Evaluating the COVID-19 impact in Italian regions via multi criteria analysis.

Italy was the first European country to be significantly impacted by the COVID-19 pandemic. The lack of similar previous experiences and the initial uncertainty regarding the new virus resulted in an unpredictable health crisis with 243,506 total confirmed cases and 34,997 deaths between February and July 2020. Despite the panorama of precariousness and the impelling calamity, the country successfully managed many aspects of the early stages of the health and socio-economic crisis. Nevertheless, many disparities can be identified at the regional level. The study aims to determine which aspects of regional management were considered more important by the citizens regarding economic and health criteria. A survey was designed to gather responses from the population on the Italian regions' response and provide a ranking of the regions. The 29-item online survey was provided to 352 individuals, and the collected data were analyzed using the Analytic Hierarchy Process methodology. The results show a general agreement in considering of greater relevance the healthcare policies rather than the economic countermeasures adopted by regional governments. Our analysis associated a weight of 64% to the healthcare criteria compared to the economic criteria with a weight of 36%. In addition to the results obtained from the Analytic Hierarchy Process, the sample's composition was analyzed to provide an overall assessment of the Italian regions. To do so, we collected objective data for each region and multiplied them by the overall weight obtained for each sub-criteria. Looking at the propensity to vaccination or the belief in a relation between COVID-19 and 5G according to age and educational qualification helps understand how public opinion is structured according to cultural and anthropological differences.

Waveform Similarity Analysis Using Graph Mining for the Optimization of Sensor Positioning in Wearable Seismocardiography.

OBJECTIVE: A major concern with wearable devices aiming to measure the seismocardiogram (SCG) signal is the variability of SCG waveform with the sensor position and a lack of a standard measurement procedure. We propose a method to optimize sensor positioning based on the similarity among waveforms collected through repeated measurements. METHOD: we design a graph-theoretical model to evaluate the similarity of SCG signals and apply the proposed methodology to signals collected by sensors placed in different positions on the chest. A similarity score returns the optimal measurement position based on the repeatability of SCG waveforms. We tested the methodology on signals collected by using two wearable patches based on optical technology placed in two positions: mitral and aortic valve auscultation site (inter-position analysis). 11 healthy subjects were enrolled in this study. Moreover, we evaluated the influence of the subject's posture on waveform similarity with a view on ambulatory use (inter-posture analysis). RESULTS: the highest similarity among SCG waveforms is obtained with the sensor on the mitral valve and the subject lying down. CONCLUSIONS: our approach aims to be a step forward in the optimization of sensor positioning in the field of wearable seismocardiography. We demonstrate that the proposed algorithm is an effective method to estimate similarity among waveforms and outperforms the state-of-the-art in comparing SCG measurement sites. SIGNIFICANCE: results obtained from this study can be exploited to design more efficient protocols for SCG recording in both research studies and future clinical examinations.

Precordial Vibrations: A Review of Wearable Systems, Signal Processing Techniques, and Main Applications.

Recently, the ever-growing interest in the continuous monitoring of heart function in out-of-laboratory settings for an early diagnosis of cardiovascular diseases has led to the investigation of innovative methods for cardiac monitoring. Among others, wearables recording seismic waves induced on the chest surface by the mechanical activity of the heart are becoming popular. For what concerns wearable-based methods, cardiac vibrations can be recorded from the thorax in the form of acceleration, angular velocity, and/or displacement by means of accelerometers, gyroscopes, and fiber optic sensors, respectively. The present paper reviews the currently available wearables for measuring precordial vibrations. The focus is on sensor technology and signal processing techniques for the extraction of the parameters of interest. Lastly, the explored application scenarios and experimental protocols with the relative influencing factors are discussed for each technique. The goal is to delve into these three fundamental aspects (i.e., wearable system, signal processing, and application scenario), which are mutually interrelated, to give a holistic view of the whole process, beyond the sensor aspect alone. The reader can gain a more complete picture of this context without disregarding any of these 3 aspects.

Intelligence-Aware Batch Processing for TMA with Bearings-Only Measurements.

This paper develops a framework to track the trajectory of a target in 2D by considering a moving ownship able to measure bearing measurements. Notably, the framework allows one to incorporate additional information (e.g., obtained via intelligence) such as knowledge on the fact the target's trajectory is contained in the intersection of some sets or the fact it lies outside the union of other sets. The approach is formally characterized by providing a constrained maximum likelihood estimation (MLE) formulation and by extending the definition of the Cramér-Rao lower bound (CRLB) matrix to the case of MLE problems with inequality constraints, relying on the concept of generalized Jacobian matrix. Moreover, based on the additional information, the ownship motion is chosen by mimicking the Artificial Potential Fields technique that is typically used by mobile robots to aim at a goal (in this case, the region where the target is assumed to be) while avoiding obstacles (i.e., the region that is assumed not to intersect the target's trajectory). In order to show the effectiveness of the proposed approach, the paper is complemented by a simulation campaign where the MLE computations are carried out via an evolutionary ant colony optimization software, namely, mixed-integer distributed ant colony optimization solver (MIDACO-SOLVER). As a result, the proposed framework exhibits remarkably better performance, and in particular, we observe that the solution is less likely to remain stuck in unsatisfactory local minima during the MLE computation.

