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Background: Heart failure (HF) is responsible for a high number of hospitalizations, caused by a progressive worsening quality of life. Telemedicine allows for better management of patients' complex conditions, improving the care released. However, the risk of remaining at a testing stage often limits the integration of remote care in daily pathways for HF patients. The aim of this study is to outline the steps needed to integrate telemedicine activities into ordinary HF clinic practices. This methodology is applied to observe activities and trend improvements over a 12-month routine phase. Method: Three steps have been defined for an efficient introduction of remote care services in ordinary activities, integrating them with traditional in-person care: (i) introduction of temporary telemedicine projects, (ii) systematization of telemedicine pathways, and (iii) evaluation of monitoring phase. Observational data have been collected from structured interviews to show the rate of telemedicine activities achieved in clinical practice over the last year. Results: The methodology has been proposed in the HF clinic of the Italian hospital ASST Bergamo Est. After an initial testing phase, in which usability and user experience have been tested, four different remote activities were added: (i) telemonitoring for patients with an implantable device, (ii) follow-up televisits, (iii) nursing telephone support, and (iv) high-intensity telesurveillance pathways for patients after an HF acute event. During the last year, 218 telemonitoring pathways, 75 televisits, 500 telephone calls, and nine telesurveillance pathways have been performed. Success rates were high, and patients gave positive feedback. Conclusion: By integrating multiple telemedicine activities, it has been possible to better manage complex patients, keep track of disease progression, and improve their participation in care. [ABSTRACT FROM AUTHOR]

Libraries often face biodeterioration caused by various biological agents, particularly fungi and insects, which harm their collections. The beetle Gastrallus pubens Fairmaire 1875 (Coleoptera: Ptinidae), once infrequently documented within European libraries, is recently emerging as a significant menace to the preservation of rare books. In this study, a G. pubens infestation occurring in an historical library hosting a unique collection of rare books dating between the sixteenth and eighteenth century is described. The observations highlighted a serious attack as many of the books showed damages with deep galleries burrowed by larval activity and holes determined by the emergence of adults. In this work we provide illustrations for the identification of adult G. pubens adults’ and further observations on the morphology of this species. High-resolution photographs in this study complement detailed morphological descriptions, aiding in accurate species identification and can serve as a practical tool for researchers, curators, and conservators. Finally, we discuss the implementation of integrated pest management (IPM) procedures, recommended to the library curator, aimed at controlling biotic infestations to mitigate G. pubens damage. [ABSTRACT FROM AUTHOR]

Purpose: Uphill ski mountaineering performance appears to be related to metabolic cost of locomotion and skiers' weight. The present study aimed to evaluate the effects of slight variations in equipment weight on metabolic and mechanical work (MW) of ski mountaineering, at race pace. Methods: Thirteen male ski mountaineers were asked to ski on a treadmill at 25% slope and 80% of their maximal aerobic speed. They completed four 5-min bouts with additional weights of 0 kg (control), 0.2 kg, 0.4 kg, and 0.6 kg added to each ski boot in a blind mode and random order. Ski mountaineering energy cost (EC) was determined by gas exchange measurements, while MW was determined from the changes in the mechanical energy of body centre of mass (COM), body segments and equipment. Results: EC and total MW were significantly (all p < 0.001) and largely (η2 = 0.712 and η2 = 0.704, respectively) increased for every 0.2 kg of mass added, by around 2% and 1%, respectively. The increase in the MW was related to a significant increase in the work needed to lift the weight against gravity and to the increased work done to move the segments of the lower body with respect to COM. Conclusion: The present investigation shows that even small increments in racing gear weight are associated with an increase in ski mountaineering EC, possibly leading to a consequent decreased performance on uphill terrains. [ABSTRACT FROM AUTHOR]

In order to reduce greenhouse gas emissions associated with power generation, the replacement of fossil fuels with renewables must be accompanied by the availability of dispatchable sources needed to balance electricity demand and production. Combined cycle (CC) power plants adopting post-combustion capture (PCC) can serve this purpose, ensuring near-zero CO2 emissions at the stack, as well as high efficiency and load flexibility. In particular, the chemical absorption process is the most established approach for industrial-scale applications, although widespread implementation is lacking. In this study, different natural gas combined cycle (NGCC) configurations were modeled to estimate the burden of retrofitting the capture process to existing power plants on thermodynamic performance. Simulations under steady-state conditions covered the widest possible load range, depending on the gas turbine (GT) model. Attention was paid to the net power loss and net efficiency penalty attributable to PCC. The former can be mitigated by lowering the GT air–fuel ratio to increase the CO2 concentration (XCO2) in the exhaust, thus decreasing the regeneration energy. The latter is reduced when the topping cycle is more efficient than the bottoming cycle for a given GT load. This is likely to be the case in the less-complex heat recovery units. [ABSTRACT FROM AUTHOR]

