Internet-of-Things-Enabled Markerless Running Gait Assessment from a Single Smartphone Camera.

Running gait assessment is essential for the development of technical optimization strategies as well as to inform injury prevention and rehabilitation. Currently, running gait assessment relies on (i) visual assessment, exhibiting subjectivity and limited reliability, or (ii) use of instrumented approaches, which often carry high costs and can be intrusive due to the attachment of equipment to the body. Here, the use of an IoT-enabled markerless computer vision smartphone application based upon Google's pose estimation model BlazePose was evaluated for running gait assessment for use in low-resource settings. That human pose estimation architecture was used to extract contact time, swing time, step time, knee flexion angle, and foot strike location from a large cohort of runners. The gold-standard Vicon 3D motion capture system was used as a reference. The proposed approach performs robustly, demonstrating good (ICC(2,1) > 0.75) to excellent (ICC(2,1) > 0.90) agreement in all running gait outcomes. Additionally, temporal outcomes exhibit low mean error (0.01−0.014 s) in left foot outcomes. However, there are some discrepancies in right foot outcomes, due to occlusion. This study demonstrates that the proposed low-cost and markerless system provides accurate running gait assessment outcomes. The approach may help routine running gait assessment in low-resource environments.

IoT-Enabled Gait Assessment: The Next Step for Habitual Monitoring.

Walking/gait quality is a useful clinical tool to assess general health and is now broadly described as the sixth vital sign. This has been mediated by advances in sensing technology, including instrumented walkways and three-dimensional motion capture. However, it is wearable technology innovation that has spawned the highest growth in instrumented gait assessment due to the capabilities for monitoring within and beyond the laboratory. Specifically, instrumented gait assessment with wearable inertial measurement units (IMUs) has provided more readily deployable devices for use in any environment. Contemporary IMU-based gait assessment research has shown evidence of the robust quantifying of important clinical gait outcomes in, e.g., neurological disorders to gather more insightful habitual data in the home and community, given the relatively low cost and portability of IMUs. The aim of this narrative review is to describe the ongoing research regarding the need to move gait assessment out of bespoke settings into habitual environments and to consider the shortcomings and inefficiencies that are common within the field. Accordingly, we broadly explore how the Internet of Things (IoT) could better enable routine gait assessment beyond bespoke settings. As IMU-based wearables and algorithms mature in their corroboration with alternate technologies, such as computer vision, edge computing, and pose estimation, the role of IoT communication will enable new opportunities for remote gait assessment.

Mental health and parenting demands among grandparent caregivers of young U.S. children.

Substance abuse epidemics and changes in incarceration and foster care policies have recently placed more young children in grandparent custody. Grandmothers bear much of this caregiving responsibility. Our objective was to compare grandparent caregivers of preschool-aged children (grandparent(s) only or in multigenerational households) to parent caregivers, by caregiver sex, in their mental health, available emotional support, and capacity to manage parenting demands. Using U.S. National Survey of Children's Health data (2016-2019), we used survey-weighted logistic regression models adjusted for socio-demographic confounders and conducted sub-group analyses by caregiver sex. Among 30,046 families with a child aged 1-5 years, 776 (4.1%) were grandparent-only, 817 (3.3%) multigenerational, 28,453 (92.7) parent-headed (weighted percentages). Most caregivers (78.7%) were in Excellent/Very Good mental health, but grandfathers in grandparent-only households were less so. Despite being more likely to parent alone, caregivers in grandparent-only households had about twice the odds of having a source of emotional support (adjusted prevalence odds ratio [aPOR] = 2.07; 95% confidence interval [CI] 1.12, 3.83). Grandmothers, in particular, had greater odds of handling day-to-day parenting demands (aPOR = 2.40, 95% CI 1.35, 4.27) and of reporting rarely/never feeling angry with the child in their care (aPOR = 2.77, 95% CI 1.53, 5.01), compared to mothers in parent households. Caregivers in multigenerational households displayed no differences as compared to parents except for grandfathers in multigenerational households who were more likely often bothered by the child. Despite increasing demands on grandparents, they generally reported faring as well as or better than parent caregivers, especially grandmothers. Their prior experience and social support may make them resilient.

