutions, cookstove intervention studies must select cooking technologies that are appropriate for local socioeconomic conditions and cooking culture, and include interdisciplinary measurement strategies along a continuum of outcomes. METHODS/DESIGN: REACCTING (Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana) is an ongoing interdisciplinary randomized cookstove intervention study in the Kassena-Nankana District of Northern Ghana. The study tests two types of biomass burning stoves that have the potential to meet local cooking needs and represent different "rungs" in the cookstove technology ladder: a locally-made low-tech rocket stove and the imported, highly efficient Philips gasifier stove. Intervention households were randomized into four different groups, three of which received different combinations of two improved stoves, while the fourth group serves as a control for the duration of the study. Diverse measurements assess different points along the causal chain linking the intervention to final outcomes of interest. We assess stove use and cooking behavior, cooking emissions, household air pollution and personal exposure, health burden, and local to regional air quality. Integrated analysis and modeling will tackle a range of interdisciplinary science questions, including examining ambient exposures among the regional population, assessing how those exposures might change with different technologies and behaviors, and estimating the comparative impact of local behavior and technological changes versus regional climate variability and change on local air quality and health outcomes. DISCUSSION: REACCTING is well-poised to generate useful data on the impact of a cookstove intervention on a wide range of outcomes. By comparing different technologies side by side and employing an interdisciplinary approach to study this issue from multiple perspectives, this study may help to inform future efforts to improve health and quality of life for populations currently relying on open fires for their cooking needs.

The impact of temperature on the bionomics of Aedes (Stegomyia) aegypti, with special reference to the cool geographic range margins.

The mosquito Aedes (Stegomyia) aegypti (L.), which occurs widely in the subtropics and tropics, is the primary urban vector of dengue and yellow fever viruses, and an important vector of chikungunya virus. There is substantial interest in how climate change may impact the bionomics and pathogen transmission potential of this mosquito. This Forum article focuses specifically on the effects of temperature on the bionomics of Ae. aegypti, with special emphasis on the cool geographic range margins where future rising temperatures could facilitate population growth. Key aims are to: 1) broadly define intra-annual (seasonal) patterns of occurrence and abundance of Ae. aegypti, and their relation to climate conditions; 2) synthesize the existing quantitative knowledge of how temperature impacts the bionomics of different life stages of Ae. aegypti; 3) better define the temperature ranges for which existing population dynamics models for Ae. aegypti are likely to produce robust predictions; 4) explore potential impacts of climate warming on human risk for exposure to Ae. aegypti at its cool range margins; and 5) identify knowledge or data gaps that hinder our ability to predict risk of human exposure to Ae. aegypti at the cool margins of its geographic range now and in the future. We first outline basic scenarios for intra-annual occurrence and abundance patterns for Ae. aegypti, and then show that these scenarios segregate with regard to climate conditions in selected cities where they occur. We then review how near-constant and intentionally fluctuating temperatures impact development times and survival of eggs and immatures. A subset of data, generated in controlled experimental studies, from the published literature is used to plot development rates and survival of eggs, larvae, and pupae in relation to water temperature. The general shape of the relationship between water temperature and development rate is similar for eggs, larvae, and pupae. Once the lower developmental zero temperature (10-14 degrees C) is exceeded, there is a near-linear relationship up to 30 degrees C. Above this temperature, the development rate is relatively stable or even decreases slightly before falling dramatically near the upper developmental zero temperature, which occurs at -38-42 degrees C. Based on life stage-specific linear relationships between water temperature and development rate in the 15-28 degrees C range, the lower developmental zero temperature is estimated to be 14.0 degrees C for eggs, 11.8 degrees C for larvae, and 10.3 degrees C for pupae. We further conclude that available population dynamics models for Ae. aegypti, such as CIMSiM and Skeeter Buster, likely produce robust predictions based on water temperatures in the 16-35 degrees C range, which includes the geographic areas where Ae. aegypti and its associated pathogens present the greatest threat to human health, but that they may be less reliable in cool range margins where water temperatures regularly fall below 15 degrees C. Finally, we identify knowledge or data gaps that hinder our ability to predict risk of human exposure to Ae. aegypti at the cool margins of its range, now and in the future, based on impacts on mosquito population dynamics of temperature and other important factors, such as water nutrient content, larval density, presence of biological competitors, and human behavior.

Intra-annual changes in abundance of Aedes (Stegomyia) aegypti and Aedes (Ochlerotatus) epactius (Diptera: Culicidae) in high-elevation communities in Mexico.

