A Framework for the Evaluation of Human Machine Interfaces of Robot-Assisted Colonoscopy.

The Human Machine Interface (HMI) of intraluminal robots has a crucial impact on the clinician's performance. It increases or decreases the difficulty of the tasks, and is connected to the users' physical and mental stress. OBJECTIVE: This article presents a framework to compare and evaluate different HMIs for robotic colonoscopy, with the objective of identifying the optimal HMI that minimises the clinician's effort and maximises the clinical outcomes. METHODS: The framework comprises a 1) a virtual simulator (clinically validated), 2) wearable sensors measuring the cognitive load, 3) a data collection unit of metrics correlated to the clinical performance, and 4) questionnaires exploring the users' impressions and perceived stress. The framework was tested with 42 clinicians investigating the optimal device for tele-operated control of robotic colonoscopes. Two control devices were selected and compared: a haptic serial-kinematic device and a standard videogame joypad. RESULTS: The haptic device was preferred by the endoscopists, but the joypad enabled better clinical performance and reduced cognitive and physical load. CONCLUSION: The framework can be used to evaluate different aspects of a HMI, both hardware and software, and determine the optimal HMI that can reduce the burden on clinicians while improving the clinical outcome. SIGNIFICANCE: The findings of this study, and of future studies performed with this framework, can inform the design and development of HMIs for intraluminal robots, leading to improved clinical performance, reduced physical and mental stress for clinicians, and ultimately better patient outcomes.

Sleep disturbances in specific learning disorders: a qualitative and quantitative investigation.

BACKGROUND: The literature reports a significant association between sleep disorders and learning disabilities. Nevertheless, not all children with learning disorders have sleep alterations, and which sleep characteristics are associated with which learning difficulty is still unknown. The study aimed at acquiring new information on the relation between sleep disturbances or habits and the learning profiles of children with a specific learning disorder (SLD). METHODS: The Sleep Disturbance Scale for Children (SDSC) and an actigraph (the FitBit-Flex, FB-F) were used in 26 and 16 SLD children respectively; all children were also assessed for learning skills. RESULTS: Although parents' reports at the SDSC did not differentiate SLD from typical readers, the awakening, respiratory and arousal disturbances at the SDSC correlated with sleep duration at the FB-F. Sleep alterations at the FB-F actigraph characterize SLD with literacy difficulties: children with reading decoding difficulties showed shorter minimum amount of sleep than typical children, and severe SLDs showed shorter maximum sleep duration and a higher number of awakenings in comparison to SLDs with mild learning deficits. CONCLUSIONS: Mild alterations in the amount, duration and quality of sleep may characterize children with learning disorders and actigraphy proves to be a useful tool in starting the individual monitoring of sleep in these populations.

Sleep Deprivation-Induced Changes in Baseline Brain Activity and Vigilant Attention Performance.

Sleep deprivation (SD) negatively affects several aspects of cognitive performance, and one of the most widely-used tools to evaluate these effects is the Psychomotor Vigilance Test (PVT). The present study investigated the possibility of predicting changes induced by SD in vigilant attention performance by evaluating the baseline electroencephalographic (EEG) activity immediately preceding the PVT stimuli onset. All participants (n = 10) underwent EEG recordings during 10 min of PVT before and after a night of SD. For each participant, the root mean square (RMS) of the baseline EEG signal was evaluated for each 1 s time window, and the respective average value was computed. After SD, participants showed slower (and less accurate) performance in the PVT task. Moreover, a close relationship between the changes in the baseline activity with those in cognitive performance was identified at several electrodes (Fp2, F7, F8, P3, T6, O1, Oz, O2), with the highest predictive power at the occipital derivations. These results indicate that vigilant attention impairments induced by SD can be predicted by the pre-stimulus baseline activity changes.

From P4 medicine to P5 medicine: transitional times for a more human-centric approach to AI-based tools for hospitals of tomorrow.

