Search Results (877)

Background: Falls among older adults are a major public health concern associated with injury, disability, reduced mobility, and loss of independence. Functional impairment, chronic diseases, and unsafe home environments may increase the risk of falls. This study examined environmental, functional, and health-related factors linked to falls among community-dwelling older adults in Iran. Methods: A comparative cross-sectional study was conducted among 329 community-dwelling older adults. Data were collected using standardized assessments of functional ability, home safety, health status, and fall history. Conventional regression and Elastic Net analyses were applied to identify significant predictors of falls. Results: Overall, 28.6% of participants reported at least one fall during the previous 12 months. Falls were significantly more common among females, adults aged ≥85 years, individuals without a spouse, and those with lower educational levels. Fallers showed poorer mobility, balance, and functional independence, greater fear of falling, and a higher risk of home accidents (all p < 0.001). Elastic Net analysis identified use of movement aids as the strongest risk factor, whereas better Performance-Oriented Mobility Assessment (POMA) scores were the main protective factor. Conclusions: Falls among community-dwelling older adults appear to result from the interaction of physical, medical, socioeconomic, and environmental factors. These findings highlight the need for multidimensional fall-prevention strategies in primary care settings. Full article

Postural sway, quantified through center of pressure (COP)-based measures, is a critical indicator of postural stability and fall risk. Despite growing interest in virtual reality (VR) and technology-assisted rehabilitation, a comprehensive synthesis of how interventions and experimental conditions affect postural sway across adults and older adults is lacking. This review aimed to systematically synthesize the effects of exercise-based interventions and experimental physiological, visual, and sensory conditions on COP-based postural sway in adults and older adults, with an emphasis on acute and short-term effects relevant to VR- and technology-assisted rehabilitation. A systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted from database inception to 31 March 2025. Studies reporting COP-based postural sway outcomes with extractable quantitative data were included. Narrative synthesis was performed due to substantial clinical and methodological heterogeneity. Ten studies were included (2 RCTs, 6 pre–post, 1 crossover, 1 cross-sectional). Exercise-based interventions—including balance training and visual feedback training—generally reduced postural sway. Acute physical perturbations (fatigue, immobilization, cryotherapy, proprioceptive vibration) consistently worsened stability. Destabilizing visual stimulation increased sway, whereas stabilizing visual feedback reduced it. Exercise-based interventions and sensory-stabilizing conditions show promise for improving postural stability. Fatigue, immobilization, and sensory perturbations represent important modifiable risk factors. IMU-based wearable assessment may serve as a clinically scalable alternative to force plate systems in VR-based and rehabilitation settings. Full article

Background/Objectives: The relationship between psychotropic medication use, prescribing appropriateness, and fall-related risk factors remains incompletely characterised. Gait speed is a key predictor of falls. We aimed to examine whether gait speed is associated with appropriately versus inappropriately prescribed psychotropic medication use among relatively healthy older adults. Methods: We conducted an observational cross-sectional study of 119 community-dwelling adults aged ≥ 70 years with low comorbidity burden (Charlson Comorbidity Index < 2) and preserved functional status (Barthel Index > 85). Gait speed was assessed over 6 metres. Psychotropic medication use was recorded and prescribing appropriateness was evaluated using STOPP/START and Beers criteria, supplemented by geriatric pharmacological considerations. Multivariable linear regression analyses adjusted for age, sex, waist-to-height ratio, and frailty status. Results: In the fully adjusted model, inappropriate psychotropic medication use was associated with significantly slower gait speed compared with no use (B = −0.109 m/s; p = 0.026). In contrast, appropriately prescribed psychotropic medication use was not associated with gait speed (B = −0.018 m/s; p = 0.699). Conclusions: In this cross-sectional sample of relatively healthy older adults, appropriate psychotropic medication use was not associated with gait speed impairment, whereas inappropriate use was associated with slower gait. Although causal inference is not supported, these findings may inform prescribing quality and fall-risk assessment in older populations. Full article

