Gait Impairment Score: A Fuzzy Logic-Based Index for Gait Assessment

The objective assessment of subject’s gait impairment is a complicated task. For this reason, several indices have been proposed in literature for achieving this purpose, taking into account different gait parameters. All of them were essentially based on the identification of “normality ranges” for the gait parameters of interest or of a “normal population”. However, it is not trivial to obtain a unique definition of “normal gait”. In this study we proposed the Gait Impairment Score (GIS) that is a novel index to evaluate the subject’s gait impairment level based on fuzzy logic. This index was obtained combining two Fuzzy Inference Systems (FISs), based on gait phases (GP) and knee joint kinematics (JK) parameters, respectively. Eight GP parameters and ten JK parameters were extracted from the basographic and knee kinematic signals, respectively. Those signals were acquired, for each subject’s lower limb, using a set of wearable sensors connected to a commercial system for gait analysis. Each parameter was used as input variable of the corresponding FIS. The output variable of the two FISs represented the impairment level from the GP and JK point of view. GP-FIS and JK-FIS were applied separately to both right and left leg parameters. Then, the fuzzy outputs of the two FISs were aggregated, independently for each side, to obtain the leg fuzzy output. The final subject’s GIS was obtained aggregating the fuzzy outputs of the two legs. The score was validated against two gait analysis experts on a population of 12 subjects both with and without walking pathologies. The Analytic Hierarchy Process (AHP) pairwise comparisons were used to obtain the subjects’ ranking from the two experts. The same population was scored using the GIS and ordered in ascending order. Comparing the three rankings (from our system and from the two human experts) it emerged that our system gives the same “judgment” of a human expert

Normalization strategies in multi-center radiomics abdominal MRI: systematic review and meta-analyses

Goal: Artificial intelligence applied to medical image analysis has been extensively used to develop non-invasive diagnostic and prognostic signatures. However, these imaging biomarkers should be largely validated on multi-center datasets to prove their robustness before they can be introduced into clinical practice. The main challenge is represented by the great and unavoidable image variability which is usually addressed using different pre-processing techniques including spatial, intensity and feature normalization. The purpose of this study is to systematically summarize normalization methods and to evaluate their correlation with the radiomics model performances through meta-analyses. This review is carried out according to the PRISMA statement: 4777 papers were collected, but only 74 were included. Two meta-analyses were carried out according to two clinical aims: characterization and prediction of response. Findings of this review demonstrated that there are some commonly used normalization approaches, but not a commonly agreed pipeline that can allow to improve performance and to bridge the gap between bench and bedside

Surface Electromyography Applied to Gait Analysis: How to Improve Its Impact in Clinics?

Surface electromyography (sEMG) is the main non-invasive tool used to record the electrical activity of muscles during dynamic tasks. In clinical gait analysis, a number of techniques have been developed to obtain and interpret the muscle activation patterns of patients showing altered locomotion. However, the body of knowledge described in these studies is very seldom translated into routine clinical practice. The aim of this work is to analyze critically the key factors limiting the extensive use of these powerful techniques among clinicians. A thorough understanding of these limiting factors will provide an important opportunity to overcome limitations through specific actions, and advance toward an evidence-based approach to rehabilitation based on objective findings and measurements

Could normalization improve robustness of abdominal MRI radiomic features?

Radiomics-based systems could improve the management of oncological patients by supporting cancer diagnosis, treatment planning, and response assessment. However, one of the main limitations of these systems is the generalizability and reproducibility of results when they are applied to images acquired in different hospitals by different scanners. Normalization has been introduced to mitigate this issue, and two main approaches have been proposed: one rescales the image intensities (image normalization), the other the feature distributions for each center (feature normalization). The aim of this study is to evaluate how different image and feature normalization methods impact the robustness of 93 radiomics features acquired using a multicenter and multi-scanner abdominal Magnetic Resonance Imaging (MRI) dataset. To this scope, 88 rectal MRIs were retrospectively collected from 3 different institutions (4 scanners), and for each patient, six 3D regions of interest on the obturator muscle were considered. The methods applied were min-max, 1st-99th percentiles and 3-Sigma normalization, z-score standardization, mean centering, histogram normalization, Nyul-Udupa and ComBat harmonization. The Mann-Whitney U-test was applied to assess features repeatability between scanners, by comparing the feature values obtained for each normalization method, including the case in which no normalization was applied. Most image normalization methods allowed to reduce the overall variability in terms of intensity distributions, while worsening or showing unpredictable results in terms of feature robustness, except for the z-score, which provided a slight improvement by increasing the number of statistically similar features from 9/93 to 10/93. Conversely, feature normalization methods positively reduced the overall variability across the scanners, in particular, 3sigma, z_score and ComBat that increased the number of similar features (79/93). According to our results, it emerged that none of the image normalization methods was able to strongly increase the number of statistically similar features

