This finding also explains the muscle inexcitability after repeated nerve stimulation observed many years ago in McArdle patients. Over 40 mutations have been identified all along the gene (PYGM) encoding myophosphorylase. While by far the most common mutation in Caucasian patients is the R49X (Arg49Stop) mutation, it is important to keep in mind that the frequency of different mutations varies in different ethnic groups. For example, the R49X mutation Inhibitors,research,lifescience,medical has never been described in Japan, where a single codon deletion 708/709 seems to

prevail (18). To complicate things further, it was documented that an apparently innocent polymorphism in the PYGM gene impaired cDNA splicing and was, Inhibitors,research,lifescience,medical in fact, pathogenic (19). This phenomenon, aptly dubbed “echo of silence” by

Mankodi and Ashizawa (20), has to be taken into account in McArdle patients without clearly pathogenic mutations. Genotype:phenotype correlations are not easily discernible, as patients with the same genotype (e.g. homozygous for the commonest mutation, R49X) may have very different clinical manifestations, varying from relatively mild exercise-related discomfort to almost crippling myalgia and recurrent myoglobinuria. Although these differences can be due in part to different lifestyles or dietary regimens, genetic must play a role. Inhibitors,research,lifescience,medical For example, rare cases of genetic “double trouble”, such as the coexistence in the same individual of homozygous mutations in PYGM and in the gene for adenylate deaminase, may explain more severe phenotypes (21, 22). Perhaps more importantly, screening for insertion/deletion polymorphism in the angiotensin-converting enzyme (ACE) in 47 patients showed a good Inhibitors,research,lifescience,medical correlation between clinical

severity and number of ACE genes harboring deletion (22). I will briefly Inhibitors,research,lifescience,medical consider only one other glycogenosis causing exercise intolerance and myoglobinuria, phosphoglycerate mutase (PGAM) deficiency (GSD X), in part for sentimental reasons, as my group discovered this enzyme defect in 1981 (23). Nine of the 13 patients identified thus far have been African American, and they all harbor one common nonsense mutation (W78X) either in homozygosity or in heterozygosity (Table ​(Table3).3). However, the disease is not confined to this ethnic group, and different mutations have been identified in Italian (24), Japanese (25), and most recently, Pakistani isothipendyl and Ashkenazi Jewish patients (Naini et al, unpublished observations). Table 3 Main features of 14 patients with GSD X (PGAM deficiency). There are two curious LY2835219 purchase aspects of PGAM deficiency. The first is the frequency of manifesting heterozygotes, which is counterintuitive considering that PGAM is the glycolytic enzyme with the highest activity (26). The second peculiarity is that this enzyme defect is frequently associated with tubular aggregates (27).

Two diterpenoids produced in rice leaves upon Magnaporthe grisea infection, momilactones A and B have received particular attention for their antifungal activity against this fungus, the casual agent of the devastating rice blast disease [27-29]. Another group of similar diterpenoids named oryzalexin A–D were identified as rice phytoalexins also in M. grisea infected leaves [30-33]. Later, orzyalexin S and orzyalexin E and F were discovered as additional diterpenoids with potent antifungal

activity [34-37]. Five cassane diterpenoids phytocassane A-E were found to increase upon M. grisea infection and Inhibitors,research,lifescience,medical present at higher concentrations in resistant strains in addition to having antifungal activity against another pathogenic fungus Rhizoctonia solani [38]. A recent study collected volatile organic compounds (VOCs) released by oat, barley and wheat in response to infection by three Fusarium species including two species that cause cortical Inhibitors,research,lifescience,medical rot disease of wheat. Piesik et al., measured

the VOCs using GC-MS identifying two terpenes linalool (Figure 1) and β-caryophyllene to be present at higher concentrations in infected tissue than controls [39]. The same authors carried out a similar study in maize identifying three additional terpenes induced Inhibitors,research,lifescience,medical upon infection, β-pinene, β-myrcene and Nutlin3 Z-ocimene [40]. A substantial amount of research into linalool synthesis and natural production has been undertaken due to its aroma and flavour in flower and vegetables for the application of perfume manufacture to metabolic engineering in tomatoes [41,42]. However, little is known Inhibitors,research,lifescience,medical regarding its involvement in plant pathogen interactions and the mechanism is assumed to be similar to other terpenoids for which evidence suggests interference and disruption of membranes [43-46].

