Fingers of a Hand Oscillate Together: Phase Syncronisation of Tremor in Hover Touch Sensing

When using non-contact finger tracking, fingers can be classified as to which hand they belong to by analysing the phase relation of physiological tremor. In this paper, we show how 3D capacitive sensors can pick up muscle tremor in fingers above a device. We develop a signal processing pipeline based on nonlinear phase synchronisation that can reliably group fingers to hands and experimentally validate our technique. This allows significant new gestural capabilities for 3D finger sensing without additional hardware

Heterogeneous determinants of quality of life in different phenotypes of Parkinson's disease

Objectives Health-related quality of life (HRQoL) is considered a very important outcome indicator in patients with Parkinson's disease (PD). A broad list of motor and non-motor features have been shown to affect HRQoL in PD, however, there is a dearth of information about the complexity of interrelationships between determinants of HRQoL in different PD phenotypes. We aimed to find independent determinates and the best structural model for HRQoL, also to investigate the heterogeneity in HRQoL between PD patients with different phenotypes regarding onset-age, progression rate and dominant symptom. Methods A broad spectrum of demographic, motor and non-motor characteristics were collected in 157 idiopathic PD patients, namely comorbidity profile, nutritional status, UPDRS (total items), psychiatric symptoms (depression, anxiety), fatigue and psychosocial functioning through physical examination, validated questionnaires and scales. Structural equation model (SEM) and multivariate regressions were applied to find determinants of Parkinson's disease summary index (PDSI) and different domains of HRQoL (PDQ-39). Results Female sex, anxiety, depression and UPDRS-part II scores were the significant independent determinants of PDSI. A structural model consisting of global motor, global non-motor and co-morbidity indicator as three main components was able to predict 89 of the variance in HRQoL. In older-onset and slow-progression phenotypes, the motor domain showed smaller contribution on HRQoL and the majority of its effects were mediated through non-motor features. Comorbidity component was a significant determinant of HRQoL only among older-onset and non-tremor-dominant PD patients. Fatigue was not a significant indicator of non-motor component to affect HRQoL in rapid-progression PD. Conclusions Our findings showed outstanding heterogeneities in the pattern and determinants of HRQoL among PD phenotypes. These factors should be considered during the assessments and developing personalized interventions to improve HRQOL in PD patients with different phenotypes or prominent feature. © 2015 Fereshtehnejad et al

Effects of dance therapy on balance, gait and neuro-psychological performances in patients with Parkinson's disease and postural instability

Postural Instability (PI) is a core feature of Parkinson’s Disease (PD) and a major cause of falls and disabilities. Impairment of executive functions has been called as an aggravating factor on motor performances. Dance therapy has been shown effective for improving gait and has been suggested as an alternative rehabilitative method. To evaluate gait performance, spatial-temporal (S-T) gait parameters and cognitive performances in a cohort of patients with PD and PI modifications in balance after a cycle of dance therapy

Alcohol and other drug withdrawal: practice guidelines.

Clinical guidelines seek to direct clinical practice by outlining recognised, evidence-based treatment interventions. They draw on current literature and clinical practice expertise. These Guidelines provide guidance for clinical decision-making in the context of individual client requirements, withdrawal setting, treatment availability and individual service protocols. These Guidelines are consistent with the World Health Organisation’s (WHO) United Nations Principles of Drug Dependence Treatment (United Nations Office on Drugs and Crime and World Health Organization, 2008). They outline current best practice for the management of AOD-dependent clients accessing withdrawal care. 1 Introduction - page 1 2 Definitions of dependence and withdrawal - page 5 3 Principles of AOD withdrawal care - page 9 4 Continuity of Care - page 11 5 Features of AOD withdrawal - page 13 6 Special needs groups - page 19 7 Presentation to AOD withdrawal - page 29 8 AOD withdrawal settings - page 31 9 Assessment - page 37 10 Alcohol withdrawal - page 45 11 Opioid withdrawal - page 65 12 Benzodiazepines - page 87 13 Amphetamine-type substances (ATS) - page 99 14 Cannabis - page 111 15 Nicotine - page 121 16 AOD withdrawal for clients with a dual diagnosis - page 133 17 References - page 16

