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Purpose Laparoscopy is used in many surgical specialties. Subjective reports have suggested that performing laparoscopic surgery in patients with a high body mass index (BMI) is leading to increased prevalence of musculoskeletal symptoms in surgeons. The aim of this study was to objectively quantify the impact on surgeon upper body kinematics and dynamic workload when performing simulated laparoscopy at different BMI levels. Methods Upper body kinematics and dynamic workload of novice, intermediate and expert surgeons were calculated based on measurements from inertial measurement units positioned on upper body segments. Varying thicknesses of foam were used to simulate patient BMIs of 20, 30, 40 and 50 kg/m2 during laparoscopic training. Results Significant increases in the jerkiness, angular speed and cumulative displacement of the head, torso and upper arms were found within all experience groups when subject to the 40 and 50 kg/m2 models. Novice surgeons were found to have less controlled kinematics and larger dynamic workloads compared to the more experienced surgeons. Conclusions Our findings indicate that performing laparoscopic surgery on a high BMI model worsens upper body motion efficiency and efficacy, and increases dynamic workload, producing conditions that are more physically demanding when compared to operating on a 20 kg/m2 model. These findings also suggest that the head, torso, and upper arm segments are especially affected by high BMI models and therefore exposure to patients with high BMIs may increase the risk of musculoskeletal injury when performing laparoscopic surgery.

IntroductionThe rapid evolution of minimally invasive surgery has had a positive impact on patient outcomes; however, it is reported to be associated with work-related musculoskeletal symptoms (WMS) in surgeons. Currently there is no objective measure to monitor the physical and psychological impact of performing a live surgical procedure on the surgeon.Methods and analysisA single-arm observational study with the aim of developing a validated assessment tool to quantify the impact of surgery (open/laparoscopic/robotic-assisted) on the surgeon. Development and validation cohorts of major surgical cases of varying levels of complexity performed by consultant gynaecological and colorectal surgeons will be recruited. Recruited surgeons wear three Xsens DOT monitors (muscle activity) and an Actiheart monitor (heart rate). Salivary cortisol levels will be taken and questionnaires (WMS and State-Trait Anxiety Inventory) completed by the participants preoperatively and postoperatively. All the measures will be incorporated to produce a single score that will be called the 'S-IMPACT' score.Ethics and disseminationEthical approval for this study has been granted by the East Midlands Leicester Central Research Ethics Committee REC ref 21/EM/0174. Results will be disseminated to the academic community through conference presentations and peer-reviewed journal publications. The S-IMPACT score developed within this study will be taken forward for use in definitive multicentre prospective randomised control trials.

The use of technology has been suggested as a means of allowing continued autonomous living for older adults, while reducing the burden on caregivers and aiding decision-making relating to healthcare. However, more clarity is needed relating to the Activities of Daily Living (ADL) recognised, and the types of technology included within current monitoring approaches. This review aims to identify these differences and highlight the current gaps in these systems. A scoping review was conducted in accordance with PRISMA-ScR, drawing on PubMed, Scopus, and Google Scholar. Articles and commercially available systems were selected if they focused on ADL recognition of older adults within their home environment. Thirty-nine ADL recognition systems were identified, nine of which were commercially available. One system incorporated environmental and wearable technology, two used only wearable technology, and 34 used only environmental technologies. Overall, 14 ADL were identified but there was variation in the specific ADL recognised by each system. Although the use of technology to monitor ADL of older adults is becoming more prevalent, there is a large variation in the ADL recognised, how ADL are defined, and the types of technology used within monitoring systems. Key stakeholders, such as older adults and healthcare workers, should be consulted in future work to ensure that future developments are functional and useable.