(1) Background: Accurate knowledge of the dynamic anatomy of facial muscles is crucial for the use of functional and aesthetic botulinum toxin injections. We studied the reliability and relevance of facial painting as a pedagogic tool for the dynamic anatomy of facial muscles. (2) Methods: Different facial expressions were performed by a female model after a professional makeup artist applied makeup to the various facial muscles on her left hemiface. A 3D photograph was taken at the beginning and end of each movement using the VECTRA H2 Imaging System device. Cutaneous movements were visualized using displacement vectors. The correlation between the theoretical and dynamic positions of the makeup–muscle was assessed by two facial anatomy experts, thanks to a correlation scale. (3) Results: The overall average score for the 11 analyzed muscles or muscle groups was 3.36 out of 4, indicating a "strong" to "very strong" estimated correlation. There was a moderate agreement between Evaluator 1 and Evaluator 2 (ICC: 0.64; 95%CI: [0.244; 0.852]; p-value: 0.005). (4) Conclusions: The educational model with facial makeup provides an indirect but nonetheless precise and reliable representation of all facial muscles on the skin's surface. It is presented as a reliable and reproducible method, which exhibits great potential as a teaching tool. [ABSTRACT FROM AUTHOR]

We investigated the relationship between maximal oxygen consumption (VO2max) and performance in vertical races (VRs). In total, 270 performances, from 26 VRs, and cardiopulmonary data of 64 highly-trained mountain runners (53 M, V O2max: 75.7±5.8 mL/min/kg; 11 F: 65.7±3.4 mL/min/kg), collected over a 11-year period (2012–2022), were analysed. The relationship between performance and VO2max was modelled separately for national (NVRs), international (IVRs), and VRs of current pole-unassisted and pole-assisted vertical kilometre (VK) records (RVRs). Three different (p<0.001) exponential models described the relationship between performance and VO2max in IVRs (R2=0.96, p<0.001), NRs (R2=0.91, p<0.001) and RVRs (R2=0.97, p<0.001). Estimated VO2max requirements (with 95% CI) to win/set a record time in IVRs were 86.2(85.3–87.1)/89.4(88.2–90.5) and 74.0(73.6–74.4)/76.8(76.4–77.3) mL/min/kg, for males and females, respectively, 86.1(85.0–87.1)/90.4(89.0–91.8) and 74.8(74.2–75.3)/77.1(77.6–77.7) mL/min/kg in RVRs, decreasing to 83.7(82.5–84.9)/87.6(86.0–89.2) and 66.8(65.9–67.7)/70.7(70.1–71.4) mL/min/kg in NVRs. Our study also suggested a tendency towards a non-uniform variation in the metabolic demand of off-road running, likely attributable to the different features of the VRs (e.g., terrain, technical level, use of poles). These data provide mean VO2max requirements for mountain runners to win and establish new records in VRs and stimulate new research on the energy cost of off-road running. [ABSTRACT FROM AUTHOR]

Background: In nursing homes, most of the patients with dementia are affected by severe cognitive disorder. Care interventions follow an accurate and recurring multidimensional assessment, including cognitive status. There is still a need to develop new performance-based scales for moderate-to-advanced dementia. Objectives: The development of the Residual Cognition Assessment (RCA) responds to the need to create new scales for global cognitive screening in advanced dementia, with some peculiar features: performance based, brief (<5 m), available without specific training, and suitable for nonverbal patients with minimal distress. Methods: Two raters have administered the RCA and the Severe Impairment Battery-short version (SIB-S) to 84 participants with MMSE = 0. After 2–3 weeks, the same sample has been retested. The RCA has been also administered to 40 participants with MMSE 1–10 for a comparison. Results: The RCA has exhibited excellent values for test-retest reliability (intraclass correlation [ICC] = 0.956) as well as for inter-rater reliability (ICC = 0.997). The concurrent validity analyzes have shown strong correlations between the RCA and the SIB-S with ρ = 0.807 (p < 0.01), and the RCA and the Clinical Dementia Rating (CDR) with ρ = −0.663 (p < 0.01). Moderate correlation has been found between the RCA and the Functional Assessment Staging Scale with ρ = −0.435 (p < 0.01). The instrument has showed high internal reliability, too (total: α = 0.899). The RCA has low floor effect (2%) with respect to the SIB-S (58%) but shows ceiling effect in the MMSE 1–10 sample (50%). The ROC curve analyses demonstrate that the RCA is acceptably able to discriminate between subjects with CDR 4/5 with an AUC of 0.92. Exploratory factor analysis shows 3 factors, defined as three major degrees of cognitive performance in advanced dementia, indeed hierarchically structured in three possible levels of decline. Conclusions: The RCA has showed excellent validity and reliability as well as good sensitivity to identify advanced cognitive impairment in dementia, without floor effect. The RCA seems complementary to the MMSE, so advisable when the latter reaches 0. Administration and scoring are simple, and only few minutes are required to assess the patient. The RCA can discriminate at least 3 different major stages in advanced dementias: severe, profound, and late. [ABSTRACT FROM AUTHOR]

