Alessandro Pepino

Exploring brain function with magnetic resonance imaging.

Since its invention in the early 1990s, functional magnetic resonance imaging (fMRI) has rapidly assumed a leading role among the techniques used to localize brain activity. The spatial and temporal resolution provided by state-of-the-art MR technology and its non-invasive character, which allows multiple studies of the same subject, are some of the main advantages of fMRI over the other functional neuroimaging modalities that are based on changes in blood flow and cortical metabolism. This paper describes the basic principles and methodology of fMRI and some aspects of its application to functional activation studies. Attention is focused on the physiology of the blood oxygenation level-dependent (BOLD) contrast mechanism and on the acquisition of functional time-series with echo planar imaging (EPI). We also provide an introduction to the current strategies for the correction of signal artefacts and other image processing techniques. In order to convey an idea of the numerous applications of fMRI, we will review some of the recent results in the fields of cognitive and sensorimotor psychology and physiology.

Functional fields in human auditory cortex revealed by time-resolved fMRI without interference of EPI noise

The gradient switching during fast echoplanar functional magnetic resonance imaging (EPI-fMRI) produces loud noises that may interact with the functional activation of the central auditory system induced by experimental acoustic stimuli. This interaction is unpredictable and is likely to confound the interpretation of functional maps of the auditory cortex. In the present study we used an experimental design which does not require the presentation of stimuli during EPI acquisitions and allows for mapping of the auditory cortex without the interference of scanner noise. The design relies on the physiological delays between the onset, or the end, of stimulation and the corresponding hemodynamic response. Owing to these delays and through a time-resolved acquisition protocol it is possible to analyze the decay of the stimulus-specific signal changes after the cessation of the stimulus itself and before the onset of the EPI-acoustic noise related activation (decay-sampling technique). This experimental design, which might permit a more detailed insight in the auditory cortex, has been applied to the study of the cortical responses to pulsed 1000 Hz sine tones. Distinct activation clusters were detected in the Heschls gyri and the planum temporale, with an increased extension compared to a conventional block-design paradigm. Furthermore, the comparison of the hemodynamic response of the most anterior and the posterior clusters of activation highlighted differential response patterns to the sound stimulation and to the EPI-noise. These differences, attributable to reciprocal saturation effects unevenly distributed over the superior temporal cortex, provided evidence for functionally distinct auditory fields.

Electrocardiogram pattern recognition and analysis based on artificial neural networks and support vector machines: a review.

Computer systems for Electrocardiogram (ECG) analysis support the clinician in tedious tasks (e.g., Holter ECG monitored in Intensive Care Units) or in prompt detection of dangerous events (e.g., ventricular fibrillation). Together with clinical applications (arrhythmia detection and heart rate variability analysis), ECG is currently being investigated in biometrics (human identification), an emerging area receiving increasing attention. Methodologies for clinical applications can have both differences and similarities with respect to biometrics. This paper reviews methods of ECG processing from a pattern recognition perspective. In particular, we focus on features commonly used for heartbeat classification. Considering the vast literature in the field and the limited space of this review, we dedicated a detailed discussion only to a few classifiers (Artificial Neural Networks and Support Vector Machines) because of their popularity; however, other techniques such as Hidden Markov Models and Kalman Filtering will be also mentioned.

“BlindMath” a new scientific editor for blind students

Today studying mathematics and science for blind students is still an open problem both in Secondary school and at the University in so far as it concerns the effectiveness of teaching approaches, methods and devices (1) Many national and international projects have given a contribution to bring different technical solutions. But, at least in Italy, these solutions are not effective yet in the schools, probably because human, social and organizational aspects have not really been taken into adequate consideration. Here a new method will be proposed, a method which will put forward new technical solutions for editing scientific books and documents but essentially will give adequate answers to operational and practical problems

Dyslexia: Study of Compensatory Software Which Aids the Mathematical Learning Process of Dyslexic Students at Secondary School and University

The disadvantage dyslexic students suffer at school is not limited to reading and spelling, but it includes mathematical aspects too. The use of assistive technologies may be particularly beneficial to students with learning disabilities. However they do have application limits preventing them from being utilized to help the study of scientific subjects. This paper introduces a research idea in this field, which aims to realise a scientific editor which allows for reading and writing mathematics with the support of a speech synthesizer.

