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Deliverable D3.2.1 del progetto PNRR Ecosistemi ed innovazione - THE

Digital accessibility is considered an important aspect to allow all people, including those with permanent or temporary disabilities, to access the continuously increasing number of digital services. This raises the need for tools able to provide support for monitoring the level of accessibility of a large number of websites in order to understand their actual level of accessibility, and identify the areas that need more interventions for their improvement. We present how we have extended a tool for accessibility validation for this purpose, and the results that we obtained in the validation of about 2.7 million Web pages of Italian public administration Web sites.

In questa nota riportiamo le principali modifiche effettuate alla piattaforma MAUVE+ per poter effetuare il monitoraggio nazionale dei siti web delle pubbliche amministrazioni di Marzo 2023, che è stato reso pubblico tramite la dashboard dell'accessibilità

Cognitive developmental disorders are common in children and can affect various abilities. Attention Deficit/Hyperactivity Disorder (ADHD) is the most prevalent childhood psychiatric condition. This work presents PlayToPickUp, a serious game that aims to stimulate children in relevant cognitive domains (attention and error monitoring). A multidisciplinary team of experts and caregivers from two different centres that support therapeutic activities with such children participated from the beginning to the design and the evaluation of the game. Depending on the characteristics and abilities of the player, therapists can customise the game to provide training that best fits the skills and the needs of the child while maintaining the player's motivation. After its development the game was used over two months "in the wild" by children recruited by the two centres. In one case the children played with it within the regular activities offered by the training centre. In the other one, the parents of the children were instructed by caregivers to have the children play the game at home. In the paper we describe the experience gathered from such two studies run in parallel, discussing the aspects that worked better and those that represented difficulties, and the lesson learnt for future studies.

One of the goals of Ambient Assisted Living (AAL) solutions is to be able to stimulate the cognitive resources of older adults. An innovative way to address such stimulation is the use of serious games delivered through humanoid robots, as they can provide an engaging way to perform exercises useful for training human memory, attention, processing, and planning activities. This paper presents an approach to supporting cognitive stimulation based on personal memories. The humanoid robot can exhibit different behaviours using various modalities, and propose the games in a way personalised to specific individuals' requirements, preferences, abilities, and motivations, which can vary among older adults, and even dynamically evolve over time for the same person depending on changing user needs and health conditions. Using personal memories associated with facts and events that occurred in older adults life in the serious games can increase their engagement, and thus potentially reduce the cognitive training drop-out.

This study aimed to investigate the impact of different personalities in humanoid robots for cognitive training scenarios with older adults with mild cognitive impairment (MCI). In particular, we have designed an application with two opposite personalities based on the Extraversion dimension of the Big Five Factors model. A user test with 16 Italian-speaking participants diagnosed with MCI aged 68+ was performed. The analysis of the data collected suggests that the robot's personality can have an effect on the engagement of such users and also found that participants can discriminate between the two personalities. Overall, the study highlights the importance of designing human-robot interactions considering personality-related aspects when considering MCI older adults.

Repetitive cognitive training can be seen as tedious by older adults and cause participants to drop out. Humanoid robots can be exploited to reduce boredom and the cognitive burden in playing serious games as part of cognitive training. In this paper, an adaptive technique to select the best actions for a robot is proposed to maintain the attention level of elderly users during a serious game. The goal is to create a strategy to adapt the robot's behaviour to stimulate the user to remain attentive through reinforcement learning. Specifically, a learning algorithm (QL) has been applied to obtain the best adaptation strategy for the selection of the robot's actions. The robot's actions consist of a combination of verbal and nonverbal interaction aspects. We have applied this approach to the behaviour of a Pepper robot for which two possible personalities have been defined. Each personality is exhibited by performing specific actions in the various modalities supported. Simulation results indicate learning convergence and seem promising to validate the effectiveness of the obtained strategy. Preliminary test results with three participants suggest that the adaption in the robot is perceived.

We present an approach to novel digital cognitive training through serious games able to adapt to personally relevant material from the older adult's life. The games are based on memories associated with the older adult's biography, thus making interactions personalised, relevant, and more engaging. The serious games are accessed through humanoid robots, which can make the training exercise more engaging because of their human-like behaviour.

