Background:ST elevation myocardial infarctions are usually a consequence of the occlusion of a single coronary artery, but in 2.5% of the cases, two or more culprit lesions are found. Simultaneous coronary artery occlusion is a potentially life-threatening condition that leads to cardiogenic shock or ventricular arrhythmias. Case summary:We presented the case of a 74-year-old man presenting with chest pain and ST segment elevation (STE) in inferior leads and evidence of alternating STE in anterior leads in a pattern like Wellens syndrome type A in subsequent electrocardiogram (ECGs). Emergency coronary angiography (CA) revealed thrombotic occlusion of the proximal right coronary artery (RCA) and sub-occlusion of mid left anterior descending artery (LAD). During the CA, he became haemodynamically unstable requiring intravenous inotropes and vasopressors, and he underwent primary percutaneous coronary intervention of both RCA and LAD culprit lesions. His subsequent hospital stay was uneventful, and he was discharged 5 days later. Discussion:ST elevation myocardial infarction with more than one culprit coronary artery is a rare but at high risk of haemodynamic decompensation. The causes of occlusion of multiple coronary arteries may be several: coronary embolism, coronary ectasia, simultaneous plaque disruption, coronary vasospasm, hypercoagulability states, smoking, and illicit drug abuse. The presumed mechanism behind the presented case may be a combination of release of pro-thrombotic cytokines due to the thrombotic occlusion of the first coronary and low output state secondary to myocardial dysfunction leading to impaired flow in a severe stenotic coronary artery with subsequent thrombosis.

Ticagrelor is currently considered a first-line choice in dual antiplatelet therapy (DAPT) following revascularization of acute coronary syndrome (ACS). However, its use is correlated with an increased incidence of two side effects, dyspnea and bradyarrhythmias, whose molecular mechanisms have not yet been defined with certainty and, consequently, neither of the therapeutic decisions they imply. We report the case of a patient with acute myocardial infarction treated with ticagrelor and aspirin as oral antithrombotic therapy after primary percutaneous coronary intervention (PCI), manifesting in a significant bradyarrhythmic episode that required a switch of antiplatelet therapy. Starting from this case report, this article aims to gather the currently available evidence regarding the molecular mechanisms underlying these side effects and propose possible decision-making algorithms regarding their management in clinical practice.

Ambient assisted living (AAL) is focused on providing assistance to people primarily in their natural environment. Over the past decade, the AAL domain has evolved at a fast pace in various directions. The stakeholders of AAL are not only limited to patients, but also include their relatives, social services, health workers, and care agencies. In fact, AAL aims at increasing the life quality of patients, their relatives and the health care providers with a holistic approach. This paper aims at providing a comprehensive overview of the AAL domain, presenting a systematic analysis of over 10 years of relevant literature focusing on the stakeholders' needs, bridging the gap of existing reviews which focused on technologies. The findings of this review clearly show that until now the AAL domain neglects the view of the entire AAL ecosystem. Furthermore, the proposed solutions seem to be tailored more on the basis of the available existing technologies, rather than supporting the various stakeholders' needs. Another major lack that this review is pointing out is a missing adequate evaluation of the various solutions. Finally, it seems that, as the domain of AAL is pretty new, it is still in its incubation phase. Thus, this review calls for moving the AAL domain to a more mature phase with respect to the research approaches.

Operation of wireless sensor nodes or battery powered embedded systems in cold and harsh environments requires careful battery selection and management. In this paper, we first provide a general model of an energy harvesting sensor system and the respective energy flows. We then present a maximum power point tracking solar harvesting system according to that model. The system is coupled with rechargeable Li-ion batteries and equipped with a battery heating mechanism. The significant signals of that system are monitored to have a deeper insight into the energy distribution. Real-world experiments demonstrate benefits of battery heating during high irradiation periods at temperatures below safe charging conditions. The presented case study for a cold winter day shows that the additional energy, which can be stored thanks to battery heating would more than double the autonomy of the sensor system.

