Association between Social Frailty and Sleep Quality among Community-dwelling Older Adults: A Cross-sectional Study

Objective: We examined the association between social frailty and subjective sleep quality among community-dwelling adults. Methods: This cross-sectional study recruited Japanese adults over the age of 60 years from health check-ups held in a public townhall in a suburban area between 2018 and 2019. Social frailty was evaluated using five criteria (living alone, not visiting friends sometimes, going out less frequently than the last year, not feeling helpful to friends or family, and not talking to someone every day) and categorized into three groups: non-frailty, pre-frailty, and frailty. Sleep quality was assessed according to the Pittsburgh Sleep Quality Index (PSQI) by giving participants a self-reported questionnaire. We performed multivariable linear regression analysis, denoting social frailty as an independent variable, and the global PSQI score as a dependent variable. Results: Data from 300 older adults were analyzed, 51.0% of whom were female. The participants'' mean age was 73.0 years (standard deviation = 5.8). Multivariable analysis revealed the notable association between social frailty and a high global PSQI score (compared with non-frailty, frailty: β = 0.94, 95% CI = 0.08 to 1.80, p = 0.033). Of the five determiners of social frailty, not talking with someone every day was especially associated with a high global PSQI score (β = 1.57, 95% CI = 0.49 to 2.66, p = 0.005). Conclusion: The present study suggests that social frailty is associated with poor sleep quality among community-dwelling older adults. Our findings indicate the importance of social frailty on sleep quality among older adults.     

Cost-effectiveness Analysis of Combined Physical and Cognitive Exercises Programs Designed for Preventing Dementia among Community-dwelling Healthy Young-old Adults

Objective: This study aims to estimate the cost-effectiveness of combined physical and cognitive programs designed to prevent community-dwelling healthy young-old adults from developing dementia. Methods: The analysis was conducted from a public healthcare and long-term care payer’s perspective. Quality-adjusted life years (QALYs) and expenses for health services and long-term care services were described in terms of effectiveness and cost, respectively. A thousand community-dwelling healthy adults aged 65 years were generated through simulation and analyzed. The incremental cost-effectiveness ratio (ICER) of adults with preventive program intervention compared to those with nonintervention was simulated with a 10-year cycle Markov model. The data sources for the parameters to build the Markov models were selected with priority given to higher levels of evidence. The threshold for assessing cost-effectiveness was set as less than 5,000,000 Japanese yen/QALY. Results: The ICER was estimated as −5,740,083 Japanese yen (US$−57,400)/QALY. Conclusion: A program targeting community-dwelling healthy young-old adults could be cost-effective.     

Improvement in the Physical Function and Quality of Life through Exercise and Physical Activity Intervention Using a Smartphone after Allogeneic Hematopoietic Cell Transplantation: A Case Report

Purpose: Physical activity (PA) interventions positively affect the physical function (PF) in patients with advanced cancer. However, patients must remain motivated during the intervention. We report a case wherein a smartphone application for PA intervention was useful in motivating the patient to improve adherence. Methods: A 40-year-old woman underwent an allogeneic hematopoietic cell transplantation (allo-HCT) for an advanced extranodal natural killer/T-cell lymphoma. On day 6, she developed the posterior reversible encephalopathy syndrome. She was managed in the intensive care unit for 3 days, and her PF declined markedly. We initiated a smartphone-based PA intervention from day 35. She was instructed to maintain a PA diary for self-monitoring of the daily steps and to set a new step-count goal every week. Results: The PA and PF improved within a short period thereafter. However, she developed severe acute graft-versus-host disease and was administered with high-dose systemic corticosteroids from day 49. The PA, PF, and quality of life (QOL) decreased again. The intervention was continued for 5 months with a high adherence. The PA, PF, and QOL improved gradually. She resumed independent activities of daily living and was discharged on day 202. Conclusion: Smartphone-based PA intervention may be effective against post-allo-HCT physical dysfunction.     

