Search Results (332)

Background: In dual-task (DT) conditions, individuals must walk while simultaneously engaging in cognitive or motor tasks, which impacts gait performance, especially in older adults and individuals with Parkinson’s disease (PD). Gait impairments in PD under DT conditions have implications for intersegmental coordination. Research question: Intersegmental coordination and gait biomechanics during the DTs were compared between people with PD and older adults. Methods: Thirty-two individuals (16 PD, H&Y 1–3; and 16 older adults) participated in this study and were asked to walk under the following self-selected conditions: single task, DT with a math component, and texting on a cell phone. Spatiotemporal, angular, and intersegmental coordination data were collected using a markerless motion analysis system (OpenCap). Results: Dual-task conditions significantly affected spatiotemporal and kinematic variables, as well as intersegmental coordination. A significant task effect was observed for thigh–shank coordination, whereas no significant group effect was found for the main coordination outcomes. Significance: Significant task effects were observed for intersegmental coordination (thigh–shank CRP), with no significant group differences. The concurrent demands of processing visual and motor information for texting and walking lead to significant reductions in gait speed and lower limb movement, as well as altered intersegmental coordination, with task demands rather than disease status being the primary driver of coordination changes. Full article

Accurately estimating the severity of crash injuries among older drivers is paramount for enhancing traffic safety, a task challenged by class imbalance and label noise. Traditional predictive paradigms often struggle to identify rare severe cases, as they tend to prioritize global accuracy, thereby compromising sensitivity to high-risk outcomes. To overcome these limitations, this study develops a Log-Loss Cleaned and Probability-Calibrated Cascade (L-CSC) framework by strategically integrating existing advanced algorithmic components for robust and reliable severity prediction. Initially, a Log-Loss-based noise filtering mechanism is implemented to purge outliers and ambiguous samples from the training data, thereby enabling higher-quality representation learning. Subsequently, a two-stage cascade architecture is designed to decouple the classification task. Stage I employs a Preliminary Screening Model, optimized via Bayesian optimization for F2-score, to specifically maximize the recall for severe and fatal cases. In Stage II, a Stacking ensemble classifier is deployed to achieve a fine-grained classification of injury levels among the cases identified in the initial screening. Finally, Isotonic Regression is employed to calibrate the output probabilities from both stages, ensuring that the resulting risk estimations are statistically sound and reliable. Empirical evaluations demonstrate that the L-CSC framework effectively balances overall performance with critical risk detection, achieving a robust Macro-F1 of 0.7296. Specifically, compared to the best-performing baseline, the recall and F1-score for the critical severe and fatal category showed relative improvements of over 82% and 62%, respectively. Ablation analyses further substantiate the vital contributions of both the data cleaning and calibration modules. This research demonstrates that the cascaded framework effectively mitigates the biases inherent in imbalanced datasets, providing a robust algorithmic foundation to potentially support future traffic safety interventions. Full article

Background: Length of stay (LOS) reflects healthcare utilization but may also capture patient clinical trajectories. We investigated the relationship between LOS categories, organ support requirements, and in-hospital mortality. Methods: This retrospective observational study included 1332 consecutive adult ICU patients in a tertiary-care center. ICU LOS patterns were categorized using median-based and predefined cutoffs. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality. Results: Prolonged ICU LOS was associated with higher crude mortality (61.0% vs. 43.5%, p < 0.001). However, in LOS-adjusted models, mortality was independently associated with mechanical ventilation (aOR 29.89, 95% CI 17.92–49.86), inotropic support (aOR 4.94, 95% CI 3.50–6.97), hemodialysis (aOR 5.43, 95% CI 2.52–11.72), older age, and diabetes mellitus. Prolonged LOS was not independently associated with mortality (aOR 0.93, p = 0.630). Conclusions: LOS reflects underlying disease severity rather than acting as an independent driver of mortality. Integrating LOS pattern assessment with markers of organ dysfunction may improve risk stratification and resource planning in hospitalized populations. Full article

