Measures of equity for multi-capital accounting.

Inequity is one of the primary economic and societal risks posed by the global food system, yet measures of inequity are missing from prominent corporate tools that aim to account for the impact of the economic activities associated with food production, manufacturing and retail. Here we suggest new metrics to measure socio-economic, gender, racial, generational and risk divides between the bearers of natural, social and human capital costs and those of benefits.

Utilizing CT with Maximum Intensity Projection Reconstruction Bypassing CTA Improves Time to Groin Puncture in Large Vessel Occlusion Stroke Thrombectomy.

BACKGROUND AND PURPOSE: Prior to thrombectomy for proximal anterior circulation large vessel occlusion (LVO) stroke, recent trials have utilized CT angiography (CTA) for vascular imaging immediately following noncontrast CT (NCCT) for decision-making, but thin-section NCCT with automated maximum intensity projection (MIP) reconstruction also has high accuracy in demonstrating the site of an occluding thrombus. We hypothesized that performing thin-section NCCT with MIP alone prior to thrombectomy improves the time to groin puncture (GP) compared to performing CTA after NCCT. MATERIALS AND METHODS: We performed a retrospective cohort study of anterior circulation LVO thrombectomy at our tertiary care academic medical center. All stroke patients evaluated with thin-section NCCT (0.625 mm) with automated MIP reconstructions alone and those who had additional CTA were included. We excluded transfer patients, in-hospital strokes, posterior circulation strokes, and patients that were evaluated with stroke imaging other than NCCT or CTA prior to thrombectomy. The study groups were compared for duration from NCCT to GP and total stroke imaging duration. RESULTS: From March 2008 through August 2015, 34 thrombectomy patients met the inclusion/exclusion criteria - 13 in the NCCT and 20 in the NCCT+CTA group. The total stroke imaging duration was shorter in the NCCT group than in the NCCT+CTA group (2 min [1-6] vs. 28 min [23-65]; p < 0.001). The NCCT-only group had a shorter time from NCCT to GP (68 min [32-99] vs. 104 min [79-128]; p = 0.030). CONCLUSION: Avoiding advanced imaging for patients with anterior circulation LVO in whom thin-section NCCT with MIPs reveals a hyperdense sign significantly shortens the imaging-to-GP time.

Evaluation of functional deficits and falls risk in the elderly--methods for preventing falls.

Falls in the elderly have a profound impact on their quality of life through injury, increased fear of falling, reduced confidence to perform daily tasks and loss of independence. Falls come at a substantial economic cost. Tools to quantify falls risk and evaluate functional deficits allow interventions to be targeted to those at increased risk of falling and tailored to correct deficits with the aim of reducing falls rate and reducing ones risk of falling. We describe a system to evaluate falls risk and functional deficits in the elderly. The system is based on the evaluation of performance in a simple set of controlled movements known as the directed routine (DR). We present preliminary results of the DR in a cohort of 68 subjects using features extracted from the DR. Linear least-squares models were trained to estimate falls risk, knee-extension strength, proprioception, mediolateral body sway, anteroposterior body sway and contrast sensitivity. The model estimates provided good to fair correlations with (r=0.76 p<0.001), (r=0.65 p<0.001), (r=0.35 p<0.01), (r=0.53 p<0.001), (r=0.48 p<0.001) and (r=0.37 p<0.01) respectively.

A wearable triaxial accelerometry system for longitudinal assessment of falls risk.

Falls-related injuries in the elderly population are a major cause of morbidity and represent one of the most significant contributors to hospitalizations and rising health care expense in developed countries. Many laboratory-based studies have described falls detection systems using wearable accelerometry. However, only a limited number of reports have tried to address the difficult issues of falls detection and falls prevention in unsupervised or free-living environments. We describe a waist-mounted triaxial accelerometry (Triax) system with a remote data collection capability to provide unsupervised monitoring of the elderly. The basis of the monitoring is a self-administered directed-routine (DR) comprising three separate tests measured by way of the Triax. We present an initial evaluation of the DR results in 36 patients to detect early changes in functional ability and facilitate falls risk stratification. Extracted features considered alone show a correlation with falls risk of approximately rho=0.5. Estimation of falls risk using a linear least squares model provides a root-mean-squared error of 0.69 (rho=0.58, p<0.0002).

Falls management: detection and prevention, using a waist-mounted triaxial accelerometer.

We describe a distributed falls management system capable of real-time falls detection in an unsupervised living context and remote longitudinal tracking of falls risk parameters using a waist-mounted triaxial accelerometer. A self-administrable falls risk assessment is used to facilitate falls prevention. A web-interface allows clinicians to monitor the status of individuals and track their compliance with exercise interventions. Early identification of increased falls risk allows targeted interventions to be promptly administered. Real-time detection of falls allows immediate emergency response protocols to be deployed, reducing morbidity and increasing the independence of the community-dwelling elderly community.