scholarly journals Crossing Virtual Doors: A New Method to Study Gait Impairments and Freezing of Gait in Parkinson’s Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Luis I. Gómez-Jordana ◽  
James Stafford ◽  
C. (Lieke) E. Peper ◽  
Cathy M. Craig
Keyword(s):  
Real World ◽  
Ecological Validity ◽  
Freezing Of Gait ◽  
Real Life ◽  
Step Length ◽  
Gait Variability ◽  
Healthy Controls ◽  
Real World Setting ◽  
History Of ◽  
Gait Impairments

Studying freezing of gait (FOG) in the lab has proven problematic. This has primarily been due to the difficulty in designing experimental setups that maintain high levels of ecological validity whilst also permitting sufficient levels of experimental control. To help overcome these challenges, we have developed a virtual reality (VR) environment with virtual doorways, a situation known to illicit FOG in real life. To examine the validity of this VR environment, an experiment was conducted, and the results were compared to a previous “real-world” experiment. A group of healthy controls (N = 10) and a group of idiopathic Parkinson disease (PD) patients without any FOG episodes (N = 6) and with a history of freezing (PD-f, N = 4) walked under three different virtual conditions (no door, narrow doorway (100% of shoulder width) and standard doorway (125% of shoulder width)). The results were similar to those obtained in the real-world setting. Virtual doorways reduced step length and velocity while increasing general gait variability. The PD-f group always walked slower, with a smaller step length, and showed the largest increases in gait variability. The narrow doorway induced FOG in 66% of the trials, while the standard doorway caused FOG in 29% of the trials. Our results closely mirrored those obtained with real doors. In short, this methodology provides a safe, personalized yet adequately controlled means to examine FOG in Parkinson’s patients, along with possible interventions.

Neuropsychology in the Real World

2014 ◽  
Vol 25 (4) ◽  
pp. 233-238 ◽  
Author(s):  
Martin Peper ◽  
Simone N. Loeffler
Keyword(s):  
Neuropsychological Assessment ◽  
Real World ◽  
Ecological Validity ◽  
Real Life ◽  
Emotional States ◽  
Context Sensitive ◽  
Traditional Assessment ◽  
Life Data ◽  
Real Life Data ◽  
Assessment And Treatment

Current ambulatory technologies are highly relevant for neuropsychological assessment and treatment as they provide a gateway to real life data. Ambulatory assessment of cognitive complaints, skills and emotional states in natural contexts provides information that has a greater ecological validity than traditional assessment approaches. This issue presents an overview of current technological and methodological innovations, opportunities, problems and limitations of these methods designed for the context-sensitive measurement of cognitive, emotional and behavioral function. The usefulness of selected ambulatory approaches is demonstrated and their relevance for an ecologically valid neuropsychology is highlighted.

scholarly journals Applications of Wearable Technology in a Real-Life Setting in People with Knee Osteoarthritis: A Systematic Scoping Review

2021 ◽  
Vol 10 (23) ◽  
pp. 5645
Author(s):  
Tomasz Cudejko ◽  
Kate Button ◽  
Jake Willott ◽  
Mohammad Al-Amri
Keyword(s):  
Knee Osteoarthritis ◽  
Real World ◽  
Real Life ◽  
Wearable Technology ◽  
Physical Activity Assessment ◽  
Activity Assessment ◽  
Real World Setting ◽  
Real Life Setting ◽  
Clinical Potential ◽  
Provision Of Care

With the growing number of people affected by osteoarthritis, wearable technology may enable the provision of care outside a traditional clinical setting and thus transform how healthcare is delivered for this patient group. Here, we mapped the available empirical evidence on the utilization of wearable technology in a real-world setting in people with knee osteoarthritis. From an analysis of 68 studies, we found that the use of accelerometers for physical activity assessment is the most prevalent mode of use of wearable technology in this population. We identify low technical complexity and cost, ability to connect with a healthcare professional, and consistency in the analysis of the data as the most critical facilitators for the feasibility of using wearable technology in a real-world setting. To fully realize the clinical potential of wearable technology for people with knee osteoarthritis, this review highlights the need for more research employing wearables for information sharing and treatment, increased inter-study consistency through standardization and improved reporting, and increased representation of vulnerable populations.