Gait Impairment in Traumatic Brain Injury: A Systematic Review.

INTRODUCTION: Gait impairment occurs across the spectrum of traumatic brain injury (TBI); from mild (mTBI) to moderate (modTBI), to severe (sevTBI). Recent evidence suggests that objective gait assessment may be a surrogate marker for neurological impairment such as TBI. However, the most optimal method of objective gait assessment is still not well understood due to previous reliance on subjective assessment approaches. The purpose of this review was to examine objective assessment of gait impairments across the spectrum of TBI. METHODS: PubMed, AMED, OVID and CINAHL databases were searched with a search strategy containing key search terms for TBI and gait. Original research articles reporting gait outcomes in adults with TBI (mTBI, modTBI, sevTBI) were included. RESULTS: 156 citations were identified from the search, of these, 13 studies met the initial criteria and were included into the review. The findings from the reviewed studies suggest that gait is impaired in mTBI, modTBI and sevTBI (in acute and chronic stages), but methodological limitations were evident within all studies. Inertial measurement units were most used to assess gait, with single-task, dual-task and obstacle crossing conditions used. No studies examined gait across the full spectrum of TBI and all studies differed in their gait assessment protocols. Recommendations for future studies are provided. CONCLUSION: Gait was found to be impaired in TBI within the reviewed studies regardless of severity level (mTBI, modTBI, sevTBI), but methodological limitations of studies (transparency and reproducibility) limit clinical application. Further research is required to establish a standardised gait assessment procedure to fully determine gait impairment across the spectrum of TBI with comprehensive outcomes and consistent protocols.

Suitability of a Low-Cost Wearable Sensor to Assess Turning in Healthy Adults.

Background: Turning is a complex measure of gait that accounts for over 50% of daily steps. Traditionally, turning has been measured in a research grade laboratory setting, however, there is demand for a low-cost and portable solution to measure turning using wearable technology. This study aimed to determine the suitability of a low-cost inertial sensor-based device (AX6, Axivity) to assess turning, by simultaneously capturing and comparing to a turn algorithm output from a previously validated reference inertial sensor-based device (Opal), in healthy young adults. Methodology: Thirty participants (aged 23.9 ± 4.89 years) completed the following turning protocol wearing the AX6 and reference device: a turn course, a two-minute walk (including 180° turns) and turning in place, alternating 360° turn right and left. Both devices were attached at the lumbar spine, one Opal via a belt, and the AX6 via double sided tape attached directly to the skin. Turning measures included number of turns, average turn duration, angle, velocity, and jerk. Results: Agreement between the outcomes from the AX6 and reference device was good to excellent for all turn characteristics (all ICCs > 0.850) during the turning 360° task. There was good agreement for all turn characteristics (all ICCs > 0.800) during the two-minute walk task, except for moderate agreement for turn angle (ICC 0.683). Agreement for turn outcomes was moderate to good during the turns course (ICCs range; 0.580 to 0.870). Conclusions: A low-cost wearable sensor, AX6, can be a suitable and fit-for-purpose device when used with validated algorithms for assessment of turning outcomes, particularly during continuous turning tasks. Future work needs to determine the suitability and validity of turning in aging and clinical cohorts within low-resource settings.

Psychoactive pollution suppresses individual differences in fish behaviour.

Environmental contamination by pharmaceuticals is global, substantially altering crucial behaviours in animals and impacting on their reproduction and survival. A key question is whether the consequences of these pollutants extend beyond mean behavioural changes, restraining differences in behaviour between individuals. In a controlled, two-year, multigenerational experiment with independent mesocosm populations, we exposed guppies (Poecilia reticulata) to environmentally realistic levels of the ubiquitous pollutant fluoxetine (Prozac). Fish (unexposed: n = 59, low fluoxetine: n = 57, high fluoxetine: n = 58) were repeatedly assayed on four separate occasions for activity and risk-taking behaviour. Fluoxetine homogenized individuals' activity, with individual variation in populations exposed to even low concentrations falling to less than half that in unexposed populations. To understand the proximate mechanism underlying these changes, we tested the relative contribution of variation within and between individuals to the overall decline in individual variation. We found strong evidence that fluoxetine erodes variation in activity between but not within individuals, revealing the hidden consequences of a ubiquitous contaminant on phenotypic variation in fish-likely to impair adaptive potential to environmental change.

Context is Key: Social Environment Mediates the Impacts of a Psychoactive Pollutant on Shoaling Behavior in Fish.

Behavior-modifying drugs, such as antidepressants, are increasingly being detected in waterways and aquatic wildlife around the globe. Typically, behavioral effects of these contaminants are assessed using animals tested in social isolation. However, for group-living species, effects seen in isolation may not reflect those occurring in realistic social settings. Furthermore, interactions between chemical pollution and other stressors, such as predation risk, are seldom considered. This is true even though animals in the wild are rarely, if ever, confronted by chemical pollution as a single stressor. Here, in a 2 year multigenerational experiment, we tested for effects of the antidepressant fluoxetine (measured concentrations [±SD]: 42.27 ± 36.14 and 359.06 ± 262.65 ng/L) on shoaling behavior in guppies (Poecilia reticulata) across different social contexts and under varying levels of perceived predation risk. Shoaling propensity and shoal choice (choice of groups with different densities) were assessed in a Y-maze under the presence of a predatory or nonpredatory heterospecific, with guppies tested individually and in male-female pairs. When tested individually, no effect of fluoxetine was seen on shoaling behavior. However, in paired trials, high-fluoxetine-exposed fish exhibited a significantly greater shoaling propensity. Hence, effects of fluoxetine were mediated by social context, highlighting the importance of this fundamental but rarely considered factor when evaluating impacts of environmental pollution.

Wearables for running gait analysis: A study protocol.

Quantitative running gait analysis is an important tool that provides beneficial outcomes to injury risk/recovery or performance assessment. Wearable devices have allowed running gait to be evaluated in any environment (i.e., laboratory or real-world settings), yet there are a plethora of different grades of devices (i.e., research-grade, commercial, or novel multi-modal) available with little information to make informed decisions on selection. This paper outlines a protocol that will examine different grades of wearables for running gait analysis in healthy individuals. Specifically, this pilot study will: 1) examine analytical validity and reliability of wearables (research-grade, commercial, high-end multimodal) within a controlled laboratory setting; 2) examine analytical validation of different grades of wearables in a real-world setting, and 3) explore clinical validation and usability of wearables for running gait analysis (e.g., injury history (previously injured, never injured), performance level (novice, elite) and relationship to meaningful outcomes). The different grades of wearable include: (1) A research-grade device, the Ax6 consists of a configurable tri-axial accelerometer and tri-axial gyroscope with variable sampling capabilities; (2) attainable (low-grade) commercial with proprietary software, the DorsaVi ViMove2 consisting of two, non-configurable IMUs modules, with a fixed sampling rate and (3) novel multimodal high-end system, the DANU Sports System that is a pair of textile socks, that contain silicone based capacitive pressure sensors, and configurable IMU modules with variable sampling rates. Clinical trial registration: Trial registration: NCT05277181.

Wearables for Running Gait Analysis: A Systematic Review.