Piesik et al. also demonstrated Inhibitors,research,lifescience,medical the ability of infected plants to lead to an increase in VOCs in uninfected neighbours. Control of VOC release in plants has significant potential for the management of crop pathogens. An early study of volatiles in wheat showed it contained the same major terpenoid species as oat and barley [47]. The utility of recent technological advances analysing VOCs using solid phase microextraction (SPME) and headspace techniques for the analysis of terpenes and other volatiles has been demonstrated over [48]. Investigation into terpenoids with antifungal activity against two maize pathogens Fusarium graminearum and Colletotrichum graminicola identified geranic acid (Table 1), which had a minimal inhibitory concentration of 7.8 μg/mL and is the most potent antifungal towards these two pathogens discovered [49]. In an attempt at metabolic engineering to increase resistance of maize to these pathogens, the enzyme geraniol synthase was cloned and overexpressed.

PMs are formed at a pH above the pKa of the protonatable group, where the hydrophobic segment essentially is uncharged. As the pH decreases below the pKa, the ionization of the polymer causes increased

hydrophilicity and electrostatic repulsions of the polymers, leading to the destabilization of the micelles and controlled drug release. Figure 3 Schematic representation of the mechanisms of pH sensitivity. (a) PMs with basic core units, (b) PMs with acidic core units. 4.2.3. Polymers Commonly Used in Oral pH-Sensitive PMs Acrylic-based polymers are widely used in oral pH-sensitive drug delivery, such as poly(methacrylic acid) (PMAA). PMAA retains a collapsed Inhibitors,research,lifescience,medical state in Inhibitors,research,lifescience,medical the low pH of the stomach and swells as it transits through the intestines. Blends of this polymer with polyethylacrylate (PMAA-PEA) and polymethacrylate (PMAA-PMA) can be tailored to dissolve in specific pH ranges corresponding to specific locations in the GI tract [100–102]. These pH-responsive micelles based on the acrylic acid core can be either multimolecular or unimolecular [103, 104]. Upon pH increase, the core of the unimolecular micelles Inhibitors,research,lifescience,medical became more polar hence promoting the release of the incorporated hydrophobic drug [103]. As these micelles do not possess a CMC, they have the advantage of being intrinsically stable upon dilution. Conversely

to unimolecular Inhibitors,research,lifescience,medical micelles that maintain their integrity upon a change in pH, pH-sensitive multimolecular PMs based on ionizable polyanions disassemble following an increase in environmental pH. Kim and his coworkers hypothesized that the physical stability of hydrotropic polymeric (HP) micelles learn more containing AA moieties may Inhibitors,research,lifescience,medical decrease in the intestine, releasing the loaded drugs faster in the intestine than in the

stomach [105]. To examine this hypothesis, they took paclitaxel (PTX) as model drug and developed a hydrotropic polymer, PEG-b-(4-(2-vinylbenzyloxy)-N,N-(diethylnicotinamide)) (PEG-b-VBODENA), these doped with AA units (≤50mol%) to confer pH sensitivity to PMs, testing PTX loading/release profiles by changing the pH condition. They observed that the loading content and efficiency of PTX were governed by the pH of the loading medium, with both maxima at pH ≤ 4. Increasing the pH above the pKa of the polymers provoked a rapid dissociation of the complexes. The self-association into well-defined micellar structure is facilitated by the hydrophobic nonionizable Al(M)A units, whereas the pH sensitivity is conferred by the carboxylic acid groups of the MAA moieties [106]. The PTX release from HPC with morethan 20% AA contents was completed within 12h in a simulated intestinal fluid (pH = 6.5) while the PMs without any AA moiety showed very slow release profiles.