Effect of Body Weight-supported Walking on Exercise Capacity and Walking Speed in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Objective: To compare the effect of body-weight-supported treadmill training (BWSTT) and full-body-weight treadmill training (FBWTT) on patients with knee osteoarthritis (OA). Methods: Design was Randomized controlled trial. Patients with knee osteoarthritis (n = 30; mean age, 76.0±7.5 y) were randomly assigned to BWSTT or FBWTT group. All patients performed 20 min walking exercise twice a week for 6 weeks under the supervision of the therapist. Main measures were 10-meter walking test (10MWT), functional reach test (FRT), timed get up and go test (TUG), one-leg standing test, 6-minute walking test (6MWT), the parameters set on the treadmill, MOS Short-Form 36-Item Health Survey (SF36), Japanese Knee Osteoarthritis Measure (JKOM). Results: Twenty-five patients (10 men, 15 women; mean age, 76.5 ± 8.0 y) completed the experiment. Exercise capacity, indicated by the heart rate, was similar in both groups. After 3 weeks of BWSTT, the patients performed significantly better in the 10-m and 6-min walking tests. This was not the case with FBWTT even after 6 weeks training. Pain levels assessed were significantly improved after 3 weeks of BWSTT and 6 weeks of FBWTT. There were no significant improvements in either group assessed by the FRT, one-leg standing time test, TUG, or SF -36 questionnaire. Conclusions: BWSTT enhanced exercise capacity in terms of walking speed and pain reduction after 3 weeks; however, there was no significant improvement in patients'' functional abilities or quality of life.     

The Effect of Toe-grasping Exercises on Balance Ability in Home-based Rehabilitation: A Randomized Controlled Trial by Block Randomization

Objective: The purpose of the study was to clarify the causal effect of toe-grasping exercises on the improvement of static or dynamic balance ability in home-based rehabilitation users. Method: Our study included 34 subjects who met the criteria and were evaluable out of 98 rehabilitation service users at home nursing stations. This study was a randomized controlled trial. The intervention group performed towel gathering exercises in addition to the regular home-based rehabilitation program. The primary outcome was one-leg standing time, and the secondary outcomes were two-step test and toe grip strength. Results: Seventeen subjects were assigned to the intervention group and seventeen to the control group by block randomization. Data from 15 and 12 subjects in the intervention group and control group, respectively, who were able to complete the initial evaluation and the evaluation after 3 months, were analyzed. We compared the amount of change after 3 months of evaluation in the intervention group with the change in the control group. The results showed that the left/right mean value of oneleg standing time in the intervention group was significantly greater than that in the control group. In terms of the amount of change in the intervention period (T2-T1) within each assessment, there were significant improvements in both the toe-grip strength and the two-step values in the intervention group. Conclusion: We found that toe-grasping exercises could improve the balance ability of home-based rehabilitation users. This suggests the clinical significance of toe function in rehabilitation programs.     

Effect of Home-based Exercise Therapy for Peripheral Arterial Disease Patients Underwent Endovascular Treatment: A Clinical Controlled Design

Objective: This study aimed to clarify the effect of home-based exercise therapy on physical activity in peripheral arterial disease (PAD) patients after EVT. Methods: Study design was controlled clinical design. The subjects were 30 patients (76.6% men) who underwent EVT in the Sakakibara Heart Institute of Okayama. Patients with EVT meeting the inclusion criteria were divided into two groups, intervention group (Home-based exercise) and control group. Patients'' basic characteristics, the number of steps walked and QOL questionnaire (WIQ, SEPA, Vascu QOL) were assessed before surgery and, at the 3 month after discharge. A two-way analysis of variance (ANOVA) was performed to compare number of steps walked and QOL questionnaire. Results: Interaction effect were observed in the number of steps walked (F (1,28) =13.89, p<0.01). A multiple comparison test confirmed a significant increase between results of before surgery and at three months after surgery in the intervention group (p<0.01). An interaction between the presence and absence of intervention was found for the WIQ pain score (F(1,28) = 5.86, p=0.01), speed score (F(1,28) = 3.80, p=0.04) and SEPA (F(1,28) = 4.99, p=0.03). In a multiple comparison study, there was a significant increase in WIQ pain and speed scores in both groups before and 3 months after discharge from the hospital. Conclusion: Home-based exercise therapy using physical activity indices has the potential to improve number of steps and quality of life in patients with PAD after EVT.     