Within the debate on shaping future clinical services, where different robotics and artificial intelligence (AI) based technologies are integrated to perform tasks, the authors take the chance to provide an interdisciplinary analysis required to validate a tool aiming at supporting the melanoma cancer diagnosis. In particular, they focus on the ethical-legal and technical requirements needed to address the Assessment List on Trustworthy AI (ALTAI), highlighting some pros and cons of the adopted self-assessment checklist. The dialogue stimulates additionally remarks on the EU regulatory initiatives on AI in the healthcare systems.

Activation of brain-heart axis during REM sleep: a trigger for dreaming.

Dreams may be recalled after awakening from sleep following a defined electroencephalographic pattern that involves local decreases in low-frequency activity in the posterior cortical regions. Although a dreaming experience implies bodily changes at many organ, system, and timescale levels, the entity and causal role of such peripheral changes in a conscious dream experience are unknown. We performed a comprehensive, causal, multivariate analysis of physiological signals acquired during rapid eye movement (REM) sleep at night, including high-density electroencephalography and peripheral dynamics including electrocardiography and blood pressure. In this preliminary study, we investigated multiple recalls and nonrecalls of dream experiences using data from nine healthy volunteers. The aim was not only to investigate the changes in central and autonomic dynamics associated with dream recalls and nonrecalls, but also to characterize the central-peripheral dynamical and (causal) directional interactions, and the temporal relations of the related arousals upon awakening. We uncovered a brain-body network that drives a conscious dreaming experience that acts with specific interaction and time delays. Such a network is sustained by the blood pressure dynamics and the increasing functional information transfer from the neural heartbeat regulation to the brain. We conclude that bodily changes play a crucial and causative role in a conscious dream experience during REM sleep.

Comparative Analysis of Diagnostic Techniques for Melanoma Detection: A Systematic Review of Diagnostic Test Accuracy Studies and Meta-Analysis.

Melanoma has the highest mortality rate among skin cancers, and early-diagnosis is essential to maximize survival rate. The current procedure for melanoma diagnosis is based on dermoscopy, i.e., a qualitative visual inspection of lesions with intrinsic limited diagnostic reliability and reproducibility. Other non-invasive diagnostic techniques may represent valuable solutions to retrieve additional objective information of a lesion. This review aims to compare the diagnostic performance of non-invasive techniques, alternative to dermoscopy, for melanoma detection in clinical settings. A systematic review of the available literature was performed using PubMed, Scopus and Google scholar databases (2010-September 2020). All human, in-vivo, non-invasive studies using techniques, alternative to dermoscopy, for melanoma diagnosis were included with no restriction on the recruited population. The reference standard was histology but dermoscopy was accepted only in case of benign lesions. Attributes of the analyzed studies were compared, and the quality was evaluated using CASP Checklist. For studies in which the investigated technique was implemented as a diagnostic tool (DTA studies), the QUADAS-2 tool was applied. For DTA studies that implemented a melanoma vs. other skin lesions classification task, a meta-analysis was performed reporting the SROC curves. Sixty-two references were included in the review, of which thirty-eight were analyzed using QUADAS-2. Study designs were: clinical trials (13), retrospective studies (10), prospective studies (8), pilot studies (10), multitiered study (1); the remain studies were proof of concept or had undefined study type. Studies were divided in categories based on the physical principle employed by each diagnostic technique. Twenty-nine out of thirty-eight DTA studies were included in the meta-analysis. Heterogeneity of studies' types, testing strategy, and diagnostic task limited the systematic comparison of the techniques. Based on the SROC curves, spectroscopy achieved the best performance in terms of sensitivity (93%, 95% CI 92.8-93.2%) and specificity (85.2%, 95%CI 84.9-85.5%), even though there was high concern regarding robustness of metrics. Reflectance-confocal-microscopy, instead, demonstrated higher robustness and a good diagnostic performance (sensitivity 88.2%, 80.3-93.1%; specificity 65.2%, 55-74.2%). Best practice recommendations were proposed to reduce bias in future DTA studies. Particular attention should be dedicated to widen the use of alternative techniques to conventional dermoscopy.

