Design of a Sustainable Blockchain-Oriented Software for Building Workers Management

The building workers sector is one of the most challenging sectors for Human Resources (HR) management. In this work, we propose a solution relying on Blockchain technology and present the design of a Blockchain-Oriented Software system conceived for managing the building workers sector with a focus on workers' safety, and it is guided by sustainable and Agile Methodologies in software design. The proposed approach takes advantage of different features of the Blockchain technology and provides transparency for labor inspectors, grants data integrity and immutability, relies on tamper-proof time stamps for any recorded activity, allows the implementation of Smart Contracts where clauses are automatically respected without the need of a trusted control authority, acknowledges the legal requirements in the field, including the possibility of creating an Operational Safety Plans, which construction companies have to provide, and finally implements the creation of vacant job positions that workers can find and apply to. In order to achieve these goals, we adopt the Blockchain-Oriented Software Engineering (BOSE) methodology to design Blockchain software applications and apply an Agile methodology centered on Blockchain Software development (called ABCDE) for the design and development of the decentralized application. Such a methodology allows us to center the software development around the actors of the system in the specific domain, such as Building Workers, Construction Companies, Labor Inspectors, and so on. In addition, we rely on the software sustainability analysis, based on the five dimensions of sustainability, to evaluate the approach and to avoid mistakes in the system development. We design system elements with specific diagrams, and we divided our system in the on-chain and the out-of-chain components. The implementation of the system, done by using Ethereum and the ERC721 standard, allows us to improve some aspect of the design, to know the deployment and usage costs, and to evaluate the effect of the user interface. Finally, we discuss the effects of our system and its sustainability, and we provide a comparison of our system with a similar per aims but centralized system

Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey

Background: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. Methods: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. Results: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. Conclusion: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths

Assessment of balance and gait abilities in the clinic, laboratory, and natural environments

Balance is fundamental in our daily life, and a proper postural control is essential to maintain it, achieve it, or restore it. Maintaining balance is a complex sensorimotor task and hence it can be affected by ageing, neurological conditions, as well as many activities in our daily routines which can lead to a loss of balance. Thus, assessing postural control is crucial. In the clinical setting, it can be used to conduct early monitoring and prevention, while, for example, in the work environment it could be adopted to correct posture and avoid injuries or pain due to a prolonged situation of discomfort. The knowledge of the daily implications of postural control on the quality of our daily life drove my PhD project and the contents of this thesis: all the studies included within this work examined postural control in different scenarios, tasks, and populations by adopting a variety of techniques and methods in order to have a clear and global understanding of postural control in all its facets. Indeed, this thesis proposes different setups, protocols, and metrics to comprehensively assess postural control in a quantitative manner overcoming the limitation of the methods traditionally used, which often suffer from high subjectivity, flooring/ceiling effects and poor sensitivity. My project started by investigating changes in postural control while standing. Specifically, my first aim was to characterize and mathematically define age-related changes in both static and dynamic balance tasks. To do so, I analyzed the data of 272 healthy subjects, with an age range spanning from 20 to 90, who underwent a test conducted using a medical robotic device, hunova. The results revealed that the decline of balance abilities with age could be described by a quadratic curve and that, as expected, the rate of age-dependent changes is also influenced by the testing conditions. The knowledge of the age's effect on postural control in a large population, covering the entire adult lifespan, can be used to evaluate the possible onset of balance problems, separating them from a normal decay of the balance ability due to age. After evaluating the effect of age on postural control, I chose to investigate how neurological disorders, such as Parkinson's Disease (PD) and Multiple Sclerosis (MS), affect balance at the early stage of the disease, when postural deficits are not clearly evident yet. Using the same setup and a similar protocol, I assessed balance deficits in PD subjects by comparing 10 PDs and 10 age-matched controls. The results highlighted how the robotic platform hunova is, indeed, capable of detecting postural control deficits in people with Parkinson’s even in case of a low Posture Instability-Gait Disturbance (PIGD) score. Then, I studied the effects of MS by comparing 27 subjects with MS and 17 age-matched controls. Here, the focus was on static standing evaluated by structural parameters that are a novelty in MS but are already studied in healthy subjects and PD. Those parameters are strictly related to the underlining neural control process as derive from the sway-density curve (SDC). Indeed, the SDC represents the instants of time in which the ankle torque is stable and detects the restoring force that compensates for the micro-falls that are typical in the dynamic of unperturbed standing and thus the descending (feed-forward) motor commands generating such force. In this study, I found that MS swayed more, and their feed forward commands were larger in amplitude. A greater posturographic command may be a strategy of MS subjects to counteract their deficit to properly calibrate the inverse model of the unstable inverted pendulum that led to the maintenance of an upright standing position. These two studies on neurological subjects highlighted the importance of instrumented balance assessments that can bring to light deficits that are not otherwise identified. Within this thesis, to keep on in the assessments of balance, I also evaluated postural control while sitting. Specifically, two different setups to quantitatively study trunk control in clinical settings are presented. First, I extensively characterized trunk control in 15 stroke subjects using a functional test. In this study, the kinematic performance and muscular activity of the upper body after stroke have been studied during the frontal and lateral modified functional reach test, with a specific and primary focus on trunk control and the corresponding trunk muscles. Then, I evaluated trunk control using the same robotic device already proposed, hunova, which also allows balance assessments while sitting. Here, I tested 18 healthy subjects to investigate the kinematic and muscular activations of the volitional and the reactive components of trunk control. Subjects, seated on the device, were requested to move the seat platform in a well-defined direction or to adapt to the continuous and predictable perturbations of the device. Subjects improved their performance with practice and learnt how to adapt to the perturbations. In this study, the kinematic and muscular performance was studied in dependence of specific parameters of the device which could be set, such as the velocity of the seat motion or its work-space. These results drove us to adapt the protocol to extensively study trunk control in Spinal Cord Injured (SCI) subjects throughout a complete, but clinically applicable, protocol. Here, I assessed the performance of 10 SCI subjects (4 with a complete lesion and 6 with an incomplete lesion of the spinal cord). In my project I have also studied the role of trunk muscles and trunk control while driving throughout a simulator, and while writing in a school environment. These two studies were conducted to highlight the feasibility of using these setups for quantitative assessments of performance in out-of-clinic scenarios. Lastly, I focused on another sensorimotor task: gait. Within this thesis, gait is studied using approaches that does not require the use of markers to avoid modifying the naturalness of the subject’s movements: the 2D and 3D markerless analysis. The former used a single lateral RGB camera while the latter included 3 RGB cameras. Deep learning algorithms are then used to extract key points from which the subject’s movement was assessed. 16 stroke survivors have been tested with a 2D setup, while 16 healthy subjects underwent an experiment using a 3D setup. Results of both studies were promising. The first study did not highlight significant differences between marker-based and markerless gait analysis: both the spatio-temporal parameters and the elevation angles in the sagittal plane computed with the markerless approach did not differ from the one computed with the marker approach. Also, those parameters detected the differences between the two legs of stroke subjects. Indeed, the second study (i.e., the one in 3D) showed comparable results when considering spatio-temporal parameters and joint angles. The only difference was an underestimation of the maximum flexion for ankle and knee angles. These results highlighted the possibility to adopt markerless technique for gait analysis inside the clinical settings, however, these setups can be easily adapted for gait analysis, and more in general, human motion analysis, outside in a freer environment. Hence, this thesis assesses postural control in terms of standing and sitting balance, but also includes its assessment during other dynamic activities. This thesis proved the usability of these setups for comprehensive and quantitative assessments in different scenarios, and also the use of these to answer scientific questions. Indeed, this thesis provided technologies, protocols and metrics that can be used and/or translate in different scenarios to allow quantitative and standardized assessments of postural control. The results reported within this thesis also contribute to enlarge the knowledge on postural control

