Clinical features of pneumonia in extreme old age

The clinical features of 70 people over the age of 85 with radiologically positive pneumonia were studied. It was shown that the classical presenting symptoms of pneumonia were often absent and 81 % had one or more acute ’geriatric’ features such as acute confusion, recent onset of falls, recent worsening immobility or recent onset of incontinence, at the time of presentation. An increased risk of mortality was associated with acute confusion, dementia, central cyanosis and long term immobility. Well kept body temperature and respiratory rate charts provide a useful early warning of possible pneumonia in very elderly in patients and the finding of a raised body temperature with a raised respiratory rate should always prompt the need to rule out lower respiratory tract infection.peer-reviewe

Relationalism about mechanics based on a minimalist ontology of matter

This paper elaborates on relationalism about space and time as motivated by a minimalist ontology of the physical world: there are only matter points that are individuated by the distance relations among them, with these relations changing. We assess two strategies to combine this ontology with physics, using classical mechanics as example: the Humean strategy adopts the standard, non-relationalist physical theories as they stand and interprets their formal apparatus as the means of bookkeeping of the change of the distance relations instead of committing us to additional elements of the ontology. The alternative theory strategy seeks to combine the relationalist ontology with a relationalist physical theory that reproduces the predictions of the standard theory in the domain where these are empirically tested. We show that, as things stand, this strategy cannot be accomplished without compromising a minimalist relationalist ontology

Blood lead levels in pregnant women and the neonate

Population studies carried out during the 1980s had shown that the Maltese population was characterized by high blood lead (PbB) levels. These high levels appeared to be a feature at all age groups including neonates. A number of environmental control measures had been initiated to attempt to decrease these PbB levels. The present study reviews PbB levels in pregnant women and newborns. It is shown that mean cord PbB levels decreased significantly in the last decade from a mean of 165.1 + 87.9 ug/I in 1985 to 89.79 + 31.23 ug/I in 1996. This decrease did not correlate with the increasing use of multimineral supplements which include the zinc cation said to be useful to counter the effects of chronic lead intoxication. Placental transfer of lead is also shown to follow closely maternal levels with a correlation coefficient of 0.81. In spite of the apparent decrease in PbB levels, about half of newborns still I have levels which require preventive community measures.peer-reviewe

A Proposal for a Bohmian Ontology of Quantum Gravity

The paper shows how the Bohmian approach to quantum physics can be applied to develop a clear and coherent ontology of non-perturbative quantum gravity. We suggest retaining discrete objects as the primitive ontology also when it comes to a quantum theory of space-time and therefore focus on loop quantum gravity. We conceive atoms of space, represented in terms of nodes linked by edges in a graph, as the primitive ontology of the theory and show how a non-local law in which a universal and stationary wave-function figures can provide an order of configurations of such atoms of space such that the classical space-time of general relativity is approximated. Although there is as yet no fully worked out physical theory of quantum gravity, we regard the Bohmian approach as setting up a standard that proposals for a serious ontology in this field should meet and as opening up a route for fruitful physical and mathematical investigations

An Automatic Gait Feature Extraction Method for Identifying Gait Asymmetry Using Wearable Sensors

This paper aims to assess the use of Inertial Measurement Unit (IMU) sensors to identify gait asymmetry by extracting automatic gait features. We design and develop an android app to collect real time synchronous IMU data from legs. The results from our method are validated using a Qualisys Motion Capture System. The data are collected from 10 young and 10 older subjects. Each performed a trial in a straight corridor comprising 15 strides of normal walking, a turn around and another 15 strides. We analyse the data for total distance, total time, total velocity, stride, step, cadence, step ratio, stance, and swing. The accuracy of detecting the stride number using the proposed method is 100% for young and 92.67% for older subjects. The accuracy of estimating travelled distance using the proposed method for young subjects is 97.73% and 98.82% for right and left legs; and for the older, is 88.71% and 89.88% for right and left legs. The average travelled distance is 37.77 (95% CI ± 3.57) meters for young subjects and is 22.50 (95% CI ± 2.34) meters for older subjects. The average travelled time for young subjects is 51.85 (95% CI ± 3.08) seconds and for older subjects is 84.02 (95% CI ± 9.98) seconds. The results show that wearable sensors can be used for identifying gait asymmetry without the requirement and expense of an elaborate laboratory setup. This can serve as a tool in diagnosing gait abnormalities in individuals and opens the possibilities for home based self-gait asymmetry assessment

Geriatric medicine learning objectives and entrustable professional activities in undergraduate medical curricula: a scoping review.

