Quality of Life in Patients Undergoing Emergency Surgery for Complex Colorectal Cancer: Protocol and Piloting of the Surgical Utilization and Recovery Patterns for Advanced Stage Colorectal Cancer Study.

Introduction: Globally, cancer is the leading cause of mortality, with colorectal neoplasia ranking third in terms of incidence and mortality worldwide. Patients face disease- and treatment-specific impacts, which can significantly influence their quality of life (QoL). Aim: This study aimed to propose a protocol to measure in-hospital and long-term QoL in patients with complicated colorectal cancer (CRC). Material and Methods: multicenter prospective observational cohort study. Results: QoL is a multidimensional concept that includes criteria for physical, mental, emotional, and social functionality as perceived by the patient. Periodically evaluating QoL offers measurable and objective tools to intervene at the appropriate time to decrease the Years of Life Lost and Years Lived with Disabilities for CRC patients. However, a structured and functional system requires dedicated and common institutional effort. A pilot study using this protocol included 69 patients, 65.12+-10.92 years, M:F ratio = 56.5:43.5%. Surgical procedure was right hemicolectomy, left colectomy, transverse colectomy, sigmoidectomy, total colectomy, rectal resection, and colorectal resection with stoma (ileostomy or colostomy) in 21.7%, 11.6%, 2.9%, 11.6%, 1.4%, 23.2%, and 27.5% of the cases, respectively. The mean Global Health Status Score, Symptom Score, and Functional Score was 82.36+-18.60, 11.89+-10.27, and 86.27, 74.50-94.11, respectively. Conclusions: CRC diagnosis has major effects on patients physical and psychological status, and concentrated efforts should be made by the involved medical team and healthcare systems to improve QoL throughout the treatment pathway.

A review of sonification solutions in assistive systems for visually impaired people.

PURPOSE: Visually impaired people (VIP) find it challenging to understand and gain awareness of their surroundings. Most activities require the use of the auditory or tactile senses. As such, assistive systems which are capable of aiding visually impaired people to understand, navigate and form a mental representation of their environment are extensively being studied and developed. The aim of this paper is to provide insight regarding the characteristics, as well as the advantages and drawbacks of different types of sonification strategies in assistive systems, to assess their suitability for certain use-cases. MATERIALS AND METHODS: To this end, we reviewed a sizeable number of assistive solutions for VIP which provide a form of auditory feedback to the user, encountered in different scientific databases (Scopus, IEEE Xplore, ACM and Google Scholar) through direct searches and cross-referencing. RESULTS: We classified these solutions based on the aural information they provide to the VIP - alerts, guidance and information about their environment, be it spatial or semantic. Our intention is not to provide an exhaustive review, but to select representative implementations from recent literature that highlight the particularities of each sonification approach. CONCLUSIONS: Thus, anyone who is intent on developing an assistive solution will be able to choose the desired sonification class, being aware of the advantages/disadvantages and at the same time having a fairly wide selection of articles from the representative class.

The motivation behind this paper is to provide an overview of sonification strategies in the context of assistive systems for the visually impaired people.Whilst surveys and reviews which provide in-depth insights into assistive technologies and sonification exist, papers which provide a combined view of these topics are rather lacking.The analysis of the selected papers provides insight regarding the characteristics of different types of sonification strategies in assistive systems for visually impaired people and their suitability for certain use-cases.

Multispectral Imaging for Skin Diseases Assessment-State of the Art and Perspectives.

Skin optical inspection is an imperative procedure for a suspicious dermal lesion since very early skin cancer detection can guarantee total recovery. Dermoscopy, confocal laser scanning microscopy, optical coherence tomography, multispectral imaging, multiphoton laser imaging, and 3D topography are the most outstanding optical techniques implemented for skin examination. The accuracy of dermatological diagnoses attained by each of those methods is still debatable, and only dermoscopy is frequently used by all dermatologists. Therefore, a comprehensive method for skin analysis has not yet been established. Multispectral imaging (MSI) is based on light-tissue interaction properties due to radiation wavelength variation. An MSI device collects the reflected radiation after illumination of the lesion with light of different wavelengths and provides a set of spectral images. The concentration maps of the main light-absorbing molecules in the skin, the chromophores, can be retrieved using the intensity values from those images, sometimes even for deeper-located tissues, due to interaction with near-infrared light. Recent studies have shown that portable and cost-efficient MSI systems can be used for extracting skin lesion characteristics useful for early melanoma diagnoses. This review aims to describe the efforts that have been made to develop MSI systems for skin lesions evaluation in the last decade. We examined the hardware characteristics of the produced devices and identified the typical structure of an MSI device for dermatology. The analyzed prototypes showed the possibility of improving the specificity of classification between the melanoma and benign nevi. Currently, however, they are rather adjuvants tools for skin lesion assessment, and efforts are needed towards a fully fledged diagnostic MSI device.