Background: In nursing homes, most of the patients with dementia are affected by severe cognitive disorder. Care interventions follow an accurate and recurring multidimensional assessment, including cognitive status. There is still a need to develop new performance-based scales for moderate-to-advanced dementia. Objectives: The development of the Residual Cognition Assessment (RCA) responds to the need to create new scales for global cognitive screening in advanced dementia, with some peculiar features: performance based, brief (<5 m), available without specific training, and suitable for nonverbal patients with minimal distress. Methods: Two raters have administered the RCA and the Severe Impairment Battery-short version (SIB-S) to 84 participants with MMSE = 0. After 2–3 weeks, the same sample has been retested. The RCA has been also administered to 40 participants with MMSE 1–10 for a comparison. Results: The RCA has exhibited excellent values for test-retest reliability (intraclass correlation [ICC] = 0.956) as well as for inter-rater reliability (ICC = 0.997). The concurrent validity analyzes have shown strong correlations between the RCA and the SIB-S with ρ = 0.807 (p < 0.01), and the RCA and the Clinical Dementia Rating (CDR) with ρ = −0.663 (p < 0.01). Moderate correlation has been found between the RCA and the Functional Assessment Staging Scale with ρ = −0.435 (p < 0.01). The instrument has showed high internal reliability, too (total: α = 0.899). The RCA has low floor effect (2%) with respect to the SIB-S (58%) but shows ceiling effect in the MMSE 1–10 sample (50%). The ROC curve analyses demonstrate that the RCA is acceptably able to discriminate between subjects with CDR 4/5 with an AUC of 0.92. Exploratory factor analysis shows 3 factors, defined as three major degrees of cognitive performance in advanced dementia, indeed hierarchically structured in three possible levels of decline. Conclusions: The RCA has showed excellent validity and reliability as well as good sensitivity to identify advanced cognitive impairment in dementia, without floor effect. The RCA seems complementary to the MMSE, so advisable when the latter reaches 0. Administration and scoring are simple, and only few minutes are required to assess the patient. The RCA can discriminate at least 3 different major stages in advanced dementias: severe, profound, and late. [ABSTRACT FROM AUTHOR]

With modern-day technical advances, high sagittal oblique osteotomy (HSOO) of the mandible was recently described as an alternative to bilateral sagittal split osteotomy for the correction of mandibular skeletal deformities. However, neither in vitro nor numerical biomechanical assessments have evaluated the performance of fixation methods in HSOO. The aim of this study was to compare the biomechanical characteristics and stress distribution in bone and osteosynthesis fixations when using different designs and placing configurations, in order to determine a favourable plating method. We established two finite element models of HSOO with advancement (T1) and set-back (T2) movements of the mandible. Six different configurations of fixation of the ramus, progressively loaded by a constant force, were assessed for each model. The von Mises stress distribution in fixations and in bone, and bony segment displacement, were analysed. The lowest mechanical stresses and minimal gradient of displacement between the proximal and distal bony segments were detected in the combined one-third anterior- and posterior-positioned double mini-plate T1 and T2 models. This suggests that the appropriate method to correct mandibular deformities in HSOO surgery is with use of double mini-plates positioned in the anterior one-third and posterior one-third between the bony segments of the ramus. [ABSTRACT FROM AUTHOR]

