Ambulatory Monitoring of Activities and Motor Symptoms in Parkinson's Disease

Ambulatory monitoring of motor symptoms in Parkinson's disease (PD) can improve our therapeutic strategies, especially in patients with motor fluctuations. Previously published monitors usually assess only one or a few basic aspects of the cardinal motor symptoms in a laboratory setting. We developed a novel ambulatory monitoring system that provides a complete motor assessment by simultaneously analyzing current motor activity of the patient (e.g., sitting, walking, etc.) and the severity of many aspects related to tremor, bradykinesia, and hypokinesia. The monitor consists of a set of four inertial sensors. Validity of our monitor was established in seven healthy controls and six PD patients treated with deep brain stimulation (DBS) of the subthalamic nucleus. The patients were tested at three different levels of DBS treatment. Subjects were monitored while performing different tasks, including motor tests of the Unified PD Rating Scale (UPDRS). Output of the monitor was compared to simultaneously recorded videos. The monitor proved very accurate in discriminating between several motor activities. Monitor output correlated well with blinded UPDRS ratings during different DBS levels. The combined analysis of motor activity and symptom severity by our PD monitor brings true ambulatory monitoring of a wide variety of motor symptoms one step close

Ambulatory Monitoring of Activities and Motor Symptoms in Parkinson's Disease

Ambulatory monitoring of motor symptoms in Parkinson’s disease (PD) can improve our therapeutic strategies, especially in patients with motor fluctuations. Previously published monitors usually assess only one or a few basic aspects of the cardinal motor symptoms in a laboratory setting. We developed a novel ambulatory monitoring system that provides a complete motor assessment by simultaneously analyzing currentmotor activity of the patient (e.g., sitting, walking, etc.) and the severity of many aspects related to tremor, bradykinesia, and hypokinesia. The monitor consists of a set of four inertial sensors. Validity of our monitor was established in seven healthy controls and six PD patients treated with deep brain stimulation (DBS) of the subthalamic nucleus. The patients were tested at three different levels of DBS treatment. Subjects were monitored while performing different tasks, including motor tests of the Unified PD Rating Scale (UPDRS). Output of the monitor was compared to simultaneously recorded videos. The monitor proved very accurate in discriminating between several motor activities. Monitor output correlated well with blinded UPDRS ratings during different DBS levels. The combined analysis of motor activity and symptom severity by our PD monitor brings true ambulatory monitoring of a wide variety of motor symptoms one step closer

Relationship between quality of life and survival in patients with pancreatic and periampullary cancer: A multicenter cohort analysis

Patient-reported outcome measures (PROMs) are used increasingly in clinical practice to assess patients’ quality of life (QoL). Addressing QoL is important for patients with a short life expectancy, such as those with pancreatic and periampullary carcinoma, which has a median overall survival of 4 to 6 months.1 Different types of treatment that may improve survival in patients with pancreatic cancer may also impact QoL. Pancreatic resection has been found to be associated with a temporary deterioration in QoL, which usually returns to baseline values after 3 to 6 months.2,3 Moreover, chemotherapy has been found to improve QoL in randomized studies in the adjuvant and palliative setting.4,5 QoL may also be used to predict survival. Previous studies with other types of cancer (eg, breast, lung, esophageal, liver) consistently found a correlation between QoL and survival.6–11 Previous studies combined patients with different types of cancer, including a limited number (∼6%) of those with pancreatic cancer.9,10 Most of the data were acquired from randomized trials that included patients who were relatively fit. Only 1 case series of 55 patients with advanced pancreatic cancer suggested a prognostic relationship between the physical functioning scale scores of the EORTC Quality of Life Questionnaire-Core 30 (QLQ-C30) and survival.12 In the Netherlands, the Dutch Pancreatic Cancer Project (PACAP) was established in 2013. This is a multicenter cohort of patients with pancreatic and periampullary carcinoma for whom clinical data and PROMs are collected.13 We used this cohort to investigate the relationship between QoL and survival in daily clinical practice. The aim of this study was to examine which domains of QoL are predictive of survival in patients with pancreatic and periampullary cancer

Relationship Between Quality of Life and Survival in Patients With Pancreatic and Periampullary Cancer:A Multicenter Cohort Analysis

Patient-reported outcome measures (PROMs) are used increasingly in clinical practice to assess patients’ quality of life (QoL). Addressing QoL is important for patients with a short life expectancy, such as those with pancreatic and periampullary carcinoma, which has a median overall survival of 4 to 6 months.1 Different types of treatment that may improve survival in patients with pancreatic cancer may also impact QoL. Pancreatic resection has been found to be associated with a temporary deterioration in QoL, which usually returns to baseline values after 3 to 6 months.2,3 Moreover, chemotherapy has been found to improve QoL in randomized studies in the adjuvant and palliative setting.4,5 QoL may also be used to predict survival. Previous studies with other types of cancer (eg, breast, lung, esophageal, liver) consistently found a correlation between QoL and survival.6–11 Previous studies combined patients with different types of cancer, including a limited number (∼6%) of those with pancreatic cancer.9,10 Most of the data were acquired from randomized trials that included patients who were relatively fit. Only 1 case series of 55 patients with advanced pancreatic cancer suggested a prognostic relationship between the physical functioning scale scores of the EORTC Quality of Life Questionnaire-Core 30 (QLQ-C30) and survival.12 In the Netherlands, the Dutch Pancreatic Cancer Project (PACAP) was established in 2013. This is a multicenter cohort of patients with pancreatic and periampullary carcinoma for whom clinical data and PROMs are collected.13 We used this cohort to investigate the relationship between QoL and survival in daily clinical practice. The aim of this study was to examine which domains of QoL are predictive of survival in patients with pancreatic and periampullary cancer

Comparison of runaway electron generation parameters in small, medium-sized and large tokamaks - A survey of experiments in COMPASS, TCV, ASDEX-Upgrade and JET

This paper presents a survey of the experiments on runaway electrons (RE) carried out recently in frames of EUROFusion Consortium in different tokamaks: COMPASS, ASDEX-Upgrade, TCV and JET. Massive gas injection (MGI) has been used in different scenarios for RE generation in small and medium-sized tokamaks to elaborate the most efficient and reliable ones for future RE experiments. New data on RE generated at disruptions in COMPASS and ASDEX-Upgrade was collected and added to the JET database. Different accessible parameters of disruptions, such as current quench rate, conversion rate of plasma current into runaways, etc have been analysed for each tokamak and compared to JET data. It was shown, that tokamaks with larger geometrical sizes provide the wider limits for spatial and temporal variation of plasma parameters during disruptions, thus extending the parameter space for RE generation. The second part of experiments was dedicated to study of RE generation in stationary discharges in COMPASS, TCV and JET. Injection of Ne/Ar have been used to mock-up the JET MGI runaway suppression experiments. Secondary RE avalanching was identified and quantified for the first time in the TCV tokamak in RE generating discharges after massive Ne injection. Simulations of the primary RE generation and secondary avalanching dynamics in stationary discharges has demonstrated that RE current fraction created via avalanching could achieve up to 70-75% of the total plasma current in TCV. Relaxations which are reminiscent the phenomena associated to the kinetic instability driven by RE have been detected in RE discharges in TCV. Macroscopic parameters of RE dominating discharges in TCV before and after onset of the instability fit well to the empirical instability criterion, which was established in the early tokamaks and examined by results of recent numerical simulations