Local and regional factors of spatial differentiation of the excess mortality related to the COVID-19 pandemic in Romania.

COVID-19 revealed some major weaknesses and threats that are related to the level of territorial development. In Romania, the manifestation and the impact of the pandemic were not homogenous, which was influenced, to a large extent, by a diversity of sociodemographic, economic, and environmental/geographic factors. The paper is an exploratory analysis focused on selecting and integrating multiple indicators that could explain the spatial differentiation of COVID-19-related excess mortality (EXCMORT) in 2020 and 2021. These indicators include, among others, health infrastructure, population density and mobility, health services, education, the ageing population and distance to the closest urban center. We analyzed the data from local (LAU2) and county level (NUTS3) by applying multiple linear regression and geographically weighted regression models. The results show that mobility and lower social distancing were far more critical factors for higher mortality than the intrinsic vulnerability of the population, at least in the first two years of COVID-19. However, the highly differentiated patterns and specificities of different areas of Romania resulting from the modelling of EXCMORT factors drive to the conclusion that the decision-making approaches should be place-specific in order to have more efficiency in case of pandemics.

The Efficacity of the NeuroAssist Robotic System for Motor Rehabilitation of the Upper Limb-Promising Results from a Pilot Study.

The research aimed to evaluate the efficacy of the NeuroAssist, a parallel robotic system comprised of three robotic modules equipped with human-robot interaction capabilities, an internal sensor system for torque monitoring, and an external sensor system for real-time patient monitoring for the motor rehabilitation of the shoulder, elbow, and wrist. The study enrolled 10 consecutive patients with right upper limb paresis caused by stroke, traumatic spinal cord disease, or multiple sclerosis admitted to the Neurology I Department of Cluj-Napoca Emergency County Hospital. The patients were evaluated clinically and electrophysiologically before (T1) and after the intervention (T2). The intervention consisted of five consecutive daily sessions of 30-45 min each of 30 passive repetitive movements performed with the robot. There were significant differences (Wilcoxon signed-rank test) between baseline and end-point clinical parameters, specifically for the Barthel Index (53.00 ± 37.72 vs. 60.50 ± 36.39, p = 0.016) and Activities of Daily Living Index (4.70 ± 3.43 vs. 5.50 ± 3.80, p = 0.038). The goniometric parameters improved: shoulder flexion (70.00 ± 56.61 vs. 80.00 ± 63.59, p = 0.026); wrist flexion/extension (34.00 ± 28.75 vs. 42.50 ± 33.7, p = 0.042)/(30.00 ± 22.97 vs. 41.00 ± 30.62, p = 0.042); ulnar deviation (23.50 ± 19.44 vs. 33.50 ± 24.15, p = 0.027); and radial deviation (17.50 ± 18.14 vs. 27.00 ± 24.85, p = 0.027). There was a difference in muscle activation of the extensor digitorum communis muscle (1.00 ± 0.94 vs. 1.40 ± 1.17, p = 0.046). The optimized and dependable NeuroAssist Robotic System improved shoulder and wrist range of motion and functional scores, regardless of the cause of the motor deficit. However, further investigations are necessary to establish its definite role in motor recovery.

A Meta-Overview and Bibliometric Analysis of Resilience in Spatial Planning - the Relevance of Place-Based Approaches.

This study offers a literature review and bibliometric analysis aiming to enhance our understanding of the actual contribution of resilience approaches to spatial and territorial development and planning studies. Using citation link-based clustering and statistical text-mining techniques (in terms of prevalence of topics, over time, extraction of relevant terms, keywords frequencies), our study maps scientific domains that include the spatial dimension of resilience thinking. It offers a systematic assessment of modern approaches by connecting profoundly theoretical views to more instrumental and policy-oriented approaches. Firstly, the theoretical background of spatial resilience used in numerous studies in various fields is analysed from the viewpoint of the type of embedded resilience (engineering, ecological, social-ecological, economic, social etc.). Secondly, we review and discuss the significance of three main and consistent research directions in terms of different scales and political/institutional contexts that matter from the viewpoint of spatial and territorial planning. Our findings show that spatial resilience debates are far from being settled, as according to many scientists, resilience measurements are often based on technical-reductionist frameworks that cannot comprehensively reflect the complex systems and issues they address. Our conclusions highlight the necessity of a harmonized framework and integrated perspective on resilience in sustainable territorial planning and development, in both theoretical and empirical contexts.

