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Duane Allman will live forever. Never mind the fact that the Allman Brothers Band guitarist died 35 years ago. As Southern rock’s most-storied axeman and the definitive Allman Brothers guitarist, Duane has transcended mortality.
This has complicated things for Warren Haynes.
When the Allman Brothers Band – which plays the Newport Folk Festival for the first time Saturday and the Bank of America Pavilion on Tuesday and Wednesday – re-formed in 1989 after a half-decade hiatus, it invited then-29-year-old Haynes to take on Duane’s role: foil to second lead guitarist, Dickie Betts.
“They made me feel like an equal right away,” Haynes said on his way to Ontario to kick off the Brothers’ summer tour. “There was a long time between Duane’s death and when I joined the band, so that made things easier, and no one ever asked me to play more like Duane or less like Duane.”
During his tenure with the band, Haynes has played more than 1,000 shows alongside founders Gregg Allman, Butch Trucks and Jaimoe Johanson. He even became the senior guitarist after Betts, another founding member and the guy who ushered Haynes into the band, was unceremoniously booted in 2000. But more importantly, his talent for remaking Allman warhorses such as “In Memory of Elizabeth Reed” and “Whipping Post” anew every night has become integral to the band’s latter-day brilliance.
Haynes won’t replace Duane as the definitive Allman Brothers guitarist. No one could. But while fans have accepted him as the best substitute, many consider it blasphemy to even insinuate today’s Brothers can hang with Duane’s Brothers.
Haynes insists he’s not competing with Duane.
“It’s never been about that,” he said. “It’s always been about adding what I can, who I am to the band.”
Haynes, who also fronts the guitar-heavy Gov’t Mule, is currently at the center of a resurgent Allman band capable of matching its illustrious, Duane-fueled past. Gregg Allman’s voice has aged into its whiskey-drowned prime. Percussionist Marc Quinones has inspired drummers Trucks and Jaimoe to up their energy and sharpen their focus. And Haynes and second guitarist Derek Trucks display an eerie chemistry equal to Dickey and Duane’s.
“I’ve known Derek since he was 11 years old and we’ve played together hundreds of times,” Haynes said. “The first time we played together was good, but the 20th was better, and the 50th was better. Now the interplay on stage between us, in fact between the whole band, is borderline telepathic. That’s what happen when you keep a lineup together. You can read each others’ thoughts.”
Haynes said what he wants out of the band’s Newport Folk Fest debut is “a definitive Allman Brothers show.” It seems a reasonable request, but for many Allman fans it’s impossible – a definitive show just can’t happen without the band’s definitive – but dead – guitarist. It’s a shame too many people will be looking back when yesterday and today’s best jam band will be looking forward.
Newport Folk Festival, Saturday and Sunday at Fort Adams State Park, Newport, R.I. Tickets: $55-$75. Call 866-468-7619. Also at the Bank of America Pavilion, Tuesday and Wednesday. Tickets: $35-$50. Call 617-728-1600.


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After finally pinpointing food sensitivities as the culprit and finding MegasporeBiotic, my son has added dairy to his diet and if he ends up enjoying a gluten-filled cupcake or treat at a birthday party, he doesn’t react. He’s so much happier having that freedom.
You know, it’s hard for a kid to have to worry about his diet all the time…as it is for many of us. And while, in our home we eat a whole foods, paleo-ish, gluten-free diet, it’s such a relief to feel free when we have less control over our food.
If you or your child is still having symptoms of a leaky gut, skin or digestive reactions or low energy, I highly encourage you to look into MegasporeBiotic for your health.
But please note! We didn’t heal by eating a bunch of junk, gluten and dairy. We healed by eating whole foods, no gluten and no dairy while taking the probiotic.
You can’t just eat anything you want, live on high stress and expect a probiotic to do all the heavy lifting. No, you’ve gotta commit to following an anti-inflammatory diet while taking the probiotic. Doing both, gives your body the support and space it needs to repair the gut.
It is BECAUSE we stopped assaulting our bodies with processed and inflammatory foods with the addition of the MegasporeBiotic that I can now add gluten and dairy back to my diet.
You may have seen in a previous email, that I tested out eating gluten while I was in Italy and it was a success! But I do refuse to eat gluten in the U.S. because of how much of our wheat is inundated with harmful pesticides and is bred to be more glutinous but because Megaspore helped me heal, I know that I’ll be just fine if I ever find myself having to eat something that contains gluten.
If you want to improve your health or the health of a child, I recommend trying out MegasporeBiotic for 6-months while eating a whole foods diet. You won’t believe how quickly you’ll start to repair the gut and see food sensitivities and symptoms vanish!
After a year of incorporating it into my healing plan, it’s clear to me, MegasporeBiotic made a major improvement in my life, my son’s life and had a huge impact on our healing.
p.s. – If you know someone struggling with IBS, Digestive Issues, Thyroid/Autoimmune conditions, diabetes or obesity, please share this post with them. Focusing on whole foods and taking MegasporeBiotic is a powerful first step to healing, having more energy and getting rid of symptoms that slow you down!
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domain: food


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Free Theatre Christchurch (est. 1979) is New Zealand's longest running producer of experimental theatre. The company serves as a laboratory for established and emerging artists to work together to create innovative, high quality, professional performance work.
Last week we had the pleasure of working together with our long time collaborator and Artist-in-Residence Taiporoutu Huata. Tai came down to the cold south to conduct some wÄnanga / workshops for Footprints/Tapuwae the bicultural opera that features as part of Te Puna Toi 2015 in June. Supported by Christchurch City Council, Te Puna Toi sees Free Theatre collaborating with Tai and NgÄi Tahu kapa haka performers from Te AhikÅmau a Hamo Te Rangi and Te Pao a Tahu, both of whom recently represented the Waitaha (greater Canterbury) region at Te Matatini. Bookings for the the workshops, symposium and performances will be available shortly via our website.
Part of the workshops involved watching film footage from the original production of Footprints/Tapuwae in 2001, the showreel of which can be viewed here. Along with Tai's presence last week, we were also delighted to celebrate the graduation of two company members. Congratulations Dr's Johnston and McCurdy!
WARHOL FACTORY UBU NIGHT MASK WORKSHOPS
Back by popular demand Andy Warhol and his extraordinary Factory return to The Gym this Friday. Expect the Superstars to come out for this exciting night: Velvet Underground with Lou Reed, John Cale and Nico, Edie Sedgwick, Viva, Jim Morrison and Warhol himself. Free Theatre explores what made The Factory such a hotbed of creativity and invention.
More information on Ubu Nights our series of entertainments (combining theatre, music, film and hospitality) that engage diverse communities in interactive and sensory experiencescan be found on our website.
In our next series of public workshops we are focusing on a variety of mask performance, exploring European, African, Asian and Pacific mask traditions.
As part of these workshops (open to all ages) we will be creating masks for the upcoming performance of Footprints/Tapuwae.
Saturday 2 May 10am-12pm $10
Saturday 9 May 10am-12pm $10
Saturday 23 May 10am-12pm $10
For more information or to book a place in any of these workshops, please email Emma at email@example.com
Following the Easter break we were very happy to host The Cavell Leitch NZ Jazz and Blues Festival in The Gym (see below). The artists that performed in the space confirmed what we've known for some time - that The Gym is a wonderful place to create sweet music. We're also looking forward to hosting the Christchurch Arts Festival in August/September in which we'll be working with artists of the calibre of Gao Ping and Hamish McKeich on a project inspired by the work of avant garde composer Mauricio Kagel.
FANTINE performing in The Gym.
Image courtesy of Modafotographica and The Cavell Leitch NZ Jazz and Blues Festival

domain: artistic


The reason I am asking this is I have a 460 out of my 79 it is actually has heads from an 82 or so from a previous rebuild, the block was in excellent shape with 0.30 pistons I had the the distributor recurved and the crank turned. They also put in new cam bearings and freeze plugs for me. I have not bought the other parts for the rebuild yet I kinda lost interest at the moment. So I was pondering at saving it for if the Winnebago ever broke down. I also have this c-6 trans is it worth saving for the winnebago? Or is it different internally. Thanks for your imput.
internally the C6 should be the same (the winnibego might have the heavier clutch packs in it but might not too) the engines should be the same, expecially if the casting number on the side of the spare block is D9TE, should be right above the starter, and that will be the same casting number on the block in the motorhome. the heads on the 79 should be D3VE and the heads on the motorhome engine might be E5 or something like that but they are totally interchangable.