With population aging, motor vehicle accidents involving older drivers have increased. Age-related cognitive decline affects driving performance; however, the underlying neural mechanisms remain unclear. This scoping review explored neurophysiological characteristics associated with driving in older adults, including those at risk of dementia. Following PRISMA-ScR guidelines, we searched PubMed, Scopus, and CINAHL for studies examining driving-related neurophysiological measures in older adults aged ≥60 years. Twelve studies were included. Findings converge on load-dependent neural compensation failure: older adults maintain driving performance under low-to-moderate demands, but compensatory mechanisms break down under high cognitive load. Electroencephalography (EEG) studies revealed blunted midfrontal theta upregulation during high-load conditions, associated with reduced steering precision and delayed responses. Event-related potential studies demonstrated that reduced P3b amplitude was associated with missed braking responses and that abnormal visual evoked potentials in Alzheimer’s disease predicted unfit-to-drive classifications. fNIRS studies during driving-related tasks and an fMRI study using a laboratory-based visual task consistently showed prefrontal hyperactivation in older adults. Although some older adults maintained comparable performance to younger adults, the brain–behavior associations observed in younger adults were absent, suggesting that this hyperactivation does not necessarily serve a functional compensatory role. Combined with EEG evidence of impaired oscillatory modulation, these findings suggest that prefrontal hyperactivation does not necessarily compensate for diminished neural synchronization under high-load conditions. Neurophysiological markers hold promise for fitness-to-drive assessments. Future research should employ high-load scenarios and multimodal neuroimaging to verify prefrontal compensatory mechanisms. Full article

Early-onset colorectal cancer (EOCRC), defined as diagnosis before the age of 50 years, is increasing globally and is frequently characterized by aggressive biology and a disproportionate burden of liver metastases. This review synthesizes emerging evidence on the distinct molecular, immunologic and clinical features that differentiate EOCRC liver metastases from those arising in older adults. Genomic studies revealed increased chromosomal instability, increased copy number variation burden and unique amplification patterns involving MYC, RAD21, GNAS and MAPK1, alongside altered frequencies of classical driver mutations and increased germline predisposition. EOCRC liver metastases also exhibit a progenitor-like transcriptional state and an immune-cold microenvironment marked by reduced myeloid infiltration, impaired antigen presentation and profound resistance to immunotherapy, particularly in microsatellite-stable disease. Mechanistic insights into ferroptosis highlight therapeutic vulnerabilities, especially in PIK3CA-mutant tumors, where aspirin and ferroptosis inducers show synergistic potential. Clinically, high-risk EOCRC patients often present with left-sided primary tumors, synchronous metastases, adverse histology, elevated CEA levels and a hereditary predisposition, with prognostic models incorporating these variables outperforming traditional staging. Collectively, accumulating evidence suggests that EOCRC liver metastases may represent a biologically and clinically distinct entity, although ongoing debates regarding the extent of this distinction underscore the need for age-specific molecular profiling and prospectively validated therapeutic strategies. Full article

In highly automated driving systems (ADSs), drivers’ ability to resume manual driving remains a road safety issue. However, to the best of our knowledge, there is no existing computational model to predict which drivers require more than the 4 seconds mandated by United Nations Regulation No. 157 to regain manual control. To address this challenge, we developed a Random Forest model that predicts takeover time using measurable human factors. Three controlled driving simulator experiments were conducted in which participants engaged in distinct tasks—texting, drinking, and traffic monitoring—before responding to a takeover request. During the experiments, we collected human factor features, including gaze behavior, age, and scores, from the self-reported driving behavior questionnaire (K-DBQ). The Random Forest classifier achieved 77% accuracy. Recursive feature elimination selected 10 dominant predictors; notably, engaging in non-driving-related tasks, reduced on-road gaze, and older age were significantly associated with longer takeover times. Although K-DBQ scores were not directly correlated with takeover time, their inclusion improved model robustness, consistent with ensemble learning from weak yet complementary signals. The proposed model can be integrated into advanced driver assistance systems (ADASs) to proactively identify drivers likely to exceed the 4-second takeover window, support targeted interventions, and enhance human-centered transition safety in ADSs. Full article