CultReal-A Rapid Development Platform for AR Cultural Spaces, with Fused Localization.

Virtual and augmented reality technologies have known an impressive market evolution due to their potential to provide immersive experiences. However, they still have significant difficulties to enable fully fledged, consumer-ready applications that can handle complex tasks such as multi-user collaboration or time-persistent experiences. In this context, CultReal is a rapid creation and deployment platform for augmented reality (AR), aiming to revitalize cultural spaces. The platform's content management system stores a representation of the environment, together with a database of multimedia objects that can be associated with a location. The localization component fuses data from beacons and from video cameras, providing an accurate estimation of the position and orientation of the visitor's smartphone. A mobile application running the localization component displays the augmented content, which is seamlessly integrated with the real world. The paper focuses on the series of steps required to compute the position and orientation of the user's mobile device, providing a comprehensive evaluation with both virtual and real data. Pilot implementations of the system are also described in the paper, revealing the potential of the platform to enable rapid deployment in new cultural spaces. Offering these functionalities, CultReal will allow for the fast development of AR solutions in any location.

Machine Learning Methods for Fear Classification Based on Physiological Features.

This paper focuses on the binary classification of the emotion of fear, based on the physiological data and subjective responses stored in the DEAP dataset. We performed a mapping between the discrete and dimensional emotional information considering the participants' ratings and extracted a substantial set of 40 types of features from the physiological data, which represented the input to various machine learning algorithms-Decision Trees, k-Nearest Neighbors, Support Vector Machine and artificial networks-accompanied by dimensionality reduction, feature selection and the tuning of the most relevant hyperparameters, boosting classification accuracy. The methodology we approached included tackling different situations, such as resolving the problem of having an imbalanced dataset through data augmentation, reducing overfitting, computing various metrics in order to obtain the most reliable classification scores and applying the Local Interpretable Model-Agnostic Explanations method for interpretation and for explaining predictions in a human-understandable manner. The results show that fear can be predicted very well (accuracies ranging from 91.7% using Gradient Boosting Trees to 93.5% using dimensionality reduction and Support Vector Machine) by extracting the most relevant features from the physiological data and by searching for the best parameters which maximize the machine learning algorithms' classification scores.

Integrating Biosignals Measurement in Virtual Reality Environments for Anxiety Detection.

This paper proposes a protocol for the acquisition and processing of biophysical signals in virtual reality applications, particularly in phobia therapy experiments. This protocol aims to ensure that the measurement and processing phases are performed effectively, to obtain clean data that can be used to estimate the users' anxiety levels. The protocol has been designed after analyzing the experimental data of seven subjects who have been exposed to heights in a virtual reality environment. The subjects' level of anxiety has been estimated based on the real-time evaluation of a nonlinear function that has as parameters various features extracted from the biophysical signals. The highest classification accuracy was obtained using a combination of seven heart rate and electrodermal activity features in the time domain and frequency domain.

Cognitive and Affective Assessment of Navigation and Mobility Tasks for the Visually Impaired via Electroencephalography and Behavioral Signals.

This paper presented the assessment of cognitive load (as an effective real-time index of task difficulty) and the level of brain activation during an experiment in which eight visually impaired subjects performed two types of tasks while using the white cane and the Sound of Vision assistive device with three types of sensory input-audio, haptic, and multimodal (audio and haptic simultaneously). The first task was to identify object properties and the second to navigate and avoid obstacles in both the virtual environment and real-world settings. The results showed that the haptic stimuli were less intuitive than the audio ones and that the navigation with the Sound of Vision device increased cognitive load and working memory. Visual cortex asymmetry was lower in the case of multimodal stimulation than in the case of separate stimulation (audio or haptic). There was no correlation between visual cortical activity and the number of collisions during navigation, regardless of the type of navigation or sensory input. The visual cortex was activated when using the device, but only for the late-blind users. For all the subjects, the navigation with the Sound of Vision device induced a low negative valence, in contrast with the white cane navigation.

Flexible Virtual Reality System for Neurorehabilitation and Quality of Life Improvement.