The current study aimed to show the validity of a portable motion sensor, the SenseWear Armband (SWA), for the estimation of energy expenditure during pole walking. Twenty healthy adults (mean ± SD: age 30.1 ± 7.2 year, body mass 66.1 ± 10.6 kg, height 172.4 ± 8.0 cm, BMI 22.1 ± 2.4 kg·m–2) wore the armband during randomized pole walking activities at a constant speed (1.25 m·s–1) and at seven grades (0%, ±5%, ±15% and ±25%). Estimates of total energy expenditure from the armband were compared with values derived from indirect calorimetry methodology (IC) using a 2–way mixed model ANOVA (Device × Slope), correlation analyses and Bland-Altman plots. Results revealed significant main effects for device, and slope (p < .025) as well as a significant interaction (p < .001). Significant differences between IC and SWA were observed for all conditions (p < .05). SWA generally underestimate the EE values during uphill PW by 0.04 kcal·kg–1·min–1 (p < .05). Whereas, a significant overestimation has been detected during flat and downhill PW by 0.01 and 0.03 kcal·kg–1·min–1 (p < .05), respectively. The Bland-Altman plots revealed bias of the armband compared with the indirect calorimetry at any condition examined. The present data suggest that the armband is not accurate to correctly detect and estimate the energy expenditure during pole walking activities. Therefore, the observed over- and under-estimations warrants more work to improve the ability of SWA to accurately measure EE for these activities. [ABSTRACT FROM AUTHOR]

Fornasiero, Alessandro, Aldo Savoldelli, Federico Stella, Alexa Callovini, Lorenzo Bortolan, Andrea Zignoli, David A. Low, Laurent Mourot, Federico Schena, and Barbara Pellegrini. Shortening work-rest durations reduces physiological and perceptual load during uphill walking in simulated cold high-altitude conditions. High Alt Med Biol. 21:249–257, 2020. Background: We investigated the effects of two different work-rest durations on the physiological and perceptual responses to a simulated mountain hike in a cold hypoxic environment. Materials and Methods: Twelve healthy nonacclimatized active men (age 31.3 ± 5.3 years, body mass index 22.4 ± 1.5 kg/m2) completed a 80-minute work-matched intermittent exercise on a motorized treadmill (25% incline, fixed self-selected speed), in a simulated mountain environment (−25°C, FiO2 = 11%, ≈5000 m a.s.l.), wearing extreme cold weather gear, once with short (20 × 3 minutes walking with 1 minute rest; SHORT) and once with long (10 × 6 minutes walking with 2 minutes rest; LONG) work-rest durations. Heart rate (HR), pulse oxygen saturation (SpO2), rate of perceived exertion (RPE), and thermal sensation (TS) were assessed throughout the exercise protocols. Cardiac autonomic modulation was assessed before (PRE) and after exercise (POST) in supine position, as well as during standing resting periods by means of HR recovery (HRR) assessment. Results: SpO2 and TS were similar (p > 0.05) in SHORT and LONG protocols. HR and RPE were increased, and HRR reduced during LONG compared to SHORT (p < 0.05). Parasympathetic activity indices were reduced at POST after both protocols (p < 0.05), but to a lesser extent after SHORT (p < 0.05). Conclusions: Reduced work-rest durations are associated with improved perceptual responses and less perturbation of cardiac autonomic balance, compared to longer work-rest durations. Shorter exercise periods from more frequent breaks during hikes at high altitude may represent a valid strategy to limit the impact of exercise under extreme environmental conditions. [ABSTRACT FROM AUTHOR]

Context: Exploring student intentions to practise in underserved areas (UAs) is necessary to inform the planning and training of the future medical workforce in order to increase effectiveness and fulfil societal needs. However, little is known about the motivational factors influencing these intentions. This paper explores medical students' intentions to practise in UAs and the motivational factors predicting these intentions. Methods: Eligible participants included graduating medical students from four of the five Swiss medical schools, who self‐reported specialty choice, intentions to practise in UAs, and motives that explained their career choices. Chi‐squared analysis was used to compare site, gender, specialty choice and UA practice intention. Motives were aggregated to obtain motivational factors using a principal component analysis with varimax rotation. Logistic regression was used to predict the effects of these motivational factors and of gender on UA practice intention. Results: Of 1749 students included in the study, 240 (13.7%) expressed an intention to practise in UAs (62.1% of whom intended to practise in rural areas) and 719 (41.1%) were undecided. In those who wished to practise in UAs, general practice (21.6%) was the most preferred specialty. Motivational factors influencing specialty choice were intellectual challenge, work variety, work conditions and enthusiasm (Kaiser‐Meyer‐Olkin index 0.79, P <.001, 49.0% of variance explained). Students motivated by work variety (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.2‐1.7) and by work conditions (OR 1.3, 95% CI 1.1‐1.6) were more likely to choose UAs and those motivated by intellectual challenge (OR 0.4, 95% CI 0.3‐0.5) were less likely. Undecided students' motivations were very similar to those of students interested in working in UAs. Conclusions: The actual number of Swiss students interested in working in UAs is low and is probably insufficient to meet current societal needs. Work variety and work conditions appear to be factors that might attract interested and undecided students towards working in UAs. The authors showed that the actual number of Swiss students interested in working in underserved areas is insufficient to meet current societal needs. Work variety and work conditions seem to be targeting factors to attract interested and undecided students towards working in underserved areas. [ABSTRACT FROM AUTHOR]

