Visualization-Driven Time-Series Extraction from Wearable Systems Can Facilitate Differentiation of Passive ADL Characteristics among Stroke and Healthy Older Adults

Wearable technologies allow the measurement of unhindered activities of daily living (ADL) among patients who had a stroke in their natural settings. However, methods to extract meaningful information from large multi-day datasets are limited. This study investigated new visualization-driven time-series extraction methods for distinguishing activities from stroke and healthy adults. Fourteen stroke and fourteen healthy adults wore a wearable sensor at the L5/S1 position for three consecutive days and collected accelerometer data passively in the participant’s naturalistic environment. Data from visualization facilitated selecting information-rich time series, which resulted in classification accuracy of 97.3% using recurrent neural networks (RNNs). Individuals with stroke showed a negative correlation between their body mass index (BMI) and higher-acceleration fraction produced during ADL. We also found individuals with stroke made lower activity amplitudes than healthy counterparts in all three activity bands (low, medium, and high). Our findings show that visualization-driven time series can accurately classify movements among stroke and healthy groups using a deep recurrent neural network. This novel visualization-based time-series extraction from naturalistic data provides a physical basis for analyzing passive ADL monitoring data from real-world environments. This time-series extraction method using unit sphere projections of acceleration can be used by a slew of analysis algorithms to remotely track progress among stroke survivors in their rehabilitation program and their ADL abilities

Validity of mannheim peritonitis index in predicting outcome of patients with perforative peritonitis in a tertiary care centre Kerala, India

Background: Perforation peritonitis is one of the most commonly encountered surgical emergencies in our country. The prognosis of secondary peritonitis remains poor despite development in diagnosis and management. Early identification of patients with severe peritonitis may help in selecting patients for aggressive surgical approach.Methods: The study was conducted in 128 cases of perforation peritonitis admitted and treated in the department of surgery in a tertiary care centre. Initial diagnosis was made on the basis of detailed history, clinical examination and presence of pneumoperitoneum on erect abdominal X-ray. Patients were first assessed using a predesigned Performa, then MPI score was calculated for each patient and the patients were followed-up till death or discharge from the hospital.Results: The ROC curve analysis shows area under the curve was 0.986 with a standard error of 0.008, 95% CI (0.971 to 1.001), p<0.0001. In our study authors found that for the MPI score of 26, sensitivity was 91.3% and specificity was 92.4%, with a positive likelihood ratio of 12.01 and a negative likelihood ratio of 0.09. Age of the patient, presence of organ failure, associated malignancy, generalised type of peritonitis and the original MPI Score has got a significant association with the final outcome (i.e. p value <0.05).Conclusions: MPI is an excellent prognostic index for peritonitis with high accuracy in individual prognosis that is cheap, cost effective, easily measurable and reproducible. The study accentuates that early diagnosis, appropriate resuscitation and prompt surgical intervention still remain the keystones in the management of perforation peritonitis

Consumer/patient Perception of the Quality of Health Care Service Delivery

In the field of health care, it was not until a decade ago that the consumer's viewpoint started to be given attention in the form of patient satisfaction studies. One criterion for assessing whether any service system is benefiting its recipients is simply the recipients' perceptions of whether or not their needs are being met. Thus, despite the public's lack of technical expertise in health care, patient perceptions are also an important factor in health care quality assessment. A model of the health care consumption process was used to conceptualize perceived quality as the consumer's evaluation of the quality of the health care service during the consumption stage. "Perceived quality" is conceptualized as being the result of a comparison of actual service received with the consumer's expectations, and is defined as a value judgment by the consumer of explicit aspects of the health care service. Consumers of health care base their evaluations of health care service quality on a number of attributes. This study was exploratory and investigated the composition and structure of the construct of "perceived quality." The findings of this study will prove useful to public policy makers and health care providers, in addition to academics in the disciplines of marketing and medical sociologyMarketin

The effect of medial unicompartmental knee replacements on the kinetic and kinematic parameters of the knee: The role of alignment and the effect of articular surface on regulation of medial compartment loading

