A Novel EEG-Based Assessment of Distraction in Simulated Driving under Different Road and Traffic Conditions.

The drivers' distraction plays a crucial role in road safety as it is one of the main impacting causes of road accidents. The phenomenon of distraction encompasses both psychological and environmental factors and, therefore, addressing the complex interplay contributing to human distraction in automotive is crucial for developing technologies and interventions for improving road safety. In scientific literature, different works were proposed for the distraction characterization in automotive, but there is still the lack of a univocal measure to assess the degree of distraction, nor a gold-standard tool that allows to "detect" eventual events, road traffic, and additional driving tasks that might contribute to the drivers' distraction. Therefore, the present study aimed at developing an EEG-based "Distraction index" obtained by the combination of the driver's mental workload and attention neurometrics and investigating and validating its reliability by analyzing together subjective and behavioral measures. A total of 25 licensed drivers were involved in this study, where they had to drive in two different scenarios, i.e., City and Highway, while different secondary tasks were alternatively proposed in addition to the main one to modulate the driver's attentional demand. The statistical analysis demonstrated the reliability of the proposed EEG-based distraction index in identifying the drivers' distraction when driving along different roads and traffic conditions (all p < 0.001). More importantly, the proposed index was demonstrated to be reliable in identifying which are the most impacting additional driving tasks on the drivers' distraction (all p < 0.01).

Neurophysiological mental fatigue assessment for developing user-centered Artificial Intelligence as a solution for autonomous driving.

The human factor plays a key role in the automotive field since most accidents are due to drivers' unsafe and risky behaviors. The industry is now pursuing two main solutions to deal with this concern: in the short term, there is the development of systems monitoring drivers' psychophysical states, such as inattention and fatigue, and in the medium-long term, there is the development of fully autonomous driving. This second solution is promoted by recent technological progress in terms of Artificial Intelligence and sensing systems aimed at making vehicles more and more accurately aware of their "surroundings." However, even with an autonomous vehicle, the driver should be able to take control of the vehicle when needed, especially during the current transition from the lower (SAE < 3) to the highest level (SAE = 5) of autonomous driving. In this scenario, the vehicle has to be aware not only of its "surroundings" but also of the driver's psychophysical state, i.e., a user-centered Artificial Intelligence. The neurophysiological approach is one the most effective in detecting improper mental states. This is particularly true if considering that the more automatic the driving will be, the less available the vehicular data related to the driver's driving style. The present study aimed at employing a holistic approach, considering simultaneously several neurophysiological parameters, in particular, electroencephalographic, electrooculographic, photopletismographic, and electrodermal activity data to assess the driver's mental fatigue in real time and to detect the onset of fatigue increasing. This would ideally work as an information/trigger channel for the vehicle AI. In all, 26 professional drivers were engaged in a 45-min-lasting realistic driving task in simulated conditions, during which the previously listed biosignals were recorded. Behavioral (reaction times) and subjective measures were also collected to validate the experimental design and to support the neurophysiological results discussion. Results showed that the most sensitive and timely parameters were those related to brain activity. To a lesser extent, those related to ocular parameters were also sensitive to the onset of mental fatigue, but with a delayed effect. The other investigated parameters did not significantly change during the experimental session.

A Neuroergonomic Approach Fostered by Wearable EEG for the Multimodal Assessment of Drivers Trainees.

When assessing trainees' progresses during a driving training program, instructors can only rely on the evaluation of a trainee's explicit behavior and their performance, without having any insight about the training effects at a cognitive level. However, being able to drive does not imply knowing how to drive safely in a complex scenario such as the road traffic. Indeed, the latter point involves mental aspects, such as the ability to manage and allocate one's mental effort appropriately, which are difficult to assess objectively. In this scenario, this study investigates the validity of deploying an electroencephalographic neurometric of mental effort, obtained through a wearable electroencephalographic device, to improve the assessment of the trainee. The study engaged 22 young people, without or with limited driving experience. They were asked to drive along five different but similar urban routes, while their brain activity was recorded through electroencephalography. Moreover, driving performance, subjective and reaction times measures were collected for a multimodal analysis. In terms of subjective and performance measures, no driving improvement could be detected either through the driver's subjective measures or through their driving performance. On the other side, through the electroencephalographic neurometric of mental effort, it was possible to catch their improvement in terms of mental performance, with a decrease in experienced mental demand after three repetitions of the driving training tasks. These results were confirmed by the analysis of reaction times, that significantly improved from the third repetition as well. Therefore, being able to measure when a task is less mentally demanding, and so more automatic, allows to deduce the degree of users training, becoming capable of handling additional tasks and reacting to unexpected events.

