Statistical Analysis and Kinematic Assessment of Upper Limb Reaching Task in Parkinson’s Disease

The impact of neurodegenerative disorders is twofold; they affect both quality of life and healthcare expenditure. In the case of Parkinson’s disease, several strategies have been attempted to support the pharmacological treatment with rehabilitation protocols aimed at restoring motor function. In this scenario, the study of upper limb control mechanisms is particularly relevant due to the complexity of the joints involved in the movement of the arm. For these reasons, it is difficult to define proper indicators of the rehabilitation outcome. In this work, we propose a methodology to analyze and extract an ensemble of kinematic parameters from signals acquired during a complex upper limb reaching task. The methodology is tested in both healthy subjects and Parkinson’s disease patients (N = 12), and a statistical analysis is carried out to establish the value of the extracted kinematic features in distinguishing between the two groups under study. The parameters with the greatest number of significances across the submovements are duration, mean velocity, maximum velocity, maximum acceleration, and smoothness. Results allowed the identification of a subset of significant kinematic parameters that could serve as a proof-of-concept for a future definition of potential indicators of the rehabilitation outcome in Parkinson’s disease

2D-3D registration of CT vertebra volume to fluoroscopy projection: A calibration model assessment (doi:10.1155/2010/806094)

This study extends a previous research concerning intervertebral motion registration by means of 2D dynamic fluoroscopy to obtain a more comprehensive 3D description of vertebral kinematics. The problem of estimating the 3D rigid pose of a CT volume of a vertebra from its 2D X-ray fluoroscopy projection is addressed. 2D-3D registration is obtained maximising a measure of similarity between Digitally Reconstructed Radiographs (obtained from the CT volume) and real fluoroscopic projection. X-ray energy correction was performed. To assess the method a calibration model was realised a sheep dry vertebra was rigidly fixed to a frame of reference including metallic markers. Accurate measurement of 3D orientation was obtained via single-camera calibration of the markers and held as true 3D vertebra position; then, vertebra 3D pose was estimated and results compared. Error analysis revealed accuracy of the order of 0.1 degree for the rotation angles of about 1?mm for displacements parallel to the fluoroscopic plane, and of order of 10?mm for the orthogonal displacement.<br/

An Innovative Business Model for a Multi-echelon Supply Chain Inventory Management Pattern

Nowadays, companies are experimenting novel organizational solutions to efficiently operate in uncertain and highly dynamic scenarios. As a potential solution, this paper proposes a new business model for a multi-echelon Supply Chain inventory management pattern. Specifically, an inventory model with proactive lateral transshipments was developed and subsequently tested carrying out 288 experiments with the aim of assessing transshipments impact on the performance of a two-echelon Supply Chain. The final goal was to investigate the potential reduction of the overall cost of the enterprise and, conversely, whether this approach could promote significant improvements in the level of service, achievable through a more efficient management of resources. The analyses and simulations indicate the use of large batches and/or low-cost products did not demand the necessity of transshipment events. These preliminary findings could be potentially validated and tested in the future considering more complex networks or multiple products

OSAS severity is associated to decreased heart rate turbulence slope

Obstructive sleep apnea syndrome (OSAS) has been associated to impaired baroreflex sensitivity (BRS) which has recently been shown to be non-invasively assessed by heart rate turbulence (HRT) analysis. Although HRT seems to be better suited than traditional heart rate variability indexes for autonomic assessment in presence of respiratory and arrhythmic disorders, very few papers addressed its evaluation in OSAS. Aim of the study is to find out whether and to which extend HRT is associated to OSAS severity. We studied HRT in polysomnographic recordings of 221 mild to severe OSAS pts. Results showed that, while HRT onset values did not significantly differ between mild (-0,78±1,50), moderate (-0,89±1,78) and severe (-0,70±1,28) pts., HRT slope significantly decreases (Kruskal-Wallis P value <0.05) from mild (3,27±2,7) to moderate (2,6±2,6) and severe (1,98±2,5) pts., with a significant Dunn's multiple comparisons post test only between mild vs. severe OSAS pts. Data indicate that the main BRS alterations do not appear in the early HRT phase triggered by transient vagal inhibition, but during the slow one, due to the sympathetic hyperactivity affecting the heart rate recovery. These findings support the conclusion that HRT assessment could have a prognostic value related to the development of cardiovascular disease in OSAS

Management of the Diabetic Patient in the Diagnostic Care Pathway

Diabetes is a complex pathology both for the affected patients and for the medical specialists who follow them. Furthermore, since diabetes is a pathology with a high prevalence and incidence, it is essential to intervene effectively in therapeutic actions through the application of common guidelines. Therefore, in order to improve the management of the diabetic patient, the aim of the work is to define a Diagnostic Therapeutic Assistance Pathway (PDTA). A questionnaire-based approach is adopted for data collection from 136 patients at the Clinical Dermatology Unit of the University Hospital “Federico II”. In most cases (64%) the diagnosis was made by the General Practitioner, 15% of patients obtained the diagnosis at the ASL and 12% at the Polyclinic of Naples AOU “Federico II” and the remaining part from the diabetologist specialist. The second access is generally carried out at the “Federico II” AOU (66%), followed by the ASL (17%), by a doctor specialized in diabetology (12%) while no patient has turned to the General Practitioner for the treatment of diabetes. The final visit is carried out at the “Federico II” AOU in almost cases. The data obtained follow the Italian guidelines: the patients get the diagnosis from the Family Doctor and then they are addressed either to ASL or to diabetologists specialists. For the subsequent visits, most of them prefer to turn to the “Federico II” AOU, especially when they have complications associated with the diseases as they are followed in a more careful and satisfying manner