Background and Aims: Acute liver failure is a multisystem disorder with a high mortality and frequent need for emergency liver transplantation. Following massive innate immune system activation, soluble markers of macrophage activation are released during liver damage and their association with disease severity and prognosis requires exploration. Methods: Patients ALF from the United States Acute Liver Failure Study Group (USALFSG, n = 224) and King's College Hospital (n = 40) together with healthy controls (HC, n = 50) were recruited. Serum from early (Days 1–3) and late (>Day 3) time points were analysed for MAMs by enzyme‐linked immunosorbent assay correlated to markers of illness severity and 21‐day spontaneous survival. Surface expression phenotyping was performed via Flow Cytometry on CD14+ monocytes. Results: All MAMs serum concentrations were significantly higher in ALF compared to controls (p <.0001). sCD206 concentration was higher in early and late stages of the disease in patients with bacteraemia (p =.002) and infection in general (p =.006). In MELD‐adjusted multivariate modelling, sCD206 and sCD163 were independently associated with mortality. CD14+ monocyte expression of CD206 (p <.001) was higher in patients with ALF compared with controls and correlated with SOFA score (p =.018). sCD206 was independently validated as a predictor of infection in an external cohort. Conclusions: sCD206 is increased in serum of ALF patients with infections and poor outcome and is upregulated on CD14+ monocytes. Later measurements of sCD163 and sCD206 during the evolution of ALF have potential as mechanistic predictors of mortality. sCD206 should be explored as a biomarker of sepsis and mortality in ALF. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Retrograde intubation is an historic technique that is now rarely used in difficult airway situations. Although not originally designed for this purpose, the use of an S‐guide is a feasible option to aid retrograde intubation because of its malleable rigid body and atraumatic tip. [ABSTRACT FROM AUTHOR]

In this work, the objective is to examine a novel approach on the biodegradability of polystyrene is examined. A two-step method for the degradation of polystyrene to chemically useful products has been devised. Initially, polystyrene is liquefied via a thermal degradation procedure predominantly into styrene monomers at low temperatures and left to cool down. Application of microorganisms in a second step targets the breaking of the polymer into smaller organic molecules. Microorganisms tested were Rhodococcus zopfii stoecker, Enterococcus faecalis , Pseudomonas putida and Salmonella with the last two being the most effective. A third step is required to treat the organic products accordingly. The suggested method exhibits total conversion of polystyrene. While the method has only been examined on a small scale, its potential advantages for the recycling of polystyrene waste, are minimized energy costs due to low temperatures of thermal treatment used and the extremely fast degradation kinetics observed. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the return on investment (ROI) and quality improvement after implementation of a centralized automated-dispensing system after 8 years of use.Design: Prospective evaluation of ROI; before and after study to evaluate dispensing errors; user satisfaction questionnaire after 8 years of use.Setting: The study was conducted at a French teaching hospital in the pharmacy department, which is equipped with decentralized automated medication cabinets in the wards.Participants: Pharmacy staff (technicians and residents).Intervention(s): Implementation of a centralized automated-dispensing robot.Main Outcome Measure(s): The true ROI was prospectively and annually compared to estimated returns calculated after implementation and upgrade of the robot; dispensing errors determined by observation of global deliveries and the satisfaction of users based on a validated questionnaire were evaluated.Results: Following the upgrade, we found little difference for the ROI (+1.86%). The payback period increased by almost 3 years. There was a significant reduction of dispensing errors, from 2.9% to 1.7% (P < 0.001). User satisfaction of the robot by the pharmacy staff was reported (score of 5.52 ± 1.20 out of 7).Conclusions: These systems are worthwhile investments and largely contribute to improving the quality and safety of the medication process. [ABSTRACT FROM AUTHOR]

