Maria Romano

• Magna Graecia University

Background Mild cognitive impairment (MCI) and freezing of gait (FOG) are two common symptoms in Parkinson's disease (PD). Objectives The objectives were to test the strength of association of fist‐palm test (FiPaT), a nonverbal motor test, with both MCI and FOG in PD and investigate the predictive ability of FiPaT in the identification of PD pati...

Subtle gait and cognitive dysfunction are common in Parkinson’s disease (PD), even before most evident clinical manifestations. Such alterations can be assumed as hypothetical phenotypical and prognostic/progression markers. To compare spatiotemporal gait parameters in PD patients with three cognitive status: cognitively intact (PD-noCI), with subj...

The study of homeostatic equilibrium is a key concern in several fields, from physiology and biology to medicine and biomedical engineering. Control theory approaches can provide effective strategies to model physiological control systems, helping in understanding the dynamics of bio- and physio-logical regulation processes. However, the intrinsic...

Some recent papers have extended the concept of finite-time stability (FTS) to the context of 2D linear systems, where it has been referred to as finite-region stability (FRS). FRS methodologies make even more sense than the classical FTS approach developed for 1D-systems, since, typically, at least one of the state variables of 2D-systems is a spa...

The assessment of Postural Control (PC) is crucial for identifying balance deficits, understanding the underlying mechanisms of instability, and guiding targeted interventions. One widely used approach to evaluate PC involves analyzing both the Center of Pressure (CoP) and Electroencephalography (EEG) data. This study aims to investigate diffe...

Osteoarthritis (OA) is a prevalent form of arthritis, characterized by the degradation of joints hyaline cartilage, particularly the knee, which often necessitates surgical intervention due to its limited ability to self-healing. This study investigates the potential of using radiomics and machine learning (ML) for the automatic classification of d...

The behavior of physiological systems is more easily understood thanks to the definition of appropriate mathematical models that facilitate the implementation of in silico experiments. Starting from the description and study of the similarities between the various negative feedback physiological systems, the objective of the present work is to stud...

Parkinson’s disease (PD) is the second most common movement disorder in the world. It is characterized by motor and non-motor symptoms that have a profound impact on the independence and quality of life of people affected by the disease, which increases caregivers’ burdens. The use of the quantitative gait data of people with PD and deep learning (...

Background Tailoring effective strategies for cancer pain management requires a careful analysis of multiple factors that influence pain phenomena and, ultimately, guide the therapy. While there is a wealth of research on automatic pain assessment (APA), its integration with clinical data remains inadequately explored. This study aimed to address t...

Mild cognitive impairment (MCI) and gait deficits are commonly associated with Parkinson’s disease (PD). Early detection of MCI associated with Parkinson’s disease (PD-MCI) and its biomarkers is critical to managing disability in PD patients, reducing caregiver burden and healthcare costs. Gait is considered a surrogate marker for cognitive decline...

Electrical impedance spectroscopy (EIS) stands as a widely employed characterization technique for studying muscular tissue in both physio/pathological conditions. This methodology commonly involves modeling tissues through equivalent electrical circuits, facilitating a correlation between electrical parameters and physiological properties. Within...

Occupational ergonomics aims to optimize the work environment and to enhance both productivity and worker well-being. Work-related exposure assessment, such as lifting loads, is a crucial aspect of this discipline, as it involves the evaluation of physical stressors and their impact on workers’ health and safety, in order to prevent the development...

Aims This study delves into the two-year opioid prescription trends in the Local Sanitary Agency Naples 3 South, Campania Region, Italy. The research aims to elucidate prescribing patterns, demographics, and dosage categories within a population representing 1.7% of the national total. Perspectives on artificial intelligence research are discussed....

Simulation models and artificial intelligence (AI) are largely used to address healthcare and biomedical engineering problems. Both approaches showed promising results in the analysis and optimization of healthcare processes. Therefore, the combination of simulation models and AI could provide a strategy to further boost the quality of health servi...

Background Recently, crowding in emergency departments (EDs) has become a recognised critical factor impacting global public healthcare, resulting from both the rising supply/demand mismatch in medical services and the paucity of hospital beds available in inpatients units and EDs. The length of stay in the ED (ED-LOS) has been found to be a signif...