Effect of Rehabilitation Nutrition Care Process on Physical Function in Lung Cancer Cachexia: A Case Report

Objectives: Patients with cancer cachexia have poor adherence to treatment, which affects their prognosis. Currently, there are many studies on the effects of rehabilitation on cancer cachexia, but there is a lack of evidence on the effects of nutrition therapy alone or in combination with rehabilitation and nutrition therapy. This article describes a case in which rehabilitation nutrition care process was effective in a patient with lung cancer who developed cancer cachexia. Methods: A 68-year-old woman was hospitalized for treatment of lung adenocarcinoma. The patient had moderate malnutrition, sarcopenia, and cachexia at the time of admission, so the authors intervened according to rehabilitation nutrition care process. The physiotherapist mainly prescribed resistance training and aerobic exercise, 40-60 minutes a day, 5-6 days a week. And the dietitian provided oral nutritional supplements (100 kcal, branched-chain amino acid: 3.0 g) in addition to hospital food and adjusted the patient''s energy intake to 26.96-33.05 kcal/kg/day and protein intake to 1.07-1.14 g/kg/day. Outcomes: Comparing the initial evaluation with the discharge, nutritional status, such as body mass index and skeletal muscle mass, and physical functions, such as maximum grip strength, gait speed, and functional independence measure (motor items), were improved. Conclusions: Rehabilitation nutrition care process-based interventions may improve nutritional status and physical functions more than exercise therapy alone in patients with lung cancer cachexia.     

Effects of Massage Therapy and Occlusal Splint Usage on Quality of Life and Pain in Individuals with Sleep Bruxism: A Randomized Controlled Trial

Purpose: The aim of the present study was to investigate the effects of massage therapy on the masticatory muscles and occlusal splint usage on quality of life and pain in individuals with sleep bruxism. Method: A randomized, controlled, blinded, clinical trial was conducted involving 78 volunteers aged 18 to 40 years with sleep bruxism. Quality of life and pain assessments were performed. Results: Significant differences (p < 0.05) were found on the physical functioning, general health state, vitality, role emotional and mental health subscales. A large effect size was found for all treatment protocols with regard to pain. The largest effect was found in the combined treatment group. Conclusions: The findings of the present study reveal that the occlusal splint usage alone led to improvements in components of quality of life among individuals with sleep bruxism. Moreover, both treatments (occlusal splint usage and massage therapy on the masticatory muscles) led to a reduction in pain.     

Effect of Interventions for Improving Lumbar Motor Control on Low Back Pain in Sedentary Office Workers: A Randomized Controlled Trials

Objective: To clarify the effect of intervention with dynamic motor control exercise (DMCE) for the lumbar region on low back pain in sedentary office workers (SOWs). Methods: The participants comprised 32 SOWs with low back pain who were randomly categorized into two groups: the DMCE group and the normal trunk exercise (NTE) group. Both groups performed each exercise for three days per week for 8 weeks. The primary endpoints were evaluated for the lumbar and hip flexion angles during trunk forward bending, effect of low back pain on activities of daily living (using the Oswestry Disability Index), and intensity of low back pain (using the Visual Analog Scale) pre- and post-intervention. The extent of changes was calculated by subtracting the pre-intervention value from the post-intervention value and was compared between the two groups using an unpaired t-test. Results: The extent of changes in the lumbar flexion and hip flexion angles at 10° of trunk forward bending were significantly greater in the DMCE group than in the NTE group, and no significant differences were noted between the two groups at other angles of trunk forward bending. The extent of changes in the Oswestry Disability Index and the Visual Analog Scale scores were significantly greater in the DMCE group than in the NTE group. Conclusion: DMCE is effective in improving motor control in the lumbar region and hip joints, thereby ameliorating low back pain in SOWs.     

Evidence of Improvement in Various Impairments by Exercise Interventions in Patients with Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Purpose: To investigate improvement in various impairments by exercise interventions in patients with knee osteoarthritis (OA). Methods: We collected data on randomized controlled trials (RCTs) comparing the effects of exercise intervention with those of either nonintervention or psychoeducational intervention in patients with knee OA. Data on pain, stiffness, muscle strength, range of motion, flexibility, maximal oxygen uptake, and position sense were synthesized. The Grading of Recommendations Assessment, Development, and Evaluation system was used to determine the quality of the evidence. Results: Thirty-three RCTs involving 3,192 participants were identified. Meta-analysis provided highquality evidence that exercise intervention improves maximal oxygen uptake, and moderate-quality evidence that exercise intervention also improves pain, stiffness, knee extensor and flexor muscle strength, and position sense. The evidence that exercise intervention improves knee extension and flexion range of motion was deemed as undetermined-quality. Conclusion: In patients with knee OA, improvement in pain, stiffness, muscle strength, maximal oxygen uptake, and position sense with the use of exercise intervention can be expected. Although the quality of evidence of the effect of exercise intervention on range of motion was inconclusive, exercise intervention should be recommended for patients with knee OA to improve various impairments.     