Background: Polyploid and chromosomal copy number gains (CNGs) cells may serve as key mediators of tumor plasticity, therapeutic resistance, and clonal evolution. Despite growing interest, their biological and clinical relevance in colorectal cancer, particularly in the metastatic setting, remains poorly defined. Methods: We performed an integrated morphological, cytogenetic, and genomic analysis of metastatic colon cancer. A tissue microarray comprising 100 tumors was evaluated, of which 47 cases were fully assessable for morphology and fluorescence in situ hybridization (FISH). Polyploid nuclei and chromosomal CNGs were assessed morphologically and cytogenetically. High-resolution targeted sequencing (TruSight Oncology 500) was conducted to characterize genomic alterations. Bioinformatic analyses included Gene Ontology enrichment and Phenolyzer network modeling. Associations with clinicopathological variables and survival outcomes were explored. Results: Polyploid nuclei and/or chromosomal CNGs were identified in approximately 25% of evaluable cases. These alterations were enriched in right-sided CRCs and in older patients, suggesting a link with age-related genomic instability. Polyploid/CNG tumors did not show significant enrichment for canonical CRC driver mutations (RAS, TP53, SMAD4), although trends toward co-occurrence with BRAF mutation and mutual exclusivity with HER2 amplification were observed. Integrative bioinformatic analyses highlighted dysregulation of pathways involved in mitotic control, centrosome organization, and DNA replication stress. Conclusions: In metastatic colon cancer, the presence of genome-wide copy number gain may delineate a tumor subset with distinctive clinicopathological and molecular characteristics. Further studies are warranted to elucidate the biological significance of these features and to explore their potential implications for tumor evolution, treatment response, and clinical stratification. Full article

Background/Objectives: Driving cessation is associated with adverse health outcomes. Proactive support that extends safe driving while preparing for life after driving cessation has been emphasized, but empirical evidence remains limited. This study examined the effects of a proactive class for older drivers on awareness and behavior related to driving and mobility (Study 1) and on longitudinal changes in on-road driving behavior (Study 2). Methods: The proactive class was implemented as a municipal program, including information provision, training activities, group discussions, and optional on-road driving evaluations. Study 1 included 71 older drivers who attended the class at least five times annually and completed an anonymous questionnaire assessing perceived changes in awareness and behavior. Study 2 included 29 participants who completed standardized on-road driving evaluations at baseline and at a 1-year follow-up. Paired t-tests or Wilcoxon signed-rank tests with effect sizes were applied. Results: In Study 1, participants reported increased awareness of safe driving, greater confidence in continuing to drive, heightened risk perception, initiation of health-related behaviors, trial use of public transportation, and increased healthcare utilization, particularly ophthalmology visits. In Study 2, total scores on the on-road driving skill test improved significantly at follow-up (Cohen’s dz = 0.805). No significant changes were observed in individual on-road driving skill subitems, physical function, cognitive function, or daily functioning after correction for multiple comparisons, except for a reduction in driving simulator accidents. Conclusions: Participation in a proactive, continuous driving transition support class was associated with multidimensional behavioral changes and improved on-road driving performance among older drivers, potentially contributing to safer mobility and healthier aging. Full article

As population aging accelerates, age-related declines in visual sensitivity and attentional control make older drivers more vulnerable to suboptimal in-vehicle interface designs. Head-up displays (HUDs) are intended to reduce gaze shifts by overlaying information within the forward field of view, yet empirical evidence remains limited on how specific HUD presentation strategies reshape older drivers’ visual attention allocation. Grounded in theories of visual attention and cognitive load, this study systematically investigates three design variables that are increasingly common in contemporary HUDs (including AR-HUDs): (1) dynamic versus static navigation cues, (2) pedestrian warning strategies under different lighting conditions, and (3) the spatial placement of high-priority information. We first conducted a formative user study to define variables and operationalizations, and then carried out three within-subject driving-simulator experiments using controlled HUD stimuli and eye tracking. Objective gaze measures (e.g., fixation count, total fixation duration, and time to first fixation) were combined with subjective preference ratings to characterize attentional capture, search efficiency, and potential attentional costs. Findings reveal a robust trade-off: continuously changing navigation cues enhance attentional capture but can also increase attentional “stickiness,” unnecessarily consuming older drivers’ limited attentional resources. In pedestrian hazard tasks, real-time overlay warnings that were spatially aligned with the hazard significantly improved visual localization under low-light conditions, outperforming early warnings and multi-stage strategies. Across tasks and layout conditions, the central HUD region showed a stable attentional advantage—placing critical information centrally elicited greater visual attention and stronger subjective preference. These results provide mechanistic evidence for how HUD parameters modulate older drivers’ attention and yield actionable implications for prioritization, temporal pacing of dynamic navigation cues, and a “center-first” layout strategy to guide age-friendly HUD design. Full article