Neurologic Abnormalities in Workers of a 1-Bromopropane Factory

We reported recently that 1-bromopropane (1-BP; n-propylbromide, CAS Registry no. 106-94-5), an alternative to ozone-depleting solvents, is neurotoxic and exhibits reproductive toxicity in rats. The four most recent case reports suggested possible neurotoxicity of 1-BP in workers. The aim of the present study was to establish the neurologic effects of 1-BP in workers and examine the relationship with exposure levels. We surveyed 27 female workers in a 1-BP production factory and compared 23 of them with 23 age-matched workers in a beer factory as controls. The workers were interviewed and examined by neurologic, electrophysiologic, hematologic, biochemical, neurobehavioral, and postural sway tests. 1-BP exposure levels were estimated with passive samplers. Tests with a tuning fork showed diminished vibration sensation of the foot in 15 workers exposed to 1-BP but in none of the controls. 1-BP factory workers showed significantly longer distal latency in the tibial nerve than did the controls but no significant changes in motor nerve conduction velocity. Workers also displayed lower values in sensory nerve conduction velocity in the sural nerve, backward recalled digits, Benton visual memory test scores, pursuit aiming test scores, and five items of the Profile of Mood States (POMS) test (tension, depression, anxiety, fatigue, and confusion) compared with controls matched for age and education. Workers hired after May 1999, who were exposed to 1-BP only (workers hired before 1999 could have also been exposed to 2-BP), showed similar changes in vibration sense, distal latency, Benton test scores, and depression and fatigue in the POMS test. Time-weighted average exposure levels in the workers were 0.34–49.19 ppm. Exposure to 1-BP could adversely affect peripheral nerves or/and the central nervous system

Neuroepidemiology of Parkinson’s disease in an urban area of Iran : from screening and prevalence to nutritional, clinical and psychiatric features and quality of life

Background. Parkinson’s disease (PD) is the second most common neurodegenerative disorder with complex presentations consisting of different motor and non-motor symptoms. The multisystem and progressive nature of PD has made it a complicated entity with broad variation in manifestations and reciprocal effects on several aspects of daily life. Aims. This doctoral thesis investigated different neuroepidemiologic aspects of PD and parkinsonism including its screening and prevalence in the urban area of Tehran, Iran, nutritional status and risk factors for malnutrition, clinical and psychiatric features, healthrelated quality of life (HRQoL) and its determinants in Iranian PD patients. For this purpose, we also aimed to validate several questionnaires and make a new screening instrument. Study I. Psychometric properties of the Persian-translated version of the short-form Parkinson’s disease questionnaire (PDQ-8) were assessed in 114 Iranian patients with PD consecutively recruited from an outpatient Movement Disorder Clinic. The Cronbach’s alpha coefficient of the entire PDQ-8 was 0.740 (95% CI: 0.661-0.806). Replacement of PDQ-8 items with other questions with the highest internal consistency within each dimension of the long-form PDQ (PDQ-39) did not further improve reliability. The Persian version of the PDQ-8 was shown to be a valid and reliable instrument to assess HRQoL in Iranian PD population especially in mental and behavioral aspects. PDQ-8 is a practical and informative instrument in daily clinical practice where clinicians are in shortage of time and need a validated self-reported brief questionnaire. Study II. To develop a new instrument for screening of parkinsonism in community-based surveys, a comprehensive questionnaire consisting of 25 items on different PD symptoms was filled in 157 patients with parkinsonism and 110 controls. Using the concept of clinical utility index (CUI), six items on “stiffness & rigidity”, “tremor & shaking”, “troublesome buttoning”, “troublesome arm swing”, “feet stuck to floor” and “slower daily activity” demonstrated good validity (CUI≥0.64) to be included in the new screening tool . We introduced a new set of six items to screen parkinsonism, which showed higher diagnostic values [area under curve (AUC)=0.977] compared to the previously developed questionnaires. This new instrument could be used in population-based surveys to screen parkinsonism in poor-resource settings. Study III. Following a random multistage sampling of the households within the network of “Health Centers” with 374 subunits in all 22 urban districts of Tehran, 20,621 individuals answered the baseline checklist and the screening questionnaire developed in study II. Data from 19,500 persons aged ≥30 years were entered in the final analysis. A total number of 157 cases were positively screened for parkinsonism that resulted in age- and sex-adjustment prevalence rates of 222.9/100,000 (95% CI: 160-300) and 285/100,000 (95% CI: 240-329) based on the real Tehran population and “WHO World Standard Population”, respectively. The male/female ratio of probable parkinsonism was 1.62 and there was a steady increase by advancing age. The calculated rates for the prevalence of parkinsonism in our study are closer to the reports from some European and Middle-East countries, higher than reports from the Eastern Asian and African populations, and lower than Australia. The prevalence rate of >200/100,000 for parkinsonism in Tehran, Iran is considered as a medium-to-high rate. Study IV. Nutritional status was evaluated in 143 Iranian PD patients and 145 age- and sexmatched controls by means of the validated Persian version of the mini-nutritional assessment (MNA). The mean of total MNA score was not significantly different between the two groups [24.4 (SD=3.8) in controls vs. 25.1 (SD=3.4) in PD patients, p=0.094]. Three (2.1%) PD patients were suffering from malnutrition and another 37 (25.9%) were at risk of malnutrition; while in control group similar feature was observed (2.0% malnourished and 35.2% at risk of malnutrition, p=0.228). Our findings indicated similar nutritional status among mild-to-moderate PD patients and matched controls from the same community. However, nearly one third of PD population were either malnourished or at risk of malnutrition necessitating more attention towards nutritional assessment in PD. Study V. Factors affecting nutritional status were investigated in 150 PD patients including a comprehensive list of motor and non-motor scales. The total score of the Unified Parkinson's disease rating scale (UPDRS) scale (r=-0.613, p<0.001) and PD duration (r=-0.284, p=0.002) had a significant inverse correlation with the total MNA score. A higher Hoehn and Yahr stage [2.5 vs. 2.0, p<0.001], more severe anxiety [8.8 vs. 5.9, p=0.002], depression [9.0 vs. 3.6, p<0.001] and fatigue [5.4 vs. 4.2, p<0.001] were observed in PD patients with nutritional insufficiency. Except for stigma, all other domains of the HRQoL significantly correlated with the total MNA score. We showed that disease duration, severity of motor and psychiatric symptoms (depression, anxiety) and fatigue associated with nutritional status in PD, which itself affected different aspects of HRQoL especially the emotional well-being and mobility. Study VI. A broad spectrum of demographic, motor and non-motor characteristics were evaluated in 157 PD patients consisting of comorbidity profile, nutritional status, UPDRS (total items), psychiatric symptoms (depression, anxiety), fatigue and psychosocial functioning through physical examination, validated questionnaires and scales. Structural equation model (SEM) and multivariate regressions were applied to find determinants of Parkinson’s disease severity index (PDSI) and different domains of HRQoL (PDQ-39). Female sex, anxiety, depression and UPDRS-part II scores were the significant independent determinants of PDSI. A structural model consisting of global motor, global non-motor and co-morbidity indicator as three main components was able to predict 89% of the variance in HRQoL. However, outstanding heterogeneities in the pattern and determinants of HRQoL were found among different PD phenotypes. Conclusions. We showed a medium-to-high prevalence rate for suspicious parkinsonism in Iranian population living in the urban area of Tehran by means of a novel 6-item screening instrument. Similar nutritional status was found in mild-to-moderate PD patients and matched controls from the same community. Yet, approximately one third of people with mild-tomoderate PD were either malnourished or at risk of malnutrition. Duration of PD, severity of motor symptoms, depression, anxiety and fatigue associated with nutritional status in PD patients. Motor symptoms affecting activities of daily living (ADL), depression, anxiety and female sex were found to be the strongest independent determinants of HRQoL in Iranian PD population. Clear heterogeneities were found in the pattern and determinants of HRQoL in different PD phenotypes, which should be considered during the assessments and developing personalized interventions to improve life quality in PD patients with different prominent features