Patients affected with type 1 diabetes and a non-negligible number of patients with type 2 diabetes are insulin dependent. Both the injection technique and the choice of the most suitable needle are fundamental for allowing them to have a good injection experience. The needles may differ in several parameters, from the length and diameter, up to th...

Perception and expression of pain in cancer patients are influenced by distress levels, tumor type and progression, and the underlying pathophysiology of pain. Relying on traditional pain assessment tools can present limitations due to the highly subjective and multifaceted nature of the symptoms. In this scenario, objective pain assessment is an o...

Mathematical models can improve the understanding of physiological systems behaviour, which is a fundamental topic in the bioengineering field. Having a reliable model enables researchers to carry out in silico experiments, which require less time and resources compared to their in vivo and in vitro counterparts. This work’s objective is to capture...

Cardiotocography (CTG) is a widely way to assess foetal well-being status, both in antepartum and intrapartum period. Automatic computerized analysis was introduced to overcome limitations of visual analysis of CTG traces. The present study extended a software previously developed for the calculation of foetal heart rate signal (FHR), floatingline...

Cardiotocography (CTG) is one of the fundamental prenatal diagnostic methods for both antepartum and intrapartum fetal surveillance. Although it has allowed a significant reduction in intrapartum and neonatal mortality and morbidity, its diagnostic accuracy is, however, still far from being fully satisfactory. In particular, the identification of u...

The aim of this study was to determine a gait pattern, i.e., a subset of spatial and temporal parameters, through a supervised machine learning (ML) approach, which could be used to reliably distinguish Parkinson’s Disease (PD) patients with and without mild cognitive impairment (MCI). Thus, 80 PD patients underwent gait analysis and spatial–tempor...

Knee replacement surgery is one of the most interesting procedures in surgery. Patients generally have an LOS of about 5 days and when it increases it is related to clinical factors and the patient’s comorbidity. Duration of stay (LOS) is a useful tool for monitoring patients and useful for hospital administrators to assess the efficiency of the ho...

Emergency medicine is a discipline that today is increasingly the focus of attention. In the emergency department, to avoid overcrowding, it is important to assess the Length of the Stay (LOS). The length of stay (LOS) is a useful tool to monitor patients and for evaluating the efficiency and quality of the services offered. This study was conducte...

Introduction: Progressive supranuclear palsy (PSP) is an atypical parkinsonism characterized by prominent gait and postural impairment. The PSP rating scale (PSPrs) is a clinician-administered tool to evaluate disease severity and progression. More recently, digital technologies have been used to investigate gait parameters. Therefore, object of t...

While in the literature there is much interest in investigating lower limbs gait of patients affected by neurological diseases, such as Parkinson’s Disease (PD), fewer publications involving upper limbs movements are available. In previous studies, 24 motion signals (the so-called reaching tasks) of the upper limbs of PD patients and Healthy Contro...

The assessment of fetal heart rate variability (FHRV) is fundamental for evaluating fetal well-being during pregnancy. Through cardiotocography (CTG), it is possible to monitor both the fetal heart rate (FHR) and the uterine contractions (UC) and, through the use og computerized analysis, it is also possible to extract synthetic parameters of the F...

Modeling of physiological systems is an important issue in the field of biomedical engineering. A good model can improve our knowledge of the dynamical behavior of the process under consideration, and allows the researchers to conduct in silico experiments, which are less expensive and time consuming. The goal of this paper consists of investigatin...

Introduction Neurological diseases, such as Parkinsonisms, are often associated with static postural instability. Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease classified among atypical Parkinsonisms. In the earliest stages, PSP is similar to Parkinson’s disease (PD) [1]. Static postural stability is an important contribu...

Introduction Among the neurodegenerative diseases, Parkinson’s disease (PD) is the most common movement disorder. In the literature, different approaches to analyse both upper and lower limbs motion patterns have been proposed [1,2]. Referring to our previous work [3], we demonstrated, after a statistical analysis, several features, extracted from...