Tuberculosis (TB) remains a major public health challenge in China despite substantial long-term progress. Using data from the Global Burden of Disease Study 2023, this study reassessed trends and determinants of TB burden in China from 1990 to 2023. Age-standardized incidence, mortality, and disability-adjusted life year (DALY) rates were analyzed using estimated annual percentage change, age–period–cohort modeling, and demographic decomposition, with comparative risk assessment to quantify behavioral and metabolic contributions. Between 1990 and 2023, age-standardized incidence, mortality, and DALY rates declined by approximately 73.24%, 94.00%, and 92.40%, respectively. Negative net and local drift values indicated sustained reductions across age groups; however, the decline slowed after 2021, with a modest rebound in incidence. Since 2015, reductions in incidence have been more moderate than the pace required to achieve the 2035 End TB Strategy targets. Decomposition analysis demonstrated that improvements in age-specific rates were the primary drivers of long-term reductions, whereas demographic shifts—particularly population aging—partially offset these gains. The burden increasingly shifted toward older adults, and males consistently experienced higher rates than females. Tobacco and alcohol use contributed substantially to sex differentials, while undernutrition and metabolic disorders remained relevant risk factors. These findings indicate that China’s TB epidemic has entered a phase shaped by demographic aging and evolving risk structures, requiring sustained and adaptive control efforts. Full article

Background: Continuity of care is a core component of high-quality, patient-centered health systems and a central domain of nursing practice, particularly for older adults and people living with chronic and complex conditions. Yet discontinuities remain common during transitions between hospital and community care, contributing to fragmented communication, delayed follow-up, negative patient experiences, and avoidable harm. Methods: Literature was identified through iterative searches in PubMed and CINAHL (2002–2024), complemented by citation tracking of seminal frameworks and reference-list screening. Sources were prioritized for conceptual frameworks and empirical studies/reviews addressing hospital-to-community transitions, patient experience, and nursing-relevant strategies to strengthen continuity. Results: Across the reviewed literature, continuity was most frequently conceptualized as informational, management, and relational continuity. Most empirical studies and reviews highlighted discharge information-transfer failures and unclear post-discharge responsibility as recurrent drivers of discontinuity, particularly among older adults and people with complex needs. Evidence also suggests that interventions combining structured discharge processes with proactive post-discharge follow-up and a consistent point of contact (often nurse-led) are associated with improved patient experience and fewer early post-discharge complications in high-risk groups. Patient-reported instruments (e.g., PCCQ and CAHPS-derived domains) complement administrative indicators by capturing continuity as lived experience. Limitations: As a narrative review, findings reflect interpretative synthesis rather than systematic evidence aggregation. Conclusions: Continuity of care should be understood as both a structural and relational process; strengthening it likely requires multi-level strategies that address information transfer, accountability, and sustained therapeutic relationships across care transitions. Full article

Winter cities face the dual pressures of climate change and population aging, urgently requiring a shift from a singular focus on winter protection toward a development model adaptable to both winter and summer conditions. This shift is essential to enhance social resilience and safeguard the health of all age groups. This case study investigates how the thermal environment of life-sustaining streets in winter cities correlates with older adults’ daily activities. Employing Spearman correlation analysis, a heat exposure–pedestrian flow coupling matrix, and a comprehensive risk diagnostic model, the research analyzes the spatiotemporal variation patterns and underlying drivers of the street thermal environment. The key findings are: (1) All 15 surveyed streets exhibited Wet Bulb Globe Temperatures (WBGT) exceeding 28 °C during peak activity hours, with afternoon values (17:00–19:00) up to 2.7 °C higher than morning values. (2) On East Chaoyang Road, despite building shade and a high Visible Green Index (39.68%), the WBGT ranked second highest. This condition is attributed to a critically low average wind speed of 0.69 m/s (significantly below the city’s summer average of 2.67 m/s) and the widespread use of low-albedo asphalt, which collectively trap heat and negate the benefits of shading. (3) Using a dual-dimensional diagnostic framework, four streets were identified as dual-pressure streets with their combination of high elderly pedestrian flow (exceeding 126 persons/h) and high thermal risk (WBGT > 29 °C), marking them as priority intervention units. Based on these findings, the study proposes categorized street retrofit strategies that synergistically integrate climate adaptation and aging-friendliness. This provides an actionable, evidence-based foundation for planning decisions to support the sustainable renewal of winter cities amid climate change and population aging. Full article

