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Abstract: The accurate identification of initial and final foot contacts is a crucial prerequisite for obtaining a reliable estimation of spatio-temporal parameters of gait. Well-accepted gold standard techniques in this field are force platforms and instrumented walkways, which provide a direct measure of the foot–ground reaction forces. Nonetheless, these tools are expensive, non-portable and restrict the analysis to laboratory settings. Instrumented insoles with a reduced number of pressure sensing elements might overcome these limitations, but a suitable method for gait events identification has not been adopted yet. The aim of this paper was to present and validate a method aiming at filling such void, as applied to a system including two insoles with 16 pressure sensing elements (element area = 310 mm2), sampling at 100 Hz. Gait events were identified exploiting the sensor redundancy and a cluster-based strategy. The method was tested in the laboratory against force platforms on nine healthy subjects for a total of 801 initial and final contacts. Initial and final contacts were detected with low average errors of (about 20 ms and 10 ms, respectively). Similarly, the errors in estimating stance duration and step duration averaged 20 ms and <10 ms, respectively. By selecting appropriate thresholds, the method may be easily applied to other pressure insoles featuring similar requirements. This work was supported by the Mobilise-D project that has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No. 820820. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation program and the European Federation of Pharmaceutical Industries and Associations (EFPIA). Content in this publication reflects the authors' view and neither IMI nor the European Union, EFPIA, or any Associated Partners are responsible for any use that may be made of the information contained herein.

Cover -- Half Title -- Title Page -- Copyright Page -- Table of Contents -- Foreword -- Preface -- Contributors -- Chapter 1 Introduction -- Observational gait analysis from video footage -- Measurements from video footage -- Gait as a biometric -- Notes -- References -- Chapter 2 The history of the use of gait analysis as evidence -- 1839 to 1959 -- 1960 to 1999 -- 2000 to 2019 -- Gait evidence in civil proceedings -- Discussion -- Note -- References -- Chapter 3 Fundamentals of human gait and gait analysis -- The gait cycle -- The gait cycle in detail -- Event 1: Initial contact -- Loading response -- Event 2: Opposite toe off -- Mid-stance -- Event 3: Heel rise -- Event 4: Opposite initial contact -- Event 5: Toe off -- Event 6: Feet adjacent -- Event 7: Tibia vertical -- Terminal foot contact -- Temporal and spatial parameters of gait -- Speed -- Cycle time and cadence -- Stride length -- Gait analysis -- Observational gait analysis without video recording -- Video-based gait analysis -- Three-dimensional motion analysis -- Notes -- References -- Chapter 4 The legal context of forensic gait analysis -- Part 1: The legal context in North America -- Principles of the law and the legal system -- Ethical role and responsibilities of the expert witness -- References -- Part 2: The legal context in the United Kingdom -- References -- Chapter 5 The development of the forensic gait analysis quality assurance process in the UK -- Identifying the requirement for quality assurance in forensic science -- Recognition of requirements for quality assurance in forensic gait analysis -- Creation of a writing group for forensic podiatry standards -- Creation of the writing group for forensic gait analysis standards -- Methods -- Practitioners -- Facilities -- Development of the Code of practice for forensic gait analysis document -- References.

Climbing stairs is a fundamental part of daily life, adding additional demands on the postural control system compared to level walking. Although real-world gait analysis studies likely contain stair ambulation sequences, algorithms dedicated to the analysis of such activities are still missing. Therefore, we propose a new gait analysis pipeline for foot-worn inertial sensors, which can segment, parametrize, and classify strides from continuous gait sequences that include level walking, stair ascending, and stair descending. For segmentation, an existing approach based on the hidden Markov model and a feature-based gait event detection were extended, reaching an average segmentation F1 score of 98.5% and gait event timing errors below ±10ms for all conditions. Stride types were classified with an accuracy of 98.2% using spatial features derived from a Kalman filter-based trajectory reconstruction. The evaluation was performed on a dataset of 20 healthy participants walking on three different staircases at different speeds. The entire pipeline was additionally validated end-to-end on an independent dataset of 13 Parkinson's disease patients. The presented work aims to extend real-world gait analysis by including stair ambulation parameters in order to gain new insights into mobility impairments that can be linked to clinically relevant conditions such as a patient's fall risk and disease state or progression. This work was supported by the Mobilise-D project that has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No. 820820. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation program and the European Federation of Pharmaceutical Industries and Associations (EFPIA). Content in this publication reflects the authors' view and neither IMI nor the European Union, EFPIA, or any Associated Partners are responsible for any use that may be made of the information contained herein.

