EEG-based mental workload neurometric to evaluate the impact of different traffic and road conditions in real driving settings

Car driving is considered a very complex activity, consisting of different concomitant tasks and subtasks, thus it is crucial to understand the impact of different factors, such as road complexity, traffic, dashboard devices, and external events on the driver’s behavior and performance. For this reason, in particular situations the cognitive demand experienced by the driver could be very high, inducing an excessive experienced mental workload and consequently an increasing of error commission probability. In this regard, it has been demonstrated that human error is the main cause of the 57% of road accidents and a contributing factor in most of them. In this study, 20 young subjects have been involved in a real driving experiment, performed under different traffic conditions (rush hour and not) and along different road types (main and secondary streets). Moreover, during the driving tasks different specific events, in particular a pedestrian crossing the road and a car entering the traffic flow just ahead of the experimental subject, have been acted. A Workload Index based on the Electroencephalographic (EEG), i.e., brain activity, of the drivers has been employed to investigate the impact of the different factors on the driver’s workload. Eye-Tracking (ET) technology and subjective measures have also been employed in order to have a comprehensive overview of the driver’s perceived workload and to investigate the different insights obtainable from the employed methodologies. The employment of such EEG-based Workload index confirmed the significant impact of both traffic and road types on the drivers’ behavior (increasing their workload), with the advantage of being under real settings. Also, it allowed to highlight the increased workload related to external events while driving, in particular with a significant effect during those situations when the traffic was low. Finally, the comparison between methodologies revealed the higher sensitivity of neurophysiological measures with respect to ET and subjective ones. In conclusion, such an EEG-based Workload index would allow to assess objectively the mental workload experienced by the driver, standing out as a powerful tool for research aimed to investigate drivers’ behavior and providing additional and complementary insights with respect to traditional methodologies employed within road safety research

Logistic regression of attitudes and coverage for influenza vaccination among Italian Public Health medical residents

Introduction. A few number of literature specifically addresses vaccination uptake among Public Health Residents (PHRs). Influ- enza vaccine attitudes and risk perceptions of PHRs across Italy were studied, contributing to literature on influenza vaccination uptake predictors, in particular among young physicians. Methods. An online survey was conducted in 25 Schools of Public Health in Italy in 2011-2012. Results were analysed using preva- lence and logistic regression methods. Results. A total of 365 Italian public health residents were included in the study. Vaccination uptake was confirmed by 22.2 and 33.2% of PHRs in 2010-2011 and 2011-2012, respectively. For the 2010-2011 influenza season, vaccination was associated with male sex (adj-OR 3.43; 95%CI = 1.5-7.84) and vaccination history (adj-OR 29.44; 95%CI = 6.4-135.04). For the 2011-2012 season, vaccination was significantly associated with having had between one and three influenza vaccinations in the previ- ous five years (adj-OR 11.56; 95%CI = 6.44-20.75) or more than three (adj-OR 136.43; 95%CI = 30.8-604.7) and with individual participation in general population vaccination campaigns (adj- OR 1.85; 95%CI = 1.01-3.41). Discussion. Italian residents in public health have no confidence and a low personal risk perception about vaccinations therefore taking no measures to protect patients, general population and themselves. Annual influenza vaccination acceptance is associ- ated with influenza vaccine uptake in the previous years and per- sonal involvement in general population vaccination campaigns. These factors should be considered for the design of future cam- paigns targeting public health residents

Maintenance deep transcranial magnetic stimulation sessions are associated with reduced depressive relapses in patients with unipolar or bipolar depression

Introduction: Deep transcranial magnetic stimulation (dTMS) is a new form of TMS allowing safe stimulation of deep brain regions. The objective of this preliminary study was to assess the role of dTMS maintenance sessions in protecting patients with bipolar disorder (BD) or recurrent major depressive disorder (MDD) from developing depressive or manic relapses in a 12-month follow-up period. Methods: Twenty-four drug-resistant patients with a current depressive episode and a diagnosis of MDD or BD have been enrolled in the study. All the participants underwent daily dTMS sessions for 4 weeks. One group (maintenance - M group) received additional maintenance dTMS sessions weekly or twice a week. Results: After the first dTMS cycle, a significant reduction of Hamilton Depression Rating Scale (HDRS) scores was observed in all participants. Subsequently, the HDRS mean scores did not significantly change over time in the M group, while it significantly increased in the non-M-group after 6 and 12 months. Discussion: This study confirms previous evidence of a positive therapeutic effect of dTMS on depressive symptoms and suggests that, after recovery from acute episodes, maintenance dTMS sessions may be helpful in maintaining euthymia in a 12-month follow-up period