We examined temporal changes in the abundance of the mosquitoes Aedes (Stegomyia) aegypti (L.) and Aedes (Ochlerotatus) epactius Dyar & Knab from June to October 2012 in one reference community at lower elevation (Rio Blanco; approximately 1,270 m) and three high-elevation communities (Acultzingo, Maltrata, and Puebla City; 1,670-2,150 m) in Veracruz and Puebla States, México. The combination of surveys for pupae in water-filled containers and trapping of adults, using BG-Sentinel traps baited with the BG-Lure, corroborated previous data from 2011 showing that Ae. aegypti is present at low abundance up to 2,150 m in this part of México. Data for Ae. aegypti adults captured through repeated trapping in fixed sites in Acultzingo--the highest elevation community (approximately 1,670 m) from which the temporal intra-annual abundance pattern for Ae. aegypti has been described--showed a gradual increase from low numbers in June to a peak occurrence in late August, and thereafter declining numbers in September. Ae. epactius adults were collected repeatedly in BG-Sentinel traps in all four study communities; this is the first recorded collection of this species with a trap aiming specifically to collect human-biting mosquitoes. We also present the first description of the temporal abundance pattern for Ae. epactius across an elevation gradient: peak abundance was reached in mid-July in the lowest elevation community (Rio Blanco) but not until mid-September in the highest elevation one (Puebla City). Finally, we present data for meteorological conditions (mean temperature and rainfall) in the examined communities during the study period, and for a cumulative measure of the abundance of adults over the full sampling period.

Associating white matter microstructural integrity and improvements in reactive stepping in people with Parkinson's Disease.

Reactive steps are rapid responses after balance challenges. People with Parkinson's Disease (PwPD) demonstrate impaired reactive stepping, increasing fall-risk. Although PwPD can improve steps through practice, the neural mechanisms contributing to improved reactive stepping are poorly understood. This study investigated white-matter correlates of responsiveness to reactive step training in PwPD. In an eighteen-week multiple-baseline study, participants (n = 22) underwent baseline assessments (B1 and B2 two-weeks apart), a two-week training protocol, and post-training assessments immediately (P1) and two-months (P2) post-training. Assessments involved three backward reactive step trials, measuring anterior-posterior margin of stability (AP MOS), step length, and step latency. Tract-Based Spatial Statistics correlated white-matter integrity (fractional anisotropy (FA) and radial diffusivity (RD)) with retained (P2-B2) and immediate improvements (P1-B2) in stepping. Significant and sustained improvements in step length and AP MOS were observed. Greater retention of step length improvement correlated with increased FA in the left anterior thalamic radiation (ATR), left posterior thalamic radiation (PTR), left superior longitudinal fasciculus (SLF), and right inferior longitudinal fasciculus (ILF). Step latency retention was associated with lower RD in the left posterior corona radiata and left PTR. Immediate improvements in AP MOS correlated with increased FA of the right ILF, right SLF, and right corticospinal tract. Immediate step length improvements were associated with increased FA in right and left ATR and right SLF. These findings highlight the importance of white-matter microstructural integrity in motor learning and retention processes in PD and could aid in identifying individuals with PD who would benefit most from balance rehabilitation.

Cognitive Predictors of Responsiveness to Reactive Step Training in People with Parkinson's Disease at Fall-Risk.

Reactive stepping can be improved in people with Parkinson's Disease (PwPD). However, there is variability in the responsiveness to such training. This study examined if cognition could predict the responsiveness of PwPD to a two-week reactive step training intervention. 25 PwPD (70.52 years ± 7.15; Hoehn & Yahr range 1-3) at risk for falls completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Reactive stepping was trained through a two-week (six-session) intervention with repeated support surface translations. Stepping performance was measured at two baseline assessments (B1 and B2), immediately after the intervention (P1), and two months after training (P2). Primary stepping outcomes were anterior-posterior margin of stability (MOS), step length, and step latency during backward steps. The primary aim assessed whether global cognition (Scales for Outcomes in Parkinson's Disease-Cognition - SCOPA-COG, & Montreal Cognitive Assessment - MoCA) was related to two-month retention of improvements in reactive stepping after practice. The secondary aim explored whether specific cognitive domains predicted retained stepping improvements, including attention/working memory, executive function, language, memory, and visuospatial function. Greater baseline global cognition was related to better two-month retention of step length improvements (SCOPA-COG: p = 0.002, f2 = 0.31; MoCA: p = 0.002, f2 = 0.38). However, only SCOPA-COG retained statistical significance after p-value adjustment for multiple comparisons (p = 0.04). Optimal cut-point analysis revealed that a SCOPA-COG threshold of 31 or higher was optimal for identifying individuals likely to retain improvement. Specific cognitive domains did not predict changes in reactive stepping outcomes. Participants with greater baseline global cognition, particularly as measured by SCOPA-COG, demonstrated greater retention of improvements in reactive stepping. In this cohort, a SCOPA-COG threshold of 31 could predict individuals likely to benefit from the intervention. These findings highlight the potential of cognitive screening to identify people more or less likely to benefit from reactive balance training.