A quantitative approach in the treatment of hemiplegic patients using an electropneumatic platform

Exercise is the central feature in the rehabilitative treatment of hemiplegic patients. In cognitive rehabilitation, great importance is attributed to the recovery of a sufficient number of proprioceptive channels before expecting the patient to regain voluntary control. The PERM [Piattaforma (Platform), Elettropneumatica (Electropneumatic) per (for) Riabilitazione (Rehabilitation) Motoria (Motor)] is a new device that can be used in the treatment of the lower limbs to provide the patient with controlled and quantifiable mechanical stimuli, thus enabling the therapist to adopt a more rigorous approach to treatment even in the very early stages of rehabilitation. Alternatively, the system can be used in a different operating mode as a normal biofeedback system capable of displaying on-screen the extent to which voluntary load has been transferred to the lower limb.

Medical technologies in developing countries: a feasibility study on the maintenance of medical equipment in Ethiopia

The authors report the results of a feasibility study, sponsored by the Italian Foreign Ministry, of setting up a Regional Centre for the Management and Maintenance of Medical Technologies in Ethiopia. After some general considerations regarding the problems of co-operation in this field, the authors draft some concrete proposals for an operative programme.

A simulation model for analyzing the nurse workload in a university hospital ward

The aim of the present work is to propose a prototype simulation of a hospital ward which permits the study of the workload and task distribution among nursing and auxiliary personnel. In our study, we took both X a generic ward in a complex healthcare structure (University Hospital “Federico II” - Naples, Italy) and a case study of a hospital immunology department as reference models. Both analyses were carried out together with a team of expert head nurses and following a specific simulation model developed in the Simul8 environment, which allowed the calculation of patient assistance timing as well as the efficiency of personnel use depending on the patient autonomy.

A pilot experience in south of Italy for the remote follow-up of patient with implanted pacemaker

The Home Care system manufactured by Card Guard company and distributed by Hewlett and Packard, has been used for this pilot experience, concerning the follow-up of patient with cardiac pacemaker at their home. The system used is:- (i) 1 Workstation for collecting information through POTS network; (ii) 10 Recording devices; (iii) 1 ISDN line BRI and modems for accessing the main workstation from remote sites. A number of patients with implanted pacemakers have been selected on the basis of different criteria: implant age; predominance of natural cardiac rhythm; mobility problems etc. In this study the GPs have been contacted as an interface with the patient. Up to now 10 patients are regularly controlled. This study will take 1 year; a questionnaire after this period will be distributed to patients and GPs in order to assess the project and mainly to evaluate the improvement in quality of life.

Telemedicine-islands project: cost-effectiveness and cost-comparison analysis

Telemedicine can provide great improvements to health care delivery in islands and remote areas, where it can bring high-quality care, often not or poorly available. The islands of Procida and Ischia, in the gulf of Naples, are well known resorts in South Italy. The little hospital of Ischia and especially the outpatient department of Procida are not always equipped to face all clinical cases. Regularly, the patients from Procida were directly transferred to the mainland, even only for diagnosis. The small size of the health service structures is related to the small population of the islands. This problem is more perceived during the summer season with the tourist invasion. A cardiological and radiological video-teleconsulting system, which connects the two islands to mainland hospitals (Pozzuoli and Giugliano), has been established. This telemedicine network allows a 24-hour connection between the main hospitals of Pozzuoli and Giugliano and the islands health centres. This telemedicine solution aims to provide a prompt and qualified health service in the islands, and to reduce the risks and the costs of patient transportation to the mainland. Technology assessment activities are carried out in order to evaluate and measure the performance of the specific telemedicine solution during its operative work. The preliminary results are promising, waiting for more extensive data to carry out cost-effectiveness analysis, a cost-comparison analysis was attempted. This project represents a pilot and demonstration site for future applications of telemedicine in emergency.