Efficient embedded sleep wake classification for open-source actigraphy.

This study presents a thorough analysis of sleep/wake detection algorithms for efficient on-device sleep tracking using wearable accelerometric devices. It develops a novel end-to-end algorithm using convolutional neural network applied to raw accelerometric signals recorded by an open-source wrist-worn actigraph. The aim of the study is to develop an automatic classifier that: (1) is highly generalizable to heterogenous subjects, (2) would not require manual features' extraction, (3) is computationally lightweight, embeddable on a sleep tracking device, and (4) is suitable for a wide assortment of actigraphs. Hereby, authors analyze sleep parameters, such as total sleep time, waking after sleep onset and sleep efficiency, by comparing the outcomes of the proposed algorithm to the gold standard polysomnographic concurrent recordings. The relatively substantial agreement (Cohen's kappa coefficient, median, equal to 0.78 ± 0.07) and the low-computational cost (2727 floating-point operations) make this solution suitable for an on-board sleep-detection approach.

Electrophysiological features of sleep in children with Kir4.1 channel mutations and Autism-Epilepsy phenotype: a preliminary study.

STUDY OBJECTIVES: Recently, a role for gain-of-function (GoF) mutations of the astrocytic potassium channel Kir4.1 (KCNJ10 gene) has been proposed in subjects with Autism-Epilepsy phenotype (AEP). Epilepsy and autism spectrum disorder (ASD) are common and complexly related to sleep disorders. We tested whether well characterized mutations in KCNJ10 could result in specific sleep electrophysiological features, paving the way to the discovery of a potentially relevant biomarker for Kir4.1-related disorders. METHODS: For this case-control study, we recruited seven children with ASD either comorbid or not with epilepsy and/or EEG paroxysmal abnormalities (AEP) carrying GoF mutations of KCNJ10 and seven children with similar phenotypes but wild-type for the same gene, comparing period-amplitude features of slow waves detected by fronto-central bipolar EEG derivations (F3-C3, F4-C4, and Fz-Cz) during daytime naps. RESULTS: Children with Kir4.1 mutations displayed longer slow waves periods than controls, in Fz-Cz (mean period = 112,617 ms ± SE = 0.465 in mutated versus mean period = 105,249 ms ± SE = 0.375 in controls, p < 0.001). An analog result was found in F3-C3 (mean period = 125,706 ms ± SE = 0.397 in mutated versus mean period = 120,872 ms ± SE = 0.472 in controls, p < 0.001) and F4-C4 (mean period = 127,914 ms ± SE = 0.557 in mutated versus mean period = 118,174 ms ± SE = 0.442 in controls, p < 0.001). CONCLUSION: This preliminary finding suggests that period-amplitude slow wave features are modified in subjects carrying Kir4.1 GoF mutations. Potential clinical applications of this finding are discussed.

Assessing Pupil-linked Changes in Locus Coeruleus-mediated Arousal Elicited by Trigeminal Stimulation.

Current scientific literature provides evidence that trigeminal sensorimotor activity associated with chewing may affect arousal, attention, and cognitive performance. These effects may be due to widespread connections of the trigeminal system to the ascending reticular activating system (ARAS), to which noradrenergic neurons of the locus coeruleus (LC) belongs. LC neurons contain projections to the whole brain, and it is known that their discharge co-varies with pupil size. LC activation is necessary for eliciting task-related mydriasis. If chewing effects on cognitive performance are mediated by the LC, it is reasonable to expect that changes in cognitive performance are correlated to changes in task-related mydriasis. Two novel protocols are presented here to verify this hypothesis and document that chewing effects are not attributable to aspecific motor activation. In both protocols, performance and pupil size changes observed during specific tasks are recorded before, soon after, and half an hour following a 2 min period of either: a) no activity, b) rhythmic, bilateral handgrip, c) bilateral chewing of soft pellet, and d) bilateral chewing of hard pellet. The first protocol measures level of performance in spotting target numbers displayed within numeric matrices. Since pupil size recordings are recorded by an appropriate pupillometer that impedes vision to ensure constant illumination levels, task-related mydriasis is evaluated during a haptic task. Results from this protocol reveal that 1) chewing-induced changes in performance and task-related mydriasis are correlated and 2) neither performance nor mydriasis are enhanced by handgrip. In the second protocol, use of a wearable pupillometer allows measurement of pupil size changes and performance during the same task, thus allowing even stronger evidence to be obtained regarding LC involvement in the trigeminal effects on cognitive activity. Both protocols have been run in the historical office of Prof. Giuseppe Moruzzi, the discoverer of ARAS, at the University of Pisa.