BACKGROUND: Running gait assessment has traditionally been performed using subjective observation or expensive laboratory-based objective technologies, such as three-dimensional motion capture or force plates. However, recent developments in wearable devices allow for continuous monitoring and analysis of running mechanics in any environment. Objective measurement of running gait is an important (clinical) tool for injury assessment and provides measures that can be used to enhance performance. OBJECTIVES: We aimed to systematically review the available literature investigating how wearable technology is being used for running gait analysis in adults. METHODS: A systematic search of the literature was conducted in the following scientific databases: PubMed, Scopus, Web of Science and SPORTDiscus. Information was extracted from each included article regarding the type of study, participants, protocol, wearable device(s), main outcomes/measures, analysis and key findings. RESULTS: A total of 131 articles were reviewed: 56 investigated the validity of wearable technology, 22 examined the reliability and 77 focused on applied use. Most studies used inertial measurement units (n = 62) [i.e. a combination of accelerometers, gyroscopes and magnetometers in a single unit] or solely accelerometers (n = 40), with one using gyroscopes alone and 31 using pressure sensors. On average, studies used one wearable device to examine running gait. Wearable locations were distributed among the shank, shoe and waist. The mean number of participants was 26 (± 27), with an average age of 28.3 (± 7.0) years. Most studies took place indoors (n = 93), using a treadmill (n = 62), with the main aims seeking to identify running gait outcomes or investigate the effects of injury, fatigue, intrinsic factors (e.g. age, sex, morphology) or footwear on running gait outcomes. Generally, wearables were found to be valid and reliable tools for assessing running gait compared to reference standards. CONCLUSIONS: This comprehensive review highlighted that most studies that have examined running gait using wearable sensors have done so with young adult recreational runners, using one inertial measurement unit sensor, with participants running on a treadmill and reporting outcomes of ground contact time, stride length, stride frequency and tibial acceleration. Future studies are required to obtain consensus regarding terminology, protocols for testing validity and the reliability of devices and suitability of gait outcomes. CLINICAL TRIAL REGISTRATION: CRD42021235527.

Validity and reliability of the DANU sports system for walking and running gait assessment.

Objective. Gait assessments have traditionally been analysed in laboratory settings, but this may not reflect natural gait. Wearable technology may offer an alternative due to its versatility. The purpose of the study was to establish the validity and reliability of temporal gait outcomes calculated by the DANU sports system, against a 3D motion capture reference system.Approach. Forty-one healthy adults (26 M, 15 F, age 36.4 ± 11.8 years) completed a series of overground walking and jogging trials and 60 s treadmill walking and running trials at various speeds (8-14 km hr-1), participants returned for a second testing session to repeat the same testing.Main results. For validity, 1406 steps and 613 trials during overground and across all treadmill trials were analysed respectively. Temporal outcomes generated by the DANU sports system included ground contact time, swing time and stride time all demonstrated excellent agreement compared to the laboratory reference (intraclass correlation coefficient (ICC) > 0.900), aside from ground contact time during overground jogging which had good agreement (ICC = 0.778). For reliability, 666 overground and 511 treadmill trials across all speeds were examined. Test re-test agreement was excellent for all outcomes across treadmill trials (ICC > 0.900), except for swing time during treadmill walking which had good agreement (ICC = 0.886). Overground trials demonstrated moderate to good test re-test agreement (ICC = 0.672-0.750), which may be due to inherent variability of self-selected (rather than treadmill set) pacing between sessions.Significance. Overall, this study showed that temporal gait outcomes from the DANU Sports System had good to excellent validity and moderate to excellent reliability in healthy adults compared to an established laboratory reference.

Sex-specific effects of psychoactive pollution on behavioral individuality and plasticity in fish.

The global rise of pharmaceutical contaminants in the aquatic environment poses a serious threat to ecological and evolutionary processes. Studies have traditionally focused on the collateral (average) effects of psychoactive pollutants on ecologically relevant behaviors of wildlife, often neglecting effects among and within individuals, and whether they differ between males and females. We tested whether psychoactive pollutants have sex-specific effects on behavioral individuality and plasticity in guppies (Poecilia reticulata), a freshwater species that inhabits contaminated waterways in the wild. Fish were exposed to fluoxetine (Prozac) for 2 years across multiple generations before their activity and stress-related behavior were repeatedly assayed. Using a Bayesian statistical approach that partitions the effects among and within individuals, we found that males-but not females-in fluoxetine-exposed populations differed less from each other in their behavior (lower behavioral individuality) than unexposed males. In sharp contrast, effects on behavioral plasticity were observed in females-but not in males-whereby exposure to even low levels of fluoxetine resulted in a substantial decrease (activity) and increase (freezing behavior) in the behavioral plasticity of females. Our evidence reveals that psychoactive pollution has sex-specific effects on the individual behavior of fish, suggesting that males and females might not be equally vulnerable to global pollutants.

