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Skills on Wheels, a 5-week pediatric wheelchair skills training program implemented over 2 years, was developed to address confidence, social participation, and mobility for wheelchair-using children. This study tests the hypothesis that pediatric wheelchair skills training will increase wheelchair skill ability, confidence, and participation of wheelchair-using children. Individualized instruction was delivered by occupational ( N  = 50) and physical ( N  = 12) therapy practitioners and doctoral students. The primary program intervention was adapted for pediatric wheelchair users from the adult Wheelchair Skills Training Program, developed by Dalhousie University, consisting of a total of 33 wheelchair skills. An adapted version of the Wheelchair Confidence measure (Wheel-Con-M-P), the Participation and Environment Measure for Children and Youth (PEM-CY), and Wheelchair Skills Test (WST) were used to measure participants confidence and ability to complete wheelchair skills, endurance, and participation and satisfaction in community, school, and home. The study resulted in: increases in confidence in ability to move wheelchair over threshold (+1.00, p  < 0.05), ability to carry lunchbox/bookbag (+0.65, p  < 0.05), ability to move in wheelchair when worried or scared (+1.3, p  < 0.05), ability to ask for help, and ability to say "no" if they don't need help (+0.58, p  < 0.05) were indicated. The WST indicated increased ability ( p  < 0.05) on several skills. The Fear of Falling Measure found an overall decrease in fear of falling (-2.37, p  < 0.01). The Skills on Wheels program demonstrated many successes in this initial 2-year study and data suggest a positive trend for iterations to come.

Introduction: Numerous tools have been developed to measure constructs related to wheelchair use. Currently, no toolkit comprehensively details assessments of wheeled mobility device use based on the quality of their measurement properties. The current review aims to systematically identify high-quality assessment tools that measure different aspects of wheeled mobility use., Objective: The objectives are two-fold: i) to synthesize outcome measures that assess use of wheeled mobility devices, and ii) to evaluate measurement properties of the assessment tools., Inclusion Criteria: The populations of interest are manual wheelchair users, power wheelchair users, and scooter users of any age, diagnosis, or setting. Instruments of any type will be included., Method: The JBI methodology for systematic reviews of measurement properties will guide this review. A search strategy will be developed to search the following databases: MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), PsycINFO (EBSCOhost), PsycTests (EBSCOhost), Web of Science, and Google Scholar. The article selection process, data extraction, and quality appraisal will be performed by 2 independent reviewers, with a third reviewer being consulted to achieve consensus. The methodological quality of the studies will be assessed through the Consensus Standards for the Selection of Measurement Instruments (COSMIN) Risk of Bias tool and the COSMIN Checklist. The quality of the pooled evidence and individual measurement properties will be graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the COSMIN Criteria for Good Measurement Properties recommendations. Measurement properties of each instrument will be described, with the goal of developing a toolkit that identifies appropriate assessment tools for wheeled mobility use outcomes., Review Registration: PROSPERO CRD4202276169., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published By Wolters Kluwer Health, Inc. on Behalf of JBI.)

Amnestic mild cognitive impairment (aMCI) is a transitional stage between normal aging and Alzheimer's disease, making early screening imperative for potential intervention and prevention of progression to Alzheimer's disease (AD). Therefore, there is a demand for research to identify effective and easy-to-use tools for aMCI screening. While behavioral tests in virtual reality environments have successfully captured behavioral features related to instrumental activities of daily living for aMCI screening, further investigations are necessary to establish connections between cognitive decline and neurological changes. Utilizing electroencephalography with steady-state visual evoked potentials, this study delved into the correlation between behavioral features recorded during virtual reality tests and neurological features obtained by measuring neural activity in the dorsal stream. As a result, this multimodal approach achieved an impressive screening accuracy of 98.38%.