LANSING — Sen. Jeremy Moss (D–Southfield) has issued the following statement on Gov. Gretchen Whitmer’s State of the State address, during which she spoke about her support for a legislative plan to tackle wage theft, which resulted in Michigan workers losing out on $429 million over a two-year period, according to the Economic Policy Institute:
“Gov. Whitmer laid out her plans for 2020 to protect Michigan families from Washington politicians threatening their health care, from crumbling infrastructure causing them unaffordable auto damage, and from unscrupulous businesses robbing their paychecks. I’m ready to turn that vision into legislative action, which is why I introduced Senate Bill 478, part of a robust bill package to crack down on payroll fraud.
“Too many hardworking Michiganders get ripped off from cheaters who refuse to follow the simple rules of doing business. Gov. Whitmer and I are committed to supporting the Michigan workers who struggle to make ends meet as a direct result of payroll fraud.”
Sen. Moss represents the 11th Senate District in Southern Oakland County that includes Farmington, Farmington Hills, Ferndale, Hazel Park, Huntington Woods, Lathrup Village, Madison Heights, Oak Park, Pleasant Ridge City, Royal Oak Township and Southfield.
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7 Nights 8 Days Meghalaya Village Adventure Tour
Planned by Experts
Places covered: Shillong(1N), Mawphlang Village(1N), Kongthong Village(1N), Cherrapunjee(2N), Mawlynnong Village(1N), Umden Village(1N)
Visit Umden Village, study the production of Eri Silk and weaving of traditional handlooms and participate in mountain biking.
Walk around the wonderful surroundings on the land of seven lakes – Mawphunlur Village and Kayaking at the lake.
Discover the traditional lifestyle of Khasi Tribes at Khasi Heritage Village and trek the hills from Mawphlang to Lad Mawphlang.
Interact with the Peoples of Kongthong Village and learn about their unique practice of whistling tune to communicate with each other.
Trek at Nongriat Village.
Explore the Single Living Root Bridge and the Double Decker Living Root Bridge.
Tour one of Asia’s cleanest Village.
Experience stays in different villages of Meghalaya.
Package Itinerary Details:-
- Day – 1 : Transfer from Guwahati to Shillong
Drive to Shillong from Guwahati, en-route visit the breath taking Umiam Lake Viewpoint.
Later transfer to shillong.
Stroll around the famous Police Bazar, have your dinner.
In the evening check in to Hotel.
Overnight Stay in Shillong
- Day – 2 : Mawphanlur (71.3 kms from Shillong) & Mawphlang Sightseeing
Drive to Mawphanlur Village (land of Seven Lakes).
Witness green carpet and seven wonderful lakes.
Walk up to the green velvet grasses and find out the hidden pools amidst in the trees.
Do kayaking at the lake.
Depart to Mawphlang Sacred Grove.
At first visit the Sacred Groves, a place for nature lovers who admires the flora and fauna.
Visit the Khasi heritage Village which showcase the traditional lifestyle of the khasi tribes.
Trek from Mawphlang to Lad Mawphlang.
Spend the evening at the village.
BreakfastOvernight stay in Mawphlang
- Day – 3 : Visit to Kongthong Village
Proceed to Kongthong Village after a sumptuous breakfast.
The villagers here communicate with and call each other by whistling tunes.
Learn a little bit of Kongthongunique tune language and take home an everlasting memory.
Roam around the pristine environment of Kongthong spread across its bee farms, rich vegetation and towering hills with a guide.
Spend the evening in the serene and calm surroundings of the village.
BreakfastOvernight stay at the cottage in Kongthong Village
- Day – 4 : Cherrapunjee Tour
After breakfast begin your Journey to the 2nd wettest place on the Earth, Cherrapunjee.
Take a Short halt at Mawkdok, get the view of astonishing sceneries and enjoy the valley of the view from the Duan Sim Singh Viewpoint. You can also do zip lining and get some thrilling experience of it.
Cover the Lime Stone Cave which is made up of odd lime stones and the Seven Sisters Falls which symbolizes the seven states in North East.
Witness the breathtaking view of the fall and take numerous pictures of the surrounding greeneries and the gushing Nokhalikai Fall.
After the daylong tour check into to the hotel and rest overnight.
BreakfastOvernight stay in Cherrapunjee
- Day – 5 : Adventure Trek to Nongriat Village
Arrive at Tyrna Village (in Cherrapunjee), the base point for the trek to the double- decker living root bridge, by morning.
Go down the 3.5kms path with your team guide and then get led into the jungle.
Drink water and try some local lime juice on the way.
Trek for few more steps to reach the double decker living root bridge.
Explore the mind blowing water bodies near the double decker bridge and feel awesome while you get a glance of free fish pedicure i.e. small and tiny fishes swimming around the pond.
Start trekking back up to your starting point at Tyrna Village.
The steep climb to reach the parking spot on the well laid steps takes time and you should keep some time in spare for rest in case you get tired.
BreakfastOvernight stay in Cherrapunjee
- Day – 6 : A walk at the Cleanest Village of Asia
After breakfast start the drive towards the cleanest village, Mawlynnong.
Explore the beauty of this place and the forests surrounding it and walk to see the single Living Root Bridge of Mawlynnong.
You will then head to the village of Dawki near the Indo-Bangladesh Border, to see the crystal clear waters of the Umngot River. Here you can choose to have a small boating session as an add on.
BreakfastOvernight stay in Mawlynnong
- Day – 7 : Umden Village – World of Eri Silk production
Begin your tour at 8am and leave for Umden Silk Village from Shillong.
Interact with the Bhoi people of the village and indulge in their culture and history.
Visit the weaving Centre and watch the production of Eri Silk and handlooms like Ryndia.
Get a close look of different variants and patterns used in weaving.
Hike around the serene and lushgreen surroundings and participate in mountain biking.
Take a heritage walk in and around the forests and monoliths.
You may have the khasi local food served in leaves.
Spend your night in the village cottage amidst the serene environment of Umden Village.
BreakfastOvernight stay in Umden Village
- Day – 8 : Guwahati Departure: End of the Village Tour
After breakfast, you will be dropped at Guwahati Airport / Railway station for your onward journey with all your cherished memories of the village tour.
Where You Will Stay
Day 1 (Shillong)
Located at the main point of Police Bazar, Shillong it is one of the finest luxury hotel of Shillong. It offers a panoramic view of the city with amenities that are best in town, some of which are 24 hours front desk, parkingandrestaurant serving variety of continental cuisines along with Indian and Chinese. The interiors are well designed and embedded with pine wood making the rooms elegant and unique.
Cherry Blossom Inn
The hotel has bigger rooms which are clean and well maintained. It is situated at a distance of about 5kms from Shillong City in Lapalang which locates it away from the hustle and bustle of the city making the ambience calm and serene. It is one of the best budget hotels in Shillong with all the major best amenities.
Day 2 (Mawphlang)
Maple Pine Farm
Nestled in the lap of nature the place located in a valley around 30kms outside Shillong with a small stream flowing around. The rooms are well maintained with all the required amenities with breakfast served in the stay by the host. The views from the rooms are mesmerizing. Your stay at the Maple Pines will be a unique experience as it is located at a quiet and serene place, out from the city crowd.
Day 3 (Kongthong Village)
Kongthong Traveller’s Nest
Kongthong Travellers Nest is located in the famous Kongthong Village, also known as Whistling Village and is at a distance of about 56kms from Shillong. The Traveller’s Nest is made of bamboo and wood showcasing the local traditional design and is located in a peaceful and calm environment amidst nature. It is a perfect place to be away for sometimes from the busy city life.
Day 4-5 (Cherrapunjee)
Cherrapunjee Holiday Resort
It is a perfect family ambience located at atop a hill in the lap of nature at Laitkynsew Village. The rooms are well maintained. It has a wide space with play area for Children. It has all the modern amenities despite being located in the remote region.
Nalgre Guest House
The guest house is located Near Sohra Market, Cherrapunjee. The rooms are furnished and have attached bathrooms. It has an attached restaurants serving variety of foods. Guests can enjoy à la carte breakfast here.
- Hotel accommodations
- All conveyance by Travenjo Air-Conditioned Sedan Cabs
- Sightseeing and Transportation
- 1 child below 6 years of age is allowed in a double room
- Complimentary breakfast
- Flight Tickets/Train Tickets
- Entry fees for visiting different places
- Lunch throughout the fare
- Airfares, airport tax, visa fees, or insurance
- Personal Drinks, laundry, camera fees etc.
- Things which are not included above
- Once we receive the payment you will receive an acknowledgment email from us showing receipt and confirmation of payment.
- 25% of total package cost if cancelled 30 days before the starting date of the trip.
- 50% of total package cost if cancelled 15-30 days before the starting date of the trip.
- 100% of total package cost if cancelled 0-15 days before the starting date of the trip.
- Warm Clothes
- Small Medicine Box
- Valid Identity Proof
- Good Quality Shoes
- Verified and Transparent Reviews: We have verified and transparent reviews from Google, Trip Advisor and other review platforms for you to analyze and assess our service.
- Quality Service at Best Price: We have the best price in the industry with quality service.
- Unique Tours and Activities: We have in our platform variety of exotic, unique, rare and handpicked collection of tours and activities which you can choose for the ultimate travel experience.
- Ample Customization: With Travenjo you have the freedom to customize the tours and create your own itinerary. Simply build your itinerary and the rest will be done by our travel experts.
- Support and Backend Assistance: We provide continuous support and backend assistance during your tour with us. We are always eager to help you whenever you need us.