Caregiver distress in parkinsonism

This study examined the frequency and degree of caregiver burden in persons with parkinsonism, a group of disorders with four primary symptoms that include tremor, rigidity, postural instability, and bradykinesia. We assessed associations between perceived caregiver burden and physical, cognitive, and functional impairments using well-established tools for persons with parkinsonism. The 49 individuals with parkinsonism ranged in age from 61 to 87 (mean = 75), while their caregivers (N = 49) ranged in age from 48 to 83 (mean = 70). The caregivers were predominantly either wives (82%) or daughters (6%), with other family members, friends, and/or neighbors (12%) making up the rest. The caregivers reported a relatively high ability for coping (mean scores = 4.6/6). Caregiver burden was significantly negatively associated with activities of daily living and motoric difficulties as measured on the Unified Parkinson\u27s Disease Rating Scale (UPDRS). Likewise, caregiver burden was negatively associated with caregiver self-reported sleep and coping ability. Results did not demonstrate an association on the UPDRS among mentation, behavior, and mood. We found a significant negative correlation for mentation between the Folstein Mini-Mental Status Examination and caregiver burden measures; however, we did not find this association with the Dementia Rating Scale-2. Patient\u27s self-reported pain and caregiver burden were not associated

Mobile Health Technologies

Mobile Health Technologies, also known as mHealth technologies, have emerged, amongst healthcare providers, as the ultimate Technologies-of-Choice for the 21st century in delivering not only transformative change in healthcare delivery, but also critical health information to different communities of practice in integrated healthcare information systems. mHealth technologies nurture seamless platforms and pragmatic tools for managing pertinent health information across the continuum of different healthcare providers. mHealth technologies commonly utilize mobile medical devices, monitoring and wireless devices, and/or telemedicine in healthcare delivery and health research. Today, mHealth technologies provide opportunities to record and monitor conditions of patients with chronic diseases such as asthma, Chronic Obstructive Pulmonary Diseases (COPD) and diabetes mellitus. The intent of this book is to enlighten readers about the theories and applications of mHealth technologies in the healthcare domain