As life expectancy is mostly increasing, the incidence of many neurological disorders is also constantly growing. For improving the physical functions affected by a neurological disorder, rehabilitation procedures are mandatory, and they must be performed regularly. Unfortunately, neurorehabilitation procedures have disadvantages in terms of costs, accessibility and a lack of therapists. This paper presents Immersive Neurorehabilitation Exercises Using Virtual Reality (INREX-VR), our innovative immersive neurorehabilitation system using virtual reality. The system is based on a thorough research methodology and is able to capture real-time user movements and evaluate joint mobility for both upper and lower limbs, record training sessions and save electromyography data. The use of the first-person perspective increases immersion, and the joint range of motion is calculated with the help of both the HTC Vive system and inverse kinematics principles applied on skeleton rigs. Tutorial exercises are demonstrated by a virtual therapist, as they were recorded with real-life physicians, and sessions can be monitored and configured through tele-medicine. Complex movements are practiced in gamified settings, encouraging self-improvement and competition. Finally, we proposed a training plan and preliminary tests which show promising results in terms of accuracy and user feedback. As future developments, we plan to improve the system's accuracy and investigate a wireless alternative based on neural networks.

A Comprehensive Survey of Indoor Localization Methods Based on Computer Vision.

Computer vision based indoor localization methods use either an infrastructure of static cameras to track mobile entities (e.g., people, robots) or cameras attached to the mobile entities. Methods in the first category employ object tracking, while the others map images from mobile cameras with images acquired during a configuration stage or extracted from 3D reconstructed models of the space. This paper offers an overview of the computer vision based indoor localization domain, presenting application areas, commercial tools, existing benchmarks, and other reviews. It provides a survey of indoor localization research solutions, proposing a new classification based on the configuration stage (use of known environment data), sensing devices, type of detected elements, and localization method. It groups 70 of the most recent and relevant image based indoor localization methods according to the proposed classification and discusses their advantages and drawbacks. It highlights localization methods that also offer orientation information, as this is required by an increasing number of applications of indoor localization (e.g., augmented reality).

An Investigation of Various Machine and Deep Learning Techniques Applied in Automatic Fear Level Detection and Acrophobia Virtual Therapy.

In this paper, we investigate various machine learning classifiers used in our Virtual Reality (VR) system for treating acrophobia. The system automatically estimates fear level based on multimodal sensory data and a self-reported emotion assessment. There are two modalities of expressing fear ratings: the 2-choice scale, where 0 represents relaxation and 1 stands for fear; and the 4-choice scale, with the following correspondence: 0-relaxation, 1-low fear, 2-medium fear and 3-high fear. A set of features was extracted from the sensory signals using various metrics that quantify brain (electroencephalogram-EEG) and physiological linear and non-linear dynamics (Heart Rate-HR and Galvanic Skin Response-GSR). The novelty consists in the automatic adaptation of exposure scenario according to the subject's affective state. We acquired data from acrophobic subjects who had undergone an in vivo pre-therapy exposure session, followed by a Virtual Reality therapy and an in vivo evaluation procedure. Various machine and deep learning classifiers were implemented and tested, with and without feature selection, in both a user-dependent and user-independent fashion. The results showed a very high cross-validation accuracy on the training set and good test accuracies, ranging from 42.5% to 89.5%. The most important features of fear level classification were GSR, HR and the values of the EEG in the beta frequency range. For determining the next exposure scenario, a dominant role was played by the target fear level, a parameter computed by taking into account the patient's estimated fear level.

3D Smith charts scattering parameters frequency-dependent orientation analysis and complex-scalar multi-parameter characterization applied to Peano reconfigurable vanadium dioxide inductors.

Recently, the field of Metal-Insulator-Transition (MIT) materials has emerged as an unconventional solution for novel energy efficient electronic functions, such as steep slope subthermionic switches, neuromorphic hardware, reconfigurable radiofrequency functions, new types of sensors, terahertz and optoelectronic devices. Employing radiofrequency (RF) electronic circuits with a MIT material like vanadium Dioxide, VO2, requires appropriate characterization tools and fabrication processes. In this work, we develop and use 3D Smith charts for devices and circuits having complex frequency dependences, like the ones resulting using MIT materials. The novel foundation of a 3D Smith chart involves here the geometrical fundamental notions of oriented curvature and variable homothety in order to clarify first theoretical inconsistencies in Foster and Non Foster circuits, where the driving point impedances exhibit mixed clockwise and counter-clockwise frequency dependent (oriented) paths on the Smith chart as frequency increases. We show here the unique visualization capability of a 3D Smith chart, which allows to quantify orientation over variable frequency. The new 3D Smith chart is applied as a joint complex-scalar 3D multi-parameter modelling and characterization environment for reconfigurable RF design exploiting Metal-Insulator-Transition (MIT) materials. We report fabricated inductors with record quality factors using VO2 phase transition to program multiple tuning states, operating in the range 4 GHz to 10 GHz.