domain: travel


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SINGLE DOSE VACCINE: A patron (right) receives the single-dose COVID-19 shot from Henry J Austin Health Center staffer on March 11th.
The weather was warm, the sun shining, and patrons were lined up in front of TASK for a reason different than food on Wednesday, March 11. Just a week after Johnson & Johnson’s single-dose vaccine was authorized by the FDA, more than 150 TASK patrons would get the “one-shot-wonder” protecting them against COVID-19.
“This is a good day,” shared TASK Executive Director, Joyce Campbell. “TASK is grateful to the Henry J. Austin Health Center for vaccinating our TASK family and restoring hope for those we serve.”
In the weeks leading up to the event, TASK worked with the New Jersey Department of Health to identify and pre-register patrons eligible for the vaccination under the state guidelines, including those experiencing homelessness and living in high-risk congregate settings. Though the double-dose option has been available for several months, successfully administering two rounds of the vaccination proved logistically challenging for organizations whose clients lack reliable transportation.
That the single-dose vaccination can additionally be stored in a regular refrigerator was another reason it was the more ideal option for TASK’s population.
With the support of the Henry J. Austin Health Center, the soup kitchen plans to conduct community-based vaccination clinics for state-eligible patrons at the community hub.
“I was reluctant and nervous,” TASK patron Michelle shared when her vaccination was complete. “But I decided to do it anyway. Sometimes you just have to do it anyway.”
In the days since March 11, Henry J. Austin returned to TASK to vaccinate another 120 individuals.
“I think this was a very fair process, and I appreciated that,” said TASK patron Monica after receiving her vaccine. “I feel good!”
TASK will continue to keep qualifying patrons informed about their vaccine eligibility. There are no clinics planned for the general public planned at TASK’s facility at this time.
Tag: Case Management - Covid-19 - Healthcare - Partnerships - Date Posted: Mar 19, 2021 - Author: Trenton Soup Kitchen

domain: medical


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Objective: To extend the validity of the Shoulder Pain and Disability Index (SPADI) by (1) making it suitable for telephone administration; (2) determining its convergent validity with other health status measures; and (3) assessing the responsiveness of the SPADI to clinical change.
Methods: Consecutive primary care patients with shoulder discomfort were followed for 3 months. At enrollment, a detailed shoulder specific history was obtained by a trained research assistant, and the Health Assessment Questionnaire (HAQ), the Medical Outcomes Study SF-20 (SF-20), and numeric and visual analog versions of the SPADI were completed by the patient. At 2, 4, and 12 weeks the numeric scaled SPADI was administered by telephone and patients rated globally the change in shoulder discomfort.
Results: One hundred and two subjects were enrolled; 96 completed at least one followup assessment and 75 completed all followup assessments. Subjects were men (98%), predominantly white (73%), with a median age of 60 years, and the majority had experienced shoulder discomfort for > 3 months (66%). At baseline the visual analog (VAS) and numeric scaled SPADI were highly concordant (intraclass correlation coefficient = 0.86), and the SPADI correlated substantially with the HAQ (r = 0.61) and the physical functioning (r = -0.50) and pain (r = -0.43) domains of the SF-20. The SPADI delta (baseline-followup) discriminated accurately between subjects who improved versus those who stayed the same or worsened [receiver operating characteristic cure, (ROC) = 0.91, likelihood ratio for improvement = 34].
Conclusion: The numerically scaled SPADI is highly correlated with the original VAS version of the SPADI and other measures of health status. The SPADI is responsive to change and accurately discriminates among patients who are improved or worsened.


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Nelly (Felicity Jones), a happily-married mother and schoolteacher, is haunted by her past. Her memories, provoked by remorse and guilt, take us back in time to follow the story of her relationship with Charles Dickens (Ralph Fiennes) with whom she discovered an exciting but fragile complicity.
Dickens - famous, controlling and emotionally isolated within his success - falls for Nelly, who comes from a family of actors. The theatre is a vital arena for Dickens - a brilliant amateur actor - a man more emotionally coherent on the page or on stage, than in life. As Nelly becomes the focus of Dickens' passion and his muse, for both of them secrecy is the price, and for Nelly a life of "invisibility".
Starring Ralph Fiennes, Felicity Jones, Kristin Scott Thomas, Michelle Fairley, John Kavanagh
Directed by Ralph Fiennes
Running Time - 1:51
Genre - Drama
Opening in Theaters - Wednesday, December 25th, 2013 (17 days)
This movie will be opening in theaters on Wednesday, December 25th, 2013
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domain: entertainment


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Good news for all pharma candidates, they will be recruited soon. Govt has approved the recruitment procedure to recruit 600 pharmacist in state. Governor has also approved the urgent temporary hiring arrangement. The recruitment process will be started soon. There are lots of posts are vacant in rural areas of Uttarakhand state. To fulfil the vacancies of pharmacist, the government has issued a government order. Under this recruitment, all pharmacist should have follow the same rule as parmanent pharmacist, they will get Rs 12000 per month.
This recruitment is only applicable for diploma of pharmacist, bachelor pharmacists are not able to apply. The recruitment will be based on previous procedure, under this requirement, candidates must be registered in Uttarakhand Pharmacy Council. Selection of candidates will be based on merit list and interview.