Examination of PD-1/PD-L1 inhibitor use and adverse events in a real-world setting.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19294-e19294
Author(s):  
Debra E. Irwin ◽  
Brenna L. Brady
Keyword(s):  
Adverse Events ◽  
Real World ◽  
Metastatic Cancer ◽  
Immune Checkpoint Blockade ◽  
Administrative Claims ◽  
Treatment Results ◽  
Real World Setting ◽  
Common Diagnosis ◽  
History Of

e19294 Background: Immune checkpoint blockade through PD-1 and PD-L1 inhibition is an effective treatment for multiple cancers. This study used administrative claims to examine potential adverse events (AEs) associated with real-world PD-1 or PD-L1 inhibitor use. Methods: Adult patients newly initiating a PD-1 (pembrolizumab or nivolumab) or PD-L1 (atezolizumab, avelumab, or durvalumab) inhibitor from September 1, 2016 to August 30, 2018 were selected in the MarketScan Commercial and Medicare Supplemental Database. Patients were grouped by use of PD-1 or PD-L1 inhibitor; the study period consisted of 90 days baseline and 60 days follow-up around drug initiation. Patients who used both PD-1 and PD-L1 inhibitors during follow-up were excluded. Clinical characteristics were examined during baseline, while AEs were investigated over follow-up. Results: A total of 6,430 patients qualified for the analysis. The majority of the sample (N = 5,956; 93%) received PD-1 inhibitors. Compared to the PD-1 cohort, the PD-L1 cohort was older (64±10 vs. 61±12 yrs) and more likely to be male (61% vs. 56%), p < 0.05. PD-L1 patients were significantly more likely to have history of chronic pulmonary disease (28% vs. 23%) or myocardial infarction (4% vs. 3%) but less likely to have liver disease (2% vs. 0.6%) compared to PD-1 patients, p < 0.05. Lung cancer was the most common diagnosis in both groups (PD-1: 47%; PD-L1: 62%, p < 0.001). The PD-L1 cohort was more likely to have evidence of bladder cancer (36% vs. 5%), while the PD-1 cohort was more likely to have a melanoma (19% vs. 0.8%) or renal cell carcinoma diagnosis (10% vs. 7%), p < 0.05. Over half of the PD-1 (65%) and PD-L1 (61%) patients had metastatic cancer diagnosis during the study period. Incident AEs occurring in > 5% of the sample included dyspnea (PD-1: 13%; PD-L1: 14%), nausea/vomiting (PD-1: 11%; PD-L1: 8%, p < 0.05), anemia (PD-1: 11%; PD-L1: 12%), fatigue (PD-1: 10%; PD-L1: 12%), abdominal pain (PD-1: 7%; PD-L1: 7%), cough (PD-1: 7%; PD-L1: 10%, p < 0.05), back pain (PD-1: 7%; PD-L1: 10%, p < 0.05), constipation (PD-1: 6%; PD-L1: 8%), arthralgia (PD-1: 6%; PD-L1: 6%), pyrexia (PD-1: 5%; PD-L1: 8%, p < 0.01), and edema (PD-1: 6%; PD-L1: 5%). Conclusions: This study assessed real-world AEs associated with PD-1/PD-L1 inhibitor use in the 60 days following first treatment. Results showed AEs are common soon after starting therapy. Although, PD-1 and PD-L1 inhibitors target the same pathway, slightly different AE profiles exist for the two classes. More longitudinal analyses of real-world AEs are needed to better understand potential impacts of prolonged therapy.

The Sexual Double Standard in the Real World

2019 ◽  
Vol 50 (2) ◽  
pp. 67-79 ◽  
Author(s):  
Michael J. Marks ◽  
Tara M. Young ◽  
Yuliana Zaikman
Keyword(s):  
Real World ◽  
Ecological Validity ◽  
Real Life ◽  
Double Standard ◽  
Sexual Partners ◽  
Sexual History ◽  
Sexual Double Standard ◽  
Female Friend ◽  
Number Of Sexual Partners ◽  
The Relationship

Abstract. The sexual double standard (SDS) has traditionally been studied by examining evaluations of hypothetical targets. Although much knowledge has been gained regarding the SDS by using this methodology, the literature thus far has suffered from a lack of ecological validity. The goal of the present study was to determine whether the SDS emerged in evaluations of participants’ real-life friends and acquaintances. Participants ( n = 4,455) evaluated a single, randomly assigned male or female friend or acquaintance whose sexual history they were familiar with. Women were evaluated more negatively as their number of sexual partners increased, whereas number of partners was not related to evaluations of men. The SDS was not moderated by the closeness of the relationship between the participant and the target person.

scholarly journals The Impact of Environment on Gait Assessment: Considerations from Real-World Gait Analysis in Dementia Subtypes

Sensors ◽  
2021 ◽  
Vol 21 (3) ◽  
pp. 813
Author(s):  
Ríona Mc Ardle ◽  
Silvia Del Din ◽  
Paul Donaghy ◽  
Brook Galna ◽  
Alan J Thomas ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Real World ◽  
Lewy Bodies ◽  
Step Length ◽  
Clinical Tool ◽  
The Real ◽  
Gait Assessment ◽  
Gait Characteristics ◽  
The Impact ◽  
Gait Impairments