Associations Between Postpartum Physical Symptoms and Breastfeeding Outcomes Among a Sample of U.S. Women 2-6 Months' Postpartum: A Cross-Sectional Study.

Objective: Postpartum urogynecologic and other physical symptoms are common and burdensome. Whether they interfere with breastfeeding has not been thoroughly examined, and this study aims to fill this gap. Methods: Mothers with an infant (2 to 6 months) were recruited from the U.S. ResearchMatch volunteer registry and completed the Life After Pregnancy Study, which assessed postpartum physical symptoms and breastfeeding self-efficacy, experiences, and problems. Modified Poisson regression and linear regression with fully conditional specification multiple imputation to handle missing data were used to examine the associations between physical symptoms and breastfeeding-related outcomes. Results: Among 222 participants, postpartum physical symptoms were common [e.g., painful sex (42%), urinary incontinence (32%)]. Breastfeeding problems were experienced by most participants [e.g., engorged breasts (72%), sore or cracked nipples (70%), breastfeeding or pumping was painful (67%)]. Although postpartum physical symptoms were not associated with breastfeeding for less than 2 months versus greater than/equal to 2 months (ß = 0.94, 95% confidence interval [CI]: 0.78, 1.13), women with excess weight retention and those reporting painful sex or hemorrhoids were more likely to report breastfeeding problems such as sore or cracked nipples or perceived low milk supply. Overall, more physical symptoms were associated with more breastfeeding problems (adj ß = 0.39, 95% CI: 0.17, 0.62) and lower breastfeeding self-efficacy (adj ß = -2.24, 95% CI: -4.36, -0.13). Conclusions: Postpartum physical symptoms were associated with breastfeeding problems and overall poorer breastfeeding self-efficacy, but not with short-term breastfeeding duration. Future studies should explore how addressing physical symptoms among postpartum mothers might improve breastfeeding outcomes.

Effects of maximal-versus submaximal-intent resistance training on functional capacity and strength in community-dwelling older adults: a systematic review and meta-analysis.

The objective of this systematic review is to investigate the effects of different methods of resistance training (RT) on functional capacity in older adults. A systematic literature search was conducted using PubMed, SPORTDiscus, Web of Science, CINAHL, Cochrane CENTRAL, ClinicalTrials.gov databases, from inception to December 2021. Eligibility criteria consisted of randomised control trials (RCT's) involving maximal-intent resistance training (MIRT), where participants (aged 60+) had specific instruction to move 'as fast as possible' during the concentric phase of the exercise. Twelve studies were included within the meta-analysis. Divided into functional capacity and strength-related outcomes; Improvements were evident for timed-up-and-go (p = 0.001, SMD: - 1.74 [95% CI - 2.79, - 0.69]) and knee extension one-repetition maximum (1RM) (p = 0.01, SMD: - 1.21, [95% CI - 2.17, - 0.25]), both in favour of MIRT, as well as in 30 s sit-to-stand in favour of T-STR (p = 0.04, SMD: 3.10 [95% CI 0.07, 6.14]). No statistical significance was found for combined functional capacity outcomes (p = 0.17, SMD: - 0.84, [95% CI - 2.04, 0.37]), with near-significance observed in strength-related outcomes (p = 0.06. SMD: - 0.57, [95% CI - 1.16, 0.02]) favouring MIRT. Heterogeneity for FC-outcomes was observed as Tau2 = 4.83; Chi = 276.19, df = 14, I2 = 95%, and for strength-outcomes Tau2 = 1.290; Chi = 109.65, df = 115, I2 = 86%. Additionally, MIRT elicited substantial clinically meaningful improvements (CMI) in Short Physical Performance Battery (SPPB) scores but fell short of CMI in 400 m walk test by 0.6 s. In conclusion, this systematic review highlights the lack of sufficient and quality evidence for maximal- versus submaximal-intent resistance training on functional capacity and strength in community-dwelling older adults. Study limitations revolved around lack of research, low quality ("low" PEDro score), and largely due to the fact many comparison studies did not match their loads lifted (1500 kg vs. 500 kg), making comparisons not possible.