BACKGROUND entrustable professional activities (EPAs) have become an important component of competency-based medical education. The aim of this study is to evaluate how geriatric medicine learning objectives are addressed by undergraduate medical curricula including EPAs. METHODS we performed a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines to identify undergraduate medical curricula that include EPAs. A content analysis was conducted to examine how these curricula address the care of older individuals. In addition, we mapped the curricula to 19 geriatric medicine learning objectives identified from the European curriculum of undergraduate medical education. RESULTS we found nine curricula, each containing between 4 and 16 core EPAs. In the sections describing the EPAs, three of the nine curricula specify that all core EPAs apply to all age groups including older patients, whereas the remaining six curricula either only refer to older patients in selected EPAs or not at all. Mapping revealed that some geriatric medicine learning objectives are covered by most curricula (e.g. medication use, multidisciplinary team work), whereas others are lacking in the majority (e.g. normal ageing, geriatric assessment, cognitive assessment, nutrition assessment, decision-making capacity assessment, long-term care). Three curricula cover most geriatric learning objectives by using a matrix aligning EPAs with geriatric competencies. CONCLUSIONS geriatric learning objectives continue to be missing from undergraduate medical curricula, also from those adopting the novel approach of EPAs. However, this review also identified some curricula that might serve as models for how geriatric learning objectives can be successfully covered within future EPA frameworks

Gait Evaluation Using Procrustes and Euclidean Distance Matrix Analysis

Objective assessment of gait is important in the treatment and rehabilitation of patients with different diseases. In this paper, we propose a gait evaluation system using Procrustes and Euclidean distance matrix analysis. We design and develop an android app to collect real time synchronous accelerometer and gyroscope data from two Inertial Measurement Unit (IMU) sensors through Bluetooth connectivity. The data is collected from 12 young (10 for modelling and 2 for validation) and 20 older subjects. We analyse the data collected from real world for stride, step, stance and swing gait features. We validate our method with measurements of gait features. Generalized Procrustes analysis is used to estimate a standard normal mean gait shape (NMGS) for 10 young subjects. Each gait feature of both young and older subjects is then converted to find the best match with the NMGS using ordinary Procrustes analysis. The shape distance between the NMGS and each gait shape is estimated using Riemannian shape distance, Riemannian size-and-shape distance, Procrustes size-and-shape distance and Root mean square deviation. A t-test is performed to provide statistical evidence of gait shape differences between young and older gaits. A mean form which is considered as a standard normal mean gait form (NMGF) and inter-feature distances are estimated from the set of 10 young subjects. The form difference is estimated between the NMGF and individual gaits of young and older. The degree of abnormality is then estimated for individual features and the result is plotted to visualize the feature in a gait. Experimental results demonstrate the performance of the proposed method

Validity and Consistency of Concurrent Extraction of Gait Features Using Inertial Measurement Units and Motion Capture System

Conditions causing gait abnormalities are very common and their treatment requires the detailed assessment of gait. Currently such assessments are carried out in gait laboratories and require the use of complex and expensive equipment. To increase availability and use at home and clinics, we design and develop an affordable, user friendly, wireless, portable automatic system to extract spatiotemporal features of gait that can be used indoors and outdoors. This study determines the concurrent validity of extracted gait features from Inertial Measurement Units (IMUs) against ‘gold standard’ Motion Capture System (MoCap) using a hybrid gait features extraction method. The analysis of the proposed method is based on minimum prominence and abrupt transition points in the IMU signals. We also compare the degree of agreement for mean spatiotemporal gait features. The concurrent data from synchronized IMUs and MoCap are collected from 18 subjects. We validate our proposed system using two experiments; 1) IMU and MoCap with self-selected (free) walking and 2) IMU and MoCap at various walking speeds. Interclass correlations, Lin’s concordance correlation coefficients and Pearson’s correlation coefficients (r) are applied to determine the correlation between extracted gait features from IMU and MoCap measurements. Bland-Altman plots are also generated to evaluate any unknown bias between the mean extracted features. The experiments show that spatiotemporal features of gait extracted from IMUs are highly valid. Our methods facilitate gait assessment in clinics and at home including the possibility of self-assessment

Orion Suit Loop Variable Pressure Regulator Development

The Orion Multi Purpose Crew Vehicle (MPCV) integrates the cabin and pressure suits with the core life support systems to provide life support during contingency depressurized cabin operations. To provide the multipule suit pressures between nominal pressurized cabin suited operations, suit leak checks, depressurized cabin suited operations, and elevated suit pressure for denitrification, a variable pressure regulator is needed. This paper documents the development and integrated testing of the suit loop regulator for Orion

LDV Measurement of Confined Parallel Jet Mixing

Laser Doppler Velocimetry (LDV) measurements were taken in a confinement, bounded by two parallel walls, into which issues a row of parallel jets. Two-component measurements were taken of two mean velocity components and three Reynolds stress components. As observed in isolated three dimensional wall bounded jets, the transverse diffusion of the jets is quite large. The data indicate that this rapid mixing process is due to strong secondary flows, transport of large inlet intensities and Reynolds stress anisotropy effects