Laboratory-based gait assessments are indicative of clinical outcomes (e.g., disease identification). Real-world gait may be more sensitive to clinical outcomes, as impairments may be exaggerated in complex environments. This study aims to investigate how different environments (e.g., lab, real world) impact gait. Different walking bout lengths in the real world will be considered proxy measures of context. Data collected in different dementia disease subtypes will be analysed as disease-specific gait impairments are reported between these groups. Thirty-two people with cognitive impairment due to Alzheimer’s disease (AD), 28 due to dementia with Lewy bodies (DLB) and 25 controls were recruited. Participants wore a tri-axial accelerometer for six 10 m walks in lab settings, and continuously for seven days in the real world. Fourteen gait characteristics across five domains were measured (i.e., pace, variability, rhythm, asymmetry, postural control). In the lab, the DLB group showed greater step length variability (p = 0.008) compared to AD. Both subtypes demonstrated significant gait impairments (p < 0.01) compared to controls. In the real world, only very short walking bouts (<10 s) demonstrated different gait impairments between subtypes. The context where walking occurs impacts signatures of gait impairment in dementia subtypes. To develop real-world gait assessment as a clinical tool, algorithms and metrics must accommodate for changes in context.

scholarly journals Challenges of Applying the SHEA/HICPAC Metrics for Multidrug-Resistant Organisms to a Real-World Setting

2011 ◽  
Vol 32 (4) ◽  
pp. 323-332 ◽  
Author(s):  
E. Yoko Furuya ◽  
Elaine Larson ◽  
Timothy Landers ◽  
Haomiao Jia ◽  
Barbara Ross ◽  
...  
Keyword(s):  
At Risk ◽  
Real World ◽  
Multidrug Resistant ◽  
Prior History ◽  
Real World Setting ◽  
Significant Difference ◽  
Multidrug Resistant Organisms ◽  
History Of ◽  
Mrsa Infection ◽  
Not At Risk

Objective.To test in a real-world setting the recommendations for measuring infection with multidrug-resistant organisms (MDRO) from the Society for Healthcare Epidemiology of America (SHEA) and the Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee (HICPAC).Methods.Using data from 3 hospital settings within a healthcare network, we applied the SHEA/HICPAC recommendations to measure methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization. Data were obtained from the hospitals' electronic surveillance system and were supplemented by manual medical record review as necessary. Additionally, we tested (1) different definitions for nosocomial incidence, (2) the effect of excluding patients not at risk from the denominator for hospital-onset incidence, and (3) the appropriate time period to use when including or excluding patients with a prior history of MRSA infection or colonization from nosocomial rates. Negative binomial regression models were used to test for differences between rate definitions. A rating scale was created for each metric, assessing the extent to which manual or electronic data elements were required.Results.There was no statistically significant difference between using 72 hours or 3 calendar days as the cutoff to define hospital-onset incidence. Excluding patients not at risk from the denominator when calculating hospital-onset incidence led to statistically significant increases in rates. When excluding patients with a prior history of MRSA infection or colonization from nosocomial incidence rates, rates were similar regardless of whether we looked at 1, 2, or 3 years' worth of prior data.Conclusions.The SHEA/HICPAC MDRO metrics are useful but can be challenging to implement. We include in our description of the data sources and processes required to calculate these metrics information that may simplify the process for institutions.

scholarly journals Ethnic Variance in Prevalence of COPD among Smokers in a Real World Setting

2020 ◽  
Vol 14 (1) ◽  
pp. 93-98
Author(s):  
Akshar Aiyer ◽  
Salim Surani ◽  
Raymond Aguillar ◽  
Munish Sharma ◽  
Mohammed Ali ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Real World ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Community Based ◽  
Obstructive Pulmonary Disease ◽  
Real World Setting ◽  
Hispanic Patients ◽  
History Of ◽  
Threshold Criteria