Fear Level Classification Based on Emotional Dimensions and Machine Learning Techniques.

There has been steady progress in the field of affective computing over the last two decades that has integrated artificial intelligence techniques in the construction of computational models of emotion. Having, as a purpose, the development of a system for treating phobias that would automatically determine fear levels and adapt exposure intensity based on the user's current affective state, we propose a comparative study between various machine and deep learning techniques (four deep neural network models, a stochastic configuration network, Support Vector Machine, Linear Discriminant Analysis, Random Forest and k-Nearest Neighbors), with and without feature selection, for recognizing and classifying fear levels based on the electroencephalogram (EEG) and peripheral data from the DEAP (Database for Emotion Analysis using Physiological signals) database. Fear was considered an emotion eliciting low valence, high arousal and low dominance. By dividing the ratings of valence/arousal/dominance emotion dimensions, we propose two paradigms for fear level estimation-the two-level (0-no fear and 1-fear) and the four-level (0-no fear, 1-low fear, 2-medium fear, 3-high fear) paradigms. Although all the methods provide good classification accuracies, the highest F scores have been obtained using the Random Forest Classifier-89.96% and 85.33% for the two-level and four-level fear evaluation modality.

Corrigendum: The Association of Unfavorable Traffic Events and Cannabis Usage: A Meta-Analysis.

[This corrects the article on p. 99 in vol. 9, PMID: 29487531.].

Patient autonomy and disclosure of material information about hospital-acquired infections.

Hospital-acquired infections are nowadays a major health care problem worldwide. The morbidity and mortality associated with them are highest in intensive care units, but their effects are identifiable in virtually any medical department. Information about hospital-acquired infections, especially about their preventive measures, are rarely presented nowadays in a correct fashion to patients. This article aims to present, in a structured manner, the theoretical and practical aspects related to disclosure of hospital-acquired infections-related information to patients and its importance in preventing their spread. We will analyze both the conceptual framework for disclosing medical information related to nosocomial infections (autonomy, veracity, social justice, the principle of double effect, the precautionary principle, and nonmaleficence) and the practicalities regarding the disclosure of proper information to patients.

The Association of Unfavorable Traffic Events and Cannabis Usage: A Meta-Analysis.

Background: In the last years were published many epidemiological articles aiming to link driving under the influence of cannabis (DUIC) with the risk of various unfavorable traffic events (UTEs), with sometimes contradictory results. Aim: The primary objective of this study was to analyze whether there is a significant association between DUIC and UTEs. Materials and Methods: We used two meta-analytical methods to assess the statistical significance of the effect size: random-effects model and inverse variance heterogeneity model. Results: Twenty-four studies were included in the meta-analysis. We obtained significant increases in the effect size for DUIC tested through blood analysis, with an odds ratio (OR) of 1.97 and a confidence interval (CI) between 1.35 and 2.87; [corrected] death as an outcome, with an OR of 1.56 and a CI between 1.16 and 2.09; and case-control as the type of study, with an OR of 1.99 and a CI between 1.05 and 3.80. Publication bias was very high. Conclusion: Our analysis suggests that the overall effect size for DUIC on UTEs is not statistically significant, but there are significant differences obtained through subgroup analysis. This result might be caused by either methodological flaws (which are often encountered in articles on this topic), the indiscriminate employment of the term "cannabis use," or an actual absence of an adverse effect. When a driver is found, in traffic, with a positive reaction suggesting cannabis use, the result should be corroborated by either objective data regarding marijuana usage (like blood analyses, with clear cut-off values), or a clinical assessment of the impairment, before establishing his/her fitness to drive.

Relative vibrotactile spatial acuity of the torso.

While tactile acuity for pressure has been extensively investigated, far less is known about acuity for vibrotactile stimulation. Vibrotactile acuity is important however, as such stimulation is used in many applications, including sensory substitution devices. We tested discrimination of vibrotactile stimulation from eccentric rotating mass motors with in-plane vibration. In 3 experiments, we tested gradually decreasing center-to-center (c/c) distances from 30 mm (experiment 1) to 13 mm (experiment 3). Observers judged whether a second vibrating stimulator ('tactor') was to the left or right or in the same place as a first one that came on 250 ms before the onset of the second (with a 50-ms inter-stimulus interval). The results show that while accuracy tends to decrease the closer the tactors are, discrimination accuracy is still well above chance for the smallest distance, which places the threshold for vibrotactile stimulation well below 13 mm, which is lower than recent estimates. The results cast new light on vibrotactile sensitivity and can furthermore be of use in the design of devices that convey information through vibrotactile stimulation.