Influence of Gait Cycle Normalization on Principal Activations

The Clustering for Identification of Muscle Activation Pattern (CIMAP) algorithm has been recently proposed to cope with the high intra-subject variability of muscle activation patterns and to allow the extraction of principal activations (PAs), defined as those muscle activation intervals that are strictly necessary to perform a specific task. To assess differences between different PAs, gait cycle normalization techniques are needed to handle between- and within-subject variability. The aim of this contribution is to assess the effect of two different time-normalization techniques (Linear Length Normalization and Piecewise Linear Length Normalization) on PA extraction, in terms of inter-subject similarity. Results demonstrated no statistically significant differences in the inter-subject similarity between the two tested approaches, revealing, on the average, inter-subject similarity values higher than 0.64. Moreover, a statistically significant difference in the inter-subject similarity among muscles was assessed, revealing a higher similarity of PAs extracted considering the distal lower limb muscles. In conclusion, our results demonstrated that PAs extracted from healthy subjects during a walking task at comfortable walking speed are not affected by the time-normalization approach implemented

Experiences of life and intersectionality of transgender refugees living in Italy: A qualitative approach

Transgender refugees are at risk of experiencing increased minority stress due to experiences of trauma in their country of origin, and the intersection of multiple marginalized identities in their host country. Adopting a transfeminist and decolonial approach, the present study aimed at exploring transgender refugees’ experiences of life and migration. A semi-structured interview protocol was developed, grounded in the perspectives of minority stress and intersectionality. Participants were five transgender refugees (four women and one non-binary) from different cultural/geographic contexts, professing different religions. Using thematic analysis, the researchers identified three themes: pre- and post-migration minority stress and transphobia; religion as a protective factor for gender affirmation; and individuation and the synthesis of social identities. Participants reported traumatic experiences and the inability to openly live out their gender identity in their country of origin as the main push factors to migration. They also reported feelings of isolation and experiences of victimization during interactions with the Italian asylum services, due to a lack of adequate training, racial prejudice, and transphobia. Participants demonstrated positive individuation, linked to gender affirmation treatments and religious protective factors. The interview protocol may be used by social operators to support the claims of transgender asylum seekers, and to clinically assess transgender people with an immigrant background

homicide by drinking glass with peculiar findings let s create safer drinking environments to reduce alcohol related murders

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Flexible sutures reduce bending moments in shells: from the echinoid test to tessellated shell structures

In the field of structural engineering, lightweight and resistant shell structures can be designed by efficiently integrating and optimizing form, structure and function to achieve the capability to sustain a variety of loading conditions with a reduced use of resources. Interestingly, a limitless variety of high-performance shell structures can be found in nature. Their study can lead to the acquisition of new functional solutions that can be employed to design innovative bioinspired constructions. In this framework, the present study aimed to illustrate the main results obtained in the mechanical analysis of the echinoid test in the common sea urchin Paracentrotus lividus (Lamarck, 1816) and to employ its principles to design lightweight shell structures. For this purpose, visual survey, photogrammetry, three-dimensional modelling, three-point bending tests and finite-element modelling were used to interpret the mechanical behaviour of the tessellated structure that characterize the echinoid test. The results achieved demonstrated that this structural topology, consisting of rigid plates joined by flexible sutures, allows for a significant reduction of bending moments. This strategy was generalized and applied to design both freeform and form-found shell structures for architecture exhibiting improved structural efficiency

Evaluation of Muscle Function by Means of a Muscle-Specific and a Global Index

Gait analysis applications in clinics are still uncommon, for three main reasons: (1) the considerable time needed to prepare the subject for the examination; (2) the lack of user-independent tools; (3) the large variability of muscle activation patterns observed in healthy and pathological subjects. Numerical indices quantifying the muscle coordination of a subject could enable clinicians to identify patterns that deviate from those of a reference population and to follow the progress of the subject after surgery or completing a rehabilitation program. In this work, we present two user-independent indices. First, a muscle-specific index (MFI) that quantifies the similarity of the activation pattern of a muscle of a specific subject with that of a reference population. Second, a global index (GFI) that provides a score of the overall activation of a muscle set. These two indices were tested on two groups of healthy and pathological children with encouraging results. Hence, the two indices will allow clinicians to assess the muscle activation, identifying muscles showing an abnormal activation pattern, and associate a functional score to every single muscle as well as to the entire muscle set. These opportunities could contribute to facilitating the diffusion of surface EMG analysis in clinics

An innovative radiomics approach to predict response to chemotherapy of liver metastases based on CT images

Liver metastases (mts) from colorectal cancer (CRC) can have different responses to chemotherapy in the same patient. The aim of this study is to develop and validate a machine learning algorithm to predict response of individual liver mts. 22 radiomic features (RF) were computed on pretreatment portal CT scans following a manual segmentation of mts. RFs were extracted from 7x7 Region of Interests (ROIs) that moved across the image by step of 2 pixels. Liver mts were classified as non-responder (R-) if their largest diameter increased more than 3 mm after 3 months of treatment and responder (R+), otherwise. Features selection (FS) was performed by a genetic algorithm and classification by a Support Vector Machine (SVM) classifier. Sensitivity, specificity, negative (NPV) and positive (PPV) predictive values were evaluated for all lesions in the training and validation sets, separately. On the training set, we obtained sensitivity of 86%, specificity of 67%, PPV of 89% and NPV of 61%, while, on the validation set, we reached a sensitivity of 73%, specificity of 47%, PPV of 64% and NPV of 57%. Specificity was biased by the low number of R- lesions on the validation set. The promising results obtained in the validation dataset should be extended to a larger cohort of patient to further validate our method.Clinical Relevance— to personalize treatment of patients with metastastic colorectal cancer, based on the likelihood of response to chemotherapy of each liver metastasis