17 Yun si et al, reported a significant reduction in fasting and postprandial glucose and decreasing HbA1c in probiotic (BNR17) treated rats.18 In the present study, we were not able to demonstrate any significant effect on fasting blood glucose after treating with probiotics. Serum triglyceride concentration was decreased but the change was not statistically significant. The reasons for these unexpected results can be related to either the small Sorafenib ic50 sample size or short duration of the study. Gilliland et al. observed some strains of Lactobacillus acidophilus may decrease cholesterol absorption by enhancing the binding of cholesterol to the intestinal lumen.19 Inhibitors,research,lifescience,medical Other possible cholesterol lowering properties of probiotics are deconjugation

of bile by bile Inhibitors,research,lifescience,medical salt hydrolyses, binding of cholesterol to cellular surface and coprecipitation of cholesterol with deconjugated bile.20 This study showed no significant improvement in serum total cholesterol, LDL-cholesterol and or HDL-cholesterol after treating diabetic patients with probiotics. Yadav et al. in their study on diabetic rats reported a marked reduction in pancreatic tissue oxidative damage due

Inhibitors,research,lifescience,medical to a significant decrease in lipid peroxidation.21 In another study the same investigators showed that probiotic dahi not only decreases oxidative damage but also increases the antioxidant content and activities of catalase, glutathione peroxidase and superoxide dismutase in diabetic rats.22 The mechanism Inhibitors,research,lifescience,medical by which oxidative stress results in diabetic complications and tissue damage is the overproduction of the reactive oxygen species and reduction of the antioxidant defense function of the body. Lipid peroxidation

is one of the main biological targets of oxidative stress, which leads to formation of secondary products such as malondialdehyde that exacerbates oxidative damage. MDA has been found Inhibitors,research,lifescience,medical to significantly increase in pathological conditions,23 which is considered as a common oxidative stress biomarker in recent years. The present study, showed a reduction in MDA levels in probiotic-treated group; however, the reduction was not statistically those significant. Ejtahed et al.24 showed a significant reduction in blood glucose and MDA level in type 2 diabetic patients after consuming probiotic yogurt. Songisepp et al. evaluated the functional efficacy of antioxidative properties of probiotic in healthy subjects and found a significant improvement in blood total antioxidant activity (TAA) and total antioxidant status (TAS) after receiving probiotics.25 Harisa et al. also reported a significant decrease in MDA concentration after treating diabetic rats with L. acidophilus.26 Divergent evidence is available on the anti-inflammatory properties of Probiotics. While some studies reported beneficial effect,27 others showed no effect at all. In this study, Interleukin-6 (IL-6) was reduced while CRP levels were elevated but the change was not statistically significant. Marschan et al.

The authors declare that they have no competing interests. Authors’ contributions All co-authors have made substantive intellectual contributions to the paper as follows: KGS, TLS, and PTY designed and implemented the DataPall software; created and carried out the study of its effectiveness; analyzed the data; and drafted the manuscript. AK and SG provided substantive input on the design and

functionality of the DataPall software and revised the manuscript. RRK and MO oversaw the work of the team creating DataPall; advised the design of the study; and Inhibitors,research,lifescience,medical provided critical insights and revisions to the manuscript. RRK had full access to all of the data in the Inhibitors,research,lifescience,medical study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1472-684X/12/31/prepub

Supplementary Material Additional file 1: A generic copy of the DataPall EMR. Click here for file(3.2M, mdb) Additional file 2: Sample DataPall Palliative Care Inhibitors,research,lifescience,medical Report output by the DataPall EMR. Click here for file(301K, pdf) Acknowledgements This work was supported in part by a grant to Rice University from the Howard Hughes Medical Institute through the Undergraduate Science Education Program. This grant supported the work of KGS, TLS, and PTY in Malawi, where the DataPall system was designed, implemented, Inhibitors,research,lifescience,medical and tested.
The Selleckchem PS341 prevalence of dementia worldwide is significantly growing, with the majority of the persons

with dementia dying in nursing homes [1,2]. Therefore, the provision of high-quality end-of-life care for nursing home residents with dementia is essential [3-6]. However, the literature reports numerous Inhibitors,research,lifescience,medical shortcomings in the end-of-life care for dementia, suffering of residents and unfulfilled needs of families [6]. For example, an Italian study reported high levels of pressure ulcers, burdensome interventions such as tube- and PEG-feeding, psychotropic drugs and poor decision-making in why the last month of life of nursing home residents with dementia [7]. Despite some encouraging trends from The Netherlands and the U.S. regarding improved symptom management in dementia [8-10], improvement of end-of-life care for dementia remains a research priority [11]. Systematic assessments of care performance that are compared to professional targets or standards (hereafter referred to as audit and feedback) is widely used as a strategy to improve professional care practice [12]. In the nursing home setting, there are indications that audit and feedback using cumulative quality of care scores based on a group of patients may improve nursing home care in general [13-15], including nursing home care for residents with dementia [16].