Neurophysiological Assessment of An Innovative Maritime Safety System in Terms of Ship Operators' Mental Workload, Stress, and Attention in the Full Mission Bridge Simulator.

The current industrial environment relies heavily on maritime transportation. Despite the continuous technological advances for the development of innovative safety software and hardware systems, there is a consistent gap in the scientific literature regarding the objective evaluation of the performance of maritime operators. The human factor is profoundly affected by changes in human performance or psychological state. The difficulty lies in the fact that the technology, tools, and protocols for investigating human performance are not fully mature or suitable for experimental investigation. The present research aims to integrate these two concepts by (i) objectively characterizing the psychological state of mariners, i.e., mental workload, stress, and attention, through their electroencephalographic (EEG) signal analysis, and (ii) validating an innovative safety framework countermeasure, defined as Human Risk-Informed Design (HURID), through the aforementioned neurophysiological approach. The proposed study involved 26 mariners within a high-fidelity bridge simulator while encountering collision risk in congested waters with and without the HURID. Subjective, behavioral, and neurophysiological data, i.e., EEG, were collected throughout the experimental activities. The results showed that the participants experienced a statistically significant higher mental workload and stress while performing the maritime activities without the HURID, while their attention level was statistically lower compared to the condition in which they performed the experiments with the HURID (all p < 0.05). Therefore, the presented study confirmed the effectiveness of the HURID during maritime operations in critical scenarios and led the way to extend the neurophysiological evaluation of the HFs of maritime operators during the performance of critical and/or standard shipboard tasks.

Real-time Pilot Crew's Mental Workload and Arousal Assessment During Simulated Flights for Training Evaluation: a Case Study.

Training assessment is usually done by evaluating information derived from instructor's supervision related to the pilot's operational performance and behavior. However, this approach lacks objective measures, especially regarding the pilots' mental states while accomplishing the flight training tasks. The study therefore aimed at developing and testing a method for gathering and analyzing in real-time pilots' brain activity and skin conductance to improve the training evaluation. In this regard, Novice pilots' neurophysiological signals were acquired throughout multi-crew training sessions. The results demonstrated how the methodology proposed was able to endow real-time pilots' mental workload and arousal assessment for i) better evaluating training progress and operational behavior during the training session, and ii) for objectively comparing different training sessions.

Assessment of advanced age candidates for liver transplantation warrants more caution.

For patients with fulminant liver failure and end-stage liver disease, liver transplantation remains the only effective treatment. Over the years, as a result of the ageing population, the average age of liver transplant donors and recipients has increased and currently about one quarter of patients receiving transplantation in the United States are above the age of 65. Recently, a study reported that patients aged 65 years or older had lower one-year survival compared to a younger cohort. Herein, we express our opinion about this interesting publication.

Wearable Technologies for Mental Workload, Stress, and Emotional State Assessment during Working-Like Tasks: A Comparison with Laboratory Technologies.

The capability of monitoring user's performance represents a crucial aspect to improve safety and efficiency of several human-related activities. Human errors are indeed among the major causes of work-related accidents. Assessing human factors (HFs) could prevent these accidents through specific neurophysiological signals' evaluation but laboratory sensors require highly-specialized operators and imply a certain grade of invasiveness which could negatively interfere with the worker's activity. On the contrary, consumer wearables are characterized by their ease of use and their comfortability, other than being cheaper compared to laboratory technologies. Therefore, wearable sensors could represent an ideal substitute for laboratory technologies for a real-time assessment of human performances in ecological settings. The present study aimed at assessing the reliability and capability of consumer wearable devices (i.e., Empatica E4 and Muse 2) in discriminating specific mental states compared to laboratory equipment. The electrooculographic (EOG), electrodermal activity (EDA) and photoplethysmographic (PPG) signals were acquired from a group of 17 volunteers who took part to the experimental protocol in which different working scenarios were simulated to induce different levels of mental workload, stress, and emotional state. The results demonstrated that the parameters computed by the consumer wearable and laboratory sensors were positively and significantly correlated and exhibited the same evidences in terms of mental states discrimination.