A little explored area of human activity recognition (HAR) is in people operating in relation to extreme environments, e.g., mountaineers. In these contexts, the ability to accurately identify activities, alongside other data streams, has the potential to prevent death and serious negative health events to the operators. This study aimed to address this user group and investigate factors associated with the placement, number, and combination of accelerometer sensors. Eight participants (age = 25.0 ± 7 years) wore 17 accelerometers simultaneously during lab-based simulated mountaineering activities, under a range of equipment and loading conditions. Initially, a selection of machine learning techniques was tested. Secondly, a comprehensive analysis of all possible combinations of the 17 accelerometers was performed to identify the optimum number of sensors, and their respective body locations. Finally, the impact of activity-specific equipment on the classifier accuracy was explored. The results demonstrated that the support vector machine (SVM) provided the most accurate classifications of the five machine learning algorithms tested. It was found that two sensors provided the optimum balance between complexity, performance, and user compliance. Sensors located on the hip and right tibia produced the most accurate classification of the simulated activities (96.29%). A significant effect associated with the use of mountaineering boots and a 12 kg rucksack was established.

BACKGROUND Many older adults prefer to remain in their own homes for as long as possible. However, there are still questions surrounding how best to ensure that an individual can cope with autonomous living. Technological monitoring systems are an attractive solution; however, there is disagreement regarding activities of daily living (ADL) and the optimal technologies that should be used to monitor them. OBJECTIVE This study aimed to understand older adults’ perceptions of important ADL and the types of technologies they would be willing to use within their own homes. METHODS Semistructured interviews were conducted on the web with 32 UK adults, divided equally into a younger group (aged 55-69 years) and an older group (≥70 years). RESULTS Both groups agreed that ADL related to personal hygiene and feeding were the most important and highlighted the value of socializing. The older group considered several activities to be more important than their younger counterparts, including stair use and foot care. The older group had less existing knowledge of monitoring technology but was more willing to accept wearable sensors than the younger group. The younger group preferred sensors placed within the home but highlighted that they would not have them until they felt that daily life was becoming a struggle. CONCLUSIONS Overall, technological monitoring systems were perceived as an acceptable method for monitoring ADL. However, developers and carers must be aware that individuals may express differences in their willingness to engage with certain types of technology depending on their age and circumstances.

The socio-economic and health consequences of our ageing population are well documented, with older adults living in long-term care facilities amongst the frailest possessing specific and significant healthcare and social care needs. These needs may be exacerbated through the sedentary behaviour which is prevalent within care home settings. Reducing sedentary time can reduce the risk of many diseases and improve functional health, implying that improvements in health may be gained by simply helping older adults substitute time spent sitting with time spent standing or in light-intensity ambulation. This study identified the impact of 1 year of lifestyle intervention in a group of older adults living in a long-term care setting in Italy. One hundred and eleven older adults (mean age, 82.37 years, SD = 10.55 years) participated in the study. Sixty-nine older adults were in the intervention group (35 without severe cognitive decline and 34 with dementia) and 42 older adults were in the control group. Data on physical functioning, basic activities of daily living (BADL) and mood were collected 4 times, before, during (every four months) and after the 1 year of intervention. The lifestyle intervention focused on improving the amount of time spent every week in active behaviour and physical activity (minimum 150 min of weekly activities). All participants completed the training program and no adverse events, related to the program, occurred. The intervention group showed steady and significant improvements in physical functioning and a stable situation in BADL and mood following the intervention in older adults with and without dementia, whilst the control group exhibited a significant decline over time. These results suggest that engagement in a physical activity intervention may benefit care home residents with and without dementia both physically and mentally, leading to improved social care and a reduced burden on healthcare services.

Laparoscopy is a cornerstone of modern surgical care. Despite clear advantages for the patients, it has been associated with inducing upper body musculoskeletal disorders amongst surgeons due to the propensity of non-neutral postures. Furthermore, there is a perception that patients with obesity exacerbate these factors. Therefore, novice, intermediate and expert surgeon upper body posture was objectively quantified using inertial measurement units and the LUBA ergonomic framework was used to assess the subsequent postural data during laparoscopic training on patient models that simulated BMI’s of 20, 30, 40 and 50 kg/m2. In all experience groups, the posture of the upper body significantly worsened during simulated surgery on the BMI 50 kg/m2 model as compared to on the baseline BMI model of 20 kg/m2. These findings suggest that performing laparoscopic surgery on patients with severe obesity increases the prevalence of non-neutral upper body posture and may further increase the risk of musculoskeletal disorders in surgeons.