However, we are not aware of any comprehensive review of both the causes and consequences of nonadherence in schizophrenia. Furthermore, there is a need for a review that investigates whether the data allow for a quantitative assessment of the specific link between nonadherence and hospitalization. The objective of this study was to perform a systematic review of Inhibitors,research,lifescience,medical the factors that influence adherence in schizophrenia and of the consequences of nonadherence for the patient, healthcare system and society. Particular attention was given to the effect of nonadherence on hospitalization rates, as a key driver of increased

costs of care. Methods A systematic Brefeldin A mouse literature review was conducted to include English-language manuscripts published from 2000 in OVID. Four electronic databases (MEDLINE, MEDLINE In-Process, EMBASE and the Cochrane Library) were searched to identify potentially relevant articles. Conference abstracts were not included in this review. The search combined free Inhibitors,research,lifescience,medical text and medical subject headings (MeSH) disease terms with adherence terms for psychosis or schizophrenia AND adherence or compliance or persistence. As the outcomes of interest included all factors and consequences of nonadherence, no search terms were included for specific outcomes, as this may have resulted in missing some

outcomes. One search was conducted for both sets of outcomes. Thus a very Inhibitors,research,lifescience,medical broad search strategy was adopted in order to avoid missing potentially relevant information, with the identification of relevant studies Inhibitors,research,lifescience,medical per outcome (i.e. nonadherence drivers or consequences) based on abstract screening [Liberati et al. 2009]. The abstract screening for identification of relevant data was based on the following predefined Inhibitors,research,lifescience,medical criteria: populations comprising adult patients with schizophrenia and disorders with psychotic features, psychosis and schizophrenia spectrum disorders; oral antipsychotic interventions were included, and subanalysis of the impact on adherence on hospitalization rates focused on studies of oral interventions comparing once daily dosing with multiple daily dosing;

studies were excluded based on comparison if they were comparing second interventions or drugs which were not of interest; outcomes including factors influencing adherence rates and consequences of nonadherence; study designs including phase II or III randomized controlled trials, observational studies such as prospective and retrospective studies, cross-sectional questionnaire-based studies, economic and epidemiologic studies, meta-analyses and qualitative reviews; and a focus on studies with larger sample sizes and more recent publications (publications after 2001) due to the large expected number of studies identified. Two research facets were assessed qualitatively: drivers of nonadherence and consequences of nonadherence.

Moreover, we will show that depression can be diagnosed in the older patient and that it can be differentiated from normal aging. Importantly, a variety of treatments have been demonstrated to be safe and efficacious in the elderly, and long-term treatment might be indicated. Onset and course of depression Depression in late life is a very heterogeneous condition. Onset may be early in life with the course recurrent from a first episode earlier in adulthood, or the onset of the first episode may be late in life. In general, compared with patients of the same age with recurrent Inhibitors,research,lifescience,medical depression, those

patients with the first onset of depression in late life are likely to have a less satisfactory response to treatment and a more chronic course. There are significant brain changes in depression: frontal and temporal lobe atrophy,11,12 periventricular and subcortical deep white matter hyperintensities,13 and significantly decreased metabolism in a variety Inhibitors,research,lifescience,medical of brain regions (dorsolateral prefrontal cortex, inferior

frontal cortex, basal ganglia).14 Many of these changes are associated with normal aging as well. Late-onset depression often is associated with a variety of brain abnormalities, such as ventriculomegaly Inhibitors,research,lifescience,medical and white matter hyperintensities, and with cognitive impairments. Recent research has uncovered important sources of clinical and biological heterogeneity within late-life-onset depression, and subgroups with distinctive patterns Inhibitors,research,lifescience,medical of clinical presentations, course, mechanisms, and outcomes have been identified.15-17 The association between depression and cognitive impairment has been well established, though the direction of causality has been disputed, as has the methodology of assessment.18,19 There does seem to be general agreement, however, that late-life depression with cognitive impairment that is reversed by antidepressant

treatment is, more often than not, a predictor of the development of an irreversible dementia such as Alzheimer’s disease or Volasertib datasheet vascular dementia.20 Converging findings implicate vascular Inhibitors,research,lifescience,medical disease in the pathogenesis of one particular subgroup. Geriatric depression is often comorbid Thymidine kinase with vascular disorders and is accompanied by lesions in the basal ganglia and prefrontal areas of the brain. The clinical profile of depression in patients with vascular disease is often characterized by motor retardation, lack of insight, and impairment of executive functions. This clinical presentation suggests that dysfunction of frontal brain systems is a possible contributing factor to depression in late life.21-24 It also suggests that treatment for cerebrovascular disease may have preventive implications for latelife-onset depression. The article by Alexopoulos and colleagues in this issue of Dialogues in Clinical Neuroscience addresses this specific topic.