Ex situ Normothermic Split Liver Machine Perfusion: Protocol for Robust Comparative Controls in Liver Function Assessment Suitable for Evaluation of Novel Therapeutic Interventions in the Pre-clinical Setting.

Background: Ex situ donor liver machine perfusion is a promising tool to assess organ viability prior to transplantation and platform to investigate novel therapeutic interventions. However, the wide variability in donor and graft characteristics between individual donor livers limits the comparability of results. We investigated the hypothesis that the development of a split liver ex situ machine perfusion protocol provides the ideal comparative controls in the investigation of machine perfusion techniques and therapeutic interventions, thus leading to more comparable results. Methods: Four discarded human donor livers were surgically split following identification and separation of right and left inflow and outflow vessels. Each lobe, on separate perfusion machines, was subjected to normothermic perfusion using an artificial hemoglobin-based oxygen carrier solution for 6 h. Metabolic parameters as well as hepatic artery and portal vein perfusion parameters monitored. Results: Trends in hepatic artery and portal vein flows showed a general increase in both lobes throughout each perfusion experiment, even when normalized for tissue weight. Progressive decreases in perfusate lactate and glucose levels exhibited comparable trends in between lobes. Conclusion: Our results demonstrate comparability between right and left lobes when simultaneously subjected to normothermic machine perfusion. In the pre-clinical setting, this model provides the ideal comparative controls in the investigation of therapeutic interventions.

Assessment of Athletes' Attitude: Physiological Evaluation via Wearable Sensors during Grappling Competitions.

Sports activity is characterised by the influence of different factors, which relate to both psychological and emotional stress of athletes. As a consequence, mental and physical preparations are fundamental in pre-competition and competition activities. In fact, being able to manage the reactions to stressful events and high demanding conditions, and adapt the strategy depending on the ongoing situation and opponent's reactions allow the athletes to properly process the surrounding information, evaluate all the possible solutions, and finally take the right decision. In this regard, the Skin Conductance (SC), Heart Rate (HR), and Skin Temperature (ST) signals were recorded during a grappling tournament from ten athletes with the aim to investigate if physiological assessments could provide an objective measure of athletes' attitude. The results proved that individual training programs can be tailored accordingly to the neurophysiological state of the athletes, but also that their awareness about both mental and physical preparations and attitudes could be improved.

Stress Assessment by Combining Neurophysiological Signals and Radio Communications of Air Traffic Controllers.

Air Traffic Control (ATC) has been classified as the fourth most stressful job. In this regard, sixteen controllers were asked to perform ecological ATC simulation during which behavioral (Radio Communications with pilots - RCs), subjective (stress perception) and neurophysiological signals (brain activity and skin conductance - SC) were collected. All the considered parameters reported significant changes under high stress conditions. In particular, the theta, alpha, and beta brain rhythms increased significantly (all p<0.05) all over the brain areas, and both the SC components exhibited higher values (p<0.01). Additionally, the number of speech under high stress decreased significantly (p<10-4) while both the mean and median value of the F0 component of the RC increased (p<0.01). The results can be employed to objectively measure and track the controller's stress level while dealing with ATC activities to better tailoring the workshift and maintaining high safety levels.

Primary Sclerosing Cholangitis: Burden of Disease and Mortality Using Data from the National Rare Diseases Registry in Italy.

Introduction: Studies on the epidemiology of primary sclerosing cholangitis (PSC) are mainly based on tertiary referral centers; and are retrospective case series susceptible to selection bias. The aim of this study was to estimate incidence; survival and cause of mortality of PSC in Italy; using population-based data. Methods: Data collected from the National Rare Diseases Registry (RNMR) and the National Mortality Database (NMD) were integrated and analyzed. Results: We identified 502 PSC incident cases. The crude incidence rate between 2012 and 2014 was 0.10 per 100,000 individuals. Sixty percent were male; mean age at disease onset and at diagnosis were 33 and 37 years; respectively; highlighting a mean diagnostic delay of 4 years. The rate of interregional mobility was 12%. Ten-year survival was 92%. In 32% of cases the cause of death was biliary-related; 12% died of biliary or gallbladder cancer. Conclusions: For rare diseases such as PSC; population-based cohort's studies are of paramount importance. Incidence rates of PSC in Italy are markedly lower and survival much longer than the ones reported from tertiary; single-centre series. Moreover; the diagnostic delay and the patient interregional mobility highlights the need for increasing awareness on the disease and for resource reallocation among Italian regions within the National Health Service.