Gender disparities in observed motorcycle helmet use in Madagascar: female motorcyclists behave safer but have lower overall protection.

BACKGROUND: Although motorcycle helmets can save lives in case of a crash, no helmet use data are available for many countries. When data is available, it is often only analysed as a global average, preventing targeted road safety education and legislative action. In this study, we conducted a detailed analysis of motorcycle helmet use in the capital of Madagascar. METHODS: Using a cross-sectional observational field survey framework, we observed 17 230 individual motorcycles. We systematically recorded motorcycle riders' helmet use, position on the motorcycle, rider numbers and gender. RESULTS: We found a general helmet use of 76.1%. Observed drivers had a significantly higher helmet use (84.6%) than passengers (47.7%), and subsequently helmet use per motorcycle decreased significantly when the number of riders per motorcycle increased. Female drivers had significantly higher helmet use than male drivers, and female passengers had significantly higher helmet use than male passengers. That is, on the same position of the motorcycle, female riders behaved safer than male riders. However, since female riders were more often passengers than drivers, their average helmet use was lower than that of male riders overall. Contrary to findings from other countries, motorcycle helmet use did not differ significantly throughout the day but was relatively constant. CONCLUSION: Our results show the potential for injury and fatality prevention in Madagascar through increased passenger helmet use. This increase would also proportionally benefit female riders more than male riders. Findings regarding road safety legislation's applied impact, education, enforcement and future research needs are discussed.

Defining Requirements and Related Methods for Designing Sensorized Garments.

Designing smart garments has strong interdisciplinary implications, specifically related to user and technical requirements, but also because of the very different applications they have: medicine, sport and fitness, lifestyle monitoring, workplace and job conditions analysis, etc. This paper aims to discuss some user, textile, and technical issues to be faced in sensorized clothes development. In relation to the user, the main requirements are anthropometric, gender-related, and aesthetical. In terms of these requirements, the user's age, the target application, and fashion trends cannot be ignored, because they determine the compliance with the wearable system. Regarding textile requirements, functional factors-also influencing user comfort-are elasticity and washability, while more technical properties are the stability of the chemical agents' effects for preserving the sensors' efficacy and reliability, and assuring the proper duration of the product for the complete life cycle. From the technical side, the physiological issues are the most important: skin conductance, tolerance, irritation, and the effect of sweat and perspiration are key factors for reliable sensing. Other technical features such as battery size and duration, and the form factor of the sensor collector, should be considered, as they affect aesthetical requirements, which have proven to be crucial, as well as comfort and wearability.

A Smart Wearable Sensor System for Counter-Fighting Overweight in Teenagers.

PEGASO is a FP7-funded project whose goal is to develop an ICT and mobile-based platform together with an appropriate strategy to tackle the diffusion of obesity and other lifestyle-related illnesses among teenagers. Indeed, the design of an engaging strategy, leveraging a complementary set of technologies, is the approach proposed by the project to promote the adoption of healthy habits such as active lifestyle and balanced nutrition and to effectively counter-fight the emergence of overweight and obesity in the younger population. A technological key element of such a strategy sees the adoption of wearable sensors to monitor teenagers' activities, which is at the basis of developing awareness about the current lifestyle. This paper describes the experience carried out in the framework of the PEGASO project in developing and evaluating wearable monitoring systems addressed to adolescents. The paper describes the methodological approach based on the co-designing of such a wearable system and the main results that, in the first phase, involved a total of 407 adolescents across Europe in a series of focus groups conducted in three countries for the requirements definition phase. Moreover, it describes an evaluation process of signal reliability during the usage of the wearable system. The main results described here are: (a) a prototype of the standardized experimental protocol that has been developed and applied to test signal reliability in smart garments; (b) the requirements definition methodology through a co-design activity and approach to address user requirements and preferences and not only technological specifications. Such co-design approach is able to support a higher system acceptance and usability together with a sustained adoption of the solution with respect to the traditional technology push system development strategy.

Assessment of lower limb prosthesis through wearable sensors and thermography.

