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Background: Sensory peripheral neuropathy (PN) is associated with gait, balance problems and high fall risk. The walk2Wellness trial investigates effects of long-term, home-based daily use of a wearable sensory prosthesis on gait function, balance, quality of life and fall rates in PN patients. The device (Walkasins®, RxFunction Inc., MN, United States) partially substitutes lost nerve function related to plantar sensation providing directional tactile cues reflecting plantar pressure measurements during standing and walking. We tested the null hypothesis that the Functional Gait Assessment (FGA) score would remain unchanged after 10 weeks of use. Methods: Participants had PN with lost plantar sensation, gait and balance problems, an FGA score < 23 (high fall risk), and ability to sense tactile stimuli above the ankle. Clinical outcomes included FGA, Gait Speed, Timed Up&Go (TUG) and 4-Stage Balance Test. Patient-reported outcomes included Activities-Specific Balance Confidence (ABC) scale, Vestibular Disorders Activities of Daily Living Scale, PROMIS participation and satisfaction scores, pain rating, and falls. Evaluations were performed at baseline and after 2, 6, and 10 weeks. Subjects were not made aware of changes in outcomes. No additional balance interventions were allowed. Results: Forty-five participants of 52 enrolled across four sites completed in-clinic assessments. FGA scores improved from 15.0 to 19.1 (p < 0.0001), normal and fast gait speed from 0.86 m/s to 0.95 m/s (p < 0.0001) and 1.24 m/s to 1.33 m/s (p = 0.002), respectively, and TUG from 13.8 s to 12.5 s (p = 0.012). Four-Stage Balance Test did not improve. Several patient-reported outcomes were normal at baseline and remained largely unchanged. Interestingly, subjects with baseline ABC scores lower than 67% (high fall risk cut-off) increased their ABC scores (49.9% to 59.3%, p = 0.01), whereas subjects with ABC scores above 67% showed a decrease (76.6% to 71.8%, p = 0.019). Subjects who reported falls in the prior 6 months (n = 25) showed a decrease in the number of fall-risk factors (5.1 to 4.3, p = 0.023) and a decrease in fall rate (13.8 to 7.4 falls/1000 days, p = 0.014). Four pre-study non-fallers (n = 20) fell during the 10 weeks. Conclusion: A wearable sensory prosthesis presents a new way to treat gait and balance problems and manage falls in high fall-risk patients with PN. Trial registration: ClinicalTrials.gov (#NCT03538756). [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to integrate conflict theory's class and race perspectives to explain police force size in large cities in the USA. Design/methodology/approach - Data on US cities with populations of 250,000 or greater (n=64) are used to test whether class and/or racial factors impact police force size. The data are analyzed using OLS regression. Findings - This study finds that class and race factors combine to impact police force size concurrently. By adjusting the model specifications of a recent article, which concludes police force size in large US cities is determined by racial factors and not class, this study shows that two class-related factors - racial economic inequality and poverty - significantly influence police force size. Additionally, this analysis calls into question the importance of racial factors; specifically, the threat caused by minority presence and a city's history of racially coded violence. Originality/value - Few conflict theorists have attempted to integrate class and race in order to explain police force size. The results of this study show that racial economic inequality interacts with poverty (class threat) and that they jointly affect police force size. This adds further nuance to the argument of the complex causal interaction of intersectionality and supports theoretical, methodological, and public policy shifts that blend class inequality and racial threat to explain police force size. [ABSTRACT FROM AUTHOR]

To investigate voluntary step behavior of healthy elderly individuals during single- and dual-task conditions and to compare it with those of young subjects. Laboratory-based study. Tests of healthy elderly and young individuals from senior community centers and from the university population in Boston, Massachusetts. Sixty-six elderly and 12 young subjects. Forward, sideways, and backward rapid voluntary stepping performed as a reaction time task while standing on a force platform and (1) awaiting a cutaneous cue (single task) and (2) awaiting a cutaneous cue while performing an attention-demanding Stroop task (dual task). Step initiation phase, foot-off time, foot contact time, and preparatory and swing phases were extracted from center-of-pressure and ground reaction force data. Elderly subjects were significantly slower than young in all step parameters under both conditions. For dual compared with single task, the initiation phase increased 108% in the elderly group and 34% in the young. There was a short-term learning effect during the dual task in elderly subjects but not in the young. The disproportional increase in step initiation time during the dual task in the elderly group suggests that they lacked neural processing resources required for swift multitasking during a voluntary postural task. This may be a factor contributing to balance loss and the large number of falls in elderly persons. Training may improve this skill. Clinical tests of postural function should incorporate multitask conditions to capture a more complete assessment of an individual's ability. [ABSTRACT FROM AUTHOR]