Laparoscopy is a cornerstone of modern surgical care, with clear advantages for the patients. However, it has also been associated with inducing upper body musculoskeletal disorders amongst surgeons due to their propensity to assume non-neutral postures. Further, there is a perception that patients with high body mass indexes (BMI) exacerbate these factors. Therefore, surgeon upper body postures were objectively quantified using inertial measurement units and the LUBA ergonomic framework was used to assess posture during laparoscopic training on patient models that simulated BMIs of 20, 30, 40 and 50 kg/m2. In all surgeons the posture of the upper body significantly worsened during simulated laparoscopic surgery on the BMI 50 kg/m2 model as compared to the baseline BMI model of 20 kg/m2. These findings suggest that performing laparoscopic surgery on patients with high BMIs increases the prevalence of non-neutral posture and may further increase the risk of musculoskeletal disorders in surgeons.

This paper is closed access. This is an abstract from the Fourth International Workshop on Chemical Science and Pharmaceutical Research (CSPR2017), 17–20 October 2017, Guangzhou, China.

Working memory (WM) training (WMT), aerobic exercise training (AET), and dual-task training improve cognitive functions and alter neural systems in older adults. In particular, the effects have been investigated of dual-task training that combines a walking or standing activity (balance exercise) simultaneously performed with cognitive training (which is ecologically difficult for the elderly). In this study, we investigated the effects of simultaneously performed dual-task training incorporating both AET and WMT (SDAEWMT), using a recumbent ergocycle bicycle and a WMT program that provided a portable console and made the training ecologically easy for the elderly. Older adults (65.9±13.7 years old) participated in 3 months of SDAEWMT, WMT, or AET after random allocation, and the effects of SDAEWMT were compared with those of WMT and AET. Prior to and after training, all the subjects underwent cognitive testing, magnetic resonance imaging (MRI) involving diffusion tensor imaging (DTI), and functional MRI during performance of an N-back WM task. SDAEWMT improved executive function (performance of a frontal assessment battery); however, there was no evidence of broader transfer effects or enhanced learning with WMT. SDAEWMT resulted in mean diffusivity changes in brain areas involving the dopaminergic system, suggesting that neural tissue changes occurred in these areas. SDAEWMT also resulted in an increase in brain activity during the 2-back working memory task in brain areas involved in attentional reorientation. These results suggest that SDAEWMT is effective for improving cognitive functions and inducing beneficial neural changes in older adults.

Work-related musculoskeletal symptoms (WMSs) are reported to be increasing in surgeons performing minimally invasive procedures. Therefore, we investigated the use of inertial measurement units (IMUs) and electromyography (EMG) sensor recorders to record real-time information on the muscle movement/activity required to perform training exercises in simulated in normal and high body mass index (BMI) models.Prospective study.University hospital.Four consultant gynecologic oncology surgeons experienced in complex straight-stick (SS) laparoscopic and robotically assisted (RA) surgery.Three exercises (hoops onto pegs and wire chase) using SS and RA surgery on 2 abdominal models: normal BMI and high BMI.We measured time to complete exercise and surgeon muscle movement/activity. The time to complete all exercises was significantly lower for RA surgery as compared with SS laparoscopy (p.05 or better). The movement of the surgeons' core was significantly greater in high BMI SS laparoscopy compared with normal BMI SS laparoscopy for exercises 1 and 2 (p.001). Muscle usage, as determined by EMG peak, was significantly higher in normal BMI SS laparoscopy and even higher in high BMI SS laparoscopy but was generally flat for all normal and high BMI RA surgery exercises (p.05 or better).Detailed real-time information can be collected through IMUs/EMG sensors. Our results indicate that RA surgery requires less surgeon movements and muscle activity to complete tasks compared with SS laparoscopy, particularly in a high BMI model. The implications of these results are that RA surgery in high BMI patients may therefore have less physical impact on the surgeon compared with SS laparoscopy and may result in lower WMS rates.