Gym staff perspectives on disability inclusion: a qualitative study.

PURPOSE: To explore gym staff perspectives on the inclusion of people with disability in the gym setting. MATERIALS AND METHODS: Semi-structured interviews were conducted with 16 staff at four urban gym facilities, exploring perspectives on disability inclusion. An interpretive descriptive approach was adopted with reflexive thematic analysis of interview data and subsequent mapping of themes to the socioecological model. RESULTS: Consistent with the socioecological model, the themes identified were "people with disability benefit from participation in gym settings" (personal); "positive interactions with people with disability" (interpersonal); "managing expectations of other gym users" (interpersonal); "inclusion is supported by a positive ethos, staff training and accessible facilities" (organisational); "people with disability lack awareness of inclusive exercise opportunities" (community); "desire to increase collaboration with healthcare professionals" (community); "access to transport can facilitate gym attendance" (community) and "local gym policy" (policy). CONCLUSION: Although an overall ethos of inclusion was apparent, areas identified for enhancement were: awareness of gym services in the community; inter-sectoral collaboration with healthcare and disability organisations; comprehensive disability inclusion training; transport systems and accessibility; engaging people with disability in gym service planning. Implications for rehabilitationGym staff value collaboration with healthcare and rehab professionals to support inclusion of people with disability in exercise.Standardised disability inclusion training for gym staff is recommended.Individuals with disability should be empowered to contribute to the development of inclusive gym facilities and services.Rehab professionals have a role to play in raising awareness and advocating for inclusive exercise opportunities.

Aedes aegypti abundance in urban neighborhoods of Maricopa County, Arizona, is linked to increasing socioeconomic status and tree cover.

BACKGROUND: Understanding coupled human-environment factors which promote Aedes aegypti abundance is critical to preventing the spread of Zika, chikungunya, yellow fever and dengue viruses. High temperatures and aridity theoretically make arid lands inhospitable for Ae. aegypti mosquitoes, yet their populations are well established in many desert cities. METHODS: We investigated associations between socioeconomic and built environment factors and Ae. aegypti abundance in Maricopa County, Arizona, home to Phoenix metropolitan area. Maricopa County Environmental Services conducts weekly mosquito surveillance with CO2-baited Encephalitis Vector Survey or BG-Sentinel traps at > 850 locations throughout the county. Counts of adult female Ae. aegypti from 2014 to 2017 were joined with US Census data, precipitation and temperature data, and 2015 land cover from high-resolution (1 m) aerial images from the National Agricultural Imagery Program. RESULTS: From 139,729 trap-nights, 107,116 Ae. aegypti females were captured. Counts were significantly positively associated with higher socioeconomic status. This association was partially explained by higher densities of non-native landscaping in wealthier neighborhoods; a 1% increase in the density of tree cover around the trap was associated with a ~ 7% higher count of Ae. aegypti (95% CI: 6-9%). CONCLUSIONS: Many models predict that climate change will drive aridification in some heavily populated regions, including those where Ae. aegypti are widespread. City climate change adaptation plans often include green spaces and vegetation cover to increase resilience to extreme heat, but these may unintentionally create hospitable microclimates for Ae. aegypti. This possible outcome should be addressed to reduce the potential for outbreaks of Aedes-borne diseases in desert cities.

Freezing of Gait in Parkinson's Disease: Implications for Dual-Task Walking.

BACKGROUND: The simultaneous completion of multiple tasks (dual-tasking, DT) often leads to poorer task performance (DT cost, DTC). People with Parkinson's disease (PwPD) exhibit difficulty with DT, and DTC may be particularly pronounced in PwPD with freezing of gait (FOG). OBJECTIVE: This study assessed the relationship between FOG status and DTC during gait. METHODS: Gait parameters were collected using inertial sensors in 106 PwPD (off-medication), including definite-freezers (dFOG; n = 25), possible-freezers (pFOG; n = 16), and non-freezers (nFOG; n = 65) during single (ST)-and DT walking. RESULTS: PwPD with dFOG had larger (worse) DTC than nFOG for foot-strike angle, stride length, toe-off angle, variability of foot-strike angle, and arm range of motion (ROM). After accounting for covariates, DTC for toe-off angle and stride length remained worse in PwPD who freeze. Worse cognition predicted larger DTC for stride length, gait cycle duration, gait speed, and step duration across groups. Men had larger DTC compared to women for gait speed, variability in foot-strike angle, stride length, and arm ROM. Increased variability in gait speed DTC was associated with increased disease severity. CONCLUSION: These findings provide additional support that PwPD who freeze may rely on greater cortical control for the execution of specific gait metrics. The results also underscore the importance of considering cognition when assessing DT ability in PwPD.