Modern distributed embedded systems frequently involve wireless communication nodes where messages have to be delivered within given timing constraints. This goal can be achieved by adopting a suitable real-time communication protocol. In addition, connecting such systems with mobile devices is also desirable for performing configuration, monitoring, and maintenance activities. The Bluetooth low energy (BLE) protocol would be an attractive solution for this purpose, because it is supported by consumer devices, such as tablets and smart phones, for implementing personal area networks with reduced energy consumption. Unfortunately, however, it cannot guarantee a bounded delay for managing real-time traffic. Modern BLE radio transceivers allow partitioning the network bandwidth between the BLE protocol and another user-defined protocol running on top of the raw radio. This paper exploits this feature to provide an analysis and a design methodology to guarantee the feasibility of a real-time custom protocol that shares the radio with the BLE. Experimental results on a Nordic reference platform show the feasibility of the dual-protocol approach and its capability to support a custom real-time protocol on the raw radio with a bounded overhead.

In swimming sport, the proper perception of moving water masses is a key factor. This paper presents an embedded system for the acquisition of values of pressure on swimmers hands and their transformation into sound. The sound, obtained using sonification, is used as an auditive representation of hand-water interactions while swimming in water. The sound obtained is used as an auditive feedback for the swimmer and as an augmented communication channel between the swimming trainer and the athlete. The developed system is self-contained, battery powered and able to work continuously for over eight hours, thus, representing a viable solution for daily usage in swimmers training. Preliminary results from in-pool experiments with both novel and experienced swimmers demonstrate the high acceptability of this technology and its promising future evolution and usage possibilities.

Self-induced aquatic propulsion is an effect of interaction of the limbs and water mass (LWI) which change the energy-density per volume and the momentum of water mass, simultaneously. The change of volumetric energy-density of water can be measured via pressure tap probes detecting static pressure of unsteady flow via pressure sensors. The data of elite breaststroke swimmers wearing gloves with pressure taps on both sides of the hands were presented as pressure difference per hand (p-diff) in real-time in a split screen video together with the hand action. The purpose of this preliminary study was to check a) the stability of the setup including the data collection under pool condition with various swimmers and b) to answer coaches’ questions concerning the relation of peak pdiff-data and hand action. Among others it is shown that p-diff(max) coincides with a) deepest hand penetration at the end of the inward sweep of the hands and b) max body acceleration during hand action, shortly before max body velocity occurs.

Nowadays, touch-based user interfaces are widely used in consumer electronics. Recent trends confirm the high potential of touchless interface technologies to manage also Human-Machine Interaction, in scenarios such as healthcare, surveillance, and outdoor activities. Moving from pointers, keyboards or joysticks to touch-screens represented a significant challenge. However, a touchless approach needs to ensure intuitiveness and robustness. This paper describes a framework enabling the wireless control of a mobile robot through a contactless controller. The data provided by a complex sensor, composed of two stereo cameras and three IR sensors, are processed with custom algorithms that recognize the movements of users’ hands. The result is promptly translated into commands for the robot running a real-time operating system. Usability tests confirm the compelling employment of contactless controllers for mobile robots and drones both in open and closed environments.

Automatic Weather Stations (AWSs) are embedded systems equipped with a number of sensors used to monitor harsh environments: glaciers and deserts. AWSs may also be equipped with some communication interfaces in order to enable remote access to data. These systems are generally far from power sources, and thus they are equipped with energy harvesting devices, wind turbines and solar panels, and storage devices, batteries. The design of an AWS represents a challenge, since designers have to maximize the sampled and transmitted data while considering the energy needs. We designed and implemented an energy-aware simulator of AWSs to support designers in the definition of the configuration of the system. The simulator relies on the Stochastic Activity Networks (SANs) formalism and has been developed using the Möbius tool. In this chapter we first show how we used SANs to model the components of an AWS, we then report results from validation experiments carried out by comparing the results of the simulator against a real-world AWS and finally show examples of its usage.

Automatic Weather Stations (AWSs) are systems equipped with a number of environmental sensors and communication interfaces used to monitor harsh environments, such as glaciers and deserts. Designing such systems is challenging, since designers have to maximize the amount of sampled and transmitted data while considering the energy needs of the system that, in most cases, is powered by rechargeable batteries and exploits energy harvesting, e.g., solar cells and wind turbines. To support designers of AWSs in the definition of the software tasks and of the hardware configuration of the AWS we designed and implemented an energy-aware simulator of such systems. The simulator relies on the Stochastic Activity Networks (SANs) formalism and has been developed using the Mobius tool. In this paper we first show how we used the SAN formalism to model the various components of an AWS, we then report results from an experiment carried out to validate the simulator against a real-world AWS and we finally show some examples of usage of the proposed simulator.

