Self-reported gait unsteadiness in mildly impaired neurological patients: an objective assessment through statistical gait analysis

Background Self-reported gait unsteadiness is often a problem in neurological patients without any clinical evidence of ataxia, because it leads to reduced activity and limitations in function. However, in the literature there are only a few papers that address this disorder. The aim of this study is to identify objectively subclinical abnormal gait strategies in these patients. Methods Eleven patients affected by self-reported unsteadiness during gait (4 TBI and 7 MS) and ten healthy subjects underwent gait analysis while walking back and forth on a 15-m long corridor. Time-distance parameters, ankle sagittal motion, and muscular activity during gait were acquired by a wearable gait analysis system (Step32, DemItalia, Italy) on a high number of successive strides in the same walk and statistically processed. Both self-selected gait speed and high speed were tested under relatively unconstrained conditions. Non-parametric statistical analysis (Mann-Whitney, Wilcoxon tests) was carried out on the means of the data of the two examined groups. Results The main findings, with data adjusted for velocity of progression, show that increased double support and reduced velocity of progression are the main parameters to discriminate patients with self-reported unsteadiness from healthy controls. Muscular intervals of activation showed a significant increase in the activity duration of the Rectus Femoris and Tibialis Anterior in patients with respect to the control group at high speed. Conclusions Patients with a subjective sensation of instability, not clinically documented, walk with altered strategies, especially at high gait speed. This is thought to depend on the mechanisms of postural control and coordination. The gait anomalies detected might explain the symptoms reported by the patients and allow for a more focused treatment design. The wearable gait analysis system used for long distance statistical walking assessment was able to detect subtle differences in functional performance monitoring, otherwise not detectable by common clinical examination

Improving Sedative-Hypnotic Prescribing in Older Hospitalized Patients: Provider-Perceived Benefits and Barriers of a Computer-Based Reminder

Background: Older adults are commonly prescribed sedative-hypnotic (SH) medications when hospitalized, yet these drugs are associated with important adverse effects such as falls and delirium. Objective: To identify provider-perceived benefits or barriers of a computer-based reminder regarding appropriate use of SH medications. Design: Qualitative study using semi-structured interviews. Participants and setting: Thirty-six house staff physicians at a university hospital. Measurements: Information was collected regarding the experiences of prescribing an SH using a computer order entry system with a reminder intervention. Clinicians were asked about their perceptions of the reminder and what they found most and least useful about it. Responses were analyzed using grounded theory methodology. Results: The 36 participants (including 29 interns) had prescribed an SH medication for a hospitalized patient over age 65 years. Three themes associated with benefits of a computer reminder were identified: increasing awareness of safety, including risk of delirium, falls, and general patient safety risks; usefulness of information technology; and the value of the educational content, including geriatric pharmacology review and nonpharmacologic treatment options. Barriers included the demands of the reminder with regard to time needed to read the reminder, the role of clinician experience with regard to preserving clinical autonomy, and the information content of the reminder, including its being too basic or not relevant for a particular patient. The mean satisfaction rating for the reminder was 8.5 (±0.9 SD), with 10 indicating high satisfaction. Conclusions: Improving decision support systems involves an understanding of how clinicians respond to real-time strategies encouraging better prescribing

TL1A/DR3 axis involvement in the inflammatory cytokine network during pulmonary sarcoidosis