Medial compartment loading is a significant factor in the progression of medial compartment osteoarthritis and medial unicompartmental replacement arthroplasty is a popular surgical treatment for medial unicompartmental knee osteoarthritis. However, there is no consensus on importance of alignment in medial unicompartmental knee replacement in orthopaedic literature. Static alignment measures like Hip Knee Ankle (HKA) angle and location of mechanical axis (MA) on the tibial plateau are known to affect loading of the knee. In addition, Peak knee adduction moment (PKAM) and angular adduction impulse (Add Imp) measured on instrumented gait analysis are recognised proxies for medial compartment loading especially in the coronal plane. A review of ninety four unicompartmental knee replacements revealed that survivorship at 10 years was 94% and at 15 years was 87%. Significantly better (p<0.01) function scores as measured by the 50 point Bristol Knee score was demonstrated in knees with good alignment where the mechanical axis passed through zones 0 or 1. An investigation into 18 medial unicompartmental knee replacements resulted in a statistically significant improvement in all domains of WOMAC score and the modified knee society score. Medial unicompartmental replacement arthroplasty resulted in a statistically significant improvement in gait velocity (p<0.01) and double limb support time (p <0.001). Further investigations into the kinetic and kinematic parameters showed excellent reliability. The coronal plane kinetics, peak knee adduction moments (ICC = 0.99), sagittal plane kinematics, flexion (ICC =0.98), sagittal plane plane kinetics, flexion extension moment (ICC =0.87), transverse plane kinematics, rotation (ICC=0.87) and transverse plane kinetics, rotation moment (ICC =0.76) showed excellent reliability as per Fleiss’s classification for intra class coefficients. Only coronal plane kinematics, varus valgus (ICC= 0.66) did not fall into the excellent category, but was still considered good. The coronal plane loading parameters improved significantly following medial unicompartmental replacement (p<0.05). The reduction in loading was related to the correction in alignment. The only sagittal plane kinetic parameter that improved significantly following medial unicompartmental replacement was the early stance extension moment (p ii! ! =0.05). The transverse plane kinetics, sagittal, coronal and transverse plane kinematics did not show statistically significant differences between the preoperative and postoperative groups.On single regression analysis, the mean adduction angle (MAA, p= 0.007) was a better predictor of coronal plane loading in the preoperative group, while the Hip Knee Ankle angle (HKA, p=0.01) was the better predictor in the postoperative group. As the adduction moments between individual knees was variable between knees even though normalised for height and weight, the percentage improvement in PKAM (%ΔPKAM) and Add Imp (%ΔAdd. Imp) was used for further analysis. On multiple regression, the effect of change of HKA (ΔHKA) was more significant (p = 3.5E-09) on %ΔAdd. Imp, than ΔMAA (p = 0.01). The correction in HKA was a significant predictor of improvement in the Add Imp (r2 = 0.90) and PKAM (r2 = 0.50). For every one degree correction of static alignment (HKA) a 7% improvement can be achieved in coronal plane loading (Add Imp). On comparison of coronal and transverse plane loading data between the asymptomatic non arthritic knees and replaced knees in this group of participants, the adduction moment curve, parameters like PKAM, Add Imp and rotation moments were nearly identical, implying that articular surfaces, does not seem to have a significant effect on the regulation of its own loading. The improvement of loading with correction of alignment is likely to have an impact on wear and subsequent survivorship of the prosthesis

Biomechanical analysis of tension band wiring (TBW) of transverse fractures of patella

Abstract Purpose Tension band wiring is commonly used for fixation of simple transverse fractures. The popular configuration is parallel Kirschner wires (K-wires) and a stainless steel wire loop placed in a vertically oriented figure-of-8. Methods We used a wooden model of a patella with a midway transverse fracture and compared four different types of fixation. The first construct had a vertical figure-of-8 with one twist of wire. The second contained a vertical figure-of-8 with two twists of wire. The third was a vertical figure-of-8 with two twists of wire placed at adjacent corners while the last one had a horizontal figure-of-8 with two twists of wire placed at adjacent corners. Interfragmentary compression at the point of wire breakage was measured for each construct as well as permanent displacement on cyclic loading. Results Placement of the figure-of-eight in a horizontal orientation with two wire twists at the corner improved interfragmentary compression by 63% (p < 0.05, Tukey post hoc test). On cyclic loading, all the constructs with vertical figure-of-eight but none with a horizontal construct failed (p = 0.01; Fisher's exact test). Permanent fracture displacement after cyclic loading was 67% lower with horizontal figure-of-eight constructs (p < 0.05; t test). Conclusion Placing wire twists at the corner and a horizontal placement of figure-of-8 improves stability of the construct

Single infrastructure utility provision to households: Technological feasibility study

This paper contemplates the future of utility infrastructure, and considers whether an “All-in-One” approach could supply all necessary utility services to tomorrow's households. The intention is not to propose infrastructure solutions that are currently technically feasible or justifiable, however; the objective is to present visions of future infrastructure that would only be possible with new advances in science and technology, or significant improvements and adaptations of existing knowledge and techniques. The All-in-One vision is explored using several vignettes, each of which envisions a novel, multi-functional infrastructure for serving future communities. The vignettes were conceived using imaginative exercises and brain-storming activities; each was then rooted in technological and scientific feasibility, as informed by extensive literature searches and the input of domain leaders. The vignettes tell their own stories, and we identify the challenges that would need to be overcome to make these visions into reality. The main aim of this work is to encourage radical approaches to thinking about future infrastructure provision, with a focus on rationalisation, efficiency, sustainability and resilience in preparation for the challenging times ahead. The All-in-One concept introduces the possibility of a unified and singular system for infrastructure service provision; this work seeks to explore the possibility space opened thereby

UBQLN2 mediates autophagy-independent protein aggregate clearance by the proteasome

Clearance of misfolded and aggregated proteins is central to cell survival. Here, we describe a new pathway for maintaining protein homeostasis mediated by the proteasome shuttle factor UBQLN2. The 26S proteasome degrades polyubiquitylated substrates by recognizing them through stoichiometrically bound ubiquitin receptors, but substrates are also delivered by reversibly bound shuttles. We aimed to determine why these parallel delivery mechanisms exist and found that UBQLN2 acts with the HSP70-HSP110 disaggregase machinery to clear protein aggregates via the 26S proteasome. UBQLN2 recognizes client-bound HSP70 and links it to the proteasome to allow for the degradation of aggregated and misfolded proteins. We further show that this process is active in the cell nucleus, where another system for aggregate clearance, autophagy, does not act. Finally, we found that mutations in UBQLN2, which lead to neurodegeneration in humans, are defective in chaperone binding, impair aggregate clearance, and cause cognitive deficits in mice