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent and progressive airflow limitation generally caused by prolonged cigarette smoking. Ethnic differences have been reported regarding COPD risk from smoking. The purpose of this study was to compare COPD prevalence in Hispanic and Caucasian smokers in a real-world setting. We studied consecutive patients referred to the community-based pulmonary practice. Hispanic and Caucasian smokers were included in the study. Methods: The clinical diagnosis of COPD was recorded from the chart. COPD was defined by PFT using GOLD criteria. Exclusion criteria were other ethnicities, non-smokers, and patients with a history of asthma /other pulmonary conditions. We reviewed a total of 1,313 consecutive PFTs of which 797 patients met our inclusion criteria. Results and Discussion: The prevalence of COPD among Hispanics was found to be lower by both clinical diagnosis as well as by spirometry compared to Caucasians (41.6% vs 54.2%). In Hispanics, clinical diagnosis was 91% higher by PFT, whereas for Caucasians, it was 6% lower. The odds of developing COPD (diagnosed based on FEV1/FVC ratio <70%) in the Caucasians are 4.1 times higher than Hispanics (Odds Ratio: 4.1; 95%CI: 2.8-5.9). Hispanic smokers have a lower prevalence of COPD both by the clinical diagnosis as well as by PFT. There is a significant disconnection between clinical and PFT diagnosis of COPD in Hispanic patients. Conclusion: The genetic basis of lower COPD risk and prevalence in Hispanics needs to be better understood. Spirometry threshold criteria for confirming a diagnosis of COPD may need to be modified based on ethnicity in clinical practice.

scholarly journals Towards ecologically valid biomarkers: real-life gait assessment in cerebellar ataxia

2019 ◽  
Author(s):  
Winfried Ilg ◽  
Jens Seemann ◽  
Martin Giese ◽  
Andreas Traschütz ◽  
Ludger Schöls ◽  
...  
Keyword(s):  
Inertial Sensors ◽  
Wearable Sensors ◽  
Real Life ◽  
Movement Analysis ◽  
High Sensitivity ◽  
Step Length ◽  
Gait Variability ◽  
Effect Sizes ◽  
Ataxic Gait ◽  
Disease Modifying Drugs

AbstractBACKGROUNDWith disease-modifying drugs on the horizon for degenerative ataxias, motor biomarkers are highly warranted. While ataxic gait and its treatment-induced improvements can be captured in laboratory-based assessments, quantitative markers of ataxic gait in real life will help to determine ecologically meaningful improvements.OBJECTIVESTo unravel and validate markers of ataxic gait in real life by using wearable sensors.METHODSWe assessed gait characteristics of 43 patients with degenerative cerebellar disease (SARA:9.4±3.9) compared to 35 controls by 3 body-worn inertial sensors in three conditions: (1) laboratory-based walking; (2) supervised free walking; (3) real-life walking during everyday living (subgroup n=21). Movement analysis focussed on measures of movement smoothness and spatio-temporal step variability.RESULTSA set of gait variability measures was identified which allowed to consistently identify ataxic gait changes in all three conditions. Lateral step deviation and a compound measure of step length categorized patients against controls in real life with a discrimination accuracy of 0.86. Both were highly correlated with clinical ataxia severity (effect size ρ=0.76). These measures allowed detecting group differences even for patients who differed only 1 point in the SARAp&g subscore, with highest effect sizes for real-life walking (d=0.67).CONCLUSIONSWe identified measures of ataxic gait that allowed not only to capture the gait variability inherent in ataxic gait in real life, but also demonstrate high sensitivity to small differences in disease severity - with highest effect sizes in real-life walking. They thus represent promising candidates for quantitative motor markers for natural history and treatment trials in ecologically valid contexts.

scholarly journals Landmark-Based Navigation Instructions Improve Incidental Spatial Knowledge Acquisition in Real-World Environments

2019 ◽  
Author(s):  
Anna Wunderlich ◽  
Klaus Gramann
Keyword(s):  
Knowledge Acquisition ◽  
Real World ◽  
Interactive Video ◽  
Ecological Validity ◽  
Real Life ◽  
Spatial Knowledge ◽  
Cued Recall ◽  
Route Knowledge ◽  
Assisted Navigation ◽  
Spatial Knowledge Acquisition

AbstractThe repeated use of navigation assistance systems leads to decreased processing of the environment. Previous studies demonstrated that auditory augmentation of landmarks in navigation instructions can improve incidental spatial knowledge acquisition when driving a single route through an unfamiliar virtual environment. Based on these results, three experiments were conducted to investigate the generalizability and ecological validity of incidental spatial knowledge acquisition by landmark augmentation in navigation instructions.In the first experiment, spatial knowledge acquisition was tested after watching an interactive video showing the navigation of a real-world urban route. A second experiment investigated incidental spatial knowledge acquisition during assisted navigation when participants walked through the same real-world, urban environment. The third experiment tested the acquired spatial knowledge two weeks after an assisted pedestrian navigation phase through the real-world.All experiments demonstrated better performance in a cued-recall task for participants navigating with landmark-based navigation instructions as compared to standard instructions. Different levels of information provided with landmark-based instructions impacted landmark recognition dependent on the delay between navigation and test. The results replicated an improved landmark and route knowledge when using landmark-based navigation instructions emphasizing that auditory landmark augmentation enhances incidental spatial knowledge acquisition, and that this enhancement can be generalized to real-life settings.This research is paving the way for navigation assistants that, instead of impairing spatial knowledge acquisition, incidentally foster the acquisition of landmark and route knowledge during every-day navigation.