Background Although cycling has definite health benefits, it is certainly not a risk-free activity; its increasing use is associated with a rise in accidents. This study aims to characterize cycling injuries and their associated factors in a tertiary trauma center, including injury severity, accident circumstances, and in-hospital costs. Methods: A retrospective observational study was conducted on patients over 15 years of age hospitalized after a cycling accident. Collected variables included the characteristics of the accident, the epidemiology of musculoskeletal injuries, helmet use, injury severity as assessed using the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS), and costs. Results: A total of 131 patients were included, of whom 90.8% were male, with a mean age of 43.2 ± 14.1 years. Most accidents were due to falls (83.7%). Accidents occurred in urban areas (56.3%), inter-urban roads (28.1%), and rural areas (15.6%). Upper limb fractures, particularly clavicle fractures (13.7%), were the most frequent injuries (31.0%). Traumatic brain injury (TBI) was present in 30.0% of patients, and 17.6% were polytraumatized. Injury severity was higher in males (p = 0.009) and in collisions compared with falls (p = 0.033). It was also correlated with length of hospital stay (r = 0.376). Patients with TBI exhibited significantly higher ISSs (p < 0.001). Helmet use was reported in 71.1% of patients and was more frequent in rural areas (p < 0.001) and associated with lower neurological AIS scores (p = 0.031). The mean cost per patient was €8545 ± 15,298, increasing with severity of injury (p < 0.001), and was higher in polytraumatized patients (p < 0.001) and in those with TBI. Conclusions: Cycling accidents most frequently resulted in upper limb fractures. Helmet use was more common where mandatory and was associated with less severe neurological injuries but not with a lower incidence of TBI. Costs increased with injury severity, particularly in patients with TBI and longer hospital stays. Full article

Objectives: Fear of falling (FoF) is a common psychological phenomenon in later life and is often accompanied by avoidance behavior and activity restriction. Although FoF is associated with anxiety, depressive symptoms, reduced self-efficacy, and fear of loss of autonomy, older adults with FoF may differ substantially in the configuration of these characteristics. The present study aimed to identify data-derived profiles of older adults based on FoF, avoidance behavior, self-efficacy, and fear of loss of autonomy, and to examine profile-specific psychological predictors of FoF and avoidance behavior. Methods: The main analytical sample included 217 older adults aged 60–97 years (M = 76.45, SD = 10.14) with Mini-Mental State Examination scores of 20 or higher. Latent profile analysis was conducted using FoF, avoidance behavior, self-efficacy, and fear of loss of autonomy. Anxiety components, depressive symptoms, coping strategies, pain catastrophizing, and loneliness-related indicators were examined in class-specific regression models. The stability of the class solution was tested across different MMSE cut-off scores. Between-class comparisons were conducted for functional, fall-related, socio-demographic, and psychological indicators. Results: A three-class solution was selected and interpreted as adaptive, vulnerable, and maladaptive profiles. The profile structure remained relatively consistent across MMSE cut-off scores, including in the broader sample with MMSE ≥ 15. The classes did not differ significantly in postural balance or number of falls, suggesting that the profiles could not be fully explained by objective fall-risk indicators. Significant between-class differences were found for age, daily pain level, and state social defense. Class-specific regression models suggested that psychological variables associated with FoF and avoidance behavior differed across profiles. Pain appraisal and emotion-related coping were more relevant in the adaptive profile, phobic anxiety and anxious appraisal of future events in the vulnerable profile, and anxiety-related, depressive, interpersonal, and coping-related factors in the maladaptive profile. All reported associations remained significant after false discovery rate correction. Conclusions: FoF and avoidance behavior are related but not identical phenomena and vary across data-derived psychological profiles. A profile-oriented approach may provide a more differentiated understanding of activity restriction in older adults and help identify profile-specific targets for psychological support. Full article