domain: news


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Original Research ARTICLE
Mental Flexibility Influences the Association Between Poor Balance and Falls in Older People – A Secondary Analysis
- 1Geriatric Division, Department of Medicine, University of Western Ontario, London, ON, Canada
- 2Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- 3Institute of Medical Physics, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
Impairments of balance predispose older people to falls. Some cognitive functions, especially executive functioning have been shown to affect balance and discriminate fallers from non-fallers. Mental flexibility is a component of the executive function and comprises multiple cognitive processes that work together to adjust the course of thoughts or actions according to the changing demands of a situation without the use of explicit instructions. However, the role of mental flexibility in balance in older people remains unclear. The study aim was to examine the relationship between mental flexibility and falls in a cohort of 212 older people (80.6 ± 4.9 years; 62% female). We hypothesized that: (i) participants with impaired balance would have worse mental flexibility compared to those with good balance; and (ii) poor mental flexibility would predict falls in the sub-group with impaired balance. Balance performance was assessed by measuring postural sway while standing on a medium density foam mat with eyes open for 30 s. Mental flexibility was assessed using a computerized short-form of the Wisconsin Card Sorting Test (WCST; 64 cards) with its sub-components comprising general performance, perseveration, failure-to-maintain set and conceptual ability. Falls were measured prospectively for 12-months using monthly calendars. MANCOVA revealed that WCST performance was associated with balance [Wilks’ Lambda = 0.883, F = 2.168; p = 0.013, partial eta squared () = 0.061] due primarily to reduced concept formation ability [F(2,207) = 5.787, p = 0.004, = 0.053]. Negative binomial regression analysis adjusting for age, education, contrast sensitivity, proprioception, inhibition, and inhibitory choice stepping reaction time (iCSRT) revealed that lower concept formation ability was predictive for falls [Incidence Rate Ratio 1.048 (95% confidence interval 1.016–1.081)]. Further, lower concept formation ability partly explained the association between balance and falls: i.e., fallers in the upper balance tertile had reduced concept formation performance whereas non-fallers had similar concept formation performance across the three balance tertiles. These findings suggest that poor mental flexibility affects the ability to maintain steady balance contributing to increased risk of falls in older people.
There is growing evidence for interrelationships between balance and cognition in older people and their associations with falls (Schäfer et al., 2006; Yogev-Seligmann et al., 2008). Impaired balance has been consistently identified as a risk factor for falls in older people (Lord et al., 2007), with objective balance measures being good markers of fall risk that can be easily administered in clinical practice (Horak et al., 1989; Piirtola and Era, 2006; Sturnieks et al., 2011). It has been shown that standing balance requires cognitive resources (Teasdale and Simoneau, 2001; Horak, 2006), and older people use cognitive control to regulate sensorimotor processing during balance tasks (Redfern et al., 2001, 2004). Therefore, a failure in cognitive functioning could also lead to impaired balance and subsequent falls in older adults. Especially executive functions have been associated with increased fall risk in older people (Anstey et al., 2009; Hsu et al., 2012; Mirelman et al., 2012).
Executive functions comprise higher-order cognitive processes responsible for planning, controlling and coordinating complex cognitive tasks (Miyake et al., 2000), although no consensus definition has been agreed upon. Impaired executive functions, especially inhibition, have been identified as risk factors for falls in several studies. Mirelman et al. (2012) demonstrated that poor executive function, especially inadequate response inhibition, predicts falls in well-functioning older people, and Anstey et al. (2009) found subtle differences in inhibition are an early marker of increased fall risk, while multiple cognitive domains are impaired in recurrent fallers. We have also shown that slow inhibitory choice stepping reaction time (iCSRT), a test of combined inhibition and rapid step initiation, was predictive of falls in older people and that this association was not mediated by body sway, processing speed or attention (Schoene et al., 2017).
Mental flexibility is a component of executive functioning, but without an agreed definition as well (Ionescu, 2012). Here, it is defined as a construct composed of multiple cognitive processes that work together to adjust the course of thoughts or actions according to the changing demands of a situation without the use of explicit instructions (Berg, 1948). However, depending on definitions, cognitive processes including abstract reasoning, concept formation (understanding implicit task rules), inhibition of irrelevant information, task switching, set shifting and working memory (information updating) comprise the mental flexibility construct (Ionescu, 2012), functions that partially overlap. Mental flexibility is important to shift mental sets to adjust behaviors quickly, e.g., when (unpredictable) environmental demands require proactive and/or reactive responses to avoid a loss of balance. However, to our knowledge no study to date has investigated the effect of mental flexibility on balance and fall risk in older people.
In the above studies on executive functions and falls, relatively easy reaction time tasks for executive functions have been administered for which the task rules were clear to participants. For elucidating the importance of mental flexibility, i.e., abstract reasoning and concept formation for fall risk in older adults, more complex tasks are required for which participants have to implicitly learn the task rules. Previous studies have also not investigated the role of mental flexibility as a confounder or potential effect modifier in the association between balance control and falls in older people. Obtaining insights into these processes would increase our understanding of the complex inter-relationships between cognitive and motor functions and their impact on falls.
The objective of the current study, therefore, was to investigate the importance of more complex mental flexibility components to balance control and falls in older people and their role as potential confounders and moderators in the association between poor balance and falls. We hypothesized that: (i) participants with impaired balance would have worse mental flexibility compared to those with good balance; (ii) poor mental flexibility would predict falls in the sub-group with impaired balance.
Materials and Methods
This is a planned secondary analysis of a cohort study conducted between July and December 2012 on stepping, cognition and falls in 212 independently living older adults in Sydney, Australia (Schoene et al., 2017). The study was conducted according to the Declaration of Helsinki and was approved by the University of New South Wales Human Research Ethics Committee (HREC 11159). All participants gave written informed consent prior to data collection.
Participants were recruited via a research institute’s volunteer database and from residents of a retirement village in Sydney, Australia. The following inclusion criteria were applied: (1) aged 70 years and older; (2) ambulant with or without walking aids; and (3) able to step without assistance (step size 25–30 cm). People were excluded if they were cognitively impaired [diagnosis of neurodegenerative disease, Rapid Dementia Screening Test ≤4 (Kalbe et al., 2003)], had movement disorders (self-reported) or limiting lower limb pain and visual impairments that could not be corrected [>6/16 on a LogMAR visual acuity chart, color-blind]. Experienced research staff performed the screening, assigned participants to the study, conducted the assessments and informed participants about the follow-up procedures.
Sway path in millimeters was measured with a sway-meter that measured displacements of the body at the level of the waist. Testing was performed with participants standing on a medium density foam rubber mat (65 × 65 × 15 cm thick) with eyes open for 30 s (Lord et al., 2003). This device has demonstrated reliability and validity for measuring sway under multiple sensory conditions (Sturnieks et al., 2011). The sample was split into tertiles: good balance (62 to 146 mm, N = 71), fair balance (147 to 209 mm, N = 72), and poor balance (>210 mm, N = 69).
Wisconsin Card Sorting Test Short-Form (WCST)
Mental flexibility was assessed using the Wisconsin Card Sorting Test (WCST). This test measures implicit rule learning, abstract reasoning and set-shifting. In this test, participants matched stimulus cards according to a rule (color, shape, or number) without being informed of the rule. After successful understanding of the rule (10 correct matches), the rule is changed to enforce a shift in cognitive sets. After each trial, visual feedback was displayed for 500 ms. Four general executive processes are measured with the WCST: (1) General Performance: total correct responses; (2) Perseveration: Perseverative responses or perseverative errors (inability to use feedback from previous errors to produce correct behaviors – only perseverative responses that are also errors); (3) Failure to maintain set: the number of times the participant fails to make between five to nine correct responses in a row; (4) Conceptual Ability: number of trials needed to complete the first category (concept formation) and proportion (in %) of consecutive correct responses occurring in runs of three or more (conceptual level responses) – this ability measures how many trials a participant takes to understand the implicit task rule to switch to a new mental set (i.e., new rule) (Haaland et al., 1987). A WCST short form (64 trials) was computer-administered using a freely available and validated software tool [The Psychology Experiment Building Language (PEBL), version 0.141] (Piper et al., 2012; Fox et al., 2013).
Attentional Network Test (ANT)
The ANT combines cued reaction time and flanker tasks and requires participants to signal by button press whether a central arrow points left or right (Fan et al., 2002). The arrow appears above or below fixation and may or may not be accompanied by flankers which can emerge in congruent or incongruent form. Scores for three attentional networks are generated by measuring how response times are influenced by alerting cues, spatial cues, and flankers. The latter is used to assess the efficiency of the executive network (inhibitory control) and requires individuals to quickly suppress their prepotent response in order to resolve conflicts correctly by indicating the direction of congruent and incongruent flankers. It is calculated by subtracting the mean RT of all congruent flanking conditions, summed across cue types, from the mean RT of incongruent flanking conditions (Fan et al., 2002). We used this score as a measure of inhibition and to determine if measures of WCST measure a different component of executive functioning.
Inhibitory Choice Stepping Reaction Time (iCSRT)
The iCSRT is a development of the CSRT (Lord and Fitzpatrick, 2001; Schoene et al., 2011, 2017). Participants were asked to stand on the two stance panels. Stance and target panels were displayed on the screen. For “go” trials, participants were instructed to step onto a panel as quickly as possible when the corresponding arrow on the monitor changed color from white to green. For no-go trials (33% of trials), signaled by an arrow on the screen changing from white to purple, participants had to suppress the prepotent stepping response. Stimuli were presented for 100 ms and time between trials was randomized, occurring 0.5 to 1 s after returning both feet to stance panels. Immediate visual feedback of step completion was provided. After six practice trials (one stimulus for each target panel with two stimuli to be withheld), a random sequence of 36 trials was presented. For this secondary analysis we used the time in milliseconds for step RT (iCSRT-RT) as fall-related measure of executive functioning.
