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.

PP469 From Theory To Practice: Which Value Framework Is Applied For Onco-Hematology Therapies In Italy? A 5-year Retrospective Analysis

2020 ◽  
Vol 36 (S1) ◽  
pp. 37-37
Author(s):  
Americo Cicchetti ◽  
Rossella Di Bidino ◽  
Entela Xoxi ◽  
Irene Luccarini ◽  
Alessia Brigido
Keyword(s):  
Real World ◽  
Ad Hoc ◽  
Grey Literature ◽  
National Level ◽  
Pharmaceutical Products ◽  
European Medicines Agency ◽  
The Real ◽  
R Process ◽  
The One ◽  
The Impact

IntroductionDifferent value frameworks (VFs) have been proposed in order to translate available evidence on risk-benefit profiles of new treatments into Pricing & Reimbursement (P&R) decisions. However limited evidence is available on the impact of their implementation. It's relevant to distinguish among VFs proposed by scientific societies and providers, which usually are applicable to all treatments, and VFs elaborated by regulatory agencies and health technology assessment (HTA), which focused on specific therapeutic areas. Such heterogeneity in VFs has significant implications in terms of value dimension considered and criteria adopted to define or support a price decision.MethodsA literature research was conducted to identify already proposed or adopted VF for onco-hematology treatments. Both scientific and grey literature were investigated. Then, an ad hoc data collection was conducted for multiple myeloma; breast, prostate and urothelial cancer; and Non Small Cell Lung Cancer (NSCLC) therapies. Pharmaceutical products authorized by European Medicines Agency from January 2014 till December 2019 were identified. Primary sources of data were European Public Assessment Reports and P&R decision taken by the Italian Medicines Agency (AIFA) till September 2019.ResultsThe analysis allowed to define a taxonomy to distinguish categories of VF relevant to onco-hematological treatments. We identified the “real-world” VF that emerged given past P&R decisions taken at the Italian level. Data was collected both for clinical and economical outcomes/indicators, as well as decisions taken on innovativeness of therapies. Relevant differences emerge between the real world value framework and the one that should be applied given the normative framework of the Italian Health System.ConclusionsThe value framework that emerged from the analysis addressed issues of specific aspects of onco-hematological treatments which emerged during an ad hoc analysis conducted on treatment authorized in the last 5 years. The perspective adopted to elaborate the VF was the one of an HTA agency responsible for P&R decisions at a national level. Furthermore, comparing a real-world value framework with the one based on the general criteria defined by the national legislation, our analysis allowed identification of the most critical point of the current national P&R process in terms ofsustainability of current and future therapies as advance therapies and agnostic-tumor therapies.

scholarly journals The Promise of Creativity

2012 ◽  
Vol 6 (1) ◽  
pp. 389-407 ◽  
Author(s):  
Maxine E. Sprague ◽  
Jim Parsons
Keyword(s):  
Real World ◽  
Teaching And Learning ◽  
The Body ◽  
The Real ◽  
Digital World ◽  
Body Of Knowledge ◽  
Imaginative Play ◽  
A Priority ◽  
The Impact

In this paper, the authors discuss creativity and the impact it might have on teaching and learning. The authors believe that imaginative play, at all ages, helps all people (children especially) create healthy environments and spaces that expand their learning. The authors contend that teaching for imagination—which asks little more than creating and trusting an ecological space that engenders it—seldom is considered a priority. Given the emphasis on creativity in the real world and the virtual digital world, the authors believe it is important to add to the body of knowledge through continued research in this field.

scholarly journals Flawed Model Misrepresents the Impact of Anesthesiologists to Patient Safety in the Real World

2012 ◽  
Vol 117 (2) ◽  
pp. 437-438
Author(s):  
Jerry A. Cohen ◽  
Norman A. Cohen ◽  
James D. Grant ◽  
Daniel J. Cole
Keyword(s):  
Patient Safety ◽  
Real World ◽  
The Real ◽  
The Impact

scholarly journals The Role of Written Feedback in Numeracy in the Primary School Classroom

2019 ◽  
Vol 11 (2) ◽  
pp. 52 ◽  
Author(s):  
Miedzo Mutendi ◽  
Chipo Makamure
Keyword(s):  
Primary School ◽  
Learning Process ◽  
Real World ◽  
Learning Goals ◽  
Written Feedback ◽  
Classroom Performance ◽  
The Real ◽  
School Classroom ◽  
The Impact