Comparative Assessment of Robotic versus Classical Physical Therapy Using Muscle Strength and Ranges of Motion Testing in Neurological Diseases.

The use of robotic systems in physical rehabilitation protocols has become increasingly attractive and has been given more focus in the last decade as a result of the high prevalence of motor deficits in the population, which is linked to an overburdened healthcare system. In accordance with current trends, three robotic devices have been designed, called ParReEx Elbow, ParReEx Wrist, and ASPIRE, which were designed to improve upper-limb medical recovery (shoulder, elbow, forearm, and wrist). The three automated systems were tested in a hospital setting with 23 patients (12 men and 11 women) suffering from motor deficits caused by various neurological diseases such as stroke, Parkinson's disease, and amyotrophic lateral sclerosis (ALS). The patients were divided into three groups based on their pathology (vascular, extrapyramidal, and neuromuscular). Objective clinical measures, such as the Medical Research Council (MRC) scale, goniometry, and dynamometry, were used to compare pre- and post-rehabilitation assessments for both robotic-aided and manual physical rehabilitation therapy. The results of these tests showed that, with the exception of a few minor differences in muscular strength recovery, the robotic-assisted rehabilitation methods performed equally as well as the manual techniques, though only minor improvements were validated during short-term rehabilitation. The greatest achievements were obtained in the goniometric analysis where some rehabilitation amplitudes increased by over 40% in the vascular group, but the same analysis returned regressions in the neuromuscular group. The MRC scale analysis returned no significant differences, with most regressions occurring in the neuromuscular group. The dynamometric analysis mostly returned improvements, but the highest value evolution was 19.07%, which also in the vascular group. While the results were encouraging, more research is needed with a larger sample size and a longer study period in order to provide more information regarding the efficacy of both rehabilitation methods in neurological illnesses.

Optimization of the ASPIRE Spherical Parallel Rehabilitation Robot Based on Its Clinical Evaluation.

The paper presents the design optimization of the ASPIRE spherical parallel robot for shoulder rehabilitation following clinical evaluation and clinicians' feedback. After the development of the robotic structure and the implementation of the control system, ASPIRE was prepared for clinical evaluation. A set of clinical trials was performed on 24 patients with different neurological disorders to obtain the patient and clinician acceptance of the rehabilitation system. During the clinical trials, the behavior of the robotic system was closely monitored and analyzed in order to improve its reliability and overall efficiency. Along with its reliability and efficiency, special attention was given to the safety characteristics during the rehabilitation task.

The Impact of Robotic Rehabilitation on the Motor System in Neurological Diseases. A Multimodal Neurophysiological Approach.

Motor disability is a key feature of many neurological diseases, influencing the social roles of affected patients and their ability to perform daily life activities. Current rehabilitation capacities are overwhelmed by the age-related increase of motor dysfunctions seen, for example, in stroke, extrapyramidal or neuromuscular diseases. As the patient to rehabilitation personnel ration increases, robotic solutions might establish the possibility to rapidly satisfy the increasing demand for rehabilitation. This paper presents an inaugural exploratory study which investigates the interchangeability of a novel experimental robotic rehabilitation device system with classical physical therapy, using a multimodal neurophysiological assessment of the motor system-quantitative electroencephalogram (EEG), motor conduction times and turn/amplitude analysis. Preliminary results show no significant difference between the two methods; however, a significant effect of the therapy was found on different pathologies (beneficial for vascular and extrapyramidal, or limited, and only on preventing reduction of joint movements in neuromuscular).