An effective way to reduce emotional distress is by sharing negative emotions with others. This is why counseling with a virtual counselor is an emerging methodology, where the sharer can consult freely anytime and anywhere without having to fear being judged. To improve counseling effectiveness, most studies so far have focused on designing verbal compassion for virtual counselors. However, recent studies showed that virtual counselors' nonverbal compassion through eye contact, facial mimicry, and head-nodding also have significant impact on the overall counseling experience. To verify this, we designed the virtual counselor's nonverbal compassion and examined its effects on counseling effectiveness (i.e., reduce the intensity of anger and improve general affect). A total of 40 participants were recruited from the university community. Participants were then randomly assigned to one of two virtual counselor conditions: a neutral virtual counselor condition without nonverbal compassion and a compassionate virtual counselor condition with nonverbal compassion (i.e., eye contact, facial mimicry, and head-nodding). Participants shared their anger-inducing episodes with the virtual counselor for an average of 16.30 min. Note that the virtual counselor was operated by the Wizard-of-Oz method without actually being technically implemented. Results showed that counseling with a compassionate virtual counselor reduced the intensity of anger significantly more than counseling with a neutral virtual counselor (F(1, 37) = 30.822, p < 0.001, η p 2  = 0.454). In addition, participants who counseled with a compassionate virtual counselor responded that they experienced higher empathy than those who counseled with a neutral virtual counselor (p < 0.001). These findings suggest that nonverbal compassion through eye contact, facial mimicry, and head-nodding of the virtual counselor makes the participants feel more empathy, which contributes to improving the counseling effectiveness by reducing the intensity of anger., (© 2024. The Author(s).)

Background: With the global rise in Alzheimer disease (AD), early screening for mild cognitive impairment (MCI), which is a preclinical stage of AD, is of paramount importance. Although biomarkers such as cerebrospinal fluid amyloid level and magnetic resonance imaging have been studied, they have limitations, such as high cost and invasiveness. Digital markers to assess cognitive impairment by analyzing behavioral data collected from digital devices in daily life can be a new alternative. In this context, we developed a "virtual kiosk test" for early screening of MCI by analyzing behavioral data collected when using a kiosk in a virtual environment., Objective: We aimed to investigate key behavioral features collected from a virtual kiosk test that could distinguish patients with MCI from healthy controls with high statistical significance. Also, we focused on developing a machine learning model capable of early screening of MCI based on these behavioral features., Methods: A total of 51 participants comprising 20 healthy controls and 31 patients with MCI were recruited by 2 neurologists from a university hospital. The participants performed a virtual kiosk test-developed by our group-where we recorded various behavioral data such as hand and eye movements. Based on these time series data, we computed the following 4 behavioral features: hand movement speed, proportion of fixation duration, time to completion, and the number of errors. To compare these behavioral features between healthy controls and patients with MCI, independent-samples 2-tailed t tests were used. Additionally, we used these behavioral features to train and validate a machine learning model for early screening of patients with MCI from healthy controls., Results: In the virtual kiosk test, all 4 behavioral features showed statistically significant differences between patients with MCI and healthy controls. Compared with healthy controls, patients with MCI had slower hand movement speed (t 49 =3.45; P=.004), lower proportion of fixation duration (t 49 =2.69; P=.04), longer time to completion (t 49 =-3.44; P=.004), and a greater number of errors (t 49 =-3.77; P=.001). All 4 features were then used to train a support vector machine to distinguish between healthy controls and patients with MCI. Our machine learning model achieved 93.3% accuracy, 100% sensitivity, 83.3% specificity, 90% precision, and 94.7% F 1 -score., Conclusions: Our research preliminarily suggests that analyzing hand and eye movements in the virtual kiosk test holds potential as a digital marker for early screening of MCI. In contrast to conventional biomarkers, this digital marker in virtual reality is advantageous as it can collect ecologically valid data at an affordable cost and in a short period (5-15 minutes), making it a suitable means for early screening of MCI. We call for further studies to confirm the reliability and validity of this approach., (©Se Young Kim, Jinseok Park, Hojin Choi, Martin Loeser, Hokyoung Ryu, Kyoungwon Seo. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 20.10.2023.)