Why are essential workers (also known as key workers) priced out of the urban areas where essential services are concentrated? This paper addresses that question by linking residential sorting to the governance of land and housing markets in Auckland, New Zealand. Drawing on bid rent theory and motivated by Crane’s theoretical framework, this study examines how households trade off urban accessibility against housing costs with varying degrees of job location uncertainties and time pressure. The analysis uses the micro-level household data from Statistics New Zealand (Stats NZ)’s Integrated Data Infrastructure (IDI) to examine how key-worker households position themselves within the city’s rental market relative to other working households. The results show a clear urban land rent gradient: rents fall with distance from the city centre. However, access to the central location is not evenly distributed across workers. Key workers, whose jobs are typically tied to more fixed workplaces, are more inclined to live farther from the city centre to lower housing costs. By contrast, workers facing tighter time constraints, especially those working longer hours, show a stronger preference for living near the CBD to improve work proximity and reduce commuting burdens. This pattern remains evident among private vehicle commuters, suggesting that time pressure, rather than transport mode alone, is an important factor shaping residential location choice. The paper argues that this is not simply a housing market outcome but also a land-governance problem. When central land values rise without corresponding housing options for key workers, cities risk pushing socially necessary labour towards peripheral areas. The findings highlight the need for land-use and housing interventions that improve the spatial match between where key workers live and where urban services are most needed. Full article

Falls among older adults are a major public health concern. Older adults living in low-income housing (LIH) are at higher risk of falls due to disadvantages linked to social determinants of health, yet remain underrepresented in research. This study aimed to assess the feasibility of a program addressing fear of falling and its consequences on activity levels among older adults living in LIH in Côte-des-Neiges (Montreal, QC, Canada). A mixed-methods pilot feasibility study was conducted using Bowen et al.’s framework, drawing on data collected through questionnaires, observation grids, attendance records, and semi-structured interviews. The program consisted of six 90 min sessions designed to enhance participants’ confidence in preventing falls while promoting engagement in activities. Fourteen older adults (mean age = 75.5 years) were recruited. Outcome data on fall-related psychological factors, activity engagement, and knowledge about falls were collected before and after the program. Moreover, older participants’ perceived benefits were assessed following program completion. Post-program interviews with older adults, facilitators, and a community field worker were conducted to further explore program feasibility, including its acceptability, implementation, and integration. The program showed strong acceptability and a high attendance rate (95%). Although no statistically significant pre-post changes were observed in the outcome variables, older participants reported several benefits at post-test, including improved knowledge about fall prevention (100%) and greater confidence in their ability to avoid falls (85%). These findings support the feasibility of implementing this culturally adapted fall prevention program in similar LIH settings and provide valuable insights for its refinement and future research. Further investigation is warranted to examine the program’s feasibility across other LIH settings and linguistic groups, as well as to assess its effectiveness. Full article