The growing research trends in the field of artificial intelligence have largely impacted the healthcare sector. Thanks to the high predictive power of machine learning approaches, new tools to support the clinical decision-making can be designed. However, since the demand for healthcare services is complex and highly changing, as it is affected by...

This work deals with the Input-Output Finite�Time Stability (IO-FTS) of linear discrete-time systems. In current control science, discrete-time systems play a very important role in many engineering contexts. Moreover, many discrete-time control problems are defined over a finite interval of time, therefore the development and appli�cation of finit...

Parkinson’s Disease (PD) is a neurodegenerative disease which involves both motor and non-motor symptoms. Non-motor mental symptoms are very common among patients with PD since the earliest stage. In this context, gait analysis allows to detect quantitative gait variables to distinguish patients affected by non-motor mental symptoms from patients w...

Background The rapid growth in the complexity of services and stringent quality requirements present a challenge to all healthcare facilities, especially from an economic perspective. The goal is to implement different strategies that allows to enhance and obtain health processes closer to standards. The Length Of Stay (LOS) is a very useful parame...

In the field of electronic fetal health monitoring, computerized analysis of fetal heart rate (FHR) signals has emerged as a valid decision-support tool in the assessment of fetal wellbeing. Despite the availability of several approaches to analyze the variability of FHR signals (namely the FHRV), there are still shadows hindering a comprehensive u...

Some recent papers have extended the concept of finite-time stability (FTS) to the context of 2-D linear systems, where it has been referred to as finite-region stability (FRS). To this regard, the novel contribution of our work considers an interesting application of FRS to the context of iterative learning control (ILC). In particular, a new proc...

Given the importance of accelerations of the fetal health rate (FHR) in the monitoring of the fetal wellbeing along the course of the pregnancy, and taking into consideration the contribution of computerized analysis of biosignals as well as the emerging role of artificial intelligence in medicine, this study describes the optimization and use of a...

The availability of standardized guidelines regarding the use of electronic fetal monitoring (EFM) in clinical practice has not effectively helped to solve the main drawbacks of fetal heart rate (FHR) surveillance methodology, which still presents inter- and intra-observer variability as well as uncertainty in the classification of unreassuring or...

Prolonged length of stay (LOS) is one of the most significant issues that hospitals must face since it can determine an increase of costs and risk of complications and a decrease of patient satisfaction. The capability of accurately predicting LOS is a valuable tool for helping hospital administrators in resource planning, encouraging quality impro...

Some recent papers have extended the concept of finite-time stability (FTS) to the context of 2-D linear systems, where it has been referred to as finite-region stability (FRS). FRS methodologies make even more sense than the classical FTS approach developed for 1-D systems, since the state variables of 2-D systems often depend on a pair of space c...

The Emergency Department (ED) is a zone of a hospital where usually the healthcare staff has to face sudden and serious heathy problems. On the other side, patients find themselves in a situation of great emotion, discomfort and anxiety, aggravated by the expectation that, in cases of lesser severity, it can be long and badly tolerated. Furthermore...

Health Technology Assessment (HTA) and Six Sigma (SS) have largely proved their reliability in the healthcare context. The former focuses on the assessment of health technologies to be introduced in a healthcare system. The latter deals with the improvement of the quality of services, reducing errors and variability in the healthcare processes. Bot...

The implementation of the training courses is remarkable in the field of education, in order to analyze and observe individual’s perception of the experience. Aim of this work is the combination of two methods, the Likert scale and the Analytic Hierarchy Process (AHP), to evaluate the quality of the training activities offered at Centre of Biotechn...

Background and Objective Cardiotocography (CTG) is the most employed methodology to monitor the foetus in the prenatal phase. Since the evaluation of CTG is often visual, and hence qualitative and too subjective, some automated methods have been introduced for its assessment. Methods In this paper, a custom-made software is exploited to extract 17...

Nowadays rehabilitation robotics has increasingly widespread applications into the biomedical field. One of the most promising strategies for the control of rehabilitation robots is the “assist-as-needed” approach, which is conceived to adapt the level of assistance of the robot on the basis of the physical characteristics and ability of the patien...