Laser plasma-based particle accelerators attract great interest in fields where conventional accelerators reach limits based on size, cost or beam parameters. Despite the fact that particle in cell simulations have predicted several advantageous ion acceleration schemes, laser accelerators have not yet reached their full potential in producing simultaneous high-radiation doses at high particle energies. The most stringent limitation is the lack of a suitable high-repetition rate target that also provides a high degree of control of the plasma conditions required to access these advanced regimes. Here, we demonstrate that the interaction of petawatt-class laser pulses with a pre-formed micrometer-sized cryogenic hydrogen jet plasma overcomes these limitations enabling tailored density scans from the solid to the underdense regime. Our proof-of-concept experiment demonstrates that the near-critical plasma density profile produces proton energies of up to 80 MeV. Based on hydrodynamic and three-dimensional particle in cell simulations, transition between different acceleration schemes are shown, suggesting enhanced proton acceleration at the relativistic transparency front for the optimal case., (© 2023. The Author(s).)

We report on the development of a pump system for ultrafast optical parametric amplifiers (uOPA) as an upgrade for the existing uOPA at the Petawatt High Energy Laser for heavy Ion eXperiments (PHELIX) and the new Petawatt ENergy-Efficient Laser for Optical Plasma Experiments (PEnELOPE). The system consists of a two-stage chirped pulse amplifier, centered around a high energy Yb:YAG regenerative amplifier that delivers 108 mJ uncompressed output energy, resulting in 92 mJ at 1030 nm after compression, pulse durations of 1.4 ps, a high beam quality of M x / y 2 = 1.02 / 1.16 and a relative energy stability of 0.35 %. A second harmonic generation (SHG) efficiency of up to 70 % is achievable and a maximum pulse energy of 43 mJ at 515 nm has been obtained, which is only limited by the damage threshold of the SHG crystal. A self-phase modulation stage makes this system a widely applicable, self-seedable pump module for uOPA without placing strong requirements on its seed oscillator.

Application experiments with laser plasma-based accelerators (LPA) for protons have to cope with the inherent fluctuations of the proton source. This creates a demand for non-destructive and online spectral characterization of the proton pulses, which are for application experiments mostly spectrally filtered and transported by a beamline. Here, we present a scintillator-based time-of-flight (ToF) beam monitoring system (BMS) for the recording of single-pulse proton energy spectra. The setup's capabilities are showcased by characterizing the spectral stability for the transport of LPA protons for two beamline application cases. For the two beamline settings monitored, data of 122 and 144 proton pulses collected over multiple days were evaluated, respectively. A relative energy uncertainty of 5.5% (1[Formula: see text]) is reached for the ToF BMS, allowing for a Monte-Carlo based prediction of depth dose distributions, also used for the calibration of the device. Finally, online spectral monitoring combined with the prediction of the corresponding depth dose distribution in the irradiated samples is demonstrated to enhance applicability of plasma sources in dose-critical scenarios., (© 2022. The Author(s).)

Background: There is limited data on the use of digital technologies in outpatient care in Switzerland. Our objectives were therefore to determine which digital technologies are used and whether they had an impact on loneliness and social isolation in the wake of the COVID-19 pandemic., Methods: A cross-sectional survey design was used with a convenience sample of 1272 outpatient care providers in Switzerland. The questionnaire used is based on an unsystematic literature review and a previous qualitative study with six outpatient caregivers and two caring relatives, based on which the 30 items for this questionnaire were developed. Data were analyzed descriptively, and group comparisons were made using the Kruskal Wallis test. Changes over time were measured using Friedman test with Bonferroni post hoc tests and Wilcoxon test for paired samples., Results: The impact of the COVID-19 pandemic was evident both on the part of the health care system, e.g., inadequate protective equipment; on the part of health care providers, e.g., increasing fatigue in keeping abreast of the virus as the pandemic progressed; and on the part of clients, who reduced services of care, e.g., out of fear of infection. According to the assessment of the outpatient caregivers, loneliness and social isolation of the clients was high in spring 2020 and increased strongly in the following winter. Alternative solutions, such as digital technologies, were hardly used or not used at all by the clients., Conclusions: The results suggest that the pandemic is dramatically impacting clients. This highlights the urgent need to invest in the development of appropriate digital technologies reducing the impact of social isolation and loneliness and the associated long-term costs to the healthcare system., (© 2022. The Author(s).)