Effects of Sleep Deprivation on Surgeons Dexterity.

Sleep deprivation is an ordinary aspect in the global society and its prevalence is increasing. Chronic and acute sleep deprivation have been linked to diabetes and heart diseases as well as depression and enhanced impulsive behaviors. Surgeons are often exposed to long hour on call and few hours of sleep in the previous days. Nevertheless, few studies have focused their attention on the effects of sleep deprivation on surgeons and more specifically on the effects of sleep deprivation on surgical dexterity, often relying on virtual surgical simulators. A better understanding of the consequences of sleep loss on the key surgical skill of dexterity can shed light on the possible risks associated to a sleepy surgeon. In this paper, the authors aim to provide a comprehensive review of the relationship between sleep deprivation and surgical dexterity.

Hypnotizability influences the cortical representation of visually and kinaesthetically imagined head position.

The study investigates the cortical representation of the visual and kinesthetic image of a rotated position of the head in highly (highs) and low hypnotizable individuals (lows) of both gender. Participants were invited to imagine maintaining their head rotated toward one side by seeing their chin aligned with their right shoulder (V, visual imagery), and in a different condition, by feeling tension in their neck muscles (K, kinaesthetic imagery). Vividness of imagery and cognitive effort were reported after each task. Alpha and beta band absolute power was studied. Highs reported higher vividness than lows only for the kinaesthetic modality of imagery. The cortical desyncronization observed during visual and kinaesthetic imagery were different in high females (HM), low females (LF), high males (HM) and low males (LM). In fact, only HF and LM exhibited significant power changes during the kinaesthetic task, whereas visual imagery was associated with cortical desynchronization in all subgroups except HM. The study supports earlier findings of an advantage of highs in kinesthetic imagery, shows an intriguing interaction of hypnotizability and gender, and indicates topographical difference in the four subgroups of participants suggesting differences in underlying generators.

Hypnotizability and the Peripersonal Space.

High hypnotizability is associated with left-sided cerebral asymmetry, which could influence measurement of the Peripersonal Space (PPS). Right-handed participants with high (highs, n = 20), medium (mediums, n = 9), and low hypnotizability scores (lows, n = 20) performed the line bisection test on a computer screen automatically displaced at distances of 30, 60, and 90 cm from the subjects' eyes. Highs' results showed rightward bias of the bisection (Relative Error, RE) for all presentation distances. In contrast, in lows RE was displaced leftward at 30 cm and exhibited a progressive rightward shift at 60 and 90 cm, as occurs in the general population. Mediums' RE values were intermediate between highs' and lows' values. Bisection Times (BT) were significantly longer in highs/mediums than in lows. Findings indicate that the highs' bisection identifies PPS as if it was extrapersonal, but further studies should assess its functional characteristics. The highs/mediums longer BT suggest less efficient sensorimotor performance.

Electrophysiological and microstructural features of sleep in children at high risk for depression: a preliminary study.