This study seeks to establish the quality and type of feedback necessary and suitable for learners, understandable by learners and implementable in the learning process by the learners to improve progress in learning numeracy. However, although written feedback is believed to be instrumental in shaping the pupils’ classroom performance, there is less agreement on whether this is workable in the real world of the classroom or has remained an intended goal of feedback. There is limited work in literature on how pupils respond or use written feedback to improve their performance. A questionnaire was administered to a group of Year 5 students at a school in England to solicit the pupils’ perceptions of the usefulness of written feedback and the challenges that were likely to be faced in interpreting and implementing the feedback. In order to measure the impact of feedback on students’ performance, a pre-test was given, pupils’ recommendations from the questionnaire were incorporated, and a second test was given two days later. The two sets of marks were then compared. It was found that pupils find it difficult to understand written feedback at times, mainly because of unfamiliar vocabulary used in the feedback and when they do understand the language, they often find it unhelpful in achieving their learning goals. Teachers are recommended to simplify and add more detail to feedback, making it as informative as possible about what was done well and suggest improvements that could be made.

scholarly journals P.051 Validation of the unruptured intracranial aneurysm treatment score against “real-world” MDT decisions

2017 ◽  
Vol 44 (S2) ◽  
pp. S26-S26
Author(s):  
H Godbout ◽  
J Jarrett ◽  
GE Pickett
Keyword(s):  
Intracranial Aneurysm ◽  
Clinical Outcomes ◽  
Real World ◽  
Aneurysm Rupture ◽  
Case Control Studies ◽  
Clinical Tool ◽  
Unruptured Intracranial Aneurysm ◽  
Aneurysm Treatment ◽  
Elective Treatment ◽  
Aneurysm Repair

Background: Intracranial aneurysms are relatively common and often incidentally detected. Elective treatment may eliminate the risk of future hemorrhage, but carries risks of permanent deficit or death. Case-control studies have suggested factors predisposing to aneurysm rupture as well as risks of elective aneurysm repair. A clinical tool was recently developed to weigh benefits of repair against treatment risks. We evaluate its performance against real-world clinical decisions made by a cerebrovascular multidisciplinary team (MDT). Methods: Chart review of all patients with unruptured intracranial berry aneurysms (UIA) discussed at cerebrovascular MDT rounds 2008-2015. Management decisions and clinical outcomes were recorded. The Unruptured Intracranial Aneurysm Treatment Score (UIATS) was calculated for each patient (each aneurysm in the case of multiple UIA). Results: We identified 240 patients with a total of 279 aneurysms. UIATS recommended aneurysm repair in 79 cases, conservative management in 88 cases, and was equivocal in 112 cases. Where the UIATS gave a clear decision, that decision was concordant with the MDT decision in 119/167 cases (71%). Discordant decisions often related to the presence of comorbidities. Clinical outcomes did not differ in cases where the recommendations were clearly concordant vs. discordant. Conclusions: The UIATS may provide guidance to non-expert clinicians. It did not outperform the MDT.

The Impact of Qualitative Research on the “Real World”

2015 ◽  
Vol 56 (4) ◽  
pp. 414-435 ◽  
Author(s):  
Leeat Granek ◽  
Ora Nakash
Keyword(s):  
Qualitative Research ◽  
Real World ◽  
The Real ◽  
The Impact

scholarly journals TO CONTROL OR NOT TO CONTROL: HOW DO WE LEARN MORE ABOUT HOW AGRONOMIC INNOVATIONS PERFORM ON FARMS?

2017 ◽  
Vol 55 (S1) ◽  
pp. 303-309 ◽  
Author(s):  
RIC COE ◽  
JOYCE NJOLOMA ◽  
FERGUS SINCLAIR
Keyword(s):  
Crop Yield ◽  
Real World ◽  
Crop Management ◽  
Maize Yield ◽  
Scaling Up ◽  
System Response ◽  
Main Concern ◽  
The Real ◽  
Important Variation ◽  
The Impact

SUMMARYOur paper ‘Loading the dice in favour of the farmer: reducing the risk of adopting agronomic innovations’ revealed mean increases but also large variation in the impact of four agroforestry practises on maize yield, as experienced by farmers in Malawi. This prompted a response from Sileshi and Akinnifesi that was critical of the data and methods used. Their main concern was that farmers did not necessarily manage crops identically in plots with and those without trees, so the yield differences that we measured may be partly caused by these differences in crop management. We argue here that it is valid and useful to look at the actual effect on crop yield of farmers having trees intercropped with maize, rather than controlling for how the crop is managed, because this is what happens in the real world. Farmers respond to having trees in their field by treating their crop differently, so this is part of the system response to having trees in fields. Attempts to eliminate this will result in measuring an artefact rather than the real impact of trees on crop yield. By doing this, we revealed important variation in the impact of trees on crop yield amongst farmers, and we argue that it is important to explore, assess and communicate to farmers and development actors the extent and implications of this variation. Understanding the contextual factors that determine who is likely to benefit most from an innovation and for whom it is less suitable can then be incorporated in scaling up, so that targeting of innovations and the appropriateness of messages given to farmers are continuously refined.

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