Due to the non-linear nature of relativistic laser induced plasma processes, the development of laser-plasma accelerators requires precise numerical modeling. Especially high intensity laser-solid interactions are sensitive to the temporal laser rising edge and the predictive capability of simulations suffers from incomplete information on the plasma state at the onset of the relativistic interaction. Experimental diagnostics utilizing ultra-fast optical backlighters can help to ease this challenge by providing temporally resolved inside into the plasma density evolution. We present the successful implementation of an off-harmonic optical probe laser setup to investigate the interaction of a high-intensity laser at [Formula: see text] peak intensity with a solid-density cylindrical cryogenic hydrogen jet target of [Formula: see text] diameter as a target test bed. The temporal synchronization of pump and probe laser, spectral filtering and spectrally resolved data of the parasitic plasma self-emission are discussed. The probing technique mitigates detector saturation by self-emission and allowed to record a temporal scan of shadowgraphy data revealing details of the target ionization and expansion dynamics that were so far not accessible for the given laser intensity. Plasma expansion speeds of up to [Formula: see text] followed by full target transparency at [Formula: see text] after the high intensity laser peak are observed. A three dimensional particle-in-cell simulation initiated with the diagnosed target pre-expansion at [Formula: see text] and post processed by ray tracing simulations supports the experimental observations and demonstrates the capability of time resolved optical diagnostics to provide quantitative input and feedback to the numerical treatment within the time frame of the relativistic laser-plasma interaction., (© 2022. The Author(s).)

The [Formula: see text] and [Formula: see text] transitions in Li-like carbon ions stored and cooled at a velocity of [Formula: see text] in the experimental storage ring (ESR) at the GSI Helmholtz Centre in Darmstadt have been investigated in a laser spectroscopy experiment. Resonance wavelengths were obtained using a new continuous-wave UV laser system and a novel extreme UV (XUV) detection system to detect forward emitted fluorescence photons. The results obtained for the two transitions are compared to existing experimental and theoretical data. A discrepancy found in an earlier laser spectroscopy measurement at the ESR with results from plasma spectroscopy and interferometry has been resolved and agreement between experiment and theory is confirmed.

We report on experimental investigations of proton acceleration from solid foils irradiated with PW-class laser-pulses, where highest proton cut-off energies were achieved for temporal pulse parameters that varied significantly from those of an ideally Fourier transform limited (FTL) pulse. Controlled spectral phase modulation of the driver laser by means of an acousto-optic programmable dispersive filter enabled us to manipulate the temporal shape of the last picoseconds around the main pulse and to study the effect on proton acceleration from thin foil targets. The results show that applying positive third order dispersion values to short pulses is favourable for proton acceleration and can lead to maximum energies of 70 MeV in target normal direction at 18 J laser energy for thin plastic foils, significantly enhancing the maximum energy compared to ideally compressed FTL pulses. The paper further proves the robustness and applicability of this enhancement effect for the use of different target materials and thicknesses as well as laser energy and temporal intensity contrast settings. We demonstrate that application relevant proton beam quality was reliably achieved over many months of operation with appropriate control of spectral phase and temporal contrast conditions using a state-of-the-art high-repetition rate PW laser system.