Polypoid lesions of the gallbladder in a consecutive series of 2631 patients. A single-center experience

INTRODUZIONE: La diagnosi ultrasonografica (US) delle lesioni polipoidi della colecisti (PLG) è difficile per la bassa sensibilità (SE) della metodica. Non sono stati ancora completamenti definiti i criteri di selezione dei pazienti con PLG da indirizzare al trattamento chirurgico o al follow-up. L’indagine istopatologica (EI) rappresenta il gold standard per la diagnosi di polipi non-neoplastici (colesterolotici, infiammatori, fibroepiteliali, adenomiomatosici), di polipi neoplastici (carcinomi, carcinoidi), di lesioni precancerose non polipoidi (displasia dibasso ed alto grado, metaplasia intestinale di tipo muciparo, metaplasia gastrica di tipo pilorico) e di irregolarità nodulari parietali della colecistite xanto-granulomatosa. Gli scopi dello studio sono stati quelli di valutare in un campione di pazienti sottoposti a colecistectomia, la prevalenza dei polipi non neoplastici e neoplastici e la sensibilità dell’US tradizionale trans-addominale rispetto all’EI nell’identificazione delle PLG. MATERIALI E METODI: Studio osservazionale retrospettivo, condotto su un campione di 2631 pazienti, sottoposti a colecistectomia laparoscopica e open, in elezione e in urgenza, identificati mediante il codice ICD-9-CM 51.2, nel periodo Aprile 2005 - Marzo 2018, presso l’ospedale universitario “A. Fiorini” di Terracina - Polo Pontino, “Sapienza” Università di Roma. Tutti i pazienti erano stati sottoposti a US. RISULTATI: Il campione esaminato era costituito da 1175(44.6%) M, età media 56 anni, range 25-95 anni, 1456(55.4%) F, età media 46anni, range 17-90 anni. La diagnosi US di PLG veniva posta in 38/2631(1.4%) pazienti. All’esame istologico i polipi erano identificati in 68/2631(2.6%) pazienti, associati a litiasi biliare in 28/2631 (1.1%) casi. Dal confronto US e EI la diagnosi ecografica risultava gravata da falsi positivi (FP) (8/38; 21%) e falsi negativi (FN) (38/2631; 1.45%), con SE 44% (95% c.i.:32.2-55.7). L’incidenza istologica di PLG neoplastiche è stata dello 0.38% (10/2631), 3M e 7F, età media 64 anni, (range 49-80 anni). In 3 casi le neoplasie erano state identificate all’US (3/10; 30 % VP); nei restanti 7 casi costituivano reperto istologico incidentale (7/10; 70 % FN), di cui 5 con diametro >1cm nel contesto di un quadro clinico di colecistite acuta litiasica e 2 con diametro <1cm in un quadro di litiasi non complicata. DISCUSSIONE: L’US tradizionale trans-addominale sottostimava l’incidenza delle PLG rispetto all’EI (p=0.021) e i FP per PLG isolate sono stati causa di errata indicazione al trattamento chirurgico. Il confronto fra diagnosi US ed EI conferma la bassa SE della metodica ecografica nell’identificazione delle PLG, sia in presenza che in assenza di litiasi biliare. Il sesso femminile si è dimostrato specifico fattore di rischio per PLG benigne e maligne e lesioni mucosali non polipoidi (p=0.041). Nel nostro studio, probabilmente, le cause della mancata identificazione US delle irregolarità parietali maligne erano l’oscuramento della lesione dall’esordio clinico della neoplasia in colecistite acuta litiasica (in 5 pazienti) e le dimensioni <1cm in presenza di litiasi non complicata (in 2 pazienti). La dimensione della lesione parietale <0.5cm non escludeva la loro natura neoplastica. Attualmente la prevenzione e la diagnosi di GBC è basata sul precoce riscontro e trattamento delle lesioni polipoidi potenzialmente evolutive nell’arco di circa 15 anni. CONCLUSIONI: Probabilmente la colecistectomia precoce in tutti i pz con PLG di diametro <1cm, isolate o associate a calcoli, sintomatici e asintomatici, può contribuire alla riduzione dell’incidenza del GBC.BACKGROUND: Challenges in the diagnosis of polypoid gallbladder lesion (PLG) is due to the low sensibility (SE) of ultrasound scan (US), and the selection criteria of patients with PLG to be addressed to surgical treatment or followup are not yet fully defined. MATERIALS AND METHODS: Retrospective observational study was conducted on 2631 patients, 1175(44.6%) M, mean age 56 years, 1456(55.4%) F, mean age 46 years, who underwent laparoscopic and open cholecystectomy. RESULTS: The US diagnosis for PLG was placed in 38/2631(1.4%) patients. On histological examination (HE) the polyps were identified in 68/2631(2.6%) patients and it was associated with biliary lithiasis in 28/2631 (1.1%) cases. From the US and HE comparison, the ultrasound diagnosis was burdened by false positives (8/38; 21%) and false negatives (38/2631;1.45%), with SE 44% (95% c.i.:32.2-55.7). The histological incidence of gall bladder cancer (GBC) was 0.38%(10/2631). DISCUSSION: US survey underestimated the incidence of PLG compared to the histological finding (p=0.021). Female gender has been shown to be a specific risk factor for benign and malignant PLG and non-polypoid mucosal lesions (p=0.041). The parietal lesion size <0.5cm does not exclude the neoplastic nature. Currently the prevention and diagnosis of GBC is based on the early detection and treatment of potentially evolutionary polypoid lesions over a period of about 15 years. CONCLUSIONS: It is probably that early cholecystectomy in all the patients with PLG of diameter <1cm, isolated or associated with lithiasis, symptomatic and asymptomatic, can contribute to the reduction of the incidence of GBC

