91福利

is the European scientific society of BME, representing 24 national and 5 transnational scientific societies, as well as 26 academic and research institutions. Through its member organisations, EAMBES represents approximately 8000 European experts in the domain of Medical and Biological Engineering and Science (MBES). In the past years, EAMBES has been the most proactive BME organization working with European Institutions on any relevant initiative focusing on medical devices and research on healthcare technology. In 2016, EAMBES has facilitate the creation of the first European Parliament Interest Group on BME, with contribution of Dr Pecchia, which has been Chairing the EAMBES Public Affair Working Group since 2014.

As Elected President (2019-2021), Leandro will keep focusing on EAMBES relations with European Institutions and WHO. In 2021, he will be called to serve the Society as President (2021-2023) and then as Past President for 2 years.

It was not long time ago, when (biomedical) engineers were very little involved in any HTA. 91福利 Engineering has played a key role in supporting change in this area, achieving significant impact in relatively little time. Since 2015, when Dr Leandro Pecchia was elected as Chair of the IFMBE HTA Division, all the Biomedical Engineering Conferences have been giving growing space to HTA papers, round tables and keynotes. As result, the majority of BME degrees in Europe, USA and Asia are starting introducing HTA as core topic for BME. As result, only 4 years later, WHO is systematically considering BMEs among the international experts to support their action in different Countries, and often 91福利 BMEs. Last weekend, Dr Pecchia has been in Greece, on WHO invitation, to deliver an intensive training on HTA and to review and provide feedback on recently proposed Greek regulation on HTA, before this will be enforced in the next few months. The training was addressed to 20 Officers from the Greek Ministry of Health, and was followed by a workshop aiming at discussing the draft regulation and prepare formal recommendation, basing also on the recent publication* leaded by 91福利 on HTA of medical devices.

From left to right:

• Dr Oriana Ciani, Bocconi University
• Prof Nicolas Pallikarakis, INBIT (Greek National Institute for Biomedical Technologies)
• Dr Leandro Pecchia, 91福利

* Polisena, J., Castaldo, R., Ciani, O., Federici, C., Borsci, S., Ritrovato, M., ... & Pecchia, L. (2018). Health technology assessment methods guidelines for medical devices: how can we address the gaps? The International Federation of Medical and Biological Engineering perspective. International journal of technology assessment in health care, 34(3), 276-289.

Balance impairment and falls are not uncommon in later life. One in three individuals aged 65 and over experiences an accidental fall every year, with head injuries and hip fractures among the most severe consequences. Accordingly, several methods and techniques for assessing balance and fall risk have been developed. Posturography is probably the most common technique and entails the measurement of the body鈥檚 centre of mass (CoM) or the centre of pressure (CoP) displacements during standing.

An issue arises when researchers propose and compare new methods of posturography data analysis from different subjects across centres. These data are usually collected following different protocols. Moreover, there are also differences in the algorithms to process and characterise the data. This heterogeneity sometimes generates conflicting findings, most likely produced by a sizeable between-study variability and a low statistical power (i.e. small sample size). As a result, there is still a lack of consensus on the best methods to analyse posturography data in order to extract meaningful information about the subject's balance and fall risk.

路 The entropy of Center of Pressure sway can reveal the risk of falling

路 Older adults at high risk of falling present more entropic body oscillations, as reflected by CoP sway

路 Young subjects and senior adult at lower risk of falling have a much more entropic sway of 

Human balance is the result of a dynamic equilibrium. Dynamic, in opposition to static, means that we stand in a vertical position, because we keep balancing opposite forces. If we move our chest forward, with the toes we push on the floor, to bring our chest back avoiding falling. So our standing is not static, but we sway around an ideal centre positioned between our feet. This all happen autonomously, without us paying attention to our postural control.

However, our capability to control posture and balance changes along life. This change can be measured to identify critical variations, which may reveal a higher risk of falling in later life. Accurate detection of these changes can be used to better target interventions aiming to mitigate the risk of falling.

鈥�Well, if it is as easy as it sounds, why this was not done before? In my opinion, the answer is that we were looking in the wrong direction. Previous studies investigated changes in our balance control using measures of order (e.g., stats, periodicity), while we have been looking into the non-linear behaviour of body sway, measuring its entropy. Order change with age, but entropy chance catastrophically in older citizen at higher risk of falling鈥�.