We report on a compact diode-pumped, chirped pulse regenerative amplifier system with a pulse duration of 162 fs and an output pulse energy of 1 mJ before as well as 910 µJ after compression optimized for the probing of ultrafast relativistic laser-plasma processes. A chirped volume Bragg grating (CVBG) acts as a combined pulse stretcher/compressor representing a robust solution for a CPA laser system in the millijoule range. Yb 3+ :CaF 2 is used as gain medium to support a large bandwidth of 16 nm (FWHM) when spectral gain shaping is applied. Chirped mirrors compensate for any additional dispersion introduced to the system.

Grasslands managed for grazing are the largest land-use category globally, with a significant proportion of these grasslands occurring in semiarid and arid regions. In such dryland systems, the effect of grazing on native plant diversity has been equivocal, some studies suggesting that grazing reduces native plant diversity, others that grazing increases or has little impact on diversity. One impediment toward generalizing grazing effects on diversity in this region is that high levels of interannual variation in precipitation may obfuscate vegetative response patterns. By analyzing a long-term data set collected over a 20-yr period in a semiarid grassland, we explicitly evaluated the role of climate in regulating the effect of cattle grazing on plant communities, finding that climate interacted with grazing intensity to shape grassland communities. Community composition of plots that were intensively grazed varied considerably in response to climatic variation and native species richness was low relative to ungrazed and moderately grazed plots. Following a severe drought in 2002, exotic species richness rapidly increased in the high-intensity grazing plots. While this pattern was mirrored in the other treatments, exotic species richness increased to a greater extent and was slower to return to pre-drought levels in the high-intensity grazing plots. Overall, moderate grazing, even compared to grazing cessation, stabilized grassland communities through time, increased resilience to drought, and maintained the highest levels of native plant diversity and lowest levels of exotic diversity. These findings suggest that grazing, at moderate levels, may support grassland resilience to climate change in semiarid regions. However, grazing that exceeds tolerances, particularly in combination with extreme climatic events, like drought, can alter plant composition over relatively long timescales and possibly increase invasibility by nonnative species., (© 2019 by the Ecological Society of America.)

We report on recent experimental results deploying a continuous cryogenic hydrogen jet as a debris-free, renewable laser-driven source of pure proton beams generated at the 150 TW ultrashort pulse laser Draco. Efficient proton acceleration reaching cut-off energies of up to 20 MeV with particle numbers exceeding 10 9 particles per MeV per steradian is demonstrated, showing for the first time that the acceleration performance is comparable to solid foil targets with thicknesses in the micrometer range. Two different target geometries are presented and their proton beam deliverance characterized: cylindrical (∅ 5 μm) and planar (20 μm × 2 μm). In both cases typical Target Normal Sheath Acceleration emission patterns with exponential proton energy spectra are detected. Significantly higher proton numbers in laser-forward direction are observed when deploying the planar jet as compared to the cylindrical jet case. This is confirmed by two-dimensional Particle-in-Cell (2D3V PIC) simulations, which demonstrate that the planar jet proves favorable as its geometry leads to more optimized acceleration conditions.

We investigated the lasing performance of a multislab Yb:QX and Yb:YAG laser amplifiers using a facet-cooled design. Di-deuterium oxide (D2O) was used as the coolant flowing between the active slabs with the pump and laser light passing through the very low absorbing heavy-water films. A square pump profile at a maximum intensity of 40  kW/cm2 drove the amplifier with a peak fluence of 5.5  J/cm2 and a pulse duration of 6 ns. We demonstrated a maximum pulse energy of 1 J for each gain medium as well as a repetition rate of 10 Hz for Yb:YAG and 1 Hz for Yb:QX glass, thus showing the feasibility and scalability of directly water-cooled, diode-pumped, high-energy short-pulse lasers.