BACKGROUND: TNF-like ligand 1A (TL1A), a recently recognized member of the TNF superfamily, and its death domain receptor 3 (DR3), firstly identified for their relevant role in T lymphocyte homeostasis, are now well-known mediators of several immune-inflammatory diseases, ranging from rheumatoid arthritis to inflammatory bowel diseases to psoriasis, whereas no data are available on their involvement in sarcoidosis, a multisystemic granulomatous disease where a deregulated T helper (Th)1/Th17 response takes place. METHODS: In this study, by flow cytometry, real-time PCR, confocal microscopy and immunohistochemistry analyses, TL1A and DR3 were investigated in the pulmonary cells and the peripheral blood of 43 patients affected by sarcoidosis in different phases of the disease (29 patients with active sarcoidosis, 14 with the inactive form) and in 8 control subjects. RESULTS: Our results demonstrated a significant higher expression, both at protein and mRNA levels, of TL1A and DR3 in pulmonary T cells and alveolar macrophages of patients with active sarcoidosis as compared to patients with the inactive form of the disease and to controls. In patients with sarcoidosis TL1A was strongly more expressed in the lung than the blood, i.e., at the site of the involved organ. Additionally, zymography assays showed that TL1A is able to increase the production of matrix metalloproteinase 9 by sarcoid alveolar macrophages characterized, in patients with the active form of the disease, by reduced mRNA levels of the tissue inhibitor of metalloproteinase (TIMP)-1. CONCLUSIONS: These data suggest that TL1A/DR3 interactions are part of the extended and complex immune-inflammatory network that characterizes sarcoidosis during its active phase and may contribute to the pathogenesis and to the progression of the disease

Gait measurements in the transverse plane using a wearable system: An experimental study of test-retest reliability

3D gait analysis comprises the study of kinematics in the sagittal, coronal, and transverse planes. The transverse plane measurements are usually less used and generally show the lowest reliability. Nevertheless, the knee and ankle joint center trajectories, in the transverse plane, provide new parameters that may be important in clinical gait analysis. The aim of this study is to analyze the test-retest variability of these parameters. Gait measurements were performed using H-Gait, a wearable system based on magnetic and inertial sensors. A normal weight and an overweight subject were recruited and were asked to walk at their preferred speed for 6 trials. For both of them, the angle between the right and left knee and ankle joint center trajectories were analyzed. Overall, results showed a standard deviation across trials always lower than 2°. This small standard deviation was found also in the overweight subject, for whom it is usually challenging to obtain reliable gait measurements. In addition, a greater knee angle between the right and left joint center trajectories was found in the overweight subject compared to the normal weight. The promising results of this study suggest that the new parameters introduced might be suitable to assess gait of subjects with different anthropometric characteristics

Gait parameters of elderly subjects in single-task and dual-task with three different MIMU set-ups

The increasing average age of the population emphasizes the strong correlation between cognitive decline and gait disorders of elderly people. Wearable technologies such as magnetic inertial measurement units (MIMUs) have been ascertained as a suitable solution for gait analysis. However, the relationship between human motion and cognitive impairments should still be investigated, considering outcomes of different MIMU set-ups. Accordingly, the aim of the present study was to compare single-task and dual-task walking of an elderly population by using three different MIMU set-ups and correlated algorithms (trunk, shanks, and ankles). Gait sessions of sixteen healthy elderly subjects were registered and spatio-temporal parameters were selected as outcomes of interest. The analysis focused both on the comparison of walking conditions and on the evaluation of differences among MIMU set-ups. Results pointed out the significant effect of cognition on walking speed (p = 0.03) and temporal parameters (p ≤ 0.05), but not on the symmetry of gait. In addition, the comparison among MIMU configurations highlighted a significant difference in the detection of gait stance and swing phases (for shanks-ankles comparison p < 0.001 in both single and dual tasks, for trunk-ankles comparison p < 0.001 in single task and p < 0.01 in dual task). Overall, cognitive impact and MIMU set-ups revealed to be fundamental aspects in the analysis of gait spatio-temporal parameters in a healthy elderly population

Inelastic scattering of broadband electron wave packets driven by an intense mid-infrared laser field

Intense, 100 fs laser pulses at 3.2 and 3.6 um are used to generate, by multi-photon ionization, broadband wave packets with up to 400 eV of kinetic energy and charge states up to Xe+6. The multiple ionization pathways are well described by a white electron wave packet and field-free inelastic cross sections, averaged over the intensity-dependent energy distribution for (e,ne) electron impact ionization. The analysis also suggests a contribution from a 4d core excitation in xenon