Effects of back extensor strengthening exercises on postural alignment,physical function and performance,self-efficacy,and quality of life in Japanese community-dwelling older adults: A controlled clinical trial

Objective: To examine the changes in postural alignment and kyphosis-correlated factors after 6 months of back extensor strengthening exercise in a group of community-dwelling older adults aged ≥65 years. Methods: We quasi-randomized 29 subjects into an intervention group treated with a back extensor strengthening program and a control group treated with a full-body exercise program. These groups completed 20-30 minutes of exercise directed by a physical therapist one or more times per week and were instructed to exercise at home as well. The participants were assessed prior to and after the intervention using the following criteria: postural alignment of “usual” and “best” posture, physical function, physical performance, self-efficacy, and quality of life. The differences between two factors (group and period) were compared for each of the measurement variables. Results: Subjects who adequately completed the exercises were analyzed. A reduced knee flexion angle was noted in the “best” posture of both groups, as were improved physical function and performance with the exception of one-leg standing time. Verifying the effect size in the post-hoc analysis, the body parts that showed changes to postural alignment after the intervention differed between groups. Conclusions: Back extensor strengthening exercises improved physical function and performance, but did not improve spinal alignment. The changes due to these interventions were not significantly different from changes observed in the full-body exercise group. However, post-hoc analysis revealed that the effect size of posture change was different, possible indicating that the two groups experienced different changes in the postural alignment.     

Effect of electron emission on the charge and shielding of a dust grain in a plasma: A continuum theory

The continuum approximation is used to analyze the effect of electron emission from the surface of a spherical dust grain immersed in a plasma on the grain charge by assuming negligible ionization and recombination in the disturbed plasma region around the grain. A parameter is introduced that quantifies the emission intensity regardless of the emission mechanism (secondary, photoelectric, or thermionic emission). An analytical expression for the grain charge Z _d is derived, and a criterion for change in the charge sign is obtained. The case of thermionic emission is examined in some detail. It is shown that the long-distance asymptotic behavior of the grain potential follows the Coulomb law with a negative effective charge Z _eff, regardless of the sign of Z _d. Thus, the potential changes sign and has a minimum if Z _d > 0, which implies that attraction is possible between positively charged dust grains.     

Combined effect of acoustic cavitation and pulsed discharge plasma on wastewater treatment efficiency in a circulating reactor: A case study of Rhodamine B

The present study investigates the wastewater treatment performance of an acoustic cavitation assisted plasma (ACAP) process in a circulating reactor using Rhodamine B (RhB) as a model water pollution. The concept of this process was proposed by the authors recently for a batch type rector. The measurements revealed that combining the ultrasound irradiation with pulsed discharge plasma allows the RhB degradation efficiency to be drastically increased as compared with the plasma-alone case. This effect is especially significant at higher values of solution electrical conductivity examined in a range of 20 ~ 400 μS/cm. Acidic conditions and larger flow rates of solution were found to be favorable for the degradation efficiency. The effect of flow rate was also analyzed through numerical simulation. The results indicated that the mass transfer of RhB to the plasma-cavitation zone is one of the controlling parameters influencing the degradation performance. Behavior of bubbles and pulse discharge frequency were examined using a high-speed video camera. Relatively large bubbles were found to favor the plasma pulse generation and propagation when move near the high-voltage electrode. On the whole, the results of this study suggest that the ACAP process has the potential to synergistically extend the application area of underwater plasma in both research and industry.     

Fermentation of Saccharomyces cerevisiae in a 7.5 L ultrasound-enhanced fermenter: Effect of sonication conditions on ethanol production,intracellular Ca2+ concentration and key regulating enzyme activity in glycolysis