A multi-point heart rate monitoring using a soft wearable system based on fiber optic technology.

Early diagnosis can be crucial to limit both the mortality and economic burden of cardiovascular diseases. Recent developments have focused on the continuous monitoring of cardiac activity for a prompt diagnosis. Nowadays, wearable devices are gaining broad interest for a continuous monitoring of the heart rate (HR). One of the most promising methods to estimate HR is the seismocardiography (SCG) which allows to record the thoracic vibrations with high non-invasiveness in out-of-laboratory settings. Despite significant progress on SCG, the current state-of-the-art lacks both information on standardized sensor positioning and optimization of wearables design. Here, we introduce a soft wearable system (SWS), whose novel design, based on a soft polymer matrix embedding an array of fiber Bragg gratings, provides a good adhesion to the body and enables the simultaneous recording of SCG signals from multiple measuring sites. The feasibility assessment on healthy volunteers revealed that the SWS is a suitable wearable solution for HR monitoring and its performance in HR estimation is strongly influenced by sensor positioning and improved by a multi-sensor configuration. These promising characteristics open the possibility of using the SWS in monitoring patients with cardiac pathologies in clinical (e.g., during cardiac magnetic resonance procedures) and everyday life settings.

A new pressure guided management tool for epidural space detection: feasibility assessment in a clinical scenario.

BACKGROUND: The detection of epidural space is usually performed by the technique of loss of resistance (LOR) without technological support, although there are few commercial options. In this work, we aimed to assess the feasibility of a new, non-invasive, mechatronic system for LOR detection in clinical settings. The system allows monitoring the pressure exerted on the syringe plunger by the clinician during the puncture. The LOR is related to the mentioned pressure. METHODS: Pressure exerted on the syringe plunger by an expert anesthesiologist was monitored using the proposed system. 58 epidural punctures were performed on 34 patients using six configurations with different sensitivities and ranges of measurements. The system capability in LOR detection was evaluated comparing the LOR detected by the system with the feedback provided by the clinician. The procedure time was estimated using the system and without its use. RESULTS: The detection of LOR is strongly related to the system configuration; it ranged from 93.3% to 27.7%, while 3 configurations never detected it. The procedure time showed a non-significant increase (p=0.56) using the proposed system (average time 71 s vs. 62 s). CONCLUSIONS: The proposed mechatronic system successfully detected the LOR in the large part of cases using the configurations characterized by the best trade-off between system sensitivity and range of measurements. A non-significant increment of the procedure time is related to the use of the system.

A New Pressure Guided Management Tool for Epidural Space Detection: Feasibility Assessment on a Simulator.

The detection of epidural space is usually performed by the technique of loss of resistance (LOR) without technological support, although there are few commercial options. We sought to design and develop a new noninvasive system able to detect the LOR without any changes to the conventional procedure. It allows detecting the LOR by a custom made algorithm. The system provides a visual and acoustic feedback when the LOR is detected. We optimized the detection algorithm and investigated the performance of the system during experiments on a custom simulator. During the experiments performed by 10 anesthetists and 10 trainees, the pressure exerted on the syringe plunger was monitored using the custom-made system. Each participant performed four experiments using the system on the simulator. The performance of the system in LOR detection was evaluated comparing the feedback activation and the breaches of the last layer of the simulator. Moreover, each participant filled out a questionnaire to assess how the procedure with the simulator mimics the clinical scenario. A higher questionnaire score corresponds to a more realistic condition (0 = not real, 5 = extremely real). Results showed that the LOR was detected in 74 of the 80 trials (92.5% of the cases); the anesthetists obtained better results than trainees: 97.5 versus 87.5%. The questionnaires showed that all the participants found the trial realistic (score ≥3); anesthetists found it more realistic than trainees (4.2 ± 0.78 vs. 3.8 ± 0.78, mean ± SD). In summary, the proposed system successfully detected the LOR in the large part of the trials. The participants found the trials realistic. A higher success rate was observed in the anesthetists group.

Long-term gait pattern assessment using a tri-axial accelerometer.