Socio-demographic and medical information was collected by self-report questionnaires. The 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 was used as a generic assessment of health and disability; participants reported their level of impairment for several instrumental activities of daily living on a five-point Likert scale2. To record the number of comorbidities we used the Functional Comorbidity Index for which participants are required to report whether they had one or more of 18 chronic conditions and from which a sum score was calculated (Groll et al., 2005). Depressive symptoms were measured using the nine-item Patient Health Questionnaire (PHQ-9) (Kroenke et al., 2001). Concern about falling was measured by the iconographical falls-efficacy scale (Icon-FES), a questionnaire which depicts line drawings of a person undertaking a range of simple through to more demanding activities of daily living (Delbaere et al., 2011). Sum scores for the PHQ-9 and Icon-FES were calculated with high scores indicating increased depressive symptoms and concern about falling, respectively.
Sensorimotor performance was assessed as part of the Physiological Profile Assessment, comprising four tests in addition to postural sway (Lord et al., 2003):
Contrast sensitivity was assessed with the Melbourne Edge Test (Verbaken and Johnston, 1986), using a chart comprising of 20 circular test patches (25 mm diameter), with a series of edges of reducing contrast and of variable orientation;
Proprioception was measured with a lower limb matching task. Errors in degrees were recorded on a protractor inscribed on a vertical clear acrylic sheet (60 × 60 × 1 cm) placed between the legs;
Maximum isometric knee extension strength was measured in the dominant leg while seated with a knee angle of 90 degrees;
Simple reaction time was recorded using a randomly presented light stimulus and a finger-press as the response.
Falls were monitored prospectively over 12 months with daily falls calendars that were sent back monthly using pre-paid envelopes. If calendars were not returned, follow-up phone calls were made within 14 days of end of each month to remind participants to send back their calendars and to obtain additional information on falls. A fall was defined as “unintentionally coming to the ground, floor or lower level” (Lamb et al., 2005). People that experienced at least one fall in the follow-up period were classified as fallers.
Missing data (less than 2%) were imputed using the Expectation Maximization method (Little’s missing completely at random test p > 0.05). Sample characteristics were compared using Analyses of Variance (ANOVAs) and chi squared tests. Based on previous study findings, showing that contrast sensitivity, proprioception, hand reaction time, and quadriceps strength were associated with balance control of older people while standing on a medium-density foam mat (Lord and Ward, 1994), balance performance was compared between groups applying Analysis of Covariance (ANCOVA) adjusting for these variables and other covariates we considered necessary to control for following comparison of demographic and sensorimotor data between the groups (Table 1). As sub-scores of the WCST are highly correlated (also observed in the current study – Supplementary Table S1), and are associated with both age and education level (Haaland et al., 1987; Barkley, 1997), multivariate analysis of covariance procedures (MANCOVAS) were performed to compare groups, with significant differences in Wilk’s Lambda used to determine whether mental flexibility was different between groups. Univariate ANOVAs were then applied to determine which variable of the WCST differed between groups using Bonferroni adjustments. (Partial) Eta squared (η2/) was calculated as effect size. Univariate and multiple negative binomial regression analyses (with individual follow-up time in months used as offset variable) were applied to determine the associations between balance as categorical variable (tertiles; good balance as reference category) and WCST and fall rate (number of falls; capped at 10 falls). Incidence rate ratios (IRR) with 95% confidence intervals were calculated. WCST performance was also investigated as a potential confounder in the association of balance and fall risk using a 10% change-in-estimate criterion as an indicator of a confounding effect (Budtz-Jorgensen et al., 2007). Potential effect modification by WCST performance was determined using interaction terms. The level of significance was set to 5%. Analyses were performed with SPSS for Windows (version 25, IBM).
Table 1. Demographics, health, psychological, sensory, and fall risk profile of participants stratified by balance performance.
Participant characteristics are displayed in Table 1. Consistent with previous findings, those with poor balance were older and performed worse in tests of contrast sensitivity, proprioception and hand reaction time than those with good balance (Lord and Ward, 1994). In contrast, knee extension strength did not differ among the balance groups in this study. A trend for significance was observed for the ability to resolve conflict (inhibition-ANT executive network), with individuals in the fair balance group being better than those in the poor balance group (p = 0.025).
As expected, sway paths differed among the three balance groups in univariate analysis [F(2,209) = 100.695, p < 0.001, η2 = 0.491]. After controlling for age, contrast sensitivity, proprioception, knee extension strength, simple reaction time and ANT performance, significant differences remained [F(2,203) = 80.861, p < 0.001, = 0.446] (Table 2), with Bonferroni post hoc tests showing linear differences between each tertile.
Table 2. Unadjusted (ANOVA) and adjusted (ANCOVA) analyses for the association between postural sway and balance tertiles.
The MANCOVA, controlling for age and education, revealed the balance groups had different cognitive flexibility profiles [Wilks’ Lambda = 0.883, F = 2.168; p = 0.013, = 0.061]. Post hoc univariate ANOVAs revealed the difference lied in the number of trials required to complete the first category [concept formation, F(2,207) = 5.787, p = 0.004, = 0.053]. Bonferroni-adjusted pairwise comparisons showed the poor balance group required more trials than the good balance group (p = 0.003) (Table 3). Comparing upper and lower balance group tertiles, there was also a trend indicating the poor balance group gave fewer correct conceptual responses compared to the good balance group [44.7 vs. 47.3%, respectively, F(1,136) = 3.581, p = 0.05].
Two-hundred-seven participants (97.6%) completed the 12-month follow-up for falls. During the 2507 person-months of follow-up (mean 11.8 months), 93 participants (44%) experienced at least one fall. The proportion of fallers differed between groups, with 35% of the good balance group, 40% of the fair balance group, and 57% of the poor balance group reporting at least one fall. The mean number of falls for the good balance group was 0.65 (SD 1.17), for the fair balance group 1.01 (1.63) and for the poor balance group 1.74 (SD 3.92). Negative binomial regression analysis revealed that balance status (sway tertiles) was associated with an increased rate of falls. Using the good balance group as the reference, the fall rate for both, the fair and poor balance groups increased [IRR 1.91 (1.14–3.22), p = 0.015 and IRR 2.80 (1.68–4.65), p < 0.001, respectively].
Concept formation was also associated with an increased fall rate after adjusting for age and education [IRR 1.06 (1.03–1.09), p < 0.001]. With respect to the balance tertiles, concept formation predicted falls in the poor balance but not in the fair or good balance groups with the incidence rate in the opposite direction for the good balance group [poor balance: IRR 1.06 (1.02–1.09), p = 0.002; fair balance: IRR 1.06 (0.98–1.14), p = 0.170; good balance: IRR 0.89 (0.75–1.05), p = 0.172]. When entering both variables along with age, education in a multiple negative binomial regression model (enter method), balance status remained significant but was reduced by 13% for the fair balance group and by 24% for the poor balance group (Table 4). Adding contrast sensitivity and proprioception further reduced the effect of balance status with no change in the predictive value of concept formation (model 3, Table 4). This confounding was driven by notably poorer concept formation performance in the fallers and no corresponding reduction in the non-fallers within the poor balance group (Figure 1). Finally, when ANT executive network performance and iCSRT_RT were entered into the model, balance status (tertile 3), concept formation, contrast sensitivity and iCSRT_RT remained significant predictors of falls status (model 4, Table 4), with no evidence of an effect modification by balance status × concept formation (p = 0.250). ANT executive network performance was not associated with falls in this sample.
Table 4. Unadjusted and adjusted models for the association between balance status and fall rates with 95% confidence intervals.
Figure 1. Concept formation ability as measured by the number of trials needed to shift first set during the short version of the Wisconsin Card Sorting Test (WCST) according to balance (sway tertiles) and faller status (one or more falls). Panel (A) shows a decline in concept formation performance across sway tertiles; Panel (B) shows the additional impact of faller status. Across sway tertiles the concept formation ability did not differ in non-fallers (blue). However, with decreasing balance status, fallers had greater difficulties to implicitly understand the first rule (red).
This study found significant associations between cognitive functioning, balance and falls in older people without major cognitive impairments. Consistent with previous findings, poor balance was associated with an increased risk of falling (Piirtola and Era, 2006; Deandrea et al., 2010). Individuals with reduced balance control also performed worse in the computerized short version of the WCST, a test of mental flexibility, mainly due to poor concept formation. Specifically, the poor balance group required more than three additional trials to shift the first mental set demonstrating an impaired ability to implicitly learn a rule. Further analyses demonstrated that this conceptual ability impairment statistically confounded the association between balance status and falls. Compared to people with good balance, those with impaired balance were at increased risk of falling when their concept formation was also poor.