Purpose The reduction of costs has a more and more relevant role in the healthcare context, therefore, a large effort is done by health providers to this aim, for example, by reducing the length of hospital stay (LOS) of patients undergoing surgery. Fast track surgery fits perfectly this issue and was applied to patients undergoing knee replacement...

It is well known that the interpretation of cardiotocographic (CTG) signals is still subjective and prone to misinterpretations; as a consequence, there has been an increase of cesarean sections, often not necessary, and initial expectations of significantly reducing perinatal morbidity and mortality have been unattended. Nevertheless, in developed...

Over the last few decades, the developed countries have witnessed a strong increase in healthcare spending, essentially due to the emergence of new diseases, the aging of the population, and the development of new and costly technologies. The Health Technology Assessment (HTA) is a powerful tool for connecting the technical-scientific and decision-...

Home ventilation involves the use of medical devices at patient's home by personnel who are not healthcare practitioners. This implies new potential risks not fully addressed by current standards and guidelines. A methodological approach to investigate potential failures and define improvement actions to address the dangerous potential situations i...

The study of networks pervades science. The techniques of networks are recently being applied to biomedical disciplines, where the complexity of biomedical systems requires new schemes that can process elevated volumes of data with high efficiency. Artificial neural networks, on which much of artificial intelligence relies, are statistical models p...

The Analytic Hierarchy Process (AHP) is a methodology, based on both mathematical and psychological approaches, exploited to analyze and solve complex problems, in order to make the best decision. AHP is also widely employed for the evaluation of healthcare systems. It works by splitting the decision problem into a hierarchy of more easily-comprehe...

Background Throughout the world, emergency departments (ED) are characterized by overcrowding and excessive waiting times. Furthermore, the related delays significantly increase patient mortality and make inefficient use of resources to the detriment of the satisfaction of employees and patients. In this work, lean thinking is applied to the ED of...

Objective: Provide a definitive analysis of the spectrum of a motor unit action potential train elicited by mechanical vibratory stimulation via a detailed and concise mathematical formulation. Experimental studies demonstrated that motor unit action potentials are not exactly synchronized with the vibratory stimulus but show a variable latency jit...

Foetal heart rate (FHR) variability is known to be a very important feature in the diagnosis of foetal well-being. Despite its clinical importance and the widespread use of foetal monitoring, a standard definition of FHR variability (FHRV) and an agreement concerning the methodologies to be employed in its evaluation are still lacking. Often, FHRV...

Background: The recovery of the functional limb mobility of patients with cerebral damages can take great benefit of the role offered by proprioceptive rehabilitation. Recently have been developed a special Regent Suit (RS) for rehabilitative applications. Actually, there are preliminary studies which describes the effects of RS on gait recovery o...

Rationale, aims, and objectives: The work is a part of a project about the application of the Lean Six Sigma to improve health care processes. A previously published work regarding the hip replacement surgery has shown promising results. Here, we propose an application of the DMAIC (Define, Measure, Analyse, Improve, and Control) cycle to improve...

Computerized systems employed for the analysis of cardiotocographic signals have become almost indispensable tools in fetal monitoring, for which evaluation of fetal heart rate signals plays a key role. Consequently to the diffusion of these systems, new software and complex signal processing methodologies are spreading and are gaining more and mor...

Many cervical spine pathologies involve degeneration of the stabilizing mechanisms of vertebrae segments and often cause pain. Abnormal intervertebral motion is an indication for surgery. Currently, spinal fusion surgery is widely adopted to fix the instable vertebral segments but recently, disk arthroplasty is more and more adopted as an alternati...

In this paper and the companion work [1] we extend the finite-time stability (FTS) theory to two dimensional (2D)-systems. Such class of systems plays an important role in many engineering contexts, such as digital filtering, image processing, gas absorpsion technology, as well as in other fields, like seismological data processing, thermal and ind...

In this document a reporting system is described with the aim of allowing an easy reading of medical report (in PDF format) to a human-user (clinician), and to a programmatic-user who has to capture and make available the clinical data contained in EHR software. The system provides a non-repudiable signature, with PADES protocol, which attests the...