Two different copper and gallium arylcorroles have been functionalized using the Vilsmeier–Haack reaction. A further Knoevenagel reaction with cyanoacetic acid was performed on both complexes, affording the desired products with yields above 90 %. The newly synthesized compounds have been thoroughly characterized by a combination of spectroscopic methods, optical analyses, and X‐ray crystallography. Moreover, they have been tested as anchoring groups for the hydrothermal synthesis of ZnO nanoparticles. The morphology of the heterogeneous composites has been studied by SEM, EDS and fluorescence microscopy analyses, thus confirming the presence of the corrole macrocycle in the hybrid material. A new class of corrole complexes bearing a cyanoacetic moiety at the β‐position was obtained in excellent yields through a Knoevenagel reaction. The newly prepared compounds were thoroughly characterized and the peripheral carboxylic moiety was used as an anchoring group in the synthesis of ZnO nanoparticles. [ABSTRACT FROM AUTHOR]

Hermetia illucens (L.) (Diptera Stratiomyidae) is a promising species as alternative protein source for animal feed, able to convert a wide range of organic materials. The knowledge on larval biology, development, nutritional needs, and nutritional composition is rich, while few information is available on adult traits. The aim of the present study was to investigate the influence of the adult nutrition on the survival, the longevity and the ovaries development of H. illucens. In detail, three food sources have been compared to starvation. Water, a sucrose solution and a protein solution were given to new emerged adults and data on longevity and ovary development were acquired. Trials were conducted on single specimen and on a cohort of adults. In all the trials, starved adults survived significantly shorter than all other thesis. When adults were maintained isolated, the survival was significantly influenced by the nourishment: longevity was longer when adults were fed with a sucrose solution, while the supply of a protein source provided a lifespan significantly higher than starvation but similar to water or to sucrose solution. In cages longevity was always shorter than in isolated adults for both males and females and the overall trend was similar to single individual trials with the exception of protein solution. Ovary development of females under different nourishment did not show differences. More studies are necessary to identify a correct nutrition considering the integration of different chemical compounds to obtain optimal adult performance in terms of longevity and reproduction. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the independent and combined effects of hypoxia (FiO2 = 13.5%) and cold (− 20 °C) on physiological and perceptual responses to endurance exercise. Methods: 14 trained male subjects ( V. O2max: 64 ± 5 mL/kg/min) randomly performed a discontinuous maximal incremental test to exhaustion on a motorized treadmill under four environmental conditions: Normothermic-Normoxia (N), Normothermic-Hypoxia (H), Cold-Normoxia (C) and Cold-Hypoxia (CH). Performance and physiological and perceptual responses throughout exercise were evaluated. Results: Maximal WorkLoad (WL) and WL at lactate threshold (LT) were reduced in C (− 2.3% and − 3.5%) and H (− 18.0% and − 21.7%) compared to N, with no interactive (p = 0.25 and 0.81) but additive effect in CH (− 21.5% and − 24.6%). Similarly, HRmax and Vemax were reduced in C (− 3.2% and − 14.6%) and H (− 5.0% and − 7%), showing additive effects in CH (− 7.7% and − 16.6%). At LT, additive effect of C (− 2.8%) and H (− 3.8%) on HR reduction in CH (− 5.7%) was maintained, whereas an interactive effect (p = 0.007) of the two stressors combined was noted on Ve (C: − 3.1%, H: + 5.5%, CH: − 10.9%). [La] curve shifted on the left in CH, displaying an interaction effect between the 2 stressors on this parameter. Finally, RPE at LT was exclusively reduced by hypoxia (p < 0.001), whereas TSmax is synergistically reduced by cold and hypoxia (interaction p = 0.047). Conclusion: If compared to single stress exposure, exercise performance and physiological and perceptual variables undergo additive or synergistic effects when cold and hypoxia are combined. These results provide new insight into human physiological responses to extreme environments. [ABSTRACT FROM AUTHOR]