Learning rules of abstract concepts is not obviously related to causes of falling in everyday life. Confirming our second hypothesis, we found older people with impaired balance and poor mental flexibility were more likely to fall. Our findings may indicate fallers have poorer executive function in general, rather than specific mental flexibility deficits confirming results from cognitive and brain-imaging studies that demonstrate executive functions, including mental flexibility reflect some common, and distinct components (Miyake et al., 2000; Wager et al., 2005). It has been previously reported that older people are susceptible to falls if they perform poorly in inhibition tasks (Anstey et al., 2009; Mirelman et al., 2012; Schoene et al., 2017). It has also been demonstrated that poor concept formation is due to lack of inhibition, rather than reduced ability for abstraction (Hartman and Stratton-Salib, 2007). In the current study inhibition was assessed with the executive network of the Attentional Network Test, which requires participants to suppress their prepotent response in order to correctly indicate the direction of congruent in incongruent (conflict resolution) Flanker tasks (Fan et al., 2002). We found a trend that the performance in this task was associated with balance, indicating the relevance of inhibitory processes on balance control. This is in accordance to recent findings that demonstrate the importance of perceptual inhibition for sensory integration during standing balance tasks in older people (Redfern et al., 2018). However, we did not identify a meaningful contribution of this task to falls in older people. This may indicate compensatory processes in our relatively healthy sample without major cognitive impairments and sufficient physical function to do the tests involved in this study. Similarly, we have previously found that a stepping conflict resolution task could not discriminate faller groups whereas the iCSRT (response selection) could (Schoene et al., 2017). The rate of commission errors during the iCSRT task would have been a more genuine reflection of inhibition. However, response selection and response inhibition should not be separated as they are linked with each other in that first the automatic response is inhibited to enable a switch to the controlled response selection (Mostofsky and Simmonds, 2008). The WCST is a demonstrated test of executive function (Greve et al., 2005) and provides distinct information in neuropsychological assessments (Greve et al., 1998). Our finding that concept formation and iCSRT are significant and independent risk factors for falls, implies that more than one executive network influences fall risk. Importantly, this may indicate that both speed dependent (based on reaction time tasks) and non-speed dependent (based on implicit rule learning, without a reaction time component) executive functions are important in this regard.
The interrelationships between sensory, motor, and cognitive functions become stronger with increasing age (Schäfer et al., 2006), and balance and executive functions are inter-connected during standing tasks (Redfern et al., 2009; Taylor et al., 2017). Confirming our first hypothesis, we found that people in different balance tertiles also differed in their concept formation ability. This suggests that understanding an implicit rule may be a sensitive marker of impaired body sway. It is possible that individuals with better concept formation are more efficient in gathering sensory information that signal when corrections in the center of mass displacement are necessary. However, according to the benchmark values reported by Cohen (1988) this can be considered a small effect. This is not surprising as balance depends on multiple sensory, motor, and cognitive functions. Particularly, in individuals with poor balance, worse mental flexibility was associated with more falls, further confirming our second hypothesis. Relative to the good balance reference group, the confounding effect was larger in the poor balance compared to the fair balance group, demonstrating increased cognitive-motor interrelationships in older people with reduced levels of functioning.
In related research conducted with nursing home residents, more than 50% of falls were due to incorrect weight shifting and poor obstacle negotiation (Robinovitch et al., 2013). These postural challenges require the integration of feedback for correct modulation of motor responses and it has been reported age-related declines in WCST are associated with inefficient feedback utilization (Fristoe et al., 1997; Ashendorf and McCaffrey, 2008). This in turn, is mostly due to poor working memory and slow processing speed (Fristoe et al., 1997), which are cognitive domains associated with falls in older people (Anstey et al., 2009). Moreover, anticipation, sensory perception, and cognitive processing of potential balance threats require cognitive resources and this is particularly the case for older adults (Rankin et al., 2000; Bernard-Demanze et al., 2009). Situational awareness, the understanding of factors that contribute to optimal task performance in expected and unexpected conditions, also affects these factors (Caserta and Abrams, 2007), i.e., a quick appraisal of the individual-environment interaction facilitates protective postural responses (Melzer et al., 2001). Indeed, findings from the current study demonstrate that non-fallers react faster in a complex stepping task (Schoene et al., 2017). Implicit rule learning may be important for navigating through complex environments and older fallers may be too slow and/or too inaccurate to process the required information. Reduced mental flexibility may compromise the ability to use feedback from the body and environment to modulate center of mass displacement required to respond appropriately to internal or external changes.
Our findings may in part explain the poorer performance of balance-impaired people in motor-cognitive dual-task paradigms (Brauer et al., 2001; Plummer-D’Amato et al., 2011). Older people with poorer postural control need to prioritize their balance to avoid falling and thus cannot shift their attention to a secondary task as well as younger people or older adults with good balance (Shumway-Cook and Woollacott, 2000), a phenomenon that has been termed the “posture-first strategy.” While the number of trials required to shift the first set was a predictor for falls in the poor balance group, this was not so in the good balance group. In fact, the effect tended in the opposite direction, further supporting the idea of a protective effect of higher levels of mental flexibility on the risk of falling. Hence, it may be that preserved mental flexibility can compensate partially for reduced balance ability, but if both are impaired fall risk increases substantially. This finding is consistent with the study by Holtzer et al. (2012), who found executive function provided a protective effect against a decline in gait speed in older people with a higher cognitive reserve. Further studies could include real life simulations to examine how poor concept formation is related to the process of falling. Such work could incorporate stressors, such as complex individual-environment interactions and anxiety as these have been shown to impair mental flexibility (Hillier et al., 2006; Han et al., 2011) as well as balance-related protective factors.
Consistent with previous reports (Lord et al., 1991; Ivers et al., 1998; de Boer et al., 2004), we found contrast sensitivity was associated with falling. Impaired contrast sensitivity is also associated with reduced stride length in older people (Duggan et al., 2017) and increased body sway, especially under conditions of reduced proprioceptive feedback, such as when standing on compliant surfaces (Lord et al., 1991). Limited evidence indicates a relationship between contrast sensitivity and cognition. Risacher et al. (2013) found contrast sensitivity became progressively worse in older people classified into healthy control, subjective cognitive complaints, mild cognitive impairment, and Alzheimer’s disease groups. Further, Anstey et al. (2006) noted contrast sensitivity was significantly associated with cognitive performance in tasks of low attentional demand (processing speed) but not in tasks requiring executive control (e.g., working memory) after controlling for processing speed, supporting the (partially) independent contributions of executive function and sensory function on fall risk in older people.
Executive functions are amenable to improvements by cognitive training in older people without cognitive impairments (Kueider et al., 2012). Furthermore, exercise can improve cognitive functioning (Gregory et al., 2013) in addition to reducing fall risk (Sherrington et al., 2017). While most research has examined aerobic training (Ludyga et al., 2016), findings from one study suggest a positive effect of resistance training on cognitive outcomes in older adults (Liu-Ambrose et al., 2012). Seated cognitive training can also improve motor functions (Verghese et al., 2010; Milman et al., 2014; Smith-Ray et al., 2015), and videogames and virtual reality interventions with high attentional switching demands may contribute to improved mental flexibility (Canty et al., 2014; Cardoso-Leite and Bavelier, 2014), as well as balance control in older adults (Schoene et al., 2014). Our findings suggest the incorporation of implicit learning tasks in interventions for older people may be beneficial to improve balance and reduce fall risk. For instance, in a cognitive-motor intervention using gamified virtual reality environments, individuals could be exposed to changing and complex, unforeseen (daily life) scenarios, during which they have to extract implicit information to anticipate and avoid postural threats in order to accrue points.
We need to acknowledge some limitations. First, participants were able to step without assistance, had no major cognitive impairments and good visual acuity. Therefore, results may not be generalizable to frailer populations. Second, all tests were done in one single session and it cannot be ruled out that fatigue played a role. However, whenever required or wished individualized breaks were taken in between tests.
We found older people with impaired balance had poorer mental flexibility, particularly concept formation, compared to those with good balance. Further, impaired concept formation confounded the association between balance status and falls. Our study confirms previous findings that balance is associated with higher order cognitive functions and shows older people with both impaired balance and reduced mental flexibility are at a substantially increased risk of falling. Training interventions targeting the preservation or improvement of mental flexibility may help prevent falls in this population by improving postural stability as well as cognition.
The study was conducted according to the Declaration of Helsinki and was approved by the University of New South Wales Human Research Ethics Committee. All participants gave written informed consent prior to data collection.
DS and SL designed the study and acquired the data. BT, DS, FP-F, SL, and WK analyzed the data. All authors interpreted the results and drafted the manuscript.
This work was supported by an International Postgraduate Research Scholarship (DS) and a NHMRC Senior Principal Research Fellowship (SL). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Conflict of Interest Statement
SL acknowledges the physiological profile assessment (NeuRA FallScreen) is commercially available through Neuroscience Research Australia.
The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fnagi.2019.00133/full#supplementary-material
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Redfern, M. S., Chambers, A. J., Sparto, P. J., Furman, J. M., and Jennings, J. R. (2018). Perceptual inhibition associated with sensory integration for balance in older adults. Dement. Geriatr. Cogn. Disord. 46, 266–274. doi: 10.1159/000493748
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Keywords: accidental falls, aged, balance, cognition, executive functions, mental flexibility
Citation: Pieruccini-Faria F, Lord SR, Toson B, Kemmler W and Schoene D (2019) Mental Flexibility Influences the Association Between Poor Balance and Falls in Older People – A Secondary Analysis. Front. Aging Neurosci. 11:133. doi: 10.3389/fnagi.2019.00133
Received: 09 January 2019; Accepted: 20 May 2019;
Published: 12 June 2019.
Edited by:Eling D. de Bruin, Karolinska Institute (KI), Sweden
Reviewed by:Patrick Eggenberger, Swiss Federal Laboratories for Materials Science and Technology, Switzerland
Tulika Nandi, University of Southern California, United States
Oron Levin, KU Leuven, Belgium
Copyright © 2019 Pieruccini-Faria, Lord, Toson, Kemmler and Schoene. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Daniel Schoene, email@example.com