Examination of a foot mounted IMU-based methodology for a running gait assessment.

Gait assessment is essential to understand injury prevention mechanisms during running, where high-impact forces can lead to a range of injuries in the lower extremities. Information regarding the running style to increase efficiency and/or selection of the correct running equipment, such as shoe type, can minimize the risk of injury, e.g., matching a runner's gait to a particular set of cushioning technologies found in modern shoes (neutral/support cushioning). Awareness of training or selection of the correct equipment requires an understanding of a runner's biomechanics, such as determining foot orientation when it strikes the ground. Previous work involved a low-cost approach with a foot-mounted inertial measurement unit (IMU) and an associated zero-crossing-based methodology to objectively understand a runner's biomechanics (in any setting) to learn about shoe selection. Here, an investigation of the previously presented ZC-based methodology is presented only to determine general validity for running gait assessment in a range of running abilities from novice (8 km/h) to experienced (16 km/h+). In comparison to Vicon 3D motion tracking data, the presented approach can extract pronation, foot strike location, and ground contact time with good [ICC(2,1) > 0.750] to excellent [ICC(2,1) > 0.900] agreement between 8-12 km/h runs. However, at higher speeds (14 km/h+), the ZC-based approach begins to deteriorate in performance, suggesting that other features and approaches may be more suitable for faster running and sprinting tasks.

A proposed computer vision model for running gait assessment.

Running gait assessment is critical in performance optimization and injury prevention. Traditional approaches to running gait assessment are inhibited by unnatural running environments (e.g., indoor lab), varied assessor (i.e., subjective experience) and high costs with traditional reference standard equipment. Thus, development of valid, reproduceable and low-cost approaches are key. Use of wearables such as inertial measurement units have shown promise but despite their flexible use in any environment and reduced cost, they often retain complexities such as connectivity to mobile platforms and stringent attachment protocols. Here, we propose a non-wearable camera-based approach to running gait assessment, focusing on identification of initial contact events within a runner's stride. We investigated different artificial intelligence and object tracking approaches to determine the optimal methodology. A cohort of 40 healthy runners were video recorded (240FPS, multi-angle) during 2-minute running bouts on a treadmill. Validation of the proposed approach is obtained from comparison to manually labelled videos. The computing vision approach can accurately identify initial contact events (ICC(2,1) = 0.902).

Exposure to an androgenic agricultural pollutant does not alter metabolic rate, behaviour, or morphology of tadpoles.

Globally, amphibian species are experiencing dramatic population declines, and many face the risk of imminent extinction. Endocrine-disrupting chemicals (EDCs) have been recognised as an underappreciated factor contributing to global amphibian declines. In this regard, the use of hormonal growth promotants in the livestock industry provides a direct pathway for EDCs to enter the environment-including the potent anabolic steroid 17ß-trenbolone. Emerging evidence suggests that 17ß-trenbolone can impact traits related to metabolism, somatic growth, and behaviour in non-target species. However, far less is known about possible effects of 17ß-trenbolone on anuran species, particularly during early life stages. Accordingly, in the present study we investigated the effects of 28-day exposure to 17ß-trenbolone (mean measured concentrations: 10 and 66 ng/L) on body size, body condition, metabolic rate, and anxiety-related behaviour of tadpoles (Limnodynastes tasmaniensis). Specifically, we measured rates of O2 consumption of individual tadpoles as a proxy for metabolic rate and quantified their swimming activity and their time spent in the upper half of the water column as indicators of anxiety-related behaviour. Counter to our predictions based on effects observed in other taxa, we detected no effect of 17ß-trenbolone on body size, metabolic rate, or behaviour of tadpoles; although, we did detect a subtle, but statistically significant decrease in body condition at the highest 17ß-trenbolone concentration. We hypothesise that 17ß-trenbolone may induce taxa-specific effects on metabolic function, growth, and anxiety-related behaviour, with anurans being less sensitive to disruption than fish, and encourage further cross-taxa investigation to test this hypothesis.