In this study, the effect of sonication on the fermentation process of a single-celled fungus was examined. During the experiment, Saccharomyces cerevisiae (S. cerevisiae) was used as the starting strain for ethanol fermentation (batch fermentation) in a 7.5 L automated fermentation tank. The fermentation tank connected with a six-frequency ultrasonic equipment. Non-sonication treatment was set up as the control. Sonication treatment with power density of 280 W/L and 48 h of treatment time were set up as trial groups for investigating the influence of different ultrasound frequency including 20, 23, 25, 28, 33 and 40 kHz on the changes in dry cell-weight, glucose consumption rate, and ethanol yield. The results showed that the dry cell-weight, glucose consumption rate, and ethanol content reached the best results under the ultrasonic condition of 28 kHz ultrasound frequency in comparison with other ultrasound frequency. The dry cell-weight and ethanol content of the 28 kHz ultrasonic treatment group increased by 17.30% and 30.79%, respectively in comparison with the control group The residual sugar content dropped to a lower level within 24 h, which was consistent with the change in ethanol production. Besides, the results found that the glucose consumption rate increased compared to the control. It indicated that ultrasound accelerated glucose consumption contributed to increase the rate of ethanol output. In order to explore the mechanism of sonication enhanced the content of ethanol output by S. cerevisiae, the morphology, permeability of S. cerevisiae and key enzyme activities of ethanol synthesis were investigated before and after sonication treatment. The results showed that after sonication treatment, the extracellular nucleic acid protein content and intracellular Ca²⁺ concentration increased significantly. The morphology of S. cerevisiae was observed by SEM and found that the surface of the strain had wrinkles and depressions after ultrasonic treatment. furthermore after sonication treatment, the activities of three key enzymes which catalyze three irreversible reactions in glycolysis metabolism, namely, hexokinase, phosphofructokinase and pyruvate kinase increased by 59.02%, 109.05% and 87.27%, respectively. In a word, low-intensity ultrasound enhance the rate of ethanol output by S. cerevisiae might due to enhancing the growth and cell permeability of strains, and increasing the activities of three key enzymes of ethanol biosynthesis.     

Impairment in Physical Function and Mental Status in a Survivor of Severe COVID-19 at Discharge from an Acute Care a Hospital: A Case Report

Background: Early mobilization and rehabilitation interventions should be provided to patients who survived severe COVID-19 to improve their physical function and activities of daily living (ADL). However, their physical and mental status at discharge has not been well described in Japan. We report the intervention provided for a survivor of severe COVID-19 and his physical and mental status at discharge from an acute care hospital. Case Report: A 62-year-old man was admitted to our emergency department with a diagnosis of COVID-19 with severe acute respiratory dysfunction. He had complicated intensive care unit-acquired weakness (ICU-AW) and delirium during mechanical ventilation therapy. Rehabilitation intervention was initiated on the seventh day post-admission and was gradually performed according to his respiratory and hemodynamic status. As a result of the rehabilitation intervention, ICU-AW and cognitive function gradually improved. On hospital day 37, he independently performed basic ADL and was discharged. However, he lost approximately 9% of his body weight at discharge. In addition, his hand grip strength and six-minute walking distance were lower and shorter than the reference values, respectively. His mental component summary of the Short Form-8™ was lower than the national standard deviation for the Japanese population. Conclusion: Although survivors of severe COVID-19 who undergo early rehabilitation can be discharged from an acute care hospital, they may have several impairments in their physical and mental status, including muscle function, diffusion capacity, exercise tolerance, and health-related quality of life.     

Understanding the Impact of Walkability,Population Density,and Population Size on COVID-19 Spread: A Pilot Study of the Early Contagion in the United States

The novel coronavirus disease 2019 (COVID-19) pandemic is an unprecedented global event that has been challenging governments, health systems, and communities worldwide. Available data from the first months indicated varying patterns of the spread of COVID-19 within American cities, when the spread was faster in high-density and walkable cities such as New York than in low-density and car-oriented cities such as Los Angeles. Subsequent containment efforts, underlying population characteristics, variants, and other factors likely affected the spread significantly. However, this work investigates the hypothesis that urban configuration and associated spatial use patterns directly impact how the disease spreads and infects a population. It follows work that has shown how the spatial configuration of urban spaces impacts the social behavior of people moving through those spaces. It addresses the first 60 days of contagion (before containment measures were widely adopted and had time to affect spread) in 93 urban counties in the United States, considering population size, population density, walkability, here evaluated through walkscore, an indicator that measures the density of amenities, and, therefore, opportunities for population mixing, and the number of confirmed cases and deaths. Our findings indicate correlations between walkability, population density, and COVID-19 spreading patterns but no clear correlation between population size and the number of cases or deaths per 100 k habitants. Although virus spread beyond these initial cases may provide additional data for analysis, this study is an initial step in understanding the relationship between COVID-19 and urban configuration.