domain: psychology


First introduced in 1955, the Colt Python .357 revolver is considered by numerous handgun enthusiasts to be one of the best revolver-style handguns ever made. The gun is built on a .41 caliber frame, which gives the weapon extreme durability. Like all Colt revolvers, the cylinder rotates into the frame for an extremely tight lock-up. The Python barrel has a ventilated rib on top and a full length underlug that houses an extractor rod. Inside, Python barrels are bored with a very slight, full length, taper toward the muzzle for superior accuracy. The internal safety consists of Colt's patented transfer bar and a cylinder stop that fixes the cylinder when the hammer is cocked. This custom revolver has been 70% engraved and features a unique Gadsden flag medallion on its wooden grips. Its grips are in very good condition and its metal and bore are in excellent condition.


Project assistant: Giannis Lampropoulos
Status: work in progress
Size of the prototype: d:40cm, h:43cm
Material: 4mm powder coated metal sheet
Photos: Nikos Alexopoulos
I have always been attracted by magnets. Attempting to use them in my design work has just been a matter of time. Considerations about the harmfulness of magnets in relation to electronic devices and heart pacemakers have been taken into account.
This project is the first evidence of my effort to create a stable structure using the invisible magnetic power as the main way of connection between the different parts of the construction. To create a structure that can be assembled and disassembled without the use of tools. Just the placement of the right parts next to each other, aided by the existence of sockets and projections and of course the magnetic power, is enough to ensure the strength and the stability of the construction.
Further research and experimentation on technical and aesthetical matters like the size and power of the magnets, the size of the structure (height, width etc.), alternative shapes (triangle, rectangle, five sided polygon), the use of different materials and a combination of them can lead to an expanded family of truly versatile products.
Alternatively the same structure can be achieved using maybe less magic and more conventional methods (screws) but eventually resulting exactly the same look and the same characteristics of a product that can be easily assembled and disassembled and shipped occupying the minimum space.


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If you like to dress elegantly at work, you should already be very familiar with wearing and styling the blazer. Today I am going to focus very specifically on talking about how to style the casual blazer. What I mean by that are blazers that look more casual because of the cut, color or texture. For example, a linen blazer would look very casual and airy compared to the typical blazers. To show you all these cool options, I have collected some of the best casual blazer outfit ideas for you. Let’s get in right away.
Gray casual blazer with a printed t-shirt and light blue jeans
To start this list of smart casual outfit ideas, I’ll show you an outfit that will make you look both smart and approachable at work. To achieve this look, wear a light gray printed t-shirt with a gray casual blazer as a top. Pair them with light blue slim jeans and pale pink ballet flats to look more ladylike.
Black and white striped t-shirt with half-sleeved black casual blazer
Here’s a pretty cool look to wear as a slightly artistic street outfit. You can also take off the hat and turn it into a business casual outfit. For a top, simply wear a black and white striped t-shirt with a casual black half-sleeve blazer. Pair them with blue cuffed jeans, sandals and a black fedora to add a stylish and artistic touch to the outfit.
White casual blazer with a pink top and black skinny jeans
To look more ladylike and loving, you can achieve this very quickly by adding some pink to your outfit. For example, you can wear a pink t-shirt with a white casual blazer as a top. Pair them with black skinny jeans and a pair of camel suede ankle boots for a clean finish.
Casual black blazer with half sleeves, gray top and blue jeans
To achieve this elegant and relatively casual work outfit, you can wear a gray t-shirt with a half-sleeved black casual blazer. Pair them with blue skinny jeans and a pair of black ballet flats. Finally, add a brown leather handbag and a gold statement necklace to look more stylish and youthful.
Navy blue blazer jacket with white t-shirt and ripped jeans
To create this cool blue and white look, you can wear a white t-shirt with a navy blue casual blazer as a top. Pair these pieces with blue badly ripped boyfriend jeans. With the shoes, you can wear a pair of black and white leather pointed-toe flats to finish off the outfit in an elegant way.
Casual jacket with white scoop neck top and black jeans
To create this artistic and minimalist black and white look, you can wear a white scoop neck tank top and black casual blazer jacket as a top. Pair them with black ripped skinny jeans and a pair of all white low top Converse. Finally, add a black leather handbag to the mix to complete this stylish look.
Black blazer with deep V-neck tank top and cropped jeans
Here is an outfit that will make you look stylish and sexy at the same time. As a top, wear a black tank top with a deep V-neck and a black casual blazer. Pair them with gray blue straight leg cropped jeans. Wear white sneakers to complete this attractive look in a casual and refreshing way.
Black jacket with half sleeves, white scoop neck tank top and blue jeans
Here is another very stylish outfit that uses the black and white color combination as its core. To create this outfit, you can wear a white scoop neck t-shirt and a black casual blazer as a top. Pair them with blue ripped straight-leg jeans and black and white leather heels to complete the look.
Black blazer with striped t-shirt and green chino jogging pants
This is a very interesting and good looking outfit that tries to combine a casual blazer with other casual clothes. In detail, the black casual blazer is combined with a black and white striped T-shirt and olive-green chino jogging pants. Wear black pointed heels to look more elegant and slim.
Gray casual oversized blazer with white t-shirt and blue jeans
Also, wearing an oversized blazer can give you that breezy and casual feel you are looking for. For example, you can pair a gray oversized blazer with a white t-shirt to look casual and stylish. For the rest of the outfit, wear light blue ripped jeans and black ballet flats to complete the outfit.
Casual blush pink blazer with white t-shirt and boyfriend jeans
To create this ladylike and stylish look, you can wear pink casual blazer with black collar design. Pair it with a white scoop neck t-shirt and light blue heavily ripped cuffed boyfriend jeans. Wear purple heels to give this outfit an extra feminine touch.
Gray draped blazer with white top and dark blue skinny jeans
To create this breezy and chic look, you might want to wear a gray silky smooth draped long blazer. Pair it with a high quality white fitted t-shirt and dark blue skinny jeans. Wear nude suede strappy heeled sandals to round off the outfit in an elegant and ladylike manner.
Light gray blazer jacket with white blouse and black skinny jeans
To look minimalist and elegant, you can simply wear a white blouse and a light gray casual blazer as a top. Pair them with black skinny jeans and pale pink suede ballerinas to complete the outfit in a stylish and feminine way.
Black casual blazer with a pink chiffon blouse and blue jeans
Pair it with a pair of leopard print ballet flats for a more mature look. For the rest of the outfit, you can wear a soft pink chiffon blouse with a black casual blazer jacket and blue skinny jeans.
Here are the casual blazer outfit ideas that I want to share with you. For those of you who like to look smart and casual at work, the above list can be very helpful to get you started.