Designing sensory-substitution devices: Principles, pitfalls and potential1.

An exciting possibility for compensating for loss of sensory function is to augment deficient senses by conveying missing information through an intact sense. Here we present an overview of techniques that have been developed for sensory substitution (SS) for the blind, through both touch and audition, with special emphasis on the importance of training for the use of such devices, while highlighting potential pitfalls in their design. One example of a pitfall is how conveying extra information about the environment risks sensory overload. Related to this, the limits of attentional capacity make it important to focus on key information and avoid redundancies. Also, differences in processing characteristics and bandwidth between sensory systems severely constrain the information that can be conveyed. Furthermore, perception is a continuous process and does not involve a snapshot of the environment. Design of sensory substitution devices therefore requires assessment of the nature of spatiotemporal continuity for the different senses. Basic psychophysical and neuroscientific research into representations of the environment and the most effective ways of conveying information should lead to better design of sensory substitution systems. Sensory substitution devices should emphasize usability, and should not interfere with other inter- or intramodal perceptual function. Devices should be task-focused since in many cases it may be impractical to convey too many aspects of the environment. Evidence for multisensory integration in the representation of the environment suggests that researchers should not limit themselves to a single modality in their design. Finally, we recommend active training on devices, especially since it allows for externalization, where proximal sensory stimulation is attributed to a distinct exterior object.

The Sound of Vision Project: On the Feasibility of an Audio-Haptic Representation of the Environment, for the Visually Impaired.

The Sound of Vision project involves developing a sensory substitution device that is aimed at creating and conveying a rich auditory representation of the surrounding environment to the visually impaired. However, the feasibility of such an approach is strongly constrained by neural flexibility, possibilities of sensory substitution and adaptation to changed sensory input. We review evidence for such flexibility from various perspectives. We discuss neuroplasticity of the adult brain with an emphasis on functional changes in the visually impaired compared to sighted people. We discuss effects of adaptation on brain activity, in particular short-term and long-term effects of repeated exposure to particular stimuli. We then discuss evidence for sensory substitution such as Sound of Vision involves, while finally discussing evidence for adaptation to changes in the auditory environment. We conclude that sensory substitution enterprises such as Sound of Vision are quite feasible in light of the available evidence, which is encouraging regarding such projects.

Translational research-the need of a new bioethics approach.

Translational research tries to apply findings from basic science to enhance human health and well-being. Many phases of the translational research may include non-medical tasks (information technology, engineering, nanotechnology, biochemistry, animal research, economy, sociology, psychology, politics, and so on). Using common bioethics principles to these areas might sometimes be not feasible, or even impossible. However, the whole process must respect some fundamental, moral principles. The purpose of this paper is to argument the need for a different approach to the morality in translational bioethics, and to suggest some directions that might be followed when constructing such a bioethics. We will show that a new approach is needed and present a few ethical issues that are specific to the translational research.

Natural orifice translumenal endoscopic surgery (NOTES) second-look peritoneoscopy for staging of limited peritoneal carcinomatosis.

BACKGROUND: Over the past decades, staging laparoscopy evolved as a useful tool in multimodality treatment of patients with abdominal malignancies, especially for detection of incurable peritoneal and liver metastasis. Natural orifice translumenal endoscopic surgery (NOTES) is a new, evolving technique which represents the next logical progression in minimally invasive surgery and has theoretical advantages in comparison with standard laparoscopic surgery. A review of the current literature revealed a continuous increasing number of fundamental and clinical studies addressing NOTES approach in multimodal management of oncologic patients. Technical possibility to use this new minimally invasive approach for oncological resection of abdominal malignancies was proved by some investigators. HYPOTHESIS: NOTES can be used as an alternative method for staging patients with limited peritoneal carcinomatosis and may have better results compared to current imaging techniques for small diameter metastatic disease. CONCLUSIONS: With the continuous development of the NOTES techniques and technology, the second-look peritoneoscopy by NOTES may become an alternative method for staging in patients with peritoneal carcinomatosis. Nevertheless, NOTES is at a very early stage of its development, and its implementation in oncologic surgery should be made very caution, and only after careful evaluation.