This study aimed to explore the application of infrared thermography in combination with ambulatory wearable monitoring of temperature and relative humidity, to assess the residual limb-to-liner interface in lower-limb prosthesis users. Five male traumatic transtibial amputees were involved, who reported no problems or discomfort while wearing the prosthesis. A thermal imaging camera was used to measure superficial thermal distribution maps of the stump. A wearable system for recording the temperature and relative humidity in up to four anatomical points was developed, tested in vitro and integrated with the measurement set. The parallel application of an infrared camera and wearable sensors provided complementary information. Four main Regions of Interest were identified on the stump (inferior patella, lateral/medial epicondyles, tibial tuberosity), with good inter-subject repeatability. An average increase of 20% in hot areas (P < 0.05) is shown after walking compared to resting conditions. The sensors inside the cuff did not provoke any discomfort during recordings and provide an inside of the thermal exchanges while walking and recording the temperature increase (a regime value is ~+1.1 ± 0.7 °C) and a more significant one (~+4.1 ± 2.3%) in humidity because of the sweat produced. This study has also begun the development of a reference data set for optimal socket/liner-stump construction.

Wearable monitoring devices for assistive technology: case studies in post-polio syndrome.

The correct choice and customization of an orthosis are crucial to obtain the best comfort and efficiency. This study explored the feasibility of a multivariate quantitative assessment of the functional efficiency of lower limb orthosis through a novel wearable system. Gait basographic parameters and energetic indexes were analysed during a Six-Minute Walking Test (6-MWT) through a cost-effective, non-invasive polygraph device, with a multichannel wireless transmission, that carried out electro-cardiograph (ECG); impedance-cardiograph (ICG); and lower-limb accelerations detection. Four subjects affected by Post-Polio Syndrome (PPS) were recruited. The wearable device and the semi-automatic post-processing software provided a novel set of objective data to assess the overall efficiency of the patient-orthosis system. Despite the small number of examined subjects, the results obtained with this new approach encourage the application of the method thus enlarging the dataset to validate this promising protocol and measuring system in supporting clinical decisions and out of a laboratory environment.

The freedom to run: developing an autonomous robot matching the needs of visually impaired citizens to technology opportunities.

Purpose: Visual impairment poses significant challenges in daily life, especially when navigating unfamiliar environments, resulting in inequalities and reduced quality of life. This study aimed to gain an in-depth understanding of the needs and perspectives of visually impaired people in sports-related contexts through surveys and focus groups, and to understand whether their needs are being met by current technological solutions.Materials and methods: To accomplish this, opinions gathered from focus groups and interviews were compared to the technological solutions found in the literature. Since many unmet needs were identified, participants from associations and organizations were asked to identify key characteristics for the development of a robot guide. The results underscored the paramount importance of an easy-to-use guide that offers accurate and personalized assistance. Participants expressed a strong desire for advanced features such as object recognition and navigation in complex environments, as well as adaptability to the user's speed while providing the necessary safety features to ensure a high level of autonomy.Results: This research serves as a bridge between technological advances and the needs of the visually impaired, contributing to a more accessible and inclusive society. By addressing the unique challenges faced by the visually impaired individuals and tailoring technology to meet their needs, this study takes a significant step toward reducing disparities and improving the independence and quality of life for this community.Conclusions: As technology continues to advance, it has the potential to be a powerful tool in breaking down barriers and fostering a world where everyone, regardless of their visual ability, can navigate the world with confidence and ease.

Inclusive design: Recognizing the importance of incorporating the unique requirements and perspectives of visually impaired individuals can guide the development of rehabilitation technology and services, ensuring they effectively support daily activities and active participation in sports and physical pursuits.Tailored-assistive technology: Understanding the specific needs of visually impaired individuals with regards to assistive technology, such as dependable robotic guides and essential features, can inform the design and customization of rehabilitation aids to enhance mobility and independence.Promising technologies: Exploring promising technologies like Aira, Be My Eyes, RoboCart, and Wayband can inspire the integration of these innovations into rehabilitation programs, facilitating better orientation, mobility, and accessibility for individuals with visual impairments.Continued research and development: Emphasizing the necessity for ongoing research and development efforts underscores the importance of advancing rehabilitation solutions that effectively address the distinct needs of visually impaired individuals, particularly in navigating unfamiliar environments.

Sport monitoring with smart wearable system.

This work presents a new system for sport monitoring. The system was composed of a t-shirt with two textile electrodes and two devices for the acquisition, storage, processing and visualization of the signals. The systems allows monitoring both ECG signal (raw and processed heart-rate) and 3 axial acceleration (raw and step counter). The systems were tested in different conditions during some races; we report the results on three subjects during a skyrunning race.

Wearable monitoring systems in pre-term newborns care.

In the last decade, the trends in the development and management of healthcare services are focused on the personalization of prevention, diagnosis and treatment. This paper presents an example of the development of wearable technology for biosignal monitoring in the field of pre-term newborns care. The system was validated by an in-hospital pre-clinical test demonstrating efficiency, reliability and quality.

Comparison of different mobile health applications for intervention in children and adolescent with overweight: a protocol for systematic review with meta-analysis and trial sequential analysis.

INTRODUCTION: Overweight in children is increasing worldwide. Innovative smartphone health applications (mHealth apps) have either sought to deliver single or multi-component interventions for the management of overweight in children. However, the clinical effects of these apps are poorly explored. The objective of the review will be to compare the benefits and harms of different categories of mHealth apps for intervention of overweight in children. METHODS AND ANALYSIS: We will include randomised clinical trials irrespective of publication type, year, status or language. Children and adolescents between 0 to 18 years will be referred to as children in the remaining part of the paper. Children with all degrees of overweight included obesity and morbidly obese in the remaining part of the paper will be referred to as overweight. We plan to classify different apps according to type of intervention, measurement device, coaching and reward system. The following databases will be used: Cochrane Library, Excerpta Medica database (Embase), PsycINFO, PubMed, IEEE Explore and Web of Science, CINAHL and LILACS. Primary outcomes will be body mass index z-score, quality of life and serious adverse event. Secondary outcomes will be body weight, self-efficacy, anxiety, depression and adverse event not considered serious. Study inclusion, data extraction and bias risk assessment will be conducted independently by at least two authors. We will assess the risk of bias through eight domains and control risks of random errors with Trial Sequential Analysis. The quality of the evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation Tool (GRADE). ETHICS AND DISSEMINATION: As the protocol is for a systematic reviews, we have not included any patient data and we do not require ethical approval. This review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019120266.

Health apps targeting children with overweight-a protocol for a systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials.

BACKGROUND: The prevalence of overweight is increasing worldwide in children. Multi-component interventions incorporating diet, physical activity, and behavioural change have been shown to reduce body mass index (BMI). Whilst many children have their own smartphone, the clinical effects of using smartphone applications (apps) for overweight are unknown. This systematic review aims to ascertain the effects of mHealth apps in children with overweight. METHODS: We will include randomised clinical trials irrespective of publication type, year, status, or language. Children between 0 and 18 years with overweight will be included. We will compare apps targeting overweight versus sham app, no app, or usual intervention. No distinction about operative system will be considered (i.e. Android, iOS, and Window Mobile will be included). The following databases will be searched: The Cochrane Library, Excerpta Medica database (Embase), PsycINFO, PubMed, IEEE Explore, Web of Science, CINAHL, and LILACS. Primary outcomes will be body weight, quality of life, and serious adverse event. Secondary outcomes will be self-efficacy, anxiety, depression, and adverse event not considered serious. Trial inclusion, data extraction, and bias risk assessment will be conducted independently by at least two authors. We will assess risk of bias through eight domains and control risks of random errors with Trial Sequential Analysis. The quality of the evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation Tool (GRADE). DISCUSSION: We will provide evidence of the beneficial and harmful effects of smartphone apps for children with overweight and highlight any gaps in the evidence in order to shape future potential interventions. By only including randomised clinical trials, we know that we bias our review towards benefits. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019120210.

Patterns of motorcycle helmet use - A naturalistic observation study in Myanmar.

Developing countries are subject to increased motorization, particularly in the number of motorcycles. As helmet use is critical to the safety of motorcycle riders, the goal of this study was to identify observable patterns of helmet use, which allow a more accurate assessment of helmet use in developing countries. In a video based observation study, 124,784 motorcycle riders were observed at seven observation sites throughout Myanmar. Recorded videos were coded for helmet use, number of riders on the motorcycle, rider position, gender, and time of day. Generally, motorcycle helmet use in Myanmar was found to be low with only 51.5% percent of riders wearing a helmet. Helmet use was highest for drivers (68.1%) and decreased for every additional passenger. It was lowest for children standing on the floorboard of the motorcycle (11.3%). During the day, helmet use followed a unimodal distribution, with the highest use observed during the late morning and lowest use observed in the early morning and late afternoon. Helmet use varied significantly between observation sites, ranging from 74.8% in Mandalay to 26.9% in Pakokku. In Mandalay, female riders had a higher helmet use than male riders, and helmet use decreased drastically on a national holiday in the city. Helmet use of motorcycle riders in Myanmar follows distinct patterns. Knowledge of these patterns can be used to design more precise helmet use evaluations and guide traffic law policy and police enforcement measures. Video based observation proved to be an efficient tool to collect helmet use data.

[Prospective study of laparoscopic treatment of incisional hernia by means of the use of composite mesh: indications, complications, mesh fixation materials and results]. / Studio prospettico sul trattamento laparoscopico del laparocele con mesh composita: indicazioni, complicanze, sistemi di fissaggio e risultati.

The aim of this study was to establish the indications, safety, efficacy, feasibility and reproducibility of laparoscopic techniques in the treatment of abdominal wall defects, even of the larger kind, in order to standardise procedures and confirm the performance of the composite mesh used (Parietex, Sofradim, Trevoux, France). From January 2001 to December 2004, 185 non-selected patients (109 females, 76 males), with a mean age of 56 years (range: 26-77) and a mean BMI of 30 (range: 26-40) were included in the study; 162 patients (87.5%) had incisional hernias and 23 patients (12.5%) primary wall defects. The size of the defects treated ranged from 4 cm to 26 cm (mean: 12.1 cm). All patients underwent laparoscopic repair and all meshes were placed intraperitoneally. Over a mean follow-up period of 29 months (range: 1-48), we observed 11 postoperative complications (6.7%): 7 seromas (4.3%) which were still present after 4 weeks, one of which turned septic after several attempts at percutaneous evacuation and in which the prosthesis had to be removed laparoscopically; 3 (1.8%) experienced persistent neuralgia which disappeared after 2 months' treatment with NSAIDs, and also one case of trocar-induced haematoma. We had 4 recurrences (2.4%), all within 1 to 3 months of surgery; 1 in the size group measuring less than 9 cm and 3 in the larger defect group. Adhesiolysis was performed in 98% of all incisional hernia cases and in 7 cases (4.3%) we had to repair iatrogenic lesions of the small bowel. In 4 patients (2.5%), because of thick adhesions (1 patient) or bowel loop fixation to the previous surgical scar (3 patients), we caused complete bowel perforation repaired by laparoscopic suture. Mean operative time was 65.6 minutes (range: 28-130) and the mean hospital stay was 2.1 days (range: 1-5). We had no conversions and no mortality. We also reviewed the main methods of mesh fixation and believe that the best system at the moment is the EndoAnchor (Ethicon Endo-Surgery, Cincinnati, Ohio) device, although in future the best option is likely to be fixation with non-traumatic biological glue (Tissucol, Baxter, Maurepas), which we have already used in a series of 16 patients with optimal results and no recurrences. The results emerging from this clinical trial confirm the safety and efficacy of laparoscopic repair techniques, of this kind of mesh and of the anchoring devices used as well as the reproducibility of this technique for the intraperitoneal repair of primary and incisional abdominal wall defects, including even those of large size.

Developmental Dyslexia With and Without Language Impairment: ERPs Reveal Qualitative Differences in Morphosyntactic Processing.

This study aimed to characterize neuropsychological and linguistic skills in children with Developmental Dyslexia (DD) with and without Language Impairment (LI). Behavioral tests of short-term memory, phonemic awareness, and morphosyntactic processing and electrophysiological responses to agreement violations were administered to 32 DD children (16 with additional LI) and 16 controls. Behavioral data revealed quantitative differences among groups: DD+LI children showed the worst performance, followed by DD-only children and controls. Event-related potential results confirmed atypical morphosyntactic processing in the DD-only group, highlighting qualitative differences between groups. These results support multifactor models of learning disabilities, where different patterns of deficits characterize different subgroups.

Use of Machine Learning to Identify Children with Autism and Their Motor Abnormalities.

In the present work, we have undertaken a proof-of-concept study to determine whether a simple upper-limb movement could be useful to accurately classify low-functioning children with autism spectrum disorder (ASD) aged 2-4. To answer this question, we developed a supervised machine-learning method to correctly discriminate 15 preschool children with ASD from 15 typically developing children by means of kinematic analysis of a simple reach-to-drop task. Our method reached a maximum classification accuracy of 96.7% with seven features related to the goal-oriented part of the movement. These preliminary findings offer insight into a possible motor signature of ASD that may be potentially useful in identifying a well-defined subset of patients, reducing the clinical heterogeneity within the broad behavioral phenotype.

[Laparoscopic liver resection using a radiofrequency dissector. Initial experience]. / Resezioni epatiche laparoscopiche mediante dissettore a radiofrequenza. Esperienza iniziale.

Laparoscopic liver surgery, especially when resective, requires both the skill of an expert laparoscopist and the experience of a liver surgeon. The aims of the study were to assess the feasibility of minor laparoscopic liver resection by means of a radiofrequency dissector and to evaluate the laparoscopic approach. From January 1993 to November 2002 we carried out 7 laparoscopic liver resections (3 men, 4 women), 5 of which for benign diseases and 2 for metastases from colorectal cancer. In 4 of the above resections we used an argon coagulator, while the last 3 were performed using a radiofrequency instrument. We had no perioperative or postoperative complications in this small series of patients. The mean perioperative blood loss was 120 ml (range: 80-200) and the procedure took about 90 minutes on average (range: 80-110). The mean hospital stay was 4 days and pain was adequately controlled by administering 2 ml of Toradol twice daily. We believe that the advantages of the laparoscopic technique together with the efficacy of the radiofrequency instrument in liver surgery will lead to a more widespread use of this procedure and extension of its use to include the safe execution of both minor and major resections.

Long-term sympathoinhibitory effects of surgically induced weight loss in severe obese patients.

Weight loss improves insulin sensitivity and exerts sympathomodulatory effects. No data, however, are available on the effects of the weight loss induced by vertical sleeve gastrectomy on sympathetic neural drive, insulin sensitivity, and their reciprocal cross talks. In 10 severe obese hypertensives (age, 54.0±2.3 years [mean±SEM]), we measured sphygmomanometric blood pressure, heart rate, body mass index, homeostatic model assessment index, plasma leptin, muscle sympathetic nerve traffic (microneurography), and baroreflex sensitivity (vasoactive drug technique). Measurements were performed 2 to 3 days before surgery and repeated 6 and 12 months after the procedure. Ten matched hypertensive obeses not undergoing gastrectomy served as controls. Six months after bariatric surgery, a significant (P<0.05) reduction in body mass index (-9.1±1.4 kg/m(2)), sphygmomanometric systolic blood pressure (-10.2±4.5 mm Hg), heart rate (-11.0±2.4 bpm), homeostatic model assessment index (-3-3±1.3 AU), plasma leptin (-53.6±8.8 µg/L), and muscle sympathetic nerve traffic (-15.0±3.4 bursts/100 heart beats) was observed. The weight loss, the plasma leptin reduction, and the sympathetic inhibition were maintained after 12 months, whereas homeostatic model assessment index showed a tendency to return toward presurgery values. A significant improvement in baroreflex control of sympathetic nerve traffic was observed both 6 (+32.1%; P<0.05) and 12 months (+60.7%; P<0.01) after gastrectomy. No significant changes in the above-mentioned variables were detected in the control group. These data provide evidence that massive weight loss induced by sleeve gastrectomy triggers profound sympathoinhibitory effects, associated with a stable and significant reduction in plasma leptin levels, whereas the improvement in insulin sensitivity was attenuated with time and unrelated to the sympathoinhibition.