Reliable detection of pacemaker pulses is getting more and more important in electrocardiography (ECG) diagnosis. Many studies recommend ECG amplifiers with higher bandwidth to prevent errors. In the past, few pilot studies showed that analysis of pacemaker pulses waveform can enhance diagnosis (eg, lead failure and fractured wire), but they were c...

The preservation of stability and body coordination in humans is assured by the correct working of the postural control system. Usually, postural oscillations is measured by the magnitude of center of pressure (CoP) movement over time. The conventional parameters in frequency domain to quantify changes of the CoP dynamics are estimated using Fourie...

Foetal heart rate variability (FHRV) is important in foetal wellbeing assessment. However, a gold standard for its evaluation is not yet available. Here, a rather new methodology, the empirical mode decomposition (EMD), is proposed to decompose FHR signal in its components. To test the reliability of this methodology, we employed simulated FHR sign...

Monitoring of foetal heart rate and its variability (FHRV) covers an important role in assessing health of foetus. Many analysis methods have been used to get quantitative measures of FHRV. FHRV has been studied in time and in frequency domain and interesting clinical results have been obtained. Nevertheless, a standardized definition of FHRV and a...

Robot-mediated therapy (RMT) has been a very dynamic area of research in recent years. Robotics devices are in fact capable to quantify the performances of a rehabilitation task in treatments of several disorders of the arm and the shoulder of various central and peripheral etiology. Different systems for robot-aided neuro-rehabilitation are availa...

Despite the widespread use of cardiotocography in foetal monitoring, the evaluation of foetal status suffers from a considerable inter and intra-observer variability. In order to overcome the main limitations of visual cardiotocographic assessment, computerised methods to analyse cardiotocographic recordings have been recently developed. In this st...

The Electrical Impedance Spectroscopy (EIS) measurements, in addition to being used for research purposes, are increasingly spreading in clinical setting. Thanks to the improvement of electronic and information technology, the necessary equipment is becoming increasingly simple and small, suitable for example for home care applications. In this wor...

Over the last decades, numerous and extensive research programs have been conducted in the field of robotic and proprioceptive rehabilitation. Robotic rehabilitation allows to record quantitative data about movement patterns that can help clinicians to better address the rehabilitation protocols providing information not captured using clinical mea...

Since the invention of the 12-lead Electrocardiography (ECG) it is taught that only eight out of the twelve signals recordable from the nine exploring electrodes are linearly independent. It is also accepted practice the use of other four linearly dependent signals to add diagnostic efficacy. Unfortunately, quality and usefulness of the 12-lead sig...

The segmentation of seemingly continuous movements into segments has been theorized for many years. These segments may be considered as 'primitive' movements, or building blocks of more complex movements. The existence of these fragments, or sub-movements as they are called, has been supported by a wide range of studies over the past 100 years. Evi...

The equilibrium system needs the coordination of three subsystems: sensory, skeletal and central nervous system. The central nervous system (CNS) counteracts equilibrium perturbations by means of compensatory and anticipatory postural adjustments (APA). While compensatory adjustments deal with actual perturbations of balance, the APA precede pertur...

Among diagnostic techniques for foetal monitoring, phonocardiography is gaining more and more interest for its low cost, passive nature and capability to detect some cardiac diseases. In spite of these characteristics, its use in clinical routine is still limited due to different troubles; for example, signals recorded through maternal abdomen show...

The objective of this work was to study the use of electrical impedance spectroscopy (EIS) measurement to characterize muscle electrical properties in different conditions. In vivo EIS measurements were carried out in the range 1–60 kHz on 32 forearm flexor muscles of healthy volunteers. Each subject underwent to a protocol consisting of three tria...

Background: In many telemedicine applications, the correct use of medical device at the point of need is essential to provide an appropriate service. Some applications may require untrained people to interact with medical devices and patients: care delivery in transportation, military actions, home care and telemedicine training.Appropriate operat...

An electronic system for the real-time denoising of fluoroscopic images is proposed in this paper. Fluoroscopic devices use X-rays to obtain real-time moving images of patients and support many surgical interventions and a variety of diagnostic procedures. In order to avoid risks for the patient, X-ray intensity has to be kept acceptably low during...