Driven by China’s “dual carbon” (carbon peak and carbon neutrality) goals and the national strategy of new-type urbanization, prefabricated construction has emerged as a pivotal pathway toward industrialized and sustainable development in the construction sector—leveraging its distinctive advantages in construction efficiency, cost optimization, environmental performance, and design adaptability. Nevertheless, the inherently sequential and interdependent nature of the full construction process—encompassing off-site component manufacturing, logistics transportation, and on-site assembly—introduces pronounced cross-stage risk transmission mechanisms, with prefabricated components serving as critical risk carriers. Such transmission dynamics significantly impede the scalable and safe deployment of prefabricated construction. To date, scholarly efforts on construction safety in prefabricated buildings have predominantly addressed isolated, stage-specific risks, falling short in quantitatively modeling the coupled propagation of risks across stages, accommodating epistemic uncertainties and latent (i.e., unknown or unobserved) risks, and informing targeted, evidence-based mitigation strategies. To bridge this gap, this study develops a rigorous quantitative framework for assessing cross-stage risk transmission in prefabricated construction safety. Specifically, it aims to (i) uncover the structural patterns and driving mechanisms underlying inter-stage risk propagation; (ii) reduce the likelihood of safety incidents throughout the construction life cycle; and (iii) deliver actionable theoretical insights and methodological guidance for practitioners and policymakers. Methodologically, we first conduct a systematic identification of safety-critical risk factors and establish a hierarchical risk indicator system comprising three first-level dimensions and twenty second-level indicators. Second, using the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method, causal relationships among risk factors are clarified, while incorporating the Leaky Noisy-or Gate (LNOG) extended model to account for unknown risks. Risk data are processed using triangular fuzzy functions, and a Bayesian network (BN) topology diagram is constructed via the GeNIe 5.0 platform, forming a DEMATEL-LNOG-BN-based model for assessing cross-phase risk transmission. Finally, applying the model to an actual project—”a prefabricated construction project in Shanghai”—the study conducts a cross-phase risk transmission analysis. Through forward probability inference, backward causality tracing, sensitivity analysis, and pathway decomposition, sensitivity comparisons are performed under different LNOG unknown risk parameters. Results are compared with those from the traditional DEMATEL-BN model to validate the stability and consistency of high-sensitivity risk factor identification, comprehensively verifying the applicability and predictive reliability of the proposed DEMATEL-LNOG-BN model. The study quantitatively reveals the progressive diffusion and amplification mechanisms of risks across the production–transportation–assembly process, providing scientific support and practical reference for precise safety risk prevention, critical node control, and the optimization of management systems in prefabricated construction sites. Full article

Grid trading is a rule-based Forex execution scheme that places a ladder of buy and sell limit orders at fixed price increments, profiting from price oscillation without a directional forecast. To accelerate recovery, the scheme is commonly paired with Martingale lot scaling, a gambling strategy—distinct from the stochastic-process notion of the same name—that increases the lot size at each adverse price level. This combination achieves a high short-term hit rate but retains a non-zero probability of catastrophic drawdown, a pattern equivalent to the Gambler’s Ruin problem. Attempts to augment grid trading with supervised machine learning face a label-misalignment problem: the usual label “did the price rise or fall at horizon $h$?” does not capture the path-dependent payoff of a grid that may still profit after an initially adverse move. This paper presents the ML-Augmented High-Frequency Grid Trading System (AHFGTS) and reports three contributions. (i) Strategy-Embedded Labeling (SEL) derives each binary training label from a full forward simulation of the deployed grid over a 15 bar H1 (one-hour) horizon, so the training objective matches the execution objective. (ii) Soft Martingale execution replaces classical 2× doubling with ten sub-linearly scaled lot multipliers generated by linspace(1, 5, 10), cutting four-level cumulative exposure by 63% relative to 2× doubling. (iii) The Drawdown Dichotomy Ratio (DDR = Maximum Equity Drawdown/Maximum Balance Drawdown) is introduced as a scalar risk metric that, to our knowledge, is the first such metric for the gap between floating and realized risk in Martingale-family systems. A twelve-month out-of-sample evaluation on EUR/USD H1 (38 million ticks, 99% modeling quality, 1:500 leverage) produced 444 trades, a 65.77% win rate (z = 6.65, p < 0.0001; Cohen’s $h$ = 0.321), Profit Factor 2.85 (a 90–138% improvement over unfiltered grid baselines), and 442.6% net annual return; DDR was 5.72× (maximum equity drawdown, MED, of 79.97% vs. maximum balance drawdown, MBD, of 13.98%), quantifying the structural Martingale risk that persists after ML augmentation. The study evaluates a single currency pair under 1:500 offshore leverage and should be read as a methodological demonstration of SEL, Soft Martingale, and DDR rather than a universal performance claim. Full article

