A multi-camera and multimodal dataset for posture and gait analysis

Monitoring gait and posture while using assisting robotic devices is relevant to attain effective assistance and assess the user’s progression throughout time. This work presents a multi-camera, multimodal, and detailed dataset involving 14 healthy participants walking with a wheeled robotic walker equipped with a pair of affordable cameras. Depth data were acquired at 30 fps and synchronized with inertial data from Xsens MTw Awinda sensors and kinematic data from the segments of the Xsens biomechanical model, acquired at 60 Hz. Participants walked with the robotic walker at 3 different gait speeds, across 3 different walking scenarios/paths at 3 different locations. In total, this dataset provides approximately 92 minutes of total recording time, which corresponds to nearly 166.000 samples of synchronized data. This dataset may contribute to the scientific research by allowing the development and evaluation of: (i) vision-based pose estimation algorithms, exploring classic or deep learning approaches; (ii) human detection and tracking algorithms; (iii) movement forecasting; and (iv) biomechanical analysis of gait/posture when using a rehabilitation device.This work has been supported by the Fundação para a Ciência e Tecnologia (FCT) with the Reference Scholarship under Grant 2020.05708.BD and under the national support to R&D units grant, through the reference project UIDB/04436/2020 and UIDP/04436/2020

Markerless gait analysis vision system for real-time gait monitoring

On this paper a vision-based contact and markerless method for gait evaluation is proposed, and validated in different experimental setups against commercial motion capture systems (Vicon) and inertial gait analysis tools (GaitShoes). While the development goal is its integration on the ASBGo Smart Walker platform, only an inexpensive depth camera is required. It is shown to have reasonable results when computing gait metrics in real time, in different experimental setups, from different walker types, vision hardware and walking scenarios. Performance is evaluated through RMSD values for several gait metrics. Results illustrate that the proposed approach can be a valuable non-invasive, contactless and low cost alternative to gait analysis systems used in clinical rehabilitation environments.This work has been supported by the FEDER Funds through COMPETE 2020 — Programa Operacional Competitividade e Internacionalizacão (POCI) and P2020 with the Reference Project EML under Grant POCI-01-0247-FEDER-033067; COMPETE 2020 — Programa Operacional Competitividade e Internacionalizacão (POCI) with the Reference Project under Grant POCI-01-0145-FEDER-006941

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Real-time patient pose estimation on a smart walker

Dissertação de mestrado em Biomedical Engineering (área de especialização em Medical Electronics)Rehabilitation is important to improve quality of life for mobility impaired patients. Smart walkers are commonly used to provide residual motor skills recovery, based on repetitive and intensity-adapted training. These should embed automatic, objective and real-time tools for user-centered control and monitoring. Yet, present solutions have focused only on extracting few very specific metrics using dedicated sensors with no unified full-body approach. This dissertation proposes the creation of a general, real-time and robust full-body spatial pose estimation solution using visual information from two camera streams, with non-overlapping ROIs, mounted on the ASBGo smart walker used in patient rehabilitation. Human joint estimation is performed using a two-stage Neural Network framework, where keypoints are first detected in 2D image frames of both cameras, using a Fully Convolutional Network, and then lifted to 3D space relative to the walker, using a Fully Connected regression module. A custom acquisition method was also developed and used to obtain a dataset containing data from 14 healthy subjects, used for training and evaluating the proposed solution offline, which was then deployed and integrated on the real smart walker. An overall detection error of 3.73 pixels and 44.05mm were reported for each stage respectively, with an inference time of 26.6ms when deployed on the constrained hardware of the equipment, during normal use. The final solution was able to extract a compact body representation from inexpensive sensors, which can be used as a common base to calculate full patient gait and posture metrics, allow Human-Robot interaction applications and human-in-the loop control for personalized rehabilitation. Despite promising results, more data should be collected with impaired subjects, in order to assess the model’s true performance as a rehabilitation tool in real-world scenarios.A reabilitação é importante para melhorar a qualidade de vida dos pacientes com mobilidade reduzida. Os andarilhos inteligentes são utilizados para favorecer a recuperação de capacidades motoras com base na repetição de exercícios com intensidade adaptada. Estes devem incorporar ferramentas automáticas, objetivas e em tempo real para fornecer técnicas de controlo personalizadas e monitorização do paciente. No entanto, as soluções atuais concentram-se apenas em extrair algumas métricas muito específicas com sensores dedicados, sem haver uma abordagem geral de corpo inteiro. Esta dissertação propõe a criação de uma solução geral, rápida e robusta para detetar o corpo completo do utilizador no espaço, usando informação visual de duas câmaras, com ROIs não sobrepostas, montadas no andarilho inteligente (ASBGo) usado na reabilitação de pacientes. A deteção das juntas humanas é realizada através de uma rede neuronal em duas etapas, onde primeiro são detetados pontos-chave nas frames 2D de ambas as câmaras, usando uma rede totalmente convolucional, e estes depois são relacionados e projetados para o espaço 3D relativamente ao andarilho, usando um módulo de regressão. Um método de aquisição personalizado foi também desenvolvido e usado para obter um conjunto de dados com 14 sujeitos saudáveis, para teinar e avaliar a solução proposta offline, que depois foi integrada no sistema do andarilho real. Um erro de detecção médio de 3,73 pixels e 44,05mm foram relatados para cada etapa, respetivamente, com uma latência de 26,6ms quando usado no hardware limitado do equipamento durante utilização normal. O algorítmo é capaz de extrair uma representação compacta do corpo, a partir de sensores baratos, e que pode ser usada como uma base comum para calcular métricas de marcha e postura completas, assim como permitir aplicações de interação Humano-Robot e soluções de controlo human-in-the-loop para uma reabilitação personalizada. Apesar de resultados promissores, mais dados devem ser obtidos com pacientes, a fim de verificar o verdadeiro desempenho do modelo como ferramenta de reabilitação em cenários reais

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc