Automatic Resting Tremor Assessment in Parkinson's Disease Using Smartwatches and Multitask Convolutional Neural Networks.

Resting tremor in Parkinson's disease (PD) is one of the most distinctive motor symptoms. Appropriate symptom monitoring can help to improve management and medical treatments and improve the patients' quality of life. Currently, tremor is evaluated by physical examinations during clinical appointments; however, this method could be subjective and does not represent the full spectrum of the symptom in the patients' daily lives. In recent years, sensor-based systems have been used to obtain objective information about the disease. However, most of these systems require the use of multiple devices, which makes it difficult to use them in an ambulatory setting. This paper presents a novel approach to evaluate the amplitude and constancy of resting tremor using triaxial accelerometers from consumer smartwatches and multitask classification models. These approaches are used to develop a system for an automated and accurate symptom assessment without interfering with the patients' daily lives. Results show a high agreement between the amplitude and constancy measurements obtained from the smartwatch in comparison with those obtained in a clinical assessment. This indicates that consumer smartwatches in combination with multitask convolutional neural networks are suitable for providing accurate and relevant information about tremor in patients in the early stages of the disease, which can contribute to the improvement of PD clinical evaluation, early detection of the disease, and continuous monitoring.

Changes in noise levels in the city of Madrid during COVID-19 lockdown in 2020.

The lockdown that Madrid has suffered during the months of March to June 2020 to try to control and minimize the spread of COVID-19 has significantly altered the acoustic environment of the city. The absence of vehicles and people on the streets has led to a noise reduction captured by the monitoring network of the City of Madrid. In this article, an analysis has been carried out to describe the reduction in noise pollution that has occurred and to analyze the changes in the temporal patterns of noise, which are strongly correlated with the adaptation of the population's activity and behavior to the new circumstances. The reduction in the sound level ranged from 4 to 6 dBA for the indicators Ld, Le, and Ln, and this is connected to a significant variation in the daily time patterns, especially during weekends, when the activity started earlier in the morning and lasted longer at midday, decreasing significantly in the afternoon.

Deep Learning Approaches for Detecting Freezing of Gait in Parkinson's Disease Patients through On-Body Acceleration Sensors.

Freezing of gait (FOG) is one of the most incapacitating motor symptoms in Parkinson's disease (PD). The occurrence of FOG reduces the patients' quality of live and leads to falls. FOG assessment has usually been made through questionnaires, however, this method can be subjective and could not provide an accurate representation of the severity of this symptom. The use of sensor-based systems can provide accurate and objective information to track the symptoms' evolution to optimize PD management and treatments. Several authors have proposed specific methods based on wearables and the analysis of inertial signals to detect FOG in laboratory conditions, however, its performance is usually lower when being used at patients' homes. This study presents a new approach based on a recurrent neural network (RNN) and a single waist-worn triaxial accelerometer to enhance the FOG detection performance to be used in real home-environments. Also, several machine and deep learning approaches for FOG detection are evaluated using a leave-one-subject-out (LOSO) cross-validation. Results show that modeling spectral information of adjacent windows through an RNN can bring a significant improvement in the performance of FOG detection without increasing the length of the analysis window (required to using it as a cue-system).

A Digital Signal Processor Based Acoustic Sensor for Outdoor Noise Monitoring in Smart Cities.

Presently, large cities have significant problems with noise pollution due to human activity. Transportation, economic activities, and leisure activities have an important impact on noise pollution. Acoustic noise monitoring must be done with equipment of high quality. Thus, long-term noise monitoring is a high-cost activity for administrations. For this reason, new alternative technological solutions are being used to reduce the costs of measurement instruments. This article presents a design for a versatile electronic device to measure outdoor noise. This device has been designed according to the technical standards for this type of instrument, which impose strict requirements on both the design and the quality of the device's measurements. This instrument has been designed under the original equipment manufacturer (OEM) concept, so the microphone-electronics set can be used as a sensor that can be connected to any microprocessor-based device, and therefore can be easily attached to a monitoring network. To validate the instrument's design, the device has been tested following the regulations of the calibration laboratories for sound level meters (SLM). These tests allowed us to evaluate the behavior of the electronics and the microphone, obtaining different results for these two elements. The results show that the electronics and algorithms implemented fully fit within the requirements of type 1 noise measurement instruments. However, the use of an electret microphone reduces the technical features of the designed instrument, which can only fully fit the requirements of type 2 noise measurement instruments. This situation shows that the microphone is a key element in this kind of instrument and an important element in the overall price. To test the instrument's quality and show how it can be used for monitoring noise in smart wireless acoustic sensor networks, the designed equipment was connected to a commercial microprocessor board and inserted into the infrastructure of an existing outdoor monitoring network. This allowed us to deploy a low-cost sub-network in the city of Málaga (Spain) to analyze the noise of conflict areas due to high levels of leisure noise. The results obtained with this equipment are also shown. It has been verified that this equipment meets the similar requirements to those obtained for type 2 instruments for measuring outdoor noise. The designed equipment is a two-channel instrument, that simultaneously measures, in real time, 86 sound noise parameters for each channel, such as the equivalent continuous sound level (Leq) (with Z, C, and A frequency weighting), the peak level (with Z, C, and A frequency weighting), the maximum and minimum levels (with Z, C, and A frequency weighting), and the impulse, fast, and slow time weighting; seven percentiles (1%, 5%, 10%, 50%, 90%, 95%, and 99%); as well as continuous equivalent sound pressure levels in the one-third octave and octave frequency bands.

Occupational Risk Prevention through Smartwatches: Precision and Uncertainty Effects of the Built-In Accelerometer.

Wearable technology has had a significant growth in the last years; this is particularly true of smartwatches, due to their potential advantages and ease of use. These smart devices integrate sensors that can be potentially used within industrial settings and for several applications, such as safety, monitoring, and the identification of occupational risks. The accelerometer is one of the main sensors integrated into these devices. However, several studies have identified that sensors integrated into smart devices may present inaccuracies during data acquisition, which may influence the performance of their potential applications. This article presents an analysis from the metrological point of view to characterize the amplitude and frequency response of the integrated accelerometers in three currently available commercial smartwatches, and it also includes an analysis of the uncertainties associated with these measurements by adapting the procedures described in several International Organization for Standardization (ISO) standards. The results show that despite the technical limitations produced by the factory configuration, these devices can be used in various applications related to occupational risk assessment. Opportunities for improvement have also been identified, which will allow us to take advantage of this technology in several innovative applications within industrial settings and, in particular, for occupational health purposes.

Efficacy of Handwashing with Soap and Nail Clipping on Intestinal Parasitic Infections in School-Aged Children: A Factorial Cluster Randomized Controlled Trial.

BACKGROUND: Intestinal parasitic infections are highly endemic among school-aged children in resource-limited settings. To lower their impact, preventive measures should be implemented that are sustainable with available resources. The aim of this study was to assess the impact of handwashing with soap and nail clipping on the prevention of intestinal parasite reinfections. METHODS AND FINDINGS: In this trial, 367 parasite-negative school-aged children (aged 6-15 y) were randomly assigned to receive both, one or the other, or neither of the interventions in a 2 × 2 factorial design. Assignment sequence was concealed. After 6 mo of follow-up, stool samples were examined using direct, concentration, and Kato-Katz methods. Hemoglobin levels were determined using a HemoCue spectrometer. The primary study outcomes were prevalence of intestinal parasite reinfection and infection intensity. The secondary outcome was anemia prevalence. Analysis was by intention to treat. Main effects were adjusted for sex, age, drinking water source, latrine use, pre-treatment parasites, handwashing with soap and nail clipping at baseline, and the other factor in the additive model. Fourteen percent (95% CI: 9% to 19%) of the children in the handwashing with soap intervention group were reinfected versus 29% (95% CI: 22% to 36%) in the groups with no handwashing with soap (adjusted odds ratio [AOR] 0.32, 95% CI: 0.17 to 0.62). Similarly, 17% (95% CI: 12% to 22%) of the children in the nail clipping intervention group were reinfected versus 26% (95% CI: 20% to 32%) in the groups with no nail clipping (AOR 0.51, 95% CI: 0.27 to 0.95). Likewise, following the intervention, 13% (95% CI: 8% to 18%) of the children in the handwashing group were anemic versus 23% (95% CI: 17% to 29%) in the groups with no handwashing with soap (AOR 0.39, 95% CI: 0.20 to 0.78). The prevalence of anemia did not differ significantly between children in the nail clipping group and those in the groups with no nail clipping (AOR 0.53, 95% CI: 0.27 to 1.04). The intensive follow-up and monitoring during this study made it such that the assessment of the observed intervention benefits was under rather ideal circumstances, and hence the study could possibly overestimate the effects when compared to usual conditions. CONCLUSIONS: Handwashing with soap at key times and weekly nail clipping significantly decreased intestinal parasite reinfection rates. Furthermore, the handwashing intervention significantly reduced anemia prevalence in children. The next essential step should be implementing pragmatic studies and developing more effective approaches to promote and implement handwashing with soap and nail clipping at larger scales.

Evaluation of the relationship between effervescent paracetamol and blood pressure: clinical trial.

BACKGROUND: Paracetamol's solubility is achieved by adding to the excipient sodium salts, either as bicarbonate, carbonate or citrate. As the relationship between salt and hypertension is well known, due to the sodium content it has raised a hypothesis that may interfere with the control of that risk factor. Therefore, the objective of this study is to evaluate the effect on blood pressure of effervescent paracetamol compared to non-effervescent, in hypertensive patients. METHODS/DESIGN: This is the protocol of a phase IV multicenter clinical trial, randomized, controlled, crossover, open, which will compare the effect of two different formulations of paracetamol (effervescent or non-effervescent) in the blood pressure of hypertensive patients, with a seven weeks follow up. 49 controlled hypertensive patients will be included (clinical BP lower than 150 and 95 mmHg, and lower than 135 mmHg and 85 mmHg in patients with diabetes or a history of cardiovascular event, and daytime ambulatory measurements lower than 140 and 90 mmHg) and mild to moderate pain (Visual Analog Scale between 1 and 4). The study was approved by the ethics committee of the Fundació Jordi Gol i Gurina and following standards of good clinical practice. The primary endpoint will be the variations in systolic BP in 24 h Ambulatory Blood Pressure Monitoring, considering significant differences 2 or more mmHg among those treated with non-effervescent and effervescent formulations. Intention-to-treat and per-protocol analysis will be held. DISCUSSION: Despite the broad recommendation not to use effervescent drugs in patients with hypertension, there are relatively little studies that show exactly this pressor effect due to sodium in salt that gives the effervescence of the product. This is the first clinical trial designed to study the effect of effervescence compared to the non-effervescent, in well-controlled hypertensive patients with mild to moderate pain, performed in routine clinical practice. TRIAL REGISTRATION: NCT 02514538.

Monipar: movement data collection tool to monitor motor symptoms in Parkinson's disease using smartwatches and smartphones.

Introduction: Parkinson's disease (PD) is a neurodegenerative disorder commonly characterized by motor impairments. The development of mobile health (m-health) technologies, such as wearable and smart devices, presents an opportunity for the implementation of clinical tools that can support tasks such as early diagnosis and objective quantification of symptoms. Objective: This study evaluates a framework to monitor motor symptoms of PD patients based on the performance of standardized exercises such as those performed during clinic evaluation. To implement this framework, an m-health tool named Monipar was developed that uses off-the-shelf smart devices. Methods: An experimental protocol was conducted with the participation of 21 early-stage PD patients and 7 healthy controls who used Monipar installed in off-the-shelf smartwatches and smartphones. Movement data collected using the built-in acceleration sensors were used to extract relevant digital indicators (features). These indicators were then compared with clinical evaluations performed using the MDS-UPDRS scale. Results: The results showed moderate to strong (significant) correlations between the clinical evaluations (MDS-UPDRS scale) and features extracted from the movement data used to assess resting tremor (i.e., the standard deviation of the time series: r = 0.772, p < 0.001) and data from the pronation and supination movements (i.e., power in the band of 1-4 Hz: r = -0.662, p < 0.001). Conclusion: These results suggest that the proposed framework could be used as a complementary tool for the evaluation of motor symptoms in early-stage PD patients, providing a feasible and cost-effective solution for remote and ambulatory monitoring of specific motor symptoms such as resting tremor or bradykinesia.

How the COVID-19 Pandemic Muted and Remixed the World's Acoustics for a While.

Purpose of Review: This review aims to analyze the effects of the pandemic on the world's sound environment. Recent Findings: The confinements associated with the pandemic led to a reduction in sound levels worldwide and a change in the perception of soundscapes in the absence of traffic noise and human-generated noise. Summary: In response to the COVID-19 pandemic, many countries and regions around the world adopted a series of interventions in 2020 that have been referred to as "lockdown" or "confinement." These sets of restrictions had a clear and obvious consequence derived from the absence of people in the streets and the reduction of daily activity and commuting, which caused an unprecedented silencing on a large scale. Along with the silence that ensued, the pandemic and the confinements affected acoustics and our relationship with sounds on different scales. In the cities, this phenomenon had a strong reduction in acoustic intensity due to the absence of vehicles on the streets. Perhaps this was more perceptible in our neighborhoods, with notable changes in their soundscapes, first due to the absence of people in the streets and later due to more outdoor activity derived from the fear of the spread of the virus in indoor spaces. The longer periods of time spent in our homes during the lockdowns also highlighted the importance of sound insulation in buildings and the acoustic conditioning of our schools or homes.

Two-Year Follow-up of a Multimodal Intervention on Functional Capacity and Muscle Power in Frail Patients With Type 2 Diabetes.

OBJECTIVES: To analyze the effects of a program composed of resistance training and nutritional interventions on functional capacity, maximal strength, and power output after 2 years of follow-up, including 2 periods of 16 weeks of intervention followed by several weeks of intervention cessation in frail patients with type 2 diabetes. DESIGN: MIDPOW is a substudy of a multicenter, multimodal intervention composed of resistance training combined with a structured diabetes and nutritional education program in frail and prefrail older people with type 2 diabetes (MID-Frail). SETTING AND PARTICIPANTS: This study recruited 52 participants (mean age: 79 ± 5.6, 63% women), with type 2 diabetes mellitus, frail or prefrail using Fried's frailty phenotype. METHODS: Primary outcomes of this substudy were Short Physical Performance Battery (SPPB) and maximal power output at 30% and 80% of 1RM. RESULTS: Each set of 16 weeks of intervention resulted in significant improvements in SPPB performance by a mean of 36.1% at week 18 (P < .001) and 10.2% at week 68 (P < .05). Maximal power output improvements at 30% and 80% of the 1RM ranged from 45.2% to 57.2% at week 18 (P < .01-.001); and no significant changes were observed after the second period of intervention. After 2 years of follow-up, the SPPB and maximal power values observed remained significantly higher than the baseline. CONCLUSIONS AND IMPLICATIONS: Resistance training combined with nutritional program improved SPPB, maximal strength, and power output in older frail patients with diabetes. These improvements were maintained above the basal levels after several weeks of intervention cessation during a 2-year follow-up.

On the Person-Place Interaction and Its Relationship with the Responses/Outcomes of Listeners of Urban Soundscape (Compared Cases of Lisbon and Bogotá): Contextual and Semiotic Aspects.

Design, planning, and management of the urban soundscape require various interacting fields of knowledge given the fact that it is the human person that experiences and provides meaning to the urban places and their acoustic environments. The process of environmental perception involves contextual information that conditions people's responses and outcomes through the relationship between the variables Person, Activity, and Place. This research focuses on the interaction between Person and Place and its impact on responses and outcomes from listeners with different geographical origin and background. Laboratory studies were conducted in the cities of Lisbon (Portugal) and Bogotá (Colombia), where local listeners were introduced to known and unknown acoustic environments. Sound data recorded in the two cities allowed comparison of responses and outcomes of the listeners according to the Person-Place Interaction, leading to different meanings depending on the contextual variables. The results clearly show a relationship between site, acoustic environment, soundscape, Person-Place Interaction, and meaning of the place. This information can be useful for urban technicians and designers dealing with planning and management of urban soundscapes.

Risk factors for intestinal parasitosis, anaemia, and malnutrition among school children in Ethiopia.

Research on associated risk factors for intestinal parasitic infections and malnutrition in various geographic regions is needed for the development of appropriate control strategies. The aim of this study was to determine the risk factors associated with intestinal parasitic infections, anaemia, and malnutrition in school children, living in urban and rural areas of northern Ethiopia. Six hundred school children, aged 6-15 years, were randomly selected in a cross-sectional survey from 12 primary schools. Sociodemographic and anthropometric data were collected. Faecal samples were examined using direct, concentration, and the Kato-Katz methods. Urine specimens were analysed for Schistosoma haematobium ova. Haemoglobin was measured using a HemoCue spectrometer. The overall prevalence of intestinal parasitosis was 72% (95% confidence interval (CI): 66-76%). The prevalence of anaemia, stunting, and thinness were 11% (95% CI: 8-13%), 35% (95% CI: 31-38%), and 34% (95% CI: 30-38%), respectively. Poor personal hygiene habits were generally associated with anaemia and nutritional deficiency (low body mass index). Multivariate logistic regression models related Schistosoma mansoni infection with boys. Boys were also more likely to be malnourished. Hookworm infection was associated with anaemia and unhygienic finger nails. Access to clean water and latrines, with some hygiene and sanitation communication activities, could improve health of children in Ethiopia. The use of smartphone technology in demographic data collection proved to be successful. The potential advantage offered by this technology for parasitological field surveys merits further investigation.