This work involved human subjects or animals in its research. Approval of all ethical and experimental procedures and protocols was granted by the Local Ethics Committee (CSIC's Ethics Committee) under Approval No. 034/2020, and performed in line with the Declaration of Helsinki. ; Inertial sensors have gained relevance as wearable sensors to acquire the kinematics of human limbs through fusion sensor algorithms and biomechanical models. However, there are some limitations to the use of Inertial Measurement Units in the control of wearable robotic devices: 1) Some approaches use magnetometer readings to estimate the orientation of the sensor, and, as a result, they are prone to errors due to electromagnetic interferences; 2) Biomechanical model-based approaches require complex and timeconsuming calibration procedures. In order to address these issues, this paper proposes an Extended Kalman Filter to estimate sagittal lower limb kinematics during gait, based on gyroscopes and accelerometers and without requiring any calibration or sensor alignment process. As magnetometer measurements are not involved, this method is not affected by electromagnetic disturbances. Our approach calculates the knee rotation axis in real-time, and it estimates hip and ankle sagittal axes considering that the movements in that plane occur around parallel axes. We carried out an experimental validation with eight healthy subjects walking on a treadmill at different velocities. We obtained waveform RMS errors about 3.8 , 3.6 , and 4.8 for hip, knee, and ankle in the sagittal plane. We also assessed the performance of this method as a tool for controlling lower-limb robotic exoskeletons by detecting gait events or estimating the phase and frequency of the gait in real-time through an Adaptive Frequency Oscillator. The average RMS delay in the detection of gait events was lower than 60 ms, and the RMSE in the estimation of the gait phase was about 3% of the gait cycle.We conclude that the described method could be used as a controller for wearable robotic devices. ; This work was supported in part by the Spanish Ministry of Science and Innovation through the Project Discover2Walk under Grant PID2019-105110RB-C31, and in part by the Programas de Actividades ICD en la Comunidad de Madrid and Structural Funds of the EU (RoboCity) under Grant S2018/NMT-4331. The work of Julio S. Lora-Millan was supported by the Ministry of Universities of the Government of Spain through the Training Program for Academic Staff Fellowship under Grant FPU16/01313. ; Peer reviewed

AbstractBackground: To investigate the safety and feasibility of six sessions of Hybrid Assistive Limb (HAL) robot-assisted gait training (RAGT) integrated into an inpatient therapy concept and their influence on walking speed and gait parameters in adult CP patients. Methods: Eleven subjects (male = 8, female = 3, mean age: 23 years and 2 months, ± 4.5 years) with spastic CP underwent six 20-minute RAGT sessions with the HAL during an 11-day hospital stay. Additionally, physiotherapy, physician-performed manual medicine, massage and exercise therapy were provided. Pre- (T1) and post- (T2) intervention assessments were: 10-metre walking test (10MWT), 6-minute walking test (6MWT), Gross Motor Function Measure (GMFM-88) and lower extremities passive range of motion (pROM). Results: All subjects completed the study. No adverse events were noted. Walking speed in the 10MWT test increased from 32.5 s (± 24.5 s) at T1 to 27.5 s (± 21.4 s) at T2, without significance. Slight, but non-significant improvements were detected in the 6MWT, GMFM and pROM. Confounding factors did not significantly affect the results. Conclusion: Intensive therapy including HAL training leads to non-significant improvements. Further studies with more patients and longer intervention time could provide further insights into the RAGT therapy of adult patients with CP. Registration DRKS-ID: DRKS00020275.

AbstractAt what point do environmental phenomena become crises, and how do these impact the quantity and quality of media attention? As climate patterns change, societies face crises that are slow‐moving in nature (such as sea level rise and drought) or fast‐changing (such as hurricanes or flash floods). A third type of event is those that are slow‐occurring while at the same time being punctuated by extreme, fast‐changing occurrences. The practical and theoretical consequences of these complex events are often difficult to pinpoint. We argue that it is necessary to evaluate how the features of such events affect stakeholder perceptions. We do so by analyzing water‐quality crises in Northeastern Patagonia, Argentina. Combining turbidity data collected over a decade with 10 years of newspaper articles published in response to high turbidity events, we assess the extent and sentiment of media attention to better understand the linkage between extreme natural events and how these relate to the media agenda. We find that as events increase in duration and intensity, their media coverage increases. These effects are more accentuated when the duration and intensity of an event surpass limits imposed by local infrastructure and practices.