Heterospilus sicanus (Marshall, 1888) is redescribed and illustrated based on the holotype of Dendrosoter sicanus Marshall, 1888 and on recently collected material from its type locality (Sicily, Italy). Previous host records for this species are unreliable. Here, the host of H. sicanus, the rare ptinid beetle Gastrallus pubens Fairmaire, 1875, is recorded for the first time, having been reared in a historic library in Palermo, Italy. Heterospilus sicanus is compared with the similar species Telebolus (= Heterospilus) corsicus Marshall, 1888, which was described in the same monograph from Corsica (France), and it is also redescribed and illustrated. Atoreuteus ceballosi Docavo Alberti, 1960, syn. nov. is synonymised under Heterospilus sicanus (Marshall, 1888), and Hormiopterus (= Rhaconotus) ollivieri Giraud var. flava Fahringer, 1931, syn. nov. is a junior synonym of Heterospilus cephi Rohwer, 1925. A key for determination of the Western Palaearctic Heterospilus species with a striate vertex is provided and the distributions of H. sicanus and H. corsicus are discussed. [ABSTRACT FROM AUTHOR]

The aims of the study were to describe the physiological profile of a 65-km (4000-m cumulative elevation gain) running mountain ultra-marathon (MUM) and to identify predictors of MUM performance. Twenty-three amateur trail-runners performed anthropometric evaluations and an uphill graded exercise test (GXT) for VO2max, ventilatory thresholds (VTs), power outputs (PMax, PVTs) and heart rate response (HRmax, HR@VTs). Heart rate (HR) was monitored during the race and intensity was expressed as: Zone I (VT2) for exercise load calculation (training impulse, TRIMP). Mean race intensity was 77.1%±4.4% of HRmax distributed as: 85.7%±19.4% Zone I, 13.9% ±18.6% Zone II, 0.4%±0.9% Zone III. Exercise load was 766±110 TRIMP units. Race time (11.8±1.6h) was negatively correlated with VO2max (r = -0.66, P <0.001) and PMax (r = -0.73, P <0.001), resulting these variables determinant in predicting MUM performance, whereas exercise thresholds did not improve performance prediction. Laboratory variables explained only 59% of race time variance, underlining the multi-factorial character of MUM performance. Our results support the idea that VT1 represents a boundary of tolerable intensity in this kind of events, where exercise load is extremely high. This information can be helpful in identifying optimal pacing strategies to complete such extremely demanding MUMs. [ABSTRACT FROM AUTHOR]

Summary: What is known: Hospital readmission within 30 days of patient discharge has become a standard to judge the quality of hospitalizations. It is estimated that 14% of the elderly, people over 75 years old or those over 65 with comorbidities, are at risk of readmission, of which 23% are avoidable. It may be possible to identify elderly patients at risk of readmission and implement steps to reduce avoidable readmissions. Objective: The aim of this study was to identify iatrogenic risk factors for readmission. The secondary objective was to evaluate the rate of drug‐related readmissions (DRRs) among all readmissions and compare it to the rate of readmissions for other reasons. Methods: We conducted a retrospective, matched, case‐control study to identify non‐demographic risk factors for avoidable readmission, specifically DRRs. The study included patients hospitalized between 1 September 2014 and 31 October 2015 in an 800‐bed university hospital. We included patients aged 75 and over. Cases consisted of patients readmitted to the emergency department within 30 days of initial discharge. Controls did not return to the emergency department within 30 days. Cases and controls were matched on sex and age because they are known as readmissions risk factors. After comparison of the mean or percentage between cases and controls for each variable, we conducted a conditional logistic regression. Results: The risk factors identified were an emergency admission at the index hospitalization, returning home after discharge, a history of unplanned readmissions and prescription of nervous system drugs. Otherwise, 11.4% of the readmissions were DRRs, of which 30% were caused by an overdose of antihypertensive. The number of drugs at readmission was higher, and potentially inappropriate medications were more widely prescribed for DRRs than for readmissions for other reasons. What is new and conclusion: In this matched case‐control retrospective study, after controlling for gender and age, we identified the typical profile of elderly patients at risk of readmission. These patients had an unplanned admission at the index hospitalization and prescribed nervous system drugs at discharge from the index admission; they have a history of unplanned readmission within 30 days and return home after discharge. [ABSTRACT FROM AUTHOR]

Copper and gallium β-acrolein corroles have been obtained by reaction of corrole complexes with 3-(dimethylamino)-acrolein/phosphoryl chloride (3-DMA/POCl3) under Vilsmeier conditions. In the case of the Ga complex, up to four acroleyl substituents have been introduced at the β-peripheral positions of the corrole macrocycle. The introduction of the acroleyl moiety on the corrole scaffold strongly influences the photophysical behaviour of the Ga corroles. [ABSTRACT FROM AUTHOR]