OBJECTIVE: This preliminary study investigated electrophysiological and microstructural features of sleep in children and adolescents 4-18 years of age who were born to depressed mothers. METHODS: A total of 31 healthy subjects (15 male and 16 female) participated in the study. In this sample, 20 children born to mothers diagnosed with Major Depressive Disorder (MDD) were designated as "high-risk"; 11 children born to mothers without a personal history of depression were designated as "low-risk." Polysomnography including three-channel electroencephalography (EEG) was recorded for one night at the Pediatric Sleep Unit of the University Hospital of Lyon, France. Clinical and demographic data were collected. Sleep architectural parameters were analyzed. Sleep microstructure was assessed with the scoring of cyclic alternating pattern (CAP) and CAP measures were calculated. Spectral analysis was performed, and mean EEG band power was computed for each sleep stage. Sleep electrophysiological features (slow waves and sleep spindles) were detected, and related parameters were analyzed. Data were compared between high- and low-risk groups using Student t tests. RESULTS: A reduction in low-frequency spindle activity and slow spindles spatio-temporal characteristics over frontal and central derivations, and an altered distribution of CAP phase A subtypes (reduction of A1 over A2-3 ratio) were observed in the high-risk group relative to the low-risk group. CONCLUSION: Limited spindles generation and increased non-rapid eye movement sleep instability, observed in children born to depressed mothers, might reflect functional anomalies in cortical plasticity that could represent a pathogenic factor or an epiphenomenon for MDD.

Musculoskeletal injuries in gastrointestinal endoscopists: a systematic review.

INTRODUCTION: Gastrointestinal(GI) endoscopy forms a significant proportion of clinicians' workloads. However, little attention is given to the ergonomic aspects of endoscopy. This systematic review of musculoskeletal pain and/or injuries in GI endoscopists aims to better understand the types of occupational injuries resulting from endoscopic procedures and associated risk factors. Areas covered: Systematic literature search conducted for articles evaluating prevalence, risk factors and mechanism of musculoskeletal pain and/or injuries related to GI endoscopy. In 13 included studies, 39-89% of surveyed endoscopists reported pain and/or injuries related to endoscopy. Common areas of pain were the back(15-57%), neck(9-46%), shoulders(9-19%), elbows(8-15%) and hands/fingers(14-82%). Risk factors included procedure volume, time spent doing endoscopy, cumulative time in practice and endoscopist age. Experimental studies showed that forces and loads placed on endoscopists' bodies during procedures place them at risk of occupational injury. Areas of pain differed between novice and experienced endoscopists implying separate mechanisms of injury. Expert commentary: Comprehensive investigation into the prevalence, types, pathophysiology and methods to minimise endoscopy-related musculoskeletal injuries is vital to ensure the continued efficient provision of endoscopy services in the face of rising demands worldwide. A paradigm shift is required in endoscopic devices and techniques to improve safety and comfort.

Daytime rumination as a feature of Insomnia Disorder: sleep related cognition is not merely a problem of the night.

Night-time sleep related cognitions have been shown to play a perpetuating role in insomnia. According to the cognitive model of insomnia day time cognitions (i.e. worry, rumination, etc.) may also contribute to it. The aim of this study was to investigate the possible role of daytime sleep-related rumination in Insomnia Disorder (n= 55, mean age 49.7±16.7 years), Obstructive Sleep Apnea Syndrome (OSAS) (n=33, mean age 58.1±10.2 years) and healthy subjects (n=33, mean age 49.8±13.9), using a set of sleep related variables which included the Daytime Insomnia Symptom Response Scale (DISRS), the Dysfunctional Beliefs about Sleep Scale (DBAS), the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). Daytime sleep related rumination was higher in insomnia when compared to both OSAS (p<.001) and good sleepers (p<.001). In insomnia, elevated sleep related daytime rumination was best determined by unhelpful sleep related beliefs (coeff=0.3 p=.004), while in OSAS by insomnia symptoms (coeff=0.9, p=.02). These findings suggest that the association between insomnia-specific daytimerumination and unhelpful beliefs may be considered a cognitive feature of insomnia. In insomnia, sleep related cognition may dominate the 24-hour period. This finding might be of use for further investigations studying therapeutic strategies acting on cognitive processes to prevent and treat insomnia disorder and its comorbid conditions.