Sometimes the only thing better than watching a filmmaker live up to our expectations is watching him defy them. Consider the curious case of Danny Boyle.
Boyle, a filmmaker who burst upon the scene with the smacked-out tour de force Trainspotting and was last seen cavorting with brain-munching zombies in 28 Days Later, has scandalized us with shots of turd-strewn toilets and dead babies creepy-crawling across ceilings, Now, in what some might see as the ultimate outrage, the iconoclast has presented us with Millions - an utterly sincere and satisfying family movie that cheerfully gives it all up to that big PG-Rating in the sky.
Millions is a kinder, gentler Boyle for sure, but by no means is it completely defanged. Clever, quirky touches identify this throughout as the director's baby, beginning with a crisp, elegantly contoured script by Frank Cottrell Boyce, another refugee from the Cinema of Excess (24 Hour Party People and the totally snarky Butterfly Kiss). The performances, particularly from the actors under the age of 10, are engaging and unaffected, and the movie's pleasantly eccentric visuals are supplied by Anthony Dod Mantle, a cinematographer best known for the edgy lensing of Dogme films such as Celebration.
Millions is a fairy tale and proud of it, a sweet, heartfelt story of children navigating the adult world, and of the perils and pleasures of lost and found treasure. Our heroes are a pair of young brothers, 7-year-old Damian (Alexander Etel) and his slightly older brother Anthony (Lewis McGibbon), two Liverpool lads in the process of adjusting to the triple whammy of a new school, new neighborhood and newly dead mum. Anthony's the more pragmatic of the pair, while young Damian's the dreamer, an ethereal child obsessed with all manner of religious martyrdom, and frequently found in friendly conversation with the numerous saints who appear to him in visions.
This being a fairy tale, albeit a distinctly modern one, it makes perfect sense when a Nike bag full of cash comes sailing through the sky one day and lands smack dab on a daydreaming Damian as he's hanging out in his homemade fort. The younger boy wants to turn the money in or give it to the poor, while Anthony, the budding capitalist, has visions of jet skis and cell phones, and therein lies the mostly affable conflict that fuels the rest of the movie. Just to complicate things, the money (a princely sum of nearly $400,000) is in crisp English pound notes, and the action takes place just a few days before the designated moment that Britain officially converts to the Euro, making all that old currency worthless.
Millions becomes increasingly frenzied, albeit charmingly so, as it shows us just how difficult it is for two more-or-less innocent kids to dispose of a whole lot of money in a very short period of time. Think of it as a sort of anti-heist flick, with Boyle finding both humor and emotional resonance in the boys' mostly bungled attempts to satisfy their materialist fantasies, even as they're unable to resist throwing pizza parties for the homeless or stuffing wads of cash through the mail slots of neighbors. And then, of course, there's the shifty-eyed creep with his own claim to the money, an ominous Big Bad Wolf who comes calling at the most inopportune times, turning the kids' dreams to nightmares and the movie, briefly, into a retooled Night of the Hunter.
Although Millions is set in a clean and sober universe miles from the hard drugs and flesh-eating viruses that infest much of Boyle's previous output, the director can't resist gussying up the proceedings with fancy moves. At various moments, Boyle speeds up the film, splits the screen into multiple images, glides his camera through walls, and causes time to flow backwards as effortlessly as it zips ahead. The soundtrack, a dreamy, Danny Elfman-esque lullaby-for-weirdos, has us half expecting a doe-eyed Edward Scissorhands to pop by at any moment asking to borrow a cup of sugar.
Despite the artsy flourishes, Millions never seems like it's condescending to its own simple, storybook logic, and the movie almost always connects on the most basic levels. It's all good fun and, by the final act, the mad rush to spend the money takes on a life of its own, as Boyle and Boyce throw in an emotional catharsis for the movie's wee-est player and a bona fide miracle or two. Best of all, in an ending free of irony but full of all the faith, hope and charity we deserve, Millions pulls off the neat trick of affirming that money can't buy happiness, even as it has a ball pretending that it can.
Still More Film Festivals!!!
The Tampa International Film Festival continues to hold court through April 9 over at Sunrise Cinemas, presenting some of the most intriguing foreign films you'll see this year. TIFF's tribute to Taiwanese director Tsai Ming-Liang resumes on Wednesday, April 6, with the minimalist masterpiece Goodbye Dragon Inn (7 p.m.), followed by the Italian Holocaust drama The Hungarian Servant (8:30 p.m.).
Thursday, April 7, gets off to a rocky start with Leela (6 p.m.), a clichéd older woman-younger man romance from India, but quickly attains cruising altitude with Fritz Lang's classic Metropolis (8 p.m.), then soars with Austrian auteur Michael Haenke's brilliantly disturbing The Seventh Continent (9:30 p.m.).
Friday, April 8, kicks off at noon with a free forum on film and technology at MOSI. The evening's line-up at Sunrise includes the Russian historical drama Rider Named Death (6:30 p.m.); the great Jean-Luc Godard's latest cerebral meditation, Notre Music (8:30 p.m.); and Happily Ever After (9:45 p.m.), a semi-engaging French romantic comedy/slice-of-life, mostly notable for the performance of Charlotte Gainsbourg.
The festival's final day, April 9, features one of its strongest programs. At 5:30 p.m. there's the unforgettable Searching for the Wrong-Eyed Jesus, a gonzo road trip through the deep South that explores that region's twin (and often intertwined) obsessions for Hellfire and salvation. Phantom of the Operator (7:30 p.m.) is a lyrical poem to technology, while the Hungarian film After the Day Before (9 p.m.) is a haunting murder mystery with unsettling, metaphysical dimensions. Great stuff, all.
All TIFF screenings are at Sunrise Cinemas in Old Hyde Park, Tampa. For information call TIFF at 813-253-3333, ext. 3425, or MOSI at 813-987-6000.


Ola founder Bhavish Aggarwal is envisioning a $330 million mega-factory in Bangalore’s outskirts’ empty 500-acre land, said a report by NDTV. The high-profile Ola founder hopes to erect the world’s largest electric scooter plant on this vacant plot within the next 12 weeks, to produce about 2 million a year, initially — a landmark for one of India’s largest startups.
According to the report, Ola’s Electric Vehicle (EV) unit “Ola Electric Mobility” hopes to make 10 million vehicles annually or 15% of the world’s e-scooters by the summer of 2022, starting with sales abroad later this year. That would be one scooter rolling out every two seconds after the plant expands next year. It’s the first step in Aggarwal’s goal to eventually assemble a full line-up of electric cars in a boost for Prime Minister Narendra Modi’s Make in India and sustainable mobility ambitions.
Last week, Aggarwal also showed-off a sleek all-black matte shade scooter prototype (on paper) with novel lighting, removable batteries and a large storage trunk. His plan is to sell the scooters digitally as well as via dealerships, offering monthly payment plans to make it easier on buyers’ pockets.
The company did not revealing prices yet but said the upcoming e-scooter but Aggarwal said that it would compete with traditional scooters going for about $1,000/ piece.
In a recent interview, Aggarwal said —
It’s a vehicle we’ve engineered ground-up so India can get a seat at the world EV table. Indian companies “have the smarts and energy to leapfrog into the future of EV.”
Ola’s upcoming e-scooter factory site, which is about two-and-a-half hour drive southeast of Bangalore, will sport more than 3,000 robots working alongside 10,000 workers. Software built by its 1,000-member team — mostly engineers — will divvy up the work. The factory’s roof will be covered with solar panels and be carbon negative. Two supplier parks at either end of the complex will make about half of the scooter components required.


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PASCAGOULA, Miss. -- At least two witnesses testified Wednesday that Jonathan Dwight Havard was standing on the porch of Alice Howell's George County home and said, "I cut my girlfriend's throat and then my own."
Havard, 35, later recanted that statement to George County Sheriff's investigators in a police interview and said, "I wouldn't have said that. I couldn't have cut that girl."
Havard is on trial in Jackson County Circuit Court in Pascagoula for stabbing to death his 20-year-old girlfriend, Cassidy Joy Hodges, on May 28, 2009. The George County Courthouse is being renovated and the case is being heard in Pascagoula before Judge Dale Harkey.
Sandy Williams, Hodges' aunt and George County Sheriff's Deputy Bobby Daffin, both testified that Havard was standing on the porch dressed in black shorts and a black muscle shirt, drenched in blood, when he confessed to stabbing Hodges.
Williams testified when she heard Havard say he'd stabbed her niece, she and Daffin ran in the house and found Hodges sitting on the floor next to her bed covered in blood and struggling to breathe.
"She couldn't talk," Daffin said. "Her throat was cut and she was breathing from her trachea, which was sticking out of her neck. She could not speak."
Williams said she got a towel to stop the bleeding and awaiting an ambulance to arrive.
"I held her hand and prayed," Williams said. "I told her I loved her and she squeezed my hand."
Christy Foster, an emergency room nurse at the University of South Alabama Medical Center in Mobile, said Havard, who was suffering from neck wounds police said were self-inflicted, told her, "I can't believe I did that. I didn't mean to do it."
David Futch, Havard's attorney, pointed out the Foster didn't know what "it" meant.
Testimony began Wednesday morning with Howell, the victim's 78-year-old grandmother, recalling that at about 9 p.m. on May 28, 2009, Havard ran from his and Hodges' bedroom to the kitchen, searching for a butcher knife.
"He had blood on his hands," Howell said. "He didn't say a word. He just grabbed the knife and locked their bedroom door."
Howell said she heard a loud thump and used a walkie-talkie to call Williams and asked her to alert the police, which she did. Williams lives in a trailer on Howell's property.
"I went back and beat on their door," Howell said, sobbing on the stand. "I begged him to not hurt my baby. I raised her. I love her. Please don't hurt her."
Chief Deputy Duane Bowlin testified that Havard told three different stories in the months following Hodges death.
"First, he remembered nothing," Bowlin said. "Then he said he remembered awaking to Hodges reaching for him and her trachea sticking out of her throat and wiggling around. He also remembered seeing Ms. Alice in the kitchen. Then, in November, he said a man wearing a turkey mask broke in and he wrestled him on the floor."
Futch pointed out that there were no identifiable fingerprints on the two knives recovered at the scene and that investigators only took blood samples from those knives and not the massive amount of blood at the house.
"They said, 'he said he did it" and you stopped investigating," Futch said.
District Attorney Tony Lawrence rested the state's case following Kenneth Snell, a forensic pathologist, testifying that Hodges had five cuts across her throat.
In opening arguments, Lawrence said Hodges had a short, but tough life.
"At eight years old, she found her mother dead in the woods behind their house," Lawrence said. "She went to live with her grandmother."
Hodges' life grew more difficult, Lawrence said, when she was 16 and had her leg crushed by a school bus.
During Hodges recovery, she became involved with Havard -- her older sister's ex-husband and the woman he shares children with, Lawrence said.
The trial continues at 9 a.m. tomorrow morning with the defense.