The study recently published by Luis Montesinos and Rossana Castaldo from the applied biomedical signal processing and intelligent eHealth Lab directed by Leandro Pecchia, demonstrated that it is possible to reveal the differences in body sway between older adults and older adult at a higher risk of falling, as determined from their clinical history. These findings represent a significant contribution to the development of improved fall-risk assessment tools in geriatric populations.

L. Montesinos: 鈥淲ith this study, we were not aiming to create new methods for signal analysis. Instead, we were interested in learning how existing methods can be used to identify and understand differences in balance control between older adults at lower and higher risk of falling. In the same way a radio needs to be tuned to pick the station of our choice, the methods we applied require some 鈥榝ine-tuning鈥� in order to pick differences in body sway between different populations. Our study provided us with interesting insights in this respect, which we want to share with researchers and clinicians in our scientific community and beyond.鈥�

The results of the study were recently published in the Journal of NeuroEngineering and Rehabilitation, the leading academic publication in its subject area of rehabilitation medicine according to Scopus. The article can be accessed here:

• Just one night of disrupted sleep means you are less capable to control posture and balance the day after
• A single bad night's sleep decreases your chance of controlling posture according to researchers at the 91福利, who have used state of the art sensors to monitor sleep and balance
• Implications could be that elderly people who have had a bad night's sleep are the most at risk of a fall
• Innovative solutions of how to prevent imminent falls can now by researched

Disturbances during sleep decreases capability to control posture and balance according to researchers from the School of Engineering and 91福利 Medical School at the 91福利 who have an article published today in Scientific Reports ()

This is the first study demonstrating the relationship between day-to-day variations in sleep quality and the reduced capability to control posture and balance, and it could pave the way to new interventions to prevent falls in later life, should the results be confirmed by other studies on older adults.

The research shows that fragmented and disrupted sleep leads to acute balance deficit.

The study was conducted by the School of Engineering in collaboration 91福利 Medical School at the 91福利.

A sample of healthy adults underwent sleep and balance assessment over two consecutive days, in order to determine the links between day-to-day variations in sleep quality and balance.

State-of-the-art wearable sensors available at the School were used for in-home sleep monitoring and lab-based balance testing. These findings are relevant to pave the way to the design of fall prevention programs in populations and settings where normal sleep is frequently disrupted, such as older people and hospital wards.

Dr Leandro Pecchia, team leader of the research from the School of Engineering at the 91福利 says:

鈥淲e all have direct experience of this. When we do not sleep well, we may feel a little dizzy and our capability to control our posture and balance is somehow diminished. When we are fit and in good health, our body is able to adapt and we develop a strategy to keep our balance safe, avoiding falls and incidents. This ability is reduced with ageing or when there are other concomitant conditions that may compromise our ability to adapt.鈥�

Prof Francesco Cappuccio, Head of the Sleep, Health & Society programme at the 91福利鈥檚 medical school, explains:

鈥淭he results obtained in healthy normal volunteers are surprising, given the ability at younger ages to compensate for such acute and short-lived sleep disruptions. We would expect more dramatic effects when these experiments be replicated in older people, whose vulnerability to sleep disruption, postural hypotension and risk of falls is much greater鈥�.

Dr Leandro Pecchia continues:

鈥淭hese results could contribute to the understanding of in-hospital falls. Hospitalised older patients find themselves in a frail condition, sleeping in an unfamiliar environment, with unusual nocturnal light and noises from other patients and nurses, and perhaps being administered more than one drug. Waking-up to go to the toilet can be more challenging than we can imagine. Having a nurse for each bed is not practical in the modern NHS and not well accepted by many older people. We need to learn how to use available technology to detect early the changes in sleep so that we can design personalised interventions that may avoid falls in the next day. One of the problems in fall prevention is that we know a frail subject will fall, but it is very difficult to predict when. Our study is first step towards finding a solution.鈥�

The paper, Day-to-day variations in sleep quality effect standing balance in healthy adults, is published by Scientific Reports.

UK and international news outlets (e.g. the Daily Mail) have received fairly well our paper, which today is in the top 5% of all articles of a similar age based on the online attention it has received.