Objectives: Stroke predominantly affects older adults and is accompanied by age-related declines in balance and mobility. Given the inter-individual variability in post-stroke functional capacity, identifying the most effective dual-task training modalities for specific patient profiles is essential for precision-based stroke rehabilitation. This systematic review and meta-analysis aimed to investigate the differential effectiveness of motor dual-task training (MDT) and cognitive dual-task training (CDT) on gait performance, balance control, and motor function while exploring other moderating factors. Methods: The study followed the PRISMA guidelines. A comprehensive search of six English databases (Web of Science, PubMed, Medline, Embase, Cochrane Library, CINAHL) and one Chinese database (CNKI) was conducted from November 2023 to June 2025. Randomized controlled trials involving adult stroke survivors were included. Outcomes included gait, balance, and lower-extremity motor function. Random-effects meta-analysis, subgroup analyses, and meta-regression were performed to evaluate modality-specific effects and moderating factors. Results: Twenty-one RCTs (n = 786) were included. Dual-task training demonstrated moderate improvements in both temporal (SMD = 0.50, p = 0.03) and spatial (SMD = 0.5, p = 0.04) gait performance and balance control (SMD = 0.71, p = 0.02), but not motor function. MDT demonstrated superior effects on gait speed and stride length (SMD = 1.15, p = 0.01; SMD = 0.89, p < 0.01), whereas CDT showed greater benefits for balance (SMD = 0.59, p < 0.01). Greater balance improvements were observed in individuals at high fall risk, and subacute patients showed enhanced responsiveness. Conclusions: These findings provide guidance for tailoring dual-task modality and timing to individual patient profiles, though high heterogeneity and the lack of direct comparisons between MDT and CDT limit definitive conclusions. Full article

Scaffold-related falls remain a major safety concern in demolition projects, where temporary access systems are frequently erected, modified, used, and dismantled under changing structural and site conditions. These characteristics complicate risk prioritization because scaffold failures may involve interacting human, technical, organizational, and environmental factors. This study develops an expert-based risk prioritization framework for scaffold-related fall risks in demolition projects by integrating Failure Mode and Effects Analysis (FMEA), interval neutrosophic fuzzy (INF) theory, Decision-Making Trial and Evaluation Laboratory (DEMATEL), and Multi-Attributive Border Approximation Area Comparison (MABAC). Using the 4M1E perspective, namely Man, Machine, Material, Method, and Environment, 37 demolition-specific failure modes were identified through literature review and expert elicitation. Ten experts evaluated these failure modes using the SODE criteria, namely Severity, Occurrence, Detection difficulty, and Expected Cost impact. INF theory was used to represent uncertainty, hesitation, and judgmental variation in expert assessments. INF-DEMATEL was applied to examine interrelationships among the SODE criteria and derive interdependence-aware criterion weights, while INF-MABAC was used to rank the failure modes according to their distance from the Border Approximation Area. The framework was illustrated through an empirical application in Taiwan’s demolition industry. The results identified Severity as the most influential criterion. The highest-priority failure modes were insufficient safety awareness, improper scaffold-to-structure anchoring, and inadequate scaffold maintenance and inspection governance. Comparison with risk priority number (RPN)-based methods and sensitivity analyses using expert exclusion and Severity-weight variation showed that the ranking was generally consistent and reasonably stable under the tested conditions. The proposed framework provides a structured, uncertainty-aware decision-support procedure for identifying prevention priorities in demolition scaffold operations. Full article

Railway cable-stayed bridge construction is characterized by high complexity and substantial safety risk. Deficiencies in safety control may result in serious accidents (e.g., collapse and falls), causing significant casualties and economic losses; therefore, clarifying risk interactions and accident-causing mechanisms is essential. This study proposes a fuzzy DEMATEL–ISM approach in which fuzzy sets capture uncertainty in experts’ linguistic assessments. DEMATEL quantifies influence strengths and causal relationships among factors, and ISM constructs a multi-level hierarchy to explain accident causation. Twenty safety influencing factors are identified and grouped into five categories: management, human, material and equipment, construction technology, and environmental conditions. The obtained accident-causing mechanism comprises seven hierarchical levels: L₁: collapse and fall accidents, L₂: direct factors, L₃–L₅: indirect factors, and L₆–L₇: root factors. This mechanism is a chain of events that leads to an accident, with the nodes improper prestressing, structural deformation and differential settlement. These key nodes can be avoided by reinforcing safety management system implementation, daily supervision and inspection, and education and training on the subject of safety to ensure the safety of railway cable-stayed bridge construction. Full article