Eye-hand coordination in children with high functioning autism and Asperger's disorder using a gap-overlap paradigm.

We investigated eye-hand coordination in children with autism spectrum disorders (ASD) in comparison with age-matched normally developing peers. The eye-hand correlation was measured by putting fixation latencies in relation with pointing and key pressing responses in visual detection tasks where a gap-overlap paradigm was used and compared to fixation latencies in absence of manual response. ASD patients showed less efficient eye-hand coordination, which was particularly evident when pointing towards a target was being fixated. The data of normally developing participants confirmed that manual gap effects are more likely for more complex hand movements. An important discrepancy was discovered in participants with ASD: beside normal eye gap effects, they showed no concurrent hand gap effects when pointing to targets. This result has been interpreted as a further sign of inefficient eye-hand coordination in this patient population.

Further evidence of complex motor dysfunction in drug naive children with autism using automatic motion analysis of gait.

In order to increase the knowledge of locomotor disturbances in children with autism, and of the mechanism underlying them, the objective of this exploratory study was to reliably and quantitatively evaluate linear gait parameters (spatio-temporal and kinematic parameters), upper body kinematic parameters, walk orientation and smoothness using an automatic motion analyser (ELITE systems) in drug naïve children with Autistic Disorder (AD) and healthy controls. The children with AD showed a stiffer gait in which the usual fluidity of walking was lost, trunk postural abnormalities, highly significant difficulties to maintain a straight line and a marked loss of smoothness (increase of jerk index), compared to the healthy controls. As a whole, these data suggest a complex motor dysfunction involving both the cortical and the subcortical area or, maybe, a possible deficit in the integration of sensory-motor information within motor networks (i.e., anomalous connections within the fronto-cerebello-thalamo-frontal network). Although the underlying neural structures involved remain to be better defined, these data may contribute to highlighting the central role of motor impairment in autism and suggest the usefulness of taking into account motor difficulties when developing new diagnostic and rehabilitation programs.

Reach and throw movement analysis with support vector machines in early diagnosis of autism.

Movement disturbances play an intrinsic part in autism. Upper limb movements like reach-and-throw seem to be helpful in early identification of children affected by autism. Nevertheless few works investigate the application of classifying methods to upper limb movements. In this study we used a machine learning approach Support Vector Machine (SVM) for identifying peculiar features in reach-and-throw movements. 10 pre-scholar age children with autism and 10 control subjects performing the same exercises were analyzed. The SVM algorithm proved to be able to separate the two groups: accuracy of 100% was achieved with a soft margin algorithm, and accuracy of 92.5% with a more conservative one. These results were obtained with a radial basis function kernel, suggesting that a non-linear analysis is possibly required.

Entropy analysis on EEG signal in a case study of focal myoclonus.

Electrophysiological studies provide useful information for diagnosis and classification of myoclonus, and for the investigation of its generative mechanisms, due to association of myoclonus with abnormally increased excitability of cortical structures. In this work we analyzed the polygraphic data of a 7-year old girl affected by continuous partial epilepsy with focal myoclonus both related and not related with epileptiform discharges on EEG. We applied Sample Entropy (SampEn) and Lempel-Ziv complexity (LZ) methods to investigate the regularity and complexity content of EEG recordings and to find possible analogies in the behaviour of non-parametric complexity measures in epilepsy and in myoclonus. Our results show that these algorithms succeeded in finding a significant difference between the hypothesized focus on C3 electrode and the contralateral electrode C4, for EEG correlated myoclonus. A significant difference between the two contralateral electrodes (C3-C4) was also found for non EEG correlated myoclonus, but only by means of SampEn. This preliminary study confirmed the ability of entropic methods in discriminating myoclonic events. Indeed, near the myoclonic focus location both SampEn and LZ methods showed below average values.