"European Union (EU)" - "Horizon 2020" - "MSCA-ITN-ETN" - "Keep Control" - "Grant number 721577" ; Gait initiation can vary as a function of the available and engaged attentional resources. Conflict resolution can disrupt movement preparation and lead to ''errors" in motor programming. These ''errors" are physiologically useful by enabling us to adapt our motor behavior to situations with conflicting information. The objective of the present study was to analyze the patterns of cortical activation associated with motor programming errors and the corresponding error corrections. Incongruent flankers around a target arrow were used to trigger errors in anticipatory postural adjustments (APAs) prior to gait initiation; i.e. perturbed motor programming but normal execution. Thirty healthy adults performed a gait initiation task. The event-related potentials (ERPs) and event-related desynchronization (ERD) after target presentation were analyzed according to the presence or absence of an APA error. The ERP was similar in both conditions, except that the Ne and P300 peak latencies were longer for APA errors. Motor programming errors during gait initiation were characterized by longer, less intense low-beta-band ERD over the sensorimotor cortex and alpha ERS followed by stronger alpha ERD during errors. APA errors were associated with a specific alpha/beta oscillation profile over the sensorimotor cortex; these beta oscillations might be sensitive markers of non-conscious motor error and correction monitoring.

"European Union (EU)" - "Horizon 2020" - "MSCA-ITN-ETN" - "Keep Control" - "Grant number 721577" ; Gait initiation can vary as a function of the available and engaged attentional resources. Conflict resolution can disrupt movement preparation and lead to ''errors" in motor programming. These ''errors" are physiologically useful by enabling us to adapt our motor behavior to situations with conflicting information. The objective of the present study was to analyze the patterns of cortical activation associated with motor programming errors and the corresponding error corrections. Incongruent flankers around a target arrow were used to trigger errors in anticipatory postural adjustments (APAs) prior to gait initiation; i.e. perturbed motor programming but normal execution. Thirty healthy adults performed a gait initiation task. The event-related potentials (ERPs) and event-related desynchronization (ERD) after target presentation were analyzed according to the presence or absence of an APA error. The ERP was similar in both conditions, except that the Ne and P300 peak latencies were longer for APA errors. Motor programming errors during gait initiation were characterized by longer, less intense low-beta-band ERD over the sensorimotor cortex and alpha ERS followed by stronger alpha ERD during errors. APA errors were associated with a specific alpha/beta oscillation profile over the sensorimotor cortex; these beta oscillations might be sensitive markers of non-conscious motor error and correction monitoring.

"European Union (EU)" - "Horizon 2020" - "MSCA-ITN-ETN" - "Keep Control" - "Grant number 721577" ; Gait initiation can vary as a function of the available and engaged attentional resources. Conflict resolution can disrupt movement preparation and lead to ''errors" in motor programming. These ''errors" are physiologically useful by enabling us to adapt our motor behavior to situations with conflicting information. The objective of the present study was to analyze the patterns of cortical activation associated with motor programming errors and the corresponding error corrections. Incongruent flankers around a target arrow were used to trigger errors in anticipatory postural adjustments (APAs) prior to gait initiation; i.e. perturbed motor programming but normal execution. Thirty healthy adults performed a gait initiation task. The event-related potentials (ERPs) and event-related desynchronization (ERD) after target presentation were analyzed according to the presence or absence of an APA error. The ERP was similar in both conditions, except that the Ne and P300 peak latencies were longer for APA errors. Motor programming errors during gait initiation were characterized by longer, less intense low-beta-band ERD over the sensorimotor cortex and alpha ERS followed by stronger alpha ERD during errors. APA errors were associated with a specific alpha/beta oscillation profile over the sensorimotor cortex; these beta oscillations might be sensitive markers of non-conscious motor error and correction monitoring.

AbstractPrimary medullary hemorrhage is a rare event that may result in ataxic respiration. Although it remains controversial whether primary medullary hemorrhage should be managed conservatively or surgically, recent advancements in neuroimaging and microsurgical techniques have shown promise for improving outcomes and prognosis following surgery. The present report discusses the case of a 70-year-old woman admitted to our institution due to sudden-onset nausea and vomiting. The patient underwent surgical removal of a right medullary hematoma for the treatment of daytime respiratory depression and nocturnal apnea while in the half-sitting position. Following surgery, her spontaneous respiration improved, and she was discharged with independent gait. Despite the risk of venous air embolism, accumulating evidence suggests that the half-sitting position is suitable for brainstem surgery because gravity-assisted blood and irrigation drainage from the surgical field allows for cleaner dissection and reduces the need for bipolar coagulation.

For about 15 centuries ago, Islamic history has portrayed the face of the true condition of Islamic education, not only describes the reality of past events, but also serves as a guide for the next generation, in order to make a better footing. Basically, with the coming of Islam in this archipelago, because one of them through education, beside through trade and marriage. The role and gait of Islamic education in seizing and uniting the archipelago into a country that is currently called Indonesia of course very much. Thus, in this paper, the author reveals a bit about the history of Islamic education in the old order, the new order and even during the current order of reform. The state has enormous power in governing and running the wheels of government, including in the world of Islamic education, so, the condition of Islamic education from the time of kemasanya have position and even a very different portion of the government which then has implications for the implementation of Islamic education.