Quantitative risk assessment of flash floods is crucial for developing disaster prevention and mitigation strategies. This study developed a refined framework that innovatively integrates field-validated data from Chongqing’s flash flood disaster investigation project with AHP, factor analysis, and cluster analysis to quantify hazard, vulnerability, resistance, and risk indicators at a 30 m grid. Unlike existing coarse-scale assessments that rely on generic indicators, this hybrid model, calibrated by observed disaster evidence, significantly enhanced the local relevance and reliability of risk zoning. The validity of this framework was confirmed through validation against objective weighting methods and historical flash flood locations. The results indicated that the risk value of flash floods in Chongqing was between 0.24 and 0.69, with extremely high-risk and high-risk zones covering 42,388 km² (51.47%) of the study area. This accurately identifies areas at high risk of flash floods and provides a basis for government decision-making regarding priority areas for disaster risk reduction investments. Verification showed that 83.44% of historical disaster points fall within medium-risk or above zones, confirming the framework’s accuracy in identifying flood-prone hotspots and providing actionable support for targeted early warning and resource allocation. Full article

Background: Dual-release sustained formulations enable rapid drug release for prompt therapeutic onset while retaining the characteristics of sustained-release dosage forms. However, due to the complexity of this dosage form, conventional trial-and-error approaches fail to mitigate development risks or improve the success rate of bioequivalence studies of the generic product. Accordingly, the present study aims to investigate the feasibility of guiding a dual-release generic formulation screening through establishing a quality-related media condition through construction of PBPK models and IVIVR for the reference product. Methods: Here, Difene^® was selected as the reference product, and GastroPlus^TM was employed as the simulation platform. Pharmacokinetic data obtained from the literature and in vitro dissolution test results were integrated to construct the PBPK model for the reference product and establish IVIVR in different media, respectively. A quality-related media condition was determined for formulation screening of the generic product. A pharmacokinetic study in beagle dogs was then conducted to evaluate the bioequivalence between the generic and the reference product. Results: In the PBPK modeling and IVIVR study, the PBPK model was successfully established. The IVIVR for the pH 4.0–pH 6.0–pH 6.8 media was optimal in all media conditions, with fold error ratios of 1.11, 0.86, and 1.11 for C_max, AUC, and T_max, respectively, all falling within the 0.80–1.25 range. Employing this medium as the quality-related media, the optimized generic product exhibited an f2 factor of 76 with the reference product in vitro. Pharmacokinetic studies in beagle dogs demonstrated that the geometric mean ratios and 90% confidence intervals for AUC and C_max of the generic product versus the reference product were within the 80.0–125.0% range. No statistically significant difference was observed for T_max, indicating bioequivalence between the two products. Conclusions: Overall, our study provides a strategic approach for generic development and a novel research framework for the generic development of other dual-release formulations. Full article

This study aimed to investigate how human, vehicle, and environment (HVE)-related factors and their interactions contribute to fall accidents related to electric scooters (e-scooters). Falls are the most common type of e-scooter accidents, and developing a thorough understanding of the factors that contribute to these accidents is critical for effective accident prevention. Unlike collisions, falls frequently result from the complex interaction among the rider, the vehicle, and the environment. To this end, this study conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and uses the Haddon Matrix framework to identify and classify factors related to e-scooter fall accidents from HVE perspectives, spanning the pre-fall and fall phases. The findings suggest that e-scooter fall accidents are multifactorial, resulting from the interaction of HVE-related factors across accident phases rather than from a single cause. Human-related factors, vehicle attributes, and environmental conditions were all found to contribute to fall risk, with notable interactions identified across all three dimensions. This study contributes to a better understanding of the mechanisms underlying e-scooter fall accidents by systematically identifying these factors and examining their interactions, highlighting the need for further investigation into HVE interactions across diverse accident contexts. Full article