Objective: To determine the validity of the key mathematical assumptions used in electrical impedance tomography for human head tissues. Approach:Conductivity and permittivity data collected from available literature for each tissue within the human head have been evaluated and critiqued. The most relevant dielectric tissue data for each tissue was then used to assess the validity of the mathematical assumptions of electrical impedance tomography in terms of their suitability for human head imaging in order to estimate related errors. Main Results:For induced currents with frequencies greater than 200 Hz the internal current source density is negligible. The assumption that magnetic effects are negligible is valid to an error of 1.7% for human head tissues for frequencies below 1 MHz. The capacitive effects are negligible for CSF, dura mater, blood, bone (cortical), and deep tissue skin for frequencies less than 3.2 MHz, 320 kHz, 25 kHz, 3.2 kHz, and 130 Hz respectively. However, the capacitive effects are not negligible for brain tissues, as the minimum error for brain tissues across the frequency range of 10 Hz to 100 GHz is 6.2% at 800 Hz, and the maximum error is 410% at 20 GHz. Significance:It is often assumed that the mathematical reduction of the base equations is valid for human head tissues over a broad frequency range; this study shows that these assumptions are not true for all tissues at all frequencies. False assumptions will result in greater errors and local distortions within tomographic images of the human head using electrical impedance tomography. This study provides the relationships between injected current frequency and the validity of the mathematical assumptions for each individual tissue, providing greater awareness of the magnitude of possible distortions.

Neuromotor training program are recommended as part of essential activity programs for older adults. With the growth of wearable sensor technology, wearable sensor provides a low-cost monitoring method for objective exercise assessment. Customized remote sensors combination with off-the-shelf smart phone provides a high performance and low-cost monitoring platform. A connection-oriented sensor network with Bluetooth Low Energy (BLE) provides high bandwidth encrypted communication. With multiple remotes sensors, synchronization between sensors is fundamental. However, the accuracy with the generic BLE time service is limited. In this paper, we present a novel method that can potentially synchronize multiple sensors with an unmodified Android Device. The method is based on timestamping the Connection Event (Anchor Point) on the Slave side. The results show an absolute error is below 1 ms across two sensors, which is ideal for motion sensing.

Objectives: The Test of Gross Motor Development-3 (TGMD-3) evaluates fundamental gross motor skills across two domains: locomotor and ball skills. This study aimed to perform a full psychometric assessment of this test in a large sample of Italian pre- and primary school children.\ud \ud Design: Cross-sectional and test-retest study design.\ud \ud Method: Children (N = 5,210; Mean age (years) = 8.38, SD = 1.97; % females = 48) completed three trials, including one practice a. Only the scores of the two latter ‘formal’ trials were recorded for the evaluation. Factorial validity and measurement invariance of TGMD-3 across age and gender groups and test-retest reliability for the overtime measure consistency were tested. Item response theory analysis further tested single items’ performances.\ud \ud Results: Explorative and confirmatory factor analyses confirmed the two-factor structure of the TGMD-3. Multi-group confirmatory factor analyses indicated that there were no significant reductions in model adjustments between the configural, metric and structural invariance solutions for gender and age groups. Test-retest results ranged between 0.967 and 0.990 for both skill sets across age groups. Item response theory analysis using a graded response model showed low standard error and high-test information levels covering a wide spectrum range of both locomotor and ball skills.\ud \ud Conclusions: These results highlight the strong construct validity and reliability of the TGMD-3 to measure gross motor skills in children across gender and age groups. Item response theory analysis evidenced how the performance criteria included in this test cover a wide range of gross the motor skills spectrum. The use of TGMD-3 may inform motor development programs and support curricular decisions in schools.