We present a novel approach for the amplification of high peak power femtosecond laser pulses at a high repetition rate. This approach is based on an all-diode pumped burst mode laser scheme. In this scheme, pulse bursts with a total duration between 1 and 2 ms are be generated and amplified. They contain 50 to 2000 individual pulses equally spaced in time. The individual pulses have an initial duration of 350 fs and are stretched to 50 ps prior to amplification. The amplifier stage is based on Yb3+:CaF2 cooled to 100 K. In this amplifier, a total output energy in excess of 600 mJ per burst at a repetition rate of 10 Hz is demonstrated. For lower repetition rates the total output energy per burst can be scaled up to 915 mJ using a longer pump duration. This corresponds to an efficiency as high as 25% of extracted energy from absorbed pump energy. This is the highest efficiency, which has so far been demonstrated for a pulsed Yb3+:CaF2 amplifier.

Temperature dependent absorption and emission cross-sections of 5 at% Yb(3+) doped yttrium lanthanum oxide (Yb:YLO) ceramic between 80K and 300 K are presented. In addition, we report on the first demonstration of ns pulse amplification in Yb:YLO ceramic. A pulse energy of 102 mJ was extracted from a multi-pass amplifier setup. The amplification bandwidth at room temperature confirms the potential of Yb:YLO ceramic for broad bandwidth amplification at cryogenic temperatures.

Fabrication, spectroscopic properties, and laser performance of a Yb:SiO(2) multicomponent glass have been investigated in this paper. The glass system composed of SiO(2), Al(2)O(3), and La(2)O(3) excels in terms of a high thermal stress resistance compared to other laser glasses. The laser experiments were conducted with a 3.4 mm thick and 0.9 mol. % Y(2)O(3) doped sample. A maximum slope efficiency of 51%, a maximum optical to optical efficiency of 42%, and a tuning range from 1010-1090 nm was realized. Due to the promising laser properties and a straightforward fabrication technique it may well qualify as an alternative gain medium in high-energy, ultrashort pulse laser systems.

We report the first short-pulse amplification results to several hundred millijoule energies in ceramic Yb:LuAG. We have demonstrated ns-pulse output from a diode-pumped Yb:LuAG amplifier at a maximum energy of 580 mJ and a peak optical-to-optical efficiency of 28% at 550 mJ. In cavity dumped operation of a nanosecond oscillator we obtained 1 mJ at up to 100 Hz repetition rate. A gain bandwidth of 5.4 nm was achieved at room temperature by measuring the small-signal single-pass gain. Furthermore, we compared our results with Yb:YAG within the same amplifier system.

We report on the first demonstration of a diode-pumped, gas cooled, cryogenic multislab Yb:YAG amplifier. The performance was characterized over a temperature range from 88 to 175 K. A maximum small-signal single-pass longitudinal gain of 11.0 was measured at 88 K. When amplifying nanosecond pulses, recorded output energies were 10.1 J at 1 Hz in a four-pass extraction geometry and 6.4 J at 10 Hz in a three-pass setup, corresponding to optical to optical conversion efficiencies of 21% and 16%, respectively. To our knowledge, this represents the highest pulse energy so far obtained from a cryo-cooled Yb-laser and the highest efficiency from a multijoule diode pumped solid-state laser system.

Yb(3+)-doped gain media offer favorable properties for diode-pumped laser amplifiers for high-energy ns-pulses. To reach high optical-to-optical conversion efficiencies at room temperature however, very high and often impractical fluences are required both for pumping and extraction. Low temperature operation offers a solution, but the required cryogenic cooling systems add considerable complexity, bulkiness and cost. Multi-passing both pump and extraction beams through the gain medium is an alternative approach to overcome efficiency limitations at room temperature. In this article we present numerical and experimental results to this effect.We demonstrated ns-pulse output from a diode-pumped Yb:YAG amplifier at an energy of 566 mJ and an optical-to-optical efficiency of 20%, which is almost a doubling of the efficiency achieved with ns-lasers employing Yb(3+)-doped gain media at this energy level.