For example, the Bonfils Intubating Fiberscope has a moderate curvature (40°), and therefore requires a retromolar or buy Cediranib lateral entry into the hypopharynx. This lateral entry (at an angle across the tongue) is unfamiliar to most anesthesia practitioners, and has another added learning curve to using this instrument. Most anesthesia providers are more accustomed with a midline approach for oral intubations. Inhibitors,research,lifescience,medical Based on the above design and use limitations, the Boedeker intubating fiberscope (Figures ​(Figures11 and ​and2)2) was fabricated

by altering a 15 Fr Bonfils Intubating Fiberscope (KARL STORZ Endoscopy, El Segundo, CA) with a modified angle of 60°. The novel curvature of this fiberscope allows the provider to use the more familiar midline

approach Inhibitors,research,lifescience,medical for intubation. The objective of the current study is to compare the newly designed Boedeker intubating fiberscope with the Bonfils Intubating Fiberscope in the intubation of a simulated difficult airway in terms of use and functional characteristics. Figure 1 Comparison of the curvature of the Boedeker vs. Bonfils intubation fiberscopes. The Boedeker fiberscope has a greater curvature of 60°. This more anterior curve, compared Inhibitors,research,lifescience,medical to the Bonfils Intubation Fiberscope (40 degrees), allows it to line up … Figure 2 The Bonfils and Boedeker fiberscopes. Photo shows the Bonfils (top) and Boedeker (bottom) fiberscopes. Methods Following IRB approval, anesthesia providers (n = 22) including anesthesia attending physicians and residents, and Certified Registered Nurse Anesthetists (including one student CRNA) at the University of Nebraska Medical Center and Omaha VAMC, Omaha, NE participated in intubation Inhibitors,research,lifescience,medical of a Laerdal Deluxe Difficult Airway Trainer™ (Laerdal Medical Corporation,

Wappingers Falls, NY) with the tongue inflated to simulate a difficult airway [7]. The providers completed a pre-experience questionnaire assessing prior experience with awake intubation, and their level of training. Prior to the exercise, the instructor demonstrated the use of both fiberscopes. The participants were then observed Inhibitors,research,lifescience,medical during their intubation attempts alternatively using the Bonfils and Boedeker intubating fiberscopes (randomized to eliminate learning isothipendyl effects) (Figures ​(Figures11 and ​and2).2). During the study, the following variables were collected: recorded Cormack Lehane (CL) airway score, the time to intubation, the number of intubation attempts, the success/failure of the intubation, and whether or not cricoid pressure was requested by the intubator. The observed view of the glottic opening was graded by the participant using the Cormack Lehane (CL view) grading scale (where Grade I = full view of the glottic opening; Grade II = posterior portion of glottic opening is visible; Grade III = only the tip of the epiglottis is visible; Grade IV = only the soft tissue is visible).

Case-control studies involving only women showed reduced risk of colorectal cancer (126,127). This was not demonstrated in studies involving both men and women (128). No significant inverse association was observed

between calcium and vitamin D check details levels and the risk of colorectal cancer (125,128). The Women’s health initiative study was a randomized controlled trial, which showed that daily supplementation of calcium with vitamin D for seven years, had no effect on the incidence of colorectal cancer among postmenopausal women (129). In terms of Vitamin D levels, a meta-analysis by Garland et al. found Inhibitors,research,lifescience,medical an inverse association between circulating levels of 25- hydroxyvitamin D3 and the risk of colorectal cancer (130). Calcium was found to have protective effect on colorectal Inhibitors,research,lifescience,medical cancer risk in some prospective studies (131-133)

but not in others (134,135). Data from the HPFS and NHS cohorts showed that total, dietary and supplemented calcium reduced the risk of distal colon but not proximal cancer. Most of the risk reduction was achieved by calcium intake of 700-800 mg/day. A meta analysis of 10 cohort studies showed 22% reduction in the risk of colorectal cancer in those with higher intake of calcium (136). Regarding colorectal polyps, a three-year intervention study with calcium and antioxidants, found no effect on polyp growth but possibly a protective role against adenoma Inhibitors,research,lifescience,medical formation (137). Higher intake of calcium alone (138) or when combined with Vitamin