Current patient follow-up practices held by General Practitioners (GPs) are often unstructured. Due to the high number of patients and time limitations, data collection and trend analysis is often performed only for a small number of critical patients. An increasing demand is coming from the physician community for having a set of supporting tools for reducing the time needed to process patient data and speed-up the diagnosis process. Furthermore, the possibility of monitoring patient activities at home would provide less biased and more significant data. Unfortunately, however, current solutions are not able to collect reliable data without the intervention of formal caregivers. This paper proposes an improved version of some medically-backed techniques in an unobtrusive platform to monitor patients at home. Data are automatically collected and analyzed to provide GPs with the current status of the monitored patients and their health trend, contributing in a more precise and reliable decision making.

Auditory biofeedback systems in the field of sports are increasingly adopted to provide an online guidance to the people performing actions. This paper concentrates on swimming and on producing auditory feedback intended to enhance the perception of the interaction between a swimmer's body and the surrounding water masses while swimming. The information is related to the concept of `feel-for-water', that is a key factor to produce an effective propulsion, through a correct perception of the boundary effects of body and water. The presented system is composed of pressure sensors, plastic tubes ending between the swimmer's hand fingers on the dorsal and palmar side, a microcontroller reading the sensors and sending data to a PC for further processing producing the auditory feedback through interactive sonification. We focus on the system setup and present a simple parameter-mapping sonification design as an example, along with possible extensions of the system and other sonification designs. Finally, we present video and audio examples of the system.

The lack of success of tele-monitoring systems in non-clinical environments is mainly due to the difficulty experienced by common users to deal with them. In particular, for achieving a correct operation, the user is required to take care of a number of annoying details, such as wearing them correctly, putting them in operation, using them in a proper way, and transferring the acquired data to the medical center. In spite of the many technological advances concerning miniaturization, energy consumption reduction, and the availability of mobile devices, many things are still missing to make these technologies simple enough to be really usable by a broad population, and in particular by elderly people. To bridge this gap between users and devices, a smart software layer could automatically manage configuration, calibration, and data transfer without requiring the intervention of a formal caregiver. This paper describes the key features that should be implemented to simplify the needed initial calibration phase of sensing systems and to support the patient with a multimodal feedback throughout the execution of the exercises. A simple mobile application is also presented as a demonstrator of the advantages of the proposed solution.

Low energy consumption is one of the primary issues that have to be addressed in body area networks to prevent frequent battery recharges in the nodes. Such networks are being increasingly used to acquire sensory data that need to be processed in real-time. The Bluetooth Low Energy (BLE) protocol is an attractive solution for implementing personal area networks with reduced energy consumption, also because it is supported by consumer devices such as tablets and smart phones; however, it cannot guarantee a bounded delay for managing real-time traffic. This paper overcomes such a limitation by presenting a bandwidth sharing mechanism that allows partitioning the available network bandwidth between the BLE and another user-defined protocol built on top of the raw radio transceiver. Experimental results are also reported to characterize the timing behavior of the dual protocol on a specific platform.

We introduce a novel setting for the measurement, real-time processing and interactive acoustic representation (sonification) of changing hydrodynamic pressure induced by the hand-water-interaction, causing momentum changes and in reaction to that propulsion. The sound is presented in real-time both to the swimmer, via in-ear waterproof headphones, and to the coach. We used our setting in a first empirical test concerning the symmetry of induced effects of hand-water-interaction during breaststroke swimming. The swimmers were asked to attend to the sounds and in case they perceive asymmetry, they should try to adapt their interaction, interactively in combination with the actual motion and body perception. Afterwards, swimmers were asked to judge the usability of the system. As a result, the functional sounds were ranked to be helpful to change hand-water-interaction.

Wearable devices are driving the development of post-surgery rehabilitation procedures, also helping in reducing the recovery time and social costs. This paper presents a real-time monitoring framework aimed at supporting telerehabilitation sessions for lower-limbs functional recovery. The presented framework supports patients during the execution of rehabilitation exercises by monitoring the limb movements through a set of low-cost wearable sensors and providing them with multi-modal bio-feedback to enhance the quality of the performed actions. The system also assists the therapist in the definition of exercises tailored to the patient and enables the collection of historical data in cloud-based services for monitoring the effects of therapies and further analysis.