Introduction: The mainstay of onchocerciasis control currently is mass administration of ivermectin; however, this may be associated with serious adverse events, including deaths, when administered in areas where onchocerciasis and loiasis are co-endemic. Objectives: The objective of the current study was to describe the central and peripheral nervous system disorders that occurred after mass administration of ivermectin in Democratic Republic of Congo (DRC). Methods: This is a retrospective descriptive study involving a review of data on adverse events related to mass administration of ivermectin. Data on reported serious adverse events following mass administration of ivermectin in the DRC were extracted from the World Health Organization (WHO) Global individual case safety report (ICSR) database (VigiBase). The review covered the period 2009–2013 and focused on central and peripheral nervous system disorders. Relevant demographic, clinical, and parasitological data, including age, sex, area of residence, adverse events, and parasite density were extracted. Descriptive statistics were analyzed using Stata 12. Results: A total of 52 ICSRs related to ivermectin intake were available in VigiBase, with 51 (98.1%) from the Province of Equateur. All patients had central and peripheral nervous system disorders; 25 (48.1%) had altered mental status. Of these, 23 (92.0%) satisfied the criteria for "probable/possible Loa loa encephalopathy temporally related to mectizan®" (PLERM). The most frequent nervous system disorders among patients with PLERM were coma (74%), stupor (30%), headache (22%), and abnormal gait (22%). There were, on average, 2149.1 microfilariae per ml (mf/ml) in peripheral blood [95% confidence interval (CI) 463.6–3834.6; n = 23]. Post-treatment, 61% of PLERM cases had <1000 L. loa mf/ml of blood. One patient had microfilariae in the cerebrospinal fluid rather than the peripheral blood. We found 21.4% co-infection with Plasmodium falciparum and 4% mortality. Conclusion: PLERM may occur at even low ...

Wearable sensing systems are becoming widely used for a variety of applications including sports, entertainment, and the military. These systems have recently enabled a variety of medical monitoring and diagnostic applications. Such sensing systems have high potential to significantly improve the quality of life for large segments of the population and enable conceptually new types of applications. However, various research challenges including energy sensitivity and semantic complexity must be addressed before these devices can reach their full potential in improving our lives. The need for multiple sensors, high frequency sampling and constant monitoring leads these systems to be power-hungry and expensive with a short operation lifetime. In addition these systems generate a massive amount of data, where designing efficient and effective data mining algorithms to interpret and analyze the data is very costly due to field experts' involvement. This dissertation presents a methodology that takes advantage of contextual and semantic properties in human physiological behavior to enable efficient design and optimization of such systems from the data and information point of view. The methodology uses combinatorial modeling and simultaneous minimization to reduce the wireless communication and local processing power consumption. The effectiveness of this technique is shown on an insole instrumented with 99 pressure sensors placed in each shoe, which is used for human gait analysis. Further, the proposed methodology is used to design unsupervised data mining techniques to extract information such as frequent or rare events and patterns from collected multi-dimensional time series data of wearable sensing devices, where high level of noise and uncertainty is inherent. This approach transforms multi-dimensional time series data to combinatorial space and constructs behavior models, which is used for frequent and rare event detection and pattern classification. The effectiveness of this method is demonstrated by applying this technique to discovery and classification of frequent human activities and abnormalities.

Frailty is an age-related state of high vulnerability to adverse health outcomes after a stressor event, predisposing individuals to progressive decline in different functional domains. A scoping search identified a large number of relevant systematic reviews (SRs) on predictive ability of frailty measures in older adults. Aiming to summarise this set of evidence an overview of reviews, based on the Joanna Briggs Institute (JBI) methodology, was conducted. This project "664367/FOCUS" was funded under the European Union's Health Programme (2014–2020). The studies considered as eligible for inclusion were quantitative SRs including older adults aged 60 years or more, recruited from any type of setting. Timeframe for searching was from January 2001 to October 2015. Of 420 records identified through searching in databases, 20 full-texts were assessed for inclusion criteria and 10 were included. Then 10 were assessed for risk of bias, using JBI critical appraisal checklist for systematic reviews and research synthesis. From those, three SRs conducted in community and emergency department settings and describing eight screening tools and eight frailty indicators were included. Between frailty measures applied to community dwelling older people, Frailty Index, gait speed and physical activity were shown to be the most powerful predictors of future adverse health outcomes. No suitable tool for assessing frailty appropriately in emergency departments was identified. Future research is required to investigate whether psychometric properties of available frailty measures are generalizable to health care settings other than primary care. There is a need for tools for use in emergency departments.