A computer interface controlled by upper limb muscles: effects of a two weeks training on younger and older adults

As the population worldwide ages, there is a growing need for assistive technology and effective human-machine interfaces to address the wider range of motor disabilities that older adults may experience. Motor disabilities can make it difficult for individuals to perform basic daily tasks, such as getting dressed, preparing meals, or using a computer. The goal of this study was to investigate the effect of two weeks of training with a myoelectric computer interface (MCI) on motor functions in younger and older subjects. Twenty people were recruited in the study: thirteen younger (range: 22-35 years old) and seven older (range: 61-78 years old) subjects. Participants completed six training sessions of about 2 hours each, during which the activity of right and left biceps and trapezius were mapped into a control signal for the cursor of a computer. Results highlighted significant improvements in cursor control, and therefore in muscle coordination, in both groups. All participants with training became faster and more accurate, although people in different age range learned with a different dynamic. Results of the questionnaire on system usability and quality highlighted a general consensus about easiness of use and intuitiveness. These findings suggest that the proposed MCI training can be a powerful tool in the framework of assistive technologies for both younger and older subjects groups. Further research is needed to determine the optimal duration and intensity of MCI training for different age groups and to investigate long-term effects of training on physical and cognitive function

Erratum to: A prospective study of the cumulative incidence and course of restless legs syndrome in de novo patients with Parkinson's disease during chronic dopaminergic therapy

n/

Markerless vs. Marker-Based Gait Analysis: A Proof of Concept Study

The analysis of human gait is an important tool in medicine and rehabilitation to evaluate the effects and the progression of neurological diseases resulting in neuromotor disorders. In these fields, the gold standard techniques adopted to perform gait analysis rely on motion capture systems and markers. However, these systems present drawbacks: they are expensive, time consuming and they can affect the naturalness of the motion. For these reasons, in the last few years, considerable effort has been spent to study and implement markerless systems based on videography for gait analysis. Unfortunately, only few studies quantitatively compare the differences between markerless and marker-based systems in 3D settings. This work presented a new RGB video-based markerless system leveraging computer vision and deep learning to perform 3D gait analysis. These results were compared with those obtained by a marker-based motion capture system. To this end, we acquired simultaneously with the two systems a multimodal dataset of 16 people repeatedly walking in an indoor environment. With the two methods we obtained similar spatio-temporal parameters. The joint angles were comparable, except for a slight underestimation of the maximum flexion for ankle and knee angles. Taking together these results highlighted the possibility to adopt markerless technique for gait analysis