Background: Frailty is a highly recognized geriatric syndrome resulting in decline in reserve across multiple physiological systems. Impaired physical function is one of the major indicators of frailty. The goal of this study was to evaluate an algorithm that discriminates between frailty groups (non-frail and pre-frail/frail) based on gait performance parameters derived from unsupervised daily physical activity (DPA). Methods: DPA was acquired for 48 h from older adults (≥65 years) using a tri-axial accelerometer motion-sensor. Continuous bouts of walking for 20s, 30s, 40s, 50s and 60s without pauses were identified from acceleration data. These were then used to extract qualitative measures (gait variability, gait asymmetry, and gait irregularity) and quantitative measures (total continuous walking duration and maximum number of continuous steps) to characterize gait performance. Association between frailty and gait performance parameters was assessed using multinomial logistic models with frailty as the dependent variable, and gait performance parameters along with demographic parameters as independent variables. Results: One hundred twenty-six older adults (44 non-frail, 60 pre-frail, and 22 frail, based on the Fried index) were recruited. Step-and stride-times, frequency domain gait variability, and continuous walking quantitative measures were significantly different between non-frail and pre-frail/frail groups (p < 0.05). Among the five different durations (20s, 30s, 40s, 50s and 60s), gait performance parameters extracted from 60s continuous walks provided the best frailty assessment results. Using the 60s gait performance parameters in the logistic model, pre-frail/frail group (vs. non-frail) was identified with 76.8% sensitivity and 80% specificity. Discussion: Everyday walking characteristics were found to be associated with frailty. Along with quantitative measures of physical activity, qualitative measures are critical elements representing the early stages of frailty. In-home gait assessment offers an opportunity to screen for and monitor frailty. Trial registration: The clinical trial was retrospectively registered on June 18th, 2013 with ClinicalTrials.gov, identifier NCT01880229.

Frailty is an increasingly recognized geriatric syndrome resulting in age-related decline in reserve across multiple physiologic systems. An impaired physical function is a prime indicator of frailty. In this study, we aim to implement a body-worn sensor to characterize the quantity and quality of everyday walking, and establish associations between gait impairment and frailty. Daily physical activity was acquired for 48 hours from 125 older adults (≥65 years; 44 non-frail, 60 pre-frail, and 21 frail based on the Fried gold standard) using a tri-axial accelerometer motion-sensor. Continuous purposeful walks (≥60s) without pauses were identified from time-domain acceleration data. Power spectral density (PSD) analysis was performed to define higher gait variability, which was identified by a shorter and wider PSD peak. Association between frailty and gait parameters was assessed using multivariable nominal logistic models with frailty as the dependent variable, and demographic parameters along with the gait parameters as the independent variables. Stride times, PSD gait variability, and total and maximum continuous purposeful walking duration were significantly different between non-frail and pre-frail/frail groups (p<0.05). Using a step-wise model with the above qualitative and quantitative gait parameters as predictors, the pre-frail/frail group (vs. non-frail) was identified with 71.4% sensitivity and 75.4% specificity. Everyday walking characteristics were found to be accurate determinants of frailty. Along with quantitative measures of physical activity, qualitative measures are critical elements representing the stages of frailty. In-home gait analysis is advantageous over clinical gait analysis as it enables cost- and space-effective continuous monitoring.

Background: Frailty is a highly recognized geriatric syndrome resulting in decline in reserve across multiple physiological systems. Impaired physical function is one of the major indicators of frailty.Objective: The goal of this study was to evaluate an algorithm that discriminates between frailty groups (non-frail and pre-frail/frail) based on gait performance parameters derived from unsupervised daily physical activity (DPA).Methods: DPA was acquired for 48 hours from older adults (≥65 years) using a tri-axial accelerometer motion-sensor. Continuous bouts of walking for 20s, 30s, 40s, 50s and 60s without pauses were identified from acceleration data. These were then used to extract qualitative measures (gait variability, gait asymmetry, and gait irregularity) and quantitative measures (total continuous walking duration and maximum number of continuous steps) to characterize gait performance. Association between frailty and gait performance parameters was assessed using multinomial logistic models with frailty as the dependent variable, and gait performance parameters along with demographic parameters as independent variables.Results: 126 older adults (44 non-frail, 60 pre-frail, and 22 frail, based on the Fried index) were recruited.Step-and stride-times, frequency domain gait variability, and continuous walking quantitative measures were significantly different between non-frail and pre-frail/frail groups (p<0.05). Among the five different durations (20s, 30s, 40s, 50s and 60s), gait performance parameters extracted from 60s continuous walks provided the best frailty assessment results. Using the 60s gait performance parameters in the logistic model, pre-frail/frail group (vs. non-frail) was identified with 76.8% sensitivity and 80% specificity.Discussion: Everyday walking characteristics were found to be associated with frailty. Along with quantitative measures of physical activity, qualitative measures are critical elements representing the early stages of frailty. In-home gait assessment offers an opportunity to screen for and monitor frailty.

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Image compression plays a crucial role in medical imaging allowing efficient storage and transmissions by reducing the amount of data required to represent the digital image. The main goal is to achieve higher compression ratios and minimum degradation in quality. To decrease the storage space, the use of different compression techniques is justified by some medical imaging modalities generate the volume that of data which will be increasing. Different medical images like X-ray angiograms, magnetic resonance images, Ultrasound and computed Tomography are used in the medical image compression techniques. In medical applications it is required to conserve the diagnostic validity of the image requires the use of lossless compression methods, producing low compression factors. For medical data, lossless compression is preferred to the greater gains of lossy compression, in the interest of accuracy. . A set of experiment has been performed for the analysis of the proposed work on the several DICOM medical images and it has been observed that the DWT, DCT and Huffman coding has higher compression ratio than the hybrid model. The proposed method gives better quality of image that includes high PSNR and CR as well as low MSE. The proposed medical "DICOM images compression scheme" is based on Hybrid DWT, DCT and Huffman coding techniques.

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Most nations and large ones at that do not simply alter their worldwide orientation. States tend to be conventional about foreign policy. Fundamental changes in foreign policy take place only when there is a radical change either at home or in the world. Much as the ascent of Deng Xiaoping in the late 1970s shaped key changes in Chinese foreign policy, India’s associations with the world have seen a fundamental alteration over the last decade and a half. A number of factors were at work in India. The old political and economic order at home had distorted and outwardly the end of the Cold War detached all the old benchmarks that guided India’s foreign policy. Many of the center viewpoints of the older system had to throw away and consensus generated on fresh ones. The fall down of the Soviet Union and the new wave of financial globalization left India scrambling to find new anchors for its conduct of outer relations.

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