Evidence, causes, and consequences of declining nitrogen availability in terrestrial ecosystems.

The productivity of ecosystems and their capacity to support life depends on access to reactive nitrogen (N). Over the past century, humans have more than doubled the global supply of reactive N through industrial and agricultural activities. However, long-term records demonstrate that N availability is declining in many regions of the world. Reactive N inputs are not evenly distributed, and global changes-including elevated atmospheric carbon dioxide (CO2) levels and rising temperatures-are affecting ecosystem N supply relative to demand. Declining N availability is constraining primary productivity, contributing to lower leaf N concentrations, and reducing the quality of herbivore diets in many ecosystems. We outline the current state of knowledge about declining N availability and propose actions aimed at characterizing and responding to this emerging challenge.

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis.

BACKGROUND: Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. METHODS: We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. RESULTS: We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region. INTERPRETATION: Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.

Trauma, Teams, and Telemedicine: Evaluating Telemedicine and Teamwork in a Mass Casualty Simulation.

INTRODUCTION: Mass casualty events (MASCAL) are on the rise globally. Although natural disasters are often unavoidable, the preparation to respond to unique patient demands in MASCAL can be improved. Utilizing telemedicine can allow for a better response to such disasters by providing access to a virtual team member with necessary specialized expertise. The purpose of this study was to examine the positive and/or negative impacts of telemedicine on teamwork in teams responding to MASCAL events. METHODS: We introduced a telemedical device (DiMobile Care) to Forward Surgical Teams during a MASCAL simulated training event. We assessed teamwork-related attitudes, behaviors, and cognitions during the MASCAL scenario through pre-post surveys and observations of use. Analyses compare users and nonusers of telemedicine and pre-post training differences in teamwork. RESULTS: We received 50 complete responses to our surveys. Overall, clinicians have positive reactions toward the potential benefits of telemedicine; further, participants report a significant decrease in psychological safety after training, with users rating psychological safety as significantly higher than non-telemedicine users. Neither training nor telemedicine use produced significant changes in cognitive and behavioral-based teamwork. Nonetheless, participants reported perceiving that telemedicine improved leadership and adaptive care plans. CONCLUSIONS: Telemedicine shows promise in connecting Forward Surgical Teams with nuanced surgical expertise without harming quality of care metrics (i.e., teamwork). However, we advise future iterations of DiMobile Care and other telemedical devices to consider contextual features of information flow to ensure favorable use by teams in time-intensive, high-stakes environments, such as MASCAL.

Chest radiographs may assist in predicting the outcome in the early phase of Covid-19. UK district general hospital experience of Covid-19 first wave.

Objectives: Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) has caused enormous strain on health-care systems worldwide. Early recognition of prognostic markers and appropriate management of patients with coronavirus disease 2019 (Covid-19) remains a major global health concern, particularly when resources are limited. We undertook a study to see if basic tests can inform frontline clinicians of disease trajectory in individual patients with COVID-19.Methods: We retrospectively assessed characteristics of the first 50 consecutive patients admitted to district general hospital in the United Kingdom with positive SARS-Cov-2 RNA swabs.Results: Our patient cohort shared broad similarities with previously published data on comorbidities and presenting features. We have found that chest radiographic assessment differed between survivors and non-survivors. Air space shadowing in middle zones were more prevalent in non-survivors (73.3% vs. 35.5% [p = 0.027]). Chest radiograph severity score was also found to be higher in non-survivors compared to survivors (3 vs. 1.5 [p = 0.007]).Conclusions: In this small retrospective study, our results suggest features of chest radiographs at presentation may provide a helpful tool for prognostication. In environments with constrained computed tomography (CT) imaging with serial chest radiographs could be a cost-effective tool in the assessment of Covid-19 patients.