Introduction Quality in medical care must be measured in order to be improved. Trauma management is part of health care, and by definition, it must be checked constantly. The only way to measure quality and outcomes is to systematically accrue data and analyze them. Material and methods A systematic revision of the literature about quality indicators in trauma associated to an international consensus conference Results An internationally approved base core set of 82 trauma quality indicators was obtained: Indicators were divided into 6 fields: prevention, structure, process, outcome, post-traumatic management, and society integrational effects. Conclusion Present trauma quality indicator core set represents the result of an international effort aiming to provide a useful tool in quality evaluation and improvement. Further improvement may only be possible through international trauma registry development. This will allow for huge international data accrual permitting to evaluate results and compare outcomes.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fritz Thyssen Stiftung T cells have a prominent role in the pathogenesis of atherosclerosis, although their function in atherosclerotic plaques is only partly understood. In this study, we utilize the advantages of high-throughput techniques and data analytic strategies to compare the inherent biological changes of T cells during plaque transition from a stable, non-haemorrhaged (low-risk) to a rupture-prone, haemorrhaged (high-risk) phenotype. We classified 43 human carotid arterial lesions into high- and low-risk plaques based on the presence/absence of intraplaque hemorrhages. RNA from these lesions was isolated and microarray gene expression data was obtained and analyzed by Weighted Gene Co-expression Network Analysis. A strong T cell signalling signature was identified in high- versus low-risk plaques, influencing angiogenesis and interferon-related processes. Bayesian network inference, cell type deconvolution and single-cell RNA sequencing analysis revealed that the T cell-associated gene program was linked to effector-memory cytotoxic, CD8+ T cells. This gene program appeared driven by CD8+ T cell-related transcription factors, including RUNX3, IRF7 and most importantly PRDM1. To validate these findings, we demonstrated in a murine model that T cell PRDM1 plays a key role in plaque formation, as atherosclerotic mice with a T cell specific Prdm1 deficiency developed larger and more advanced atherosclerotic plaques compared to control mice. In conclusion, our study unveils a clear PRDM1-regulated effector-memory cytotoxic CD8+ T cell footprint in plaque development and the shift from low- to high-risk plaques, thereby revealing CD8+ T cells and PRMD1 as potential targets for intervention in adverse T cell responses in human atherosclerotic lesions.

Moderate and severe traumatic brain injury (TBI) are major causes of disability and death. In addition, when TBI occurs during pregnancy, it can lead to miscarriage, premature birth, and maternal/fetal death, engendering clinical and ethical issues. Several recommendations have been proposed for the management of TBI patients; however, none of these have been specifically applied to pregnant women, which often have been excluded from major trials. Therefore, at present, evidence on TBI management in pregnant women is limited and mostly based on clinical experience. The aim of this manuscript is to provide the clinicians with practical suggestions, based on 10 rules, for the management of moderate to severe TBI during pregnancy. In particular, we firstly describe the pathophysiological changes occurring during pregnancy; then we explore the main strategies for the diagnosis of TBI taking in consideration the risks related to mother and fetus, and finally we discuss the most appropriate approaches for the management in this particular condition. Based on the available evidence, we suggest a stepwise approach consisting of different tiers of treatment and we describe the specific risks according to the severity of the neurological and systemic conditions of both fetus and mother in relation to each trimester of pregnancy. The innovative feature of this approach is the fact that it focuses on the vulnerability and specificity of this population, without forgetting the current knowledge on adult non-pregnant patients, which has to be applied to improve the quality of the care process.

This paper outlines a proposal for how to address transparency of automations in daily environments, such as smart homes, based on experiences carried out in previous projects. The trigger-action programming paradigm has been used to describe and implement such automations in both commercial and research tools. Such automations can be generated through machine learning techniques or directly by the end users or through an interaction between an intelligent agent and the user. When they are executed the resulting behaviour does not always result in the desired actions, and users may have difficulties in understanding and controlling them. Thus, there is a need for design criteria and associated tools that help people to understand and control what happens with the automations active in the environments where they live, and explain how they work and can be modified to better meet their needs.