Background: Despite recent breakthroughs in pharmacological treatment for Alzheimer’s disease, high costs and the complex procedure to monitor safety have limited access for many patients. Less invasive and more accessible non-pharmacological therapies that support neuroplasticity and slow cognitive decline are needed. Processing Inner Strength Toward Actualization (PISTA) stimulation applies structured tactile input to promote cortical–subcortical activation. This study evaluated the long-term effects of PISTA on cognition and pain in older adults with mild cognitive impairment or early dementia. Methods: This single-arm, prospective trial enrolled 100 outpatients aged 47–70 years at outset (50 women, 50 men) with no control group. Participants received clinician-supervised PISTA stimulation three times weekly for 48 months. Each 30 min session delivered rhythmic tactile input calibrated to individual sensory thresholds. Cognitive performance was assessed monthly using the Mini-Mental State Examination (MMSE). Perceived pain was measured monthly with the Numeric Pain Rating Scale. Outcomes were analyzed using ANCOVA, adjusting for age, sex, and baseline cognitive status. Results: Cognitive scores improved significantly across all age strata, with a mean annual MMSE increase of 0.75 points (95% CI: 0.26–1.21; p < 0.0025). Pain intensity decreased in parallel (mean reduction: 0.56 points; 95% CI: 0.34–0.78; p < 0.001). Improvements in cognition and pain were moderately correlated (r = 0.38). The greatest combined benefits occurred in participants aged 55–62 years. No serious adverse events were observed during the 48-month trial. Conclusions: PISTA stimulation produced sustained improvement in cognition and reduced perceived pain, supporting its promising role as a safe, non-invasive adjunct for neurodegenerative cognitive decline. These findings suggest peripheral sensory activation as a promising driver of functional neuroplasticity and warrant verification in randomized, controlled trials. Full article

Croatia’s tourism market is highly exposed to digital platforms and peer-to-peer information flows, yet evidence on how Croatian users differentiate between promotional formats (digital channels, agency websites, traditional media and word-of-mouth) remains fragmented and rarely translated into actionable priorities. This study aims to identify the underlying dimensions of perceived promotional influence and to prioritize promotional formats for destination choice in Croatia by integrating PCA and the Analytic Hierarchy Process (AHP). An online survey (N = 299) was used to extract promotional dimensions via PCA and to test group differences by gender, age and primary information source, while AHP translated expert judgments into a comparative priority structure. Results consistently indicate that word-of-mouth is the most persuasive driver of destination choice, but its perceived importance varies significantly across demographic segments and information-source profiles. Younger respondents place greater emphasis on digital channels (especially social media and travel agency websites), whereas older respondents show higher reliance on traditional formats. The combined PCA–AHP approach provides a structured bridge between user perceptions and managerial prioritization, offering segment-specific guidance for more efficient allocation of promotional resources in Croatian destination marketing. Full article

Background/Objectives: Mental health issues pose a growing public health burden in aging societies, a challenge particularly accentuated in rural China. This study investigated whether the establishment of rural community organizations—specifically volunteer groups, agricultural cooperatives, cultural and sports clubs, senior dance troupes, and senior associations—influences depressive symptoms and life satisfaction among rural older adults. Methods: Data were obtained from the Well-being of Elderly Survey in Anhui Province (WESAP) across three waves (2015, 2018, and 2021). The final sample comprised a balanced panel of 511 older adults, providing 1533 observations. A two-way fixed-effects model was employed to analyze the data. Results: Empirical results show that the establishment of agricultural cooperatives was associated with lower depressive symptoms. Cultural and sports clubs were associated with reduced depressive symptoms and positively correlated with life satisfaction. Mechanism analysis revealed associations consistent with a dual “economic–social” pathway: establishing agricultural cooperatives was associated with greater economic resilience and stronger social bonds. The establishment of cultural and sports clubs correlated with higher mental well-being, accompanied by increased time spent in social interaction. Notably, volunteer groups and senior associations showed no significant association with mental health outcomes. Conclusions: Rural community organizations are critical drivers of mental health equity. Policymakers should prioritize support for organizations that are deeply embedded in rural daily life and integrate economic functions with social interaction to maximize mental health benefits for older adults. Full article