Quality of Life (QoL) and Clinical Outcomes of Dasatinib Treatment in TKI-Naive and Early Switched from Imatinib Patients with Chronic Myeloid Leukemia in Chronic Phase (CP CML) in a Real World Setting

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5456-5456
Author(s):  
Tatyana Ionova ◽  
Natalia Bulieva ◽  
Olga Vinogradova ◽  
Kira Kurbatova ◽  
Elza Lomaia ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Outcomes ◽  
Real World ◽  
Research Funding ◽  
Imatinib Treatment ◽  
Healthy Controls ◽  
Front Line ◽  
Real World Setting ◽  
Dasatinib Treatment

Abstract Dasatinib as a front-line is a promising treatment option for CP-CML pts. Assessment of benefits and risks of this treatment regimen both from physician's and patient's perspective sounds worthy. We aimed to study QoL and clinical outcomes of dasatinib as a front-line treatment in CP CML pts in a real world setting. The total of 30 pts with CP CML (16 pts - TKI-naive, 14 pts - early switched to dasatinib after failure of imatinib treatment, median duration of imatinib treatment - 6 mths; switched pts) were involved in the multicenter observational prospective study. Median age - 47.6 y.o. (20-74), female - 33.3%; median disease duration - 5 mths; distribution of pts according to the Sokal score - 27.6% pts at low risk, 41.4% - at intermediate risk, 31% - at high risk. 27% pts had comorbidities: median Charlson Comorbidity Index was 3.0. All the pts filled out the QoL questionnaire SF-36 before dasatinib treatment, 3 and 12 mths after treatment start. Hematological, cytogenetic and molecular response rates (HR, CyR, MR) were registered after 3 and 12 mths of dasatinib treatment. Healthy controls (n=30) from QoL population normative database adjusted by age and gender to pts group were used for QoL comparison at baseline. Group comparisons were made using Mann-Whitney test, ANOVA and Wilcoxon matched pair test. QoL in CP CML pts at baseline was lower than in healthy controls: Integral QoL Index - 0.358 in pts vs 0.497 in healthy controls (p<0.05). Physical functioning in CP CML pts was significantly lower than in healthy controls: 78.8 vs 90.8 (p<0.05). No QoL differences were found between TKI-naive and switched pts before dasatinib treatment (p>0.05). During 12 months of dasatinib treatment positive changes in QoL were observed: Integral Quality of Life Index increased from 0.358 at baseline to 0.493 after 12 mths (p=0.05) and became comparable to healthy controls (p>0.05). Significant QoL improvement was registered in 12 mths of dasatinib treatment for role emotional (48.1 vs 81.5), role physical (44.4 vs 56.5) and social functioning(62.5 vs 80.6); p<0.05. Clinical outcomes were similar to the data of randomized clinical trials. After 3 mths of dasatinib treatment the majority of pts (92%) achieved complete HR, others had partial HR. After 12 mths of treatment 81.6% pts maintained or achieved complete HR; 69.2% pts exhibited complete CyR; 53.8% pts - major/complete MR. Four pts were dropped out of the study due to resistance to dasatinib (n=2) or due to severe AE (n=2). No cases of death were observed during the study. AE were similar to the ones registered within the clinical trials: in the most cases they were non-severe/moderate; severe AE (lung edema, bleeding from stomach ulcer) were observed in 2 pts; no cases of pleural effusion were revealed. In conclusion, patient-reported and clinical outcomes of dasatinib treatment in TKI-naïve pts and in pts early switched to dasatinib after failure of imatinib were obtained in a real world study. Significant QoL improvement in terms of role physical, role emotional and social functioning was observed. Clinical outcomes support the data obtained in clinical trials. Benefits and risks of front-line treatment with dasatinib in CML-CP both from physician's and patient's perspective were demonstrated in a real world setting. Disclosures Ionova: BMS: Research Funding; MSD: Speakers Bureau. Bulieva:BMS: Research Funding. Vinogradova:BMS: Research Funding. Kurbatova:BMS: Research Funding. Nikitina:BMS: Research Funding. Novitskaya:BMS: Research Funding. Rodionova:BMS: Research Funding. Usacheva:BMS: Research Funding. Chukavina:BMS: Research Funding. Shumkova:BMS: Research Funding.

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