Impact of different driving cycles and operating conditions on CO2 emissions and energy management strategies of a Euro-6 hybrid electric vehicle

Although Hybrid Electric Vehicles (HEVs) represent one of the key technologies to reduce CO2 emissions, their effective potential in real world driving conditions strongly depends on the performance of their Energy Management System (EMS) and on its capability to maximize the efficiency of the powertrain in real life as well as during Type Approval (TA) tests. Attempting to close the gap between TA and real world CO2 emissions, the European Commission has decided to introduce from September 2017 theWorldwide Harmonized Light duty Test Procedure (WLTP), replacing the previous procedure based on the New European Driving Cycle (NEDC). The aim of this work is the analysis of the impact of different driving cycles and operating conditions on CO2 emissions and on energy management strategies of a Euro-6 HEV through the limited number of information available from the chassis dyno tests. The vehicle was tested considering different initial battery State of Charge (SOC), ranging from 40% to 65%, and engine coolant temperatures, from 7 C to 70 C. The change of test conditions from NEDC to WLTP was shown to lead to a significant reduction of the electric drive and to about a 30% increase of CO2 emissions. However, since the specific energy demand of WLTP is about 50% higher than that of NEDC, these results demonstrate that the EMS strategies of the tested vehicle can achieve, in test conditions closer to real life, even higher efficiency levels than those that are currently evaluated on the NEDC, and prove the effectiveness of HEV technology to reduce CO2 emissions

Detection of Alkaline Sphingomyelinase Activity in Human Stool: Proposed Role as a New Diagnostic and Prognostic Marker of Colorectal Cancer

Abstract Objectives: Intestinal alkaline sphingomyelinase, by exerting a major role in dietary sphingomyelin digestion, is responsible for the generation of messengers able to trigger the rapid turnover and apoptosis in intestinal epithelial cells. Markedly reduced mucosal alkaline sphingomyelinase activity has been associated with human colorectal neoplasms. The aim of this study was to analyze the alkaline sphingomyelinase activity in feces from healthy subjects and colorectal adenocarcinoma patients and to correlate it with the enzyme activity in intestinal tissues. Materials and Methods: The enzyme activity was measured both in the intestinal samples from 12 healthy controls and 51 patients with colorectal adenocarcinoma (tumoral and paratumoral tissue) and in the fecal samples of 34 healthy subjects and 29 patients with adenocarcinoma. The relation between sphingomyelinase activity and Dukes' stage, cell differentiation degree, age, and gender was also analyzed. Results: Alkaline sphingomyelinase was significantly decreased (P < 0.001; mean reduction >90%) in tumoral intestinal mucosa of patients compared with controls independently of Dukes' stage and tumor differentiation grade. Interestingly, the enzyme activity in histologically normal paratumoral tissues was statistically lower than control samples (P < 0.001). As occurs in neoplastic tissues, a relevant mean reduction (P < 0.0001; almost 90%) of alkaline sphingomyelinase was revealed in stool samples from tumor patients when compared with controls. Conclusion: These findings may have implications for cancer biology and perhaps also for the design of clinical test, thus suggesting that the fecal sphingomyelinase activity could really reflect the human intestinal mucosa enzyme level and could represent a new marker for human colorectal adenocarcinoma, mainly taking into account its early appearance in intestinal neoplasms