D (139) was found to be protective against adenoma recurrence. In conclusion, Inhibitors,research,lifescience,medical data from case-control studies are inconsistent but cohort studies and meta-analyses provide evidence on the benefits of circulating, diet-derived and supplemented vitamin D and calcium. Further studies are needed to ascertain whether there is any sex predilection. On the basis of current evidence one could suggest Inhibitors,research,lifescience,medical intake of vitamin D at a dose of 1,000 IU per day which is regarded as safe, and attaining calcium intakes of 700-800 mg per day. Modest duration of sunlight exposure should be PD184352 (CI-1040) sought to raise levels of 25-hydroxyvitamin D3. Diets rich in oily fish, shellfish, milk and dairy products contain high amounts of calcium and vitamin D. Polyphenols Polyphenols are a class of chemicals known for their numerous benefits especially their antioxidant effects (113,140,141), inhibition of cellular proliferation (142), induction of cell cycle arrest (143), interaction with apoptotic pathways and antiangiogenic and antimetastatic properties (144). They are divided in five classes; flavonoids, phenolic acids, ligans, stillbenes and others. The most important dietary sources of polyphenols are fruits, vegetables, seeds, and beverages such as fruit juice, green tea, coffee, cocoa drinks, red wine, and beer. The chemoprotective role of polyphenols against cancer has been extensively studied.

The score uses a maximum range of 2 to 4 points for each of the 15 items, and it provides a total score that selleck reflects the patient’s

mobility status at one particular moment in time. A high score indicates few potential mobility barriers and decreased assistance whereas a low score indicates more potential barriers to mobility and more assistance needed for mobility. Figure 1A Perme Intensive Care Unit Mobility Score Instructions. Figure 1B Perme ICU Mobility Score. The categories were designed Inhibitors,research,lifescience,medical to reflect the impaired mobility of patients in the ICU, which can stem from a variety of factors including but not limited to severity of critical illness, mental status, equipment specifically related to ICU care, and neuromuscular deficits. The items included in the “mental

status” category are variable levels of arousal and ability to follow commands, which reflect the patient’s ability to participate in planned mobility activities. The “potential mobility barriers” category identifies pain, the use of a ventilator, multiple Inhibitors,research,lifescience,medical lines and tubes routinely used in ICU, and continuous infusion of fluids or medications. This category was included because Inhibitors,research,lifescience,medical patients can be mobilized even in the presence of one or more of the above items; however, it is less likely that early mobility will occur under these circumstances. It is possible that a patient who is able to move limbs Inhibitors,research,lifescience,medical against gravity will have the functional strength necessary for progressive mobility. “Functional strength” focused on the ability to raise arms and legs against gravity.3,

20, 21 Based on the Oxford Scale for muscle strength testing, patients should be able to raise arms and legs with a score of at least 3 out of 5.27 The upper and lower extremities, as well as the right and left sides of the body, were addressed separately to detect individual strength impairments in cases such as stroke or spinal cord injury. It is important to note that a patient should have approximately 20 degrees of hip flexion and Inhibitors,research,lifescience,medical 45 degrees of shoulder flexion in order to complete items 7 and 8 of the Perme ICU Mobility Score. “Bed mobility” measured a patient’s ability to move from a supine or semirecumbent position to sitting and the sitting balance on the side of the bed. It is imperative that patients have enough head and trunk control to start standing Dipeptidyl peptidase activities. The “transfers” category addressed a patient’s ability to move from a sitting position to standing at the side of the bed, static standing balance, and the ability to transfer from the bed to various surfaces including a chair, wheelchair, bedside commode, or recliner. The “gait” category assessed a patient’s ability to walk using any assistive devices, such as a walker or cane, or without an assistive device. The “endurance” category assessed the distance walked in 2 minutes.