In this article, we present a pervasive solution for gait pattern classification that uses accelerometer data retrieved from a waist-mounted inertial sensor. The proposed algorithm has been conceived to operate continuously for long-term applications. With respect to traditional approaches that use a large number of features and sophisticated classifiers, our solution is able to assess four different gait patterns (standing, level walking, stair ascending and descending) by using three features and a decision tree. We assess the algorithm detection performances using data that we retrieved from a validation group composed by nine young and healthy volunteers, for a total number of 36 tests and 12.5 h of recorded acceleration data. Experimental results show that in continuous applications the proposed algorithm is able to effectively discriminate between standing (100%), level walking (∼99%), stair ascending (∼84%), and descending (∼85%), with an average classification accuracy for the four patterns that exceeds 92% in continuous, long-lasting applications.

A new model for the length of stay of hospital patients.

Hospital Length of Stay (LoS) is a valid proxy to estimate the consumption of hospital resources. Average LoS, however, albeit easy to quantify and calculate, can be misleading if the underlying distribution is not symmetric. Therefore the average does not reflect the nature of such underlying distribution and may mask different effects. This paper uses routinely collected data of an Italian hospital patients from different departments over a period of 5 years. This will be the basis for a running example illustrating the alternative models of patients length of stay. The models includes a new density model called Hypergamma. The paper concludes by summarizing these various modelling techniques and highlighting the use of a risk measure in bed planning.

Characterization of Protein-Protein Interfaces through a Protein Contact Network Approach.

Anthrax toxin comprises three different proteins, jointly acting to exert toxic activity: a non-toxic protective agent (PA), toxic edema factor (EF), and lethal factor (LF). Binding of PA to anthrax receptors promotes oligomerization of PA, binding of EF and LF, and then endocytosis of the complex. Homomeric forms of PA, complexes of PA bound to LF and to the endogenous receptor capillary morphogenesis gene 2 (CMG2) were analyzed. In this work, we characterized protein-protein interfaces (PPIs) and identified key residues at PPIs of complexes, by means of a protein contact network (PCN) approach. Flexibility and global and local topological properties of each PCN were computed. The vulnerability of each PCN was calculated using different node removal strategies, with reference to specific PCN topological descriptors, such as participation coefficient, contact order, and degree. The participation coefficient P, the topological descriptor of the node's ability to intervene in protein inter-module communication, was the key descriptor of PCN vulnerability of all structures. High P residues were localized both at PPIs and other regions of complexes, so that we argued an allosteric mechanism in protein-protein interactions. The identification of residues, with key role in the stability of PPIs, has a huge potential in the development of new drugs, which would be designed to target not only PPIs but also residues localized in allosteric regions of supramolecular complexes.

Assessing bone loss in micro-gravity: a fuzzy approach.

A prolonged stay in microgravity has various negative effects on the human body; one of these problems is a noticeable demineralization of bone tissues. Such effects are quite similar to those experienced by subjects on earth affected by osteoporosis; therefore it seems quite straightforward to adopt a similar pharmacological therapy during the stay in the space. In this paper a first step in the identification of a monitoring procedure for the bone demineralization in microgravity, as well as some guidelines for the choice of adequate therapies are given. Such a procedure is based on a mathematical model of the interaction of the most relevant blood and urine indicators of bone demineralization. Specifically, some bone metabolites have been identified, which are relevant to the phenomena and are feasible to be evaluated in the space. Moreover, a model to foresee the evolution of these parameters in the space, depending on the therapy chosen, is provided. The model is derived from the experience of doctors and experts, hence it is based mainly on linguistic information; such an information is codified by means of fuzzy numbers, in order to take into account their uncertainty.

Discrete event simulation of a proton therapy facility: a case study.

Proton therapy is a type of particle therapy which utilizes a beam of protons to irradiate diseased tissue. The main difference with respect to conventional radiotherapy (X-rays, γ-rays) is the capability to target tumors with extreme precision, which makes it possible to treat deep-seated tumors and tumors affecting noble tissues as brain, eyes, etc. However, proton therapy needs high-energy cyclotrons and this requires sophisticated control-supervision schema to guarantee, further than the prescribed performance, the safety of the patients and of the operators. In this paper we present the modeling and simulation of the irradiation process of the PROSCAN facility at the Paul Scherrer Institut. This is a challenging task because of the complexity of the operation scenario, which consists of deterministic and stochastic processes resulting from the coordination-interaction among diverse entities such as distributed automatic control systems, safety protection systems, and human operators.

Video-rhino-hygrometer: a new method for evaluation of nasal breathing after nasal surgery.

BACKGROUND: Nasal obstruction is one of the most frequent symptoms in the ear, nose, and throat (ENT) setting. It can be evaluated either subjectively or objectively. In a subjective way, a visual analog scale (VAS) and the Sino-Nasal Outcome Test 20 (SNOT 20) can rapidly quantify the degree of obstruction, whereas the most commonly used objective methods are nasal endoscopy and active anterior rhinomanometry (AAR). It is still a matter of controversy to what extent the sense of nasal obstruction is associated with objective measures for nasal space and airflow. The aim of the study was to evaluate nasal breathing before and after functional nasal surgery by video-rhino-hygrometer (VRH) comparing the results with widely accepted methods. METHODS: Twenty patient candidates for septoplasty and inferior turbinate reduction were included in the study. SNOT-20, VAS, nasal endoscopy, and AAR were analyzed and compared with VRH values. RESULTS: Before surgery VRH showed variability of nasal respiratory flow between individuals and between nostrils. After surgery we had an increase (p < 0.05) of airflow in both nostrils. VRH data were found to be correlated with VAS and SNOT-20 values (p < 0.05) both pre- and postoperatively. Despite the statistically significant correlation of AAR with SNOT-20 and VAS, no statistically significant correlation between AAR and VRH was found. CONCLUSION: VRH provides an immediate, easy, and noninvasive assessment of nasal respiration. For these reasons it can be used, in association with rhinoscopic data and other instrumental tests, to evaluate nasal breathing in daily ENT practice.

Security of the food supply chain.

The food supply chain could became a dangerous weapon in the hands of enemies, for this reason the strategies developed to fight food adulteration (food safety) should be complemented with specific actions devoted to improve food "security" in the sense of food defence. This paper illustrate the methodological approach used in the EU project SecuFood to analyze threats, vulnerabilities and countermeasures existing in major European countries about what concerns deliberate attacks and manipulations of food.

DyCoH: an innovative tool to dynamic contrast enhancement analysis.

Contrast-Enhancement (CE) is an innovative approach, used in radiological framework, to evaluate the vascularization of the diseases. This non-invasive method determines the nature of a diseases, analysing the perfusion' dynamic of contrast media in the tissues. In this paper we present an innovative tool named DyCoH (Dynamic Contrast Enhancement). This software, being specifically designed for this type of analysis, provides to medical doctor, in a very user-friendly framework, all the information needed to perform the CE analysis. DyCoH produces four inspectionable colour-maps that radiologists can use to identify the most relevant areas over which dynamically evaluates the contrast enhancement curve. However, the most interesting feature of DyCoH is its capability to manage, into a single framework, DICOM images produced by US, CT and MR of different vendors, allowing to support many types of clinical tests and to compare results provided by different diagnostic devices. Clinical tests have shown the effectiveness of the software and its capability to concretely support CE diagnoses.

An innovative device to support Politzer manoeuvre.

Politzer manoeuvre causes retrograde inflation of the middle ear by forcing air through the Eustachian tube. It has been proposed as nonsurgical treatment of middle ear with effusion, Eustachian tube dysfunction and negative middle ear pressure from elevation changes. Even if Politzer manoeuvre can be considered a classical technique, it is generally performed without any feedback about its correctness neither about qualitative evidence about its efficacy. In this paper we describe an innovative device, named OTOFREE, specifically designed to support medical doctors during Politzer manoeuvre. OTOFREE provides information about the correctness of the manoeuvre and also useful hints about the treatments results.

The old-fashioned Politzer maneuver: a video clip demonstration.

Politzer maneuver causes retrograde inflation of the middle ear by forcing air through the eustachian tube, and it has been proposed by many authors as the main nonsurgical treatment of middle ear effusion. To our knowledge, this is the first case in the literature in which air entering into a middle ear with effusion through a Politzer maneuver has been captured on video (www.laryngoscope.com).

Video-Rhino-Hygrometer (VRH).

Rhinomanometry includes a set of methodologies to diagnose pathological alterations of the nostrils and nasal cavities. Some anatomic variations could cause partial or sub total obstruction of one or both nostrils, leading to insufficient nasal respiration. Rhinomanometry measures the airflow through one nostril at time, while a pad occludes the other. This method has some drawbacks, such as the alteration of airflow in the not-occluded nostril due to the presence of the pad, the low reproducibility, and a reduced patient comfort. In this paper we propose a new methodologies that, we call Video-Rhino- Hygrometer (VRH) and illustrate specific device to perform it. VRH may be considered as an automatized evolution of the classical Glatzel methods, because it infers information on clinical parameters analysing the image produced by the condense of the breath on a suitable surface. Specifically, VRH uses a web-cam to record these images and, after a suitable processing, it is able to compute a set of clinical features useful to perform diagnosis. Encouraging clinical tests show that the proposed approach provides results comparable with classical rhinomanometry tools without using the pad, obtaining reproducibility results, with an higher comfort for the patient and with a reduced examination time.