This study evaluated whether the Test of Gross Motor Development 3 (TGMD-3) is a reliable tool to compare children with and without mental and behavioral disorders across gross motor skill domains. A total of 1,075 children (aged 3-11 years), 98 with mental and behavioral disorders and 977 without (typically developing), were included in the analyses. The TGMD-3 evaluates fundamental gross motor skills of children across two domains: locomotor skills and ball skills. Two independent testers simultaneously observed children's performances (agreement over 95%). Each child completed one practice and then two formal trials. Scores were recorded only during the two formal trials. Multigroup confirmatory factor analysis tested the assumption of TGMD-3 measurement invariance across disability groups. According to the magnitude of changes in root mean square error of approximation and comparative fit index between nested models, the assumption of measurement invariance across groups was valid. Loadings of the manifest indicators on locomotor and ball skills were significant (p < .001) in both groups. Item response theory analysis showed good reliability results across locomotor and the ball skills full latent traits. The present study confirmed the factorial structure of TGMD-3 and demonstrated its feasibility across normally developing children and children with mental and behavioral disorders. These findings provide new opportunities for understanding the effect of specific intervention strategies on this population. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

BackgroundUnfortunately, global efforts to promote “how much” physical activity people should be undertaking have been largely unsuccessful. Given the difficulty of achieving a sustained lifestyle behavior change, many scientists are reexamining their approaches. One such approach is to focus on understanding the context of the lifestyle behavior (ie, where, when, and with whom) with a view to identifying promising intervention targets. ObjectiveThe aim of this study was to develop and implement an innovative algorithm to determine “where” physical activity occurs using proximity sensors coupled with a widely used physical activity monitor. MethodsA total of 19 Bluetooth beacons were placed in fixed locations within a multilevel, mixed-use building. In addition, 4 receiver-mode sensors were fitted to the wrists of a roving technician who moved throughout the building. The experiment was divided into 4 trials with different walking speeds and dwelling times. The data were analyzed using an original and innovative algorithm based on graph generation and Bayesian filters. ResultsLinear regression models revealed significant correlations between beacon-derived location and ground-truth tracking time, with intraclass correlations suggesting a high goodness of fit (R2=.9780). The algorithm reliably predicted indoor location, and the robustness of the algorithm improved with a longer dwelling time (>100 s; error

Objective: The aim of the study was to explore the association between fear of falling (FOF), dual-task ability during a mobility task, and the activities of daily living (ADL) in a sample of older adults.\ud \ud Methods: Seventy-six older adults (mean age M = 70.87 ± 5.16 years) participated in the study. Data on FOF (using the Falls Self-Efficacy Scale-International), walking ability during both single- and dual-task performances and ADL were collected.\ud \ud Results: Mediation analysis demonstrated the mediation effect of dual-task ability (β = 0.238, p = 0.011) between FOF and ADL level (β = 0.559, p < 0.001). Moreover, significantly lower performances were observed during dual-task condition [F (2, 73) = 7.386, p < 0.001], and lower ADL levels were also found in older adults with FOF [F (2, 73) = 13.734, p < 0.001].\ud \ud Conclusion: The study underlines the relationship between FOF, dual-task ability and ADL level. These results could be used to develop specific intervention programmes for successful ageing.

Previous research has established significant positive associations between social trust and wellbeing among older adults. This study aimed to obtain a deeper understanding of the relationship between different sources of social trust and wellbeing by examining the mediational role of political interest. A sample of 4,406 Italian residents aged 65 years and over was extracted from a national cross-sectional survey during 2013 in Italy, representative of the non-institutionalised population. Measures included trust in people, trust in institutions, political interest, life satisfaction and self-perceived health. Mediation path analysis and structural equation modelling were used to test the mediation effects of political interest on the relationship between trust in people and trust in institutions with life satisfaction and self-perceived health. Associations between trust in people, life satisfaction and self-perceived health, and between trust in institutions and life satisfaction were partially mediated by political interest, while the association between trust in institutions and self-perceived health was fully mediated by political interest. Having high levels of political interest may thus enhance the relationship between social trust and wellbeing among older adults. These results suggest that interventions to enhance wellbeing in older adults may benefit from examining individuals’ levels of political interest.

Poor balance control and falls are big issues for older adults that due to aging decline have a lower postural balance and directional control in balance performance than younger age groups. The four square step test (FSST) was developed to evaluate rapid stepping that is often required when changing direction and avoiding obstacles while walking. However, previous researchers used only the total time as the assessment in the test. The aim of this letter is to objectively quantify the sequence and direction of the steps in FSST, by using two inertial sensors placed on both feet. An algorithm was developed to automatically segment the steps performed during the test, and calculate the stepping direction from the linear velocity of the foot. Experiments were conducted with 100 Japanese healthy older adults, where sensor data and video of 20 subjects were randomly subtracted for algorithm verification. The results showed that the algorithm succeeded for 71.7% trials in recognizing both the step sequence and step direction in FSST, while 90.2% of the detection failure could be excluded with an auto verification method.