Currently, cognitive stimulation exercises conducted with Mild Cognitive Impairment (MCI)-affected older adults are typically administered by care professionals through exercises, which require a high degree of involvement by professional therapists, and are often perceived as tedious by the older adults. We aim to offer novel digital training through serious games designed using personally relevant material from the older adults' life. They will be based on memories associated with their biography, thus making interactions personalised, relevant, and more engaging. The serious games can be accessed through humanoid robots, which can make the training exercise more engaging because of their human-like behaviour. In this paper we discuss our approach to biography-based games for older adults

Serious games in humanoid robots have an interesting potential to help older adults with cognitive stimulation in non-pharmacological treatments. Additionally, exploiting the multimodal possibilities of the humanoid robots in such a way to provide them with a personality can be suitable to improve users' engagement, and thus their potential participation in cognitive training programmes.

Oral health care can be a challenging experience for children with autism, for their parents and for dentists. Recently, some technology-enhanced systems have been proposed to help people with autism to cope with distressing situations originated by unknown social-life contexts, such as dental care settings with intense sound-visual stimulations. Results were positive in mitigating anxiety at the dental clinic but seem to fail in supporting proper oral hygiene at home. Thanks to the increasing spread of household Intelligent Personal Assistants (IPA) and Vocal Conversational Agents (VCAs), we envisage new opportunities considering the Voice-enabled IPAs not only as support on daily activities but also to enrich and simplify access to healthcare procedures from home. This work attempts to extend the use of technology-enhanced systems for dental care by exploiting the potential of the Vocal User Interface, Amazon Alexa, as an instructional agent with children on the spectrum. To this purpose, we developed a personalized Alexa Skill with two different functionalities: (i) support the child during the routine transition toward the target activity: move to the bathroom to brush their teeth; (ii) act as a persuader and a timer to guide the child during the procedure observing the proper brushing time. We conducted a three-week preliminary study with three children of different autistic profiles. The goal was to collect opportunities and issues deriving from the device introduction in the home context and test the device usage to favour dental care. Results and feedback were encouraging and gave insights to improve this approach.

The importance of guaranteeing accessible Web applications is becoming widely recognised, and supported by national and international legislation. This implies an increasing need for large scale validations, which can be achieved only through automatic support. Thus, there is a need for a new generation of accessibility validation tools able to check against the continuously evolving guidelines and report any issues revealed, considering that their results will be used by many people with varied backgrounds and goals. Such tools should be able to support monitoring of Web sites' accessibility, provide user-friendly information suitable for various purposes, and be transparent in terms of what they are actually able to evaluate in order to elicit the right expectations from their users. They should also consider how the technologies for implementing Web sites have evolved in recent years. In this paper, we provide a description of the requirements and design dimensions that characterise such tools in order to address emerging needs, providing indications on whether and how several existing validation tools support them, and present how we have addressed and implemented them in a specific tool. We also report on a first usability test of such tool, which has provided encouraging feedback.

Cognitive developmental disorders are common in children and affect the language or attention area, such as attention deficit and hyperactivity. In these cases, the individual is unable to engage and interact effectively with the environment, resulting in difficulties in learning and autonomously carrying out daily activities. For these reasons, this work proposes a solution that aims to stimulate children in the relevant cognitive aspects, which are attention, planning tasks and error monitoring. The proposed solution is PlayToPickUp, a serious game that supports tasks that replicate the activities of daily life, such as preparing the backpack, recognising money or emotions.

One of the goals of Ambient Assisted Living (AAL) solutions is to be able to stimulate the cognitive resources of older adults. An innovative way to address such stimulation is the use of serious games delivered through humanoid robots. Such devices are based on Internet of Things technologies since they are collections of sensors and actuators in a human shape. Serious games delivered through humanoid robots can provide an engaging way to perform exercises useful for training human memory, attention, processing, and planning activities. This paper presents an approach to supporting cognitive stimulation based on personal memories. The humanoid robot can exhibit different behaviours through different modalities, and propose the games in a way personalized to specific individuals' requirements, preferences, abilities, and motivations, which can vary among older adults, and even dynamically evolve over time for the same person depending on changing user needs and health conditions.