A smartphone-based architecture to detect and quantify freezing of gait in Parkinson’s disease

Introduction The freezing of gait (FOG) is a common and highly distressing motor symptom in patients with Parkinson’s Disease (PD). Effective management of FOG is difficult given its episodic nature, heterogeneous manifestation and limited responsiveness to drug treatment. Methods In order to verify the acceptance of a smartphone-based architecture and its reliability at detecting FOG in real-time, we studied 20 patients suffering from PD-related FOG. They were asked to perform video-recorded Timed Up and Go (TUG) test with and without dual-tasks while wearing the smartphone. Video and accelerometer recordings were synchronized in order to assess the reliability of the FOG detection system as compared to the judgement of the clinicians assessing the videos. The architecture uses two different algorithms, one applying the Freezing and Energy Index (Moore-Bächlin Algorithm), and the other adding information about step cadence, to algorithm 1. Results A total 98 FOG events were recognized by clinicians based on video recordings, while only 7 FOG events were missed by the application. Sensitivity and specificity were 70.1% and 84.1%, respectively, for the Moore-Bächlin Algorithm, rising to 87.57% and 94.97%, respectively, for algorithm 2 (McNemar value = 28.42; p = 0.0073). Conclusion Results confirm previous data on the reliability of Moore-Bächlin Algorithm, while indicating that the evolution of this architecture can identify FOG episodes with higher sensitivity and specificity. An acceptable, reliable and easy-to-implement FOG detection system can support a better quantification of the phenomenon and hence provide data useful to ascertain the efficacy of therapeutic approaches

LA VALUTAZIONE DEGLI INVESTIMENTI PER LA MOBILITÀ: UN MODELLO MATEMATICO DI AIUTO ALLA DECISIONE

The Italian mobility system is characterized by obsolete, inefficient, often unsafe infrastructural networks and by long and complex processes in public administrations, as well as by procurement legal disputes that discourage private investments: these multiple factors hinder the socio-economic development and the national GDP growth. In the EU report “Transport in the European Union" of March 2019, Italy is below the European average, both in terms of the services quality and the reliability of the transport network, with over 80% car trips. Logistics, local public transport and related modal integrations (train-bus-bicycle, etc.), and tariffs are fundamental elements for “sustainable development". Considering the strategic importance and the problem relevance, in this paper, the variables characterizing the quadrinomial “infrastructural network-mobility service-economy-environment" are analysed in order to develop a mathematical model to support the decision-making process for transport investments. The proposed algorithm allows to evaluate the right choice among not indifferent alternatives which respect technical, economic and ecosystemic constraints. Thanks to this model, the project manager is able to evaluate and choose the best alternative for improving the “territory-mobility" system into a global configuration which considers the overall impact (all effects) of the investment, taking into account every possible scenario. The model is based on the elements of function theory and linear and relational algebra: through pre-established “input" parameters, a decision-making strategy is set up to achieve pre-established strategic objectives, with “excellent" decision trajectories which maximize the global utilities of the project or of the action program

The KIMORE dataset: KInematic assessment of MOvement and clinical scores for remote monitoring of physical REhabilitation

The paper proposes a free dataset, available at the following link1, named KIMORE, regarding different rehabilitation exercises collected by a RGB-D sensor. Three data inputs including RGB, Depth videos and skeleton joint positions were recorded during five physical exercises, specific for low back pain and accurately selected by physicians. For each exercise, the dataset also provides a set of features, specifically defined by the physicians, and relevant to describe its scope. These features, validated with respect to a stereophotogrammetric system, can be analyzed to compute a score for the subject's performance. The dataset also contains an evaluation of the same performance provided by the clinicians, through a clinical questionnaire. The impact of KIMORE has been analyzed by comparing the output obtained by an example of rule and template-based approaches and the clinical score. The dataset presented is intended to be used as a benchmark for human movement assessment in a rehabilitation scenario in order to test the effectiveness and the reliability of different computational approaches. Unlike other existing datasets, the KIMORE merges a large heterogeneous population of 78 subjects, divided into 2 groups with 44 healthy subjects and 34 with motor dysfunctions. It provides the most clinically-relevant features and the clinical score for each exercise

An instrumental approach for monitoring physical exercises in a visual markerless scenario: A proof of concept

none8This work proposes a real-time monitoring tool aimed to support clinicians for remote assessing exercise performances during home-based rehabilitation. The study relies on clinician indications to define kinematic features, that describe five motor tasks (i.e., the lateral tilt of the trunk, lifting of the arms, trunk rotation, pelvis rotation, squatting) usually adopted in the rehabilitation program for axial disorders. These features are extracted by the Kinect v2 skeleton tracking system and elaborated to return disaggregated scores, representing a measure of subjects performance. A bell-shaped function is used to rank the patient performances and to provide the scores. The proposed rehabilitation tool has been tested on 28 healthy subjects and on 29 patients suffering from different neurological and orthopedic diseases. The reliability of the study has been performed through a cross-sectional controlled design methodology, comparing algorithm scores with respect to blinded judgment provided by clinicians through filling a specific questionnaire. The use of task-specific features and the comparison between the clinical evaluation and the score provided by the instrumental approach constitute the novelty of the study. The proposed methodology is reliable for measuring subject's performance and able to discriminate between the pathological and healthy condition.Capecci, Marianna; Ceravolo, Maria Gabriella; Ferracuti, Francesco; Grugnetti, Martina; Iarlori, Sabrina; Longhi, Sauro; Romeo, Luca; Verdini, FedericaCapecci, Marianna; Ceravolo, Maria Gabriella; Ferracuti, Francesco; Grugnetti, Martina; Iarlori, Sabrina; Longhi, Sauro; Romeo, Luca; Verdini, Federic

EMG-Based Characterization of Walking Asymmetry in Children with Mild Hemiplegic Cerebral Palsy

5 May 2019; Accepted: 24 June 2019; Published: 27 June 2019 Abstract: Hemiplegia is a neurological disorder that is often detected in children with cerebral palsy. Although many studies have investigated muscular activity in hemiplegic legs, few EMG-based findings focused on una ected limb. This study aimed to quantify the asymmetric behavior of lower-limb-muscle recruitment during walking in mild-hemiplegic children from surface-EMG and foot-floor contact features. sEMG signals from tibialis anterior (TA) and gastrocnemius lateralis and foot-floor contact data during walking were analyzed in 16 hemiplegic children classified as W1 according to Winter’ scale, and in 100 control children. Statistical gait analysis, a methodology achieving a statistical characterization of gait by averaging surface-EMG-based features, was performed. Results, achieved in hundreds of strides for each child, indicated that in the hemiplegic side with respect to the non-hemiplegic side, W1 children showed a statistically significant: decreased number of strides with normal foot-floor contact; decreased stance-phase length and initial-contact sub-phase; curtailed, less frequent TA activity in terminal swing and a lack of TA activity at heel-strike. The acknowledged impairment of anti-phase eccentric control of dorsiflexors was confirmed in the hemiplegic side, but not in the contralateral side. However, a modified foot-floor contact pattern is evinced also in the contralateral side, probably to make up for balance requirements

SIAMOC position paper on gait analysis in clinical practice: General requirements, methods and appropriateness. Results of an Italian consensus conference

Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly. To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts' opinion, when the quality/quantity of the relevant literature was deemed insufficient. The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness. SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI