The "5 a day" game: a nutritional intervention utilising innovative methodologies with primary school children.

The aim of this study was observing and improving children's eating habits through an edutainment technological platform. A single-group education intervention was carried out in primary schools in Parma and Milano, Italy. A total of 76 children (32 females and 44 males, 8-10 years old) were involved in a 3-month nutritional program including lessons and educational videogames. Intakes of fruits, vegetables, juices and dietary total antioxidant capacity (TAC) were measured using 3-day food diaries before and after the intervention. The daily total consumption of fruit and vegetables increased from 421.8 (320.3) to 484.3 (337.2) g/day (p = 0.016). Consequently, daily dietary TAC increased by 26%, rising from 1.4 (1.3) to 1.6 (1.3) mmol of Trolox equivalents (p = 0.006). The methods and, particularly, the use of technological tools proved to be effective in conducting an educational intervention in children aged 8-10 years old.

Older Adults' and Clinicians' Perspectives on a Smart Health Platform for the Aging Population: Design and Evaluation Study.

BACKGROUND: Over recent years, interest in the development of smart health technologies aimed at supporting independent living for older populations has increased. The integration of innovative technologies, such as the Internet of Things, wearable technologies, artificial intelligence, and ambient-assisted living applications, represents a valuable solution for this scope. Designing such an integrated system requires addressing several aspects (eg, equipment selection, data management, analytics, costs, and users' needs) and involving different areas of expertise (eg, medical science, service design, biomedical and computer engineering). OBJECTIVE: The objective of this study is 2-fold; we aimed to design the functionalities of a smart health platform addressing 5 chronic conditions prevalent in the older population (ie, hearing loss, cardiovascular diseases, cognitive impairments, mental health problems, and balance disorders) by considering both older adults' and clinicians' perspectives and to evaluate the identified smart health platform functionalities with a small group of older adults. METHODS: Overall, 24 older adults (aged >65 years) and 118 clinicians were interviewed through focus group activities and web-based questionnaires to elicit the smart health platform requirements. Considering the elicited requirements, the main functionalities of smart health platform were designed. Then, a focus group involving 6 older adults was conducted to evaluate the proposed solution in terms of usefulness, credibility, desirability, and learnability. RESULTS: Eight main functionalities were identified and assessed-cognitive training and hearing training (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 6/6, 100%; learnability: 6/6, 100%), monitoring of physiological parameters (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 6/6, 100%; learnability: 5/6, 83%), physical training (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 5/6, 83%; learnability: 2/6, 33%), psychoeducational intervention (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 4/6, 67%; learnability: 2/6, 33%), mood monitoring (usefulness: 4/6, 67%; credibility: 4/6, 67%; desirability: 3/6, 50%; learnability: 5/6, 50%), diet plan (usefulness: 5/6, 83%; credibility: 4/6, 67%; desirability: 1/6, 17%; learnability: 2/6, 33%), and environment monitoring and adjustment (usefulness: 1/6, 17%; credibility: 1/6, 17%; desirability: 0/6, 0%; learnability: 0/6, 0%). Most of them were highly appreciated by older participants, with the only exception being environment monitoring and adjustment. The results showed that the proposed functionalities met the needs and expectations of users (eg, improved self-management of patients' disease and enhanced patient safety). However, some aspects need to be addressed (eg, technical and privacy issues). CONCLUSIONS: The presented smart health platform functionalities seem to be able to meet older adults' needs and desires to enhance their self-awareness and self-management of their medical condition, encourage healthy and independent living, and provide evidence-based support for clinicians' decision-making. Further research with a larger and more heterogeneous pool of stakeholders in terms of demographics and clinical conditions is needed to assess system acceptability and overall user experience in free-living conditions.

Improving Health Monitoring With Adaptive Data Movement in Fog Computing.

Pervasive sensing is increasing our ability to monitor the status of patients not only when they are hospitalized but also during home recovery. As a result, lots of data are collected and are available for multiple purposes. If operations can take advantage of timely and detailed data, the huge amount of data collected can also be useful for analytics. However, these data may be unusable for two reasons: data quality and performance problems. First, if the quality of the collected values is low, the processing activities could produce insignificant results. Second, if the system does not guarantee adequate performance, the results may not be delivered at the right time. The goal of this document is to propose a data utility model that considers the impact of the quality of the data sources (e.g., collected data, biographical data, and clinical history) on the expected results and allows for improvement of the performance through utility-driven data management in a Fog environment. Regarding data quality, our approach aims to consider it as a context-dependent problem: a given dataset can be considered useful for one application and inadequate for another application. For this reason, we suggest a context-dependent quality assessment considering dimensions such as accuracy, completeness, consistency, and timeliness, and we argue that different applications have different quality requirements to consider. The management of data in Fog computing also requires particular attention to quality of service requirements. For this reason, we include QoS aspects in the data utility model, such as availability, response time, and latency. Based on the proposed data utility model, we present an approach based on a goal model capable of identifying when one or more dimensions of quality of service or data quality are violated and of suggesting which is the best action to be taken to address this violation. The proposed approach is evaluated with a real and appropriately anonymized dataset, obtained as part of the experimental procedure of a research project in which a device with a set of sensors (inertial, temperature, humidity, and light sensors) is used to collect motion and environmental data associated with the daily physical activities of healthy young volunteers.

Mapping spiral structure on the far side of the Milky Way.

Little is known about the portion of the Milky Way lying beyond the Galactic center at distances of more than 9 kiloparsec from the Sun. These regions are opaque at optical wavelengths because of absorption by interstellar dust, and distances are very large and hard to measure. We report a direct trigonometric parallax distance of [Formula: see text] kiloparsec obtained with the Very Long Baseline Array to a water maser source in a region of active star formation. These measurements allow us to shed light on Galactic spiral structure by locating the Scutum-Centaurus spiral arm as it passes through the far side of the Milky Way and to validate a kinematic method for determining distances in this region on the basis of transverse motions.

Fascial Manipulation Associated With Standard Care Compared to Only Standard Postsurgical Care for Total Hip Arthroplasty: A Randomized Controlled Trial.

BACKGROUND: Postsurgical physiotherapy programs after total hip arthroplasty (THA) show important differences between types and numbers of treatment sessions. To increase functional recovery in postsurgical patients, manual therapy can be added to traditional physiotherapy programs. Fascial manipulation (FM) has been demonstrated to be effective in decreasing pain and increasing muscular capacity. OBJECTIVE: To compare the effectiveness of FM when added to a standard protocol of care. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center. PATIENTS: A total of 51 patients were recruited after total hip arthroplasty. Inclusion criteria were first THA surgery, posterior-lateral access, and onset of pain within a maximum 2 years. Exclusion criteria were previous hip or knee prosthesis, congenital hip dysplasia, elective THA secondary to trauma, real leg-length discrepancy (≥1.5 cm), cognitive impairment, concomitant rheumatic pathology in acute phase, and serious comorbidities such as cardiac, respiratory, and/or neuromuscular pathologies. METHODS: Patients were randomized into 2 groups; both followed a standard protocol based on 2 daily sessions of active exercises for 45 minutes. In the study group, 2 sessions were replaced by FM. The clinical trial was registered at clinicaltrials.gov (NCT02576028). MAIN OUTCOME MEASURES: Functional outcome measures were collected before and after treatment and at the end of the rehabilitation program. The measures included the Harris Hip Score; Timed Up-and-Go test; articular range of motion in abduction, flexion, extension, and bilateral external rotation with heels together; and verbal numerical scale. RESULTS: Statistically significant differences were observed in degrees of flexion between the study and control group with 25.4 (±11.3) and 18.7 (±9.5), respectively (P = .04); for abduction with 16.8 (±7.0) and 11.1 (±6.1), respectively (P = .005); for extension with 16.2 (±4.9) and 9.3 (±3.8), respectively (P = .001); for bilateral external rotation with heels together with 8.3 (±4.3) and 5.5 (±4.6), respectively (P = .04); for the Harris Hip Score 23.3 (±8.9) and 14.5 (±8.5), respectively (P = .002); and for verbal numerical scale score 1.1 (±2.1) and 0.5 (±1.1), respectively. CONCLUSIONS: This study demonstrates that 2 FM sessions are able to significantly improve several functional outcomes in patients compared to usual treatment after THA. LEVEL OF EVIDENCE: II.

Building new computational models to support health behavior change and maintenance: new opportunities in behavioral research.

Adverse and suboptimal health behaviors and habits are responsible for approximately 40 % of preventable deaths, in addition to their unfavorable effects on quality of life and economics. Our current understanding of human behavior is largely based on static "snapshots" of human behavior, rather than ongoing, dynamic feedback loops of behavior in response to ever-changing biological, social, personal, and environmental states. This paper first discusses how new technologies (i.e., mobile sensors, smartphones, ubiquitous computing, and cloud-enabled processing/computing) and emerging systems modeling techniques enable the development of new, dynamic, and empirical models of human behavior that could facilitate just-in-time adaptive, scalable interventions. The paper then describes concrete steps to the creation of robust dynamic mathematical models of behavior including: (1) establishing "gold standard" measures, (2) the creation of a behavioral ontology for shared language and understanding tools that both enable dynamic theorizing across disciplines, (3) the development of data sharing resources, and (4) facilitating improved sharing of mathematical models and tools to support rapid aggregation of the models. We conclude with the discussion of what might be incorporated into a "knowledge commons," which could help to bring together these disparate activities into a unified system and structure for organizing knowledge about behavior.

New technologies for promoting a healthy diet and active living.

Information and communication technologies (ICT) offer innovative formats for promoting healthy lifestyles and reinforcing public health initiatives. They can be applied to large population segments without losing the functionality of being tailored to individual fluctuating needs. Advantages of ICT include real-time provision and adaptation of nutrition and health recommendations based on an individual's particular situation, the potential to combine assessment procedures with healthy lifestyle support and the ability to unify psychosocial and cultural dimensions to enhance adherence. Two pilot programs are presented that show the potential for applying ICT to the promotion of healthy eating and physical activity habits.

Process and risk analysis to reduce errors in clinical laboratories.

BACKGROUND: An important point in improving laboratory quality is the definition of some indicators to be monitored as measures of a laboratory trend. The continuous observation of these indicators can help to reduce errors and risk of errors, thus enhancing the laboratory outcome. In addition, the standardization of risk evaluation techniques and the definition of a set of indicators can eventually contribute to a benchmarking process in clinical laboratories. METHODS: Five Italian hospital laboratories cooperated in a project in which methodologies for process and risk analysis, usually applied in fields other than healthcare (typically aeronautical and transport industries), were adapted and applied to laboratory medicine. The collaboration of a board of experts played a key role in underlining the limits of the proposed techniques and adapting them to the laboratory situation. A detailed process analysis performed in each center was the starting point, followed by risk analysis to evaluate risks and facilitate benchmarking among the participants. RESULTS AND CONCLUSIONS: The techniques applied allowed the formulation of a list of non-conformities that represented risks of errors. The level of risk related to each was quantified and graphically represented for each laboratory to identify the risk area characteristic for each of the centers involved.