The commercially available Perception Neuron motion capture (Mo-Cap) system is a cost effective and easy to use option for motion analysis. However, the accuracy of this system in a practical setting is unknown and needs to be evaluated if it is to be considered for applications that require a specific level of measurement precision. Therefore, the validity of the Mo-Cap system for estimating postural angular kinematics of the upper body was assessed. Upper body motion was evaluated through three-dimensional analysis of functional movements performed by the neck, thorax and shoulders. Range of motion (RoM) estimates were compared to Vicon using Bland-Altman analysis. Systematic biases in neutral to peak RoM differences were all ≤4.5° and random biases ≤±4.5° except for neck extension where the values were larger. The present findings suggest that the Mo-Cap system is a valid method for assessing the majority of upper body ROM to within 5°.

Automatic and objective detection algorithms for gait events from MEMS Inertial Measurement Units data have been developed to overcome subjective inaccuracy in traditional visual observation. Their accuracy and sensitivity have been verified with healthy older adults, Parkinson's disease and spinal injured patients, using single-task gait exercises, where events are precise as the subject is focusing only on walking. Multi-task walking instead simulates a more realistic and challenging scenario where subjects perform secondary cognitive task while walking, so it is a better benchmark. In this paper, we test two algorithms based on shank and foot angular velocity data in single-task, dual-task and multi-task walking. Results show that both algorithms fail when the subject slows extremely down or pauses due to high cognitive and attentional load, and, in particular, the first stride detection error rate of the foot-based algorithm increases. Stride time is accurate with both algorithms regardless of walking types, but the shank-based algorithm leads to an overestimation on the proportion of swing phase in one gait cycle. Increasing the number of cognitive tasks also causes this error with both algorithms.

Nowadays, with the development of the proportion of the elderly population in the world, several problems caused by the population aging gradually into people's horizons. One of the biggest problems plagued the vast majority of the elderly is hemiplegia, which leads to the vigorous development of the physical therapists. However, these traditional methods of physical therapy mainly rely on the skill of the physical therapists. In order to make up the defects of traditional methods, many research groups have developed different kinds of robots for lower limb rehabilitation training but most of them can only realize passive training which cannot adopt rehabilitation training based on the patients' individual condition effectively and they do not have a rehabilitation evaluation system to assess the real time training condition of the hemiplegic patients effectively. In order to solve the problems above, this paper proposed a lower limb rehabilitation evaluation system which is based on the virtual reality technology. This system has an easy observation of the human-computer interaction interface and the doctor is able to adjust the rehabilitation training direct at different patients in different rehabilitation stage based on this lower limb rehabilitation evaluation system. Compared with current techniques, this novel lower limb rehabilitation evaluation system is expected to have significant impacts in medical rehabilitation robot field.

Up to now, with the increasing of the elderly population, more and more patients are suffering from hemiplegia. The needs for hemiplegic rehabilitation is increasing quickly. As traditional rehabilitation, each patient must be treated by therapist, one by one. However, because of the different levels of therapists, the rehabilitation cannot be performed as the as the same. Normally, the rehabilitation status diagnosing is still be performed by therapists with the subjective experience. It caused the inhomogeneity on rehabilitation evaluation. It also sometimes causes negative influence on the rehabilitation effect. To solve these problems, many researches focusing on assessing the status of the hemiplegic patients quantitatively are proposed rehabilitation evaluation systems. Rehabilitation motion detection is the basis of the evaluation system, and it requires the participation of therapist. In this paper, a method is presented to detect lower limb motion of hemiplegic patients based on inertial sensor technology. The gesture quaternion of lower limb can be obtained through LPMS. With the matrix and Euler angle changing algorithm, combining with the simplified lower limb motion model, the rotation angle of joint can be computed. Finally, the curve of rotation angle of knee is established.