Bilateral sagittal split osteotomy (BSSO) is a widely-performed procedure in orthognathic surgery for the correction of dentofacial deformity. Condylar positioning is a critical step during BSSO to maximize functional and morphological results. The unsuitable positioning of condyles represents one of the causative mechanisms that may induce temporomandibular joint noxious effects after BSSO. Repositioning devices can assist surgeons in maintaining the preoperative condylar position; however, empirical repositioning methods based on experience gained are still commonly used. Trainee learning curves are difficult to assess. The aim of this study was to evaluate the relevance of computer-assisted surgery in the acquisition of condylar positioning skills. Forty-eight patients underwent BSSO performed by six maxillofacial trainees (four junior residents and two senior experienced residents). A condyle positioning system (CPS) was used by a senior surgeon to record a condylar position score during the procedure. Firstly, scores were recorded when the trainee manually positioned the condyle without access to the CPS score (phase 1) and then when the trainee positioned the condyle and performed osteosynthesis with visual access to the CPS score (phase 2). Six parameters describing condylar three-dimensional motions were assessed: translational motion from top to bottom (TB), back to front (BF), and left to right (LR), axial rotation (AR), sagittal rotation (SR), frontal rotation (FR), and a total score (TS). There were no significant differences between junior and senior residents in condyle positioning without access to the CPS. Condyles were significantly better positioned during phase 2 with access to the CPS (p<0.001). Over time, use of the CPS (phase 2) produced significantly quicker improvements in scores (p = 0.042). For those teaching surgeries to trainees, computer-assisted devices can potentially result in more rapid learning curves than traditional “observations-imitation” models. Use of a CPS by trainees facilitated condylar repositioning that resulted in an accurate occlusal result and avoidance of adverse effects on the temporomandibular joint. [ABSTRACT FROM AUTHOR]

In the literature there is a lack of data about the development of top level athletes in cross-country mountain biking (XCO). The purpose of this study was to analyze anthropometric and physiological characteristics of some of the best XCO bikers aged between 13 and 16. The study involved 45 bikers (26 males and 19 females) belonging to a youth national team. The evaluations, consisting of anthropometric measures, incremental cycling tests (VO2max, PPO, P@RCP), and 30 s Wingate Tests (PMax, PMean), were conducted over a lapse of 4 years. Our findings showed in bikers, already at young age, a specific athletic profile advantageous for XCO performance. At the age of 16, just before entering the junior category and competing at international level, male and female bikers showed physiological values normalized to the body mass comparable to those reported in literature for high level athletes (VO2max>70 and >60 ml/kg/min, PPO >6.5 and >5.5 W/kg, respectively in males and females). The production of high power-to-weight ratios and high peaks of anaerobic power attests the presence of highly developed aerobic and anaerobic systems in young XCO cyclists reflecting the high physiological demand of this sport. [ABSTRACT FROM AUTHOR]

Purpose: Despite their increasing popularity, there are no studies analyzing the performance of ski-mountaineering vertical races. For the first time, this study examined a vertical competition, exploring the association between laboratory measures and uphill performance by means of multiple regression analysis.Methods: Nine high-level ski-mountaineers (age 20.6 ± 3.0 years, VO2max 69.3 ± 7.4 mL/min/kg) performed an anthropometric assessment and a laboratory ski-mountaineering graded exercise test (GXT) to evaluate VO2max, gross efficiency (GE), ventilatory thresholds (VTs), blood lactate thresholds (LTs), as well as the power output associated with these indices. Race characteristics in terms of vertical gain, length, and mean gradient were, respectively, as follows: 460 m, 3 km, 15.3% for junior men and senior women; 600 m, 3.5 km, 17.1% for senior men.Results: Average race time was 23:35 ± 01:25 (mm:ss). Mean power output exerted during the race was 3.40 ± 0.34 W/kg, equal to 79.0 ± 3.5% of maximal and 95.3 ± 5.2% of VT2 calculated in the GXT. The most performance-correlated variable was the VO2 at VT2 (mL/min/kg) (r = 0.91, p < 0.001), which accounted for the 80% of performance variation (adjusted R2 = 0.80, p = 0.001). When GE was included in the analysis, the regression model was significantly improved (adjusted R2 = 0.90, p = 0.031).Conclusions: The study showed that the mean power output sustained during a vertical race is close to the power associated with VT2 and it is highly correlated with athletes’ physiological characteristics. Particularly, two variables, VO2 at VT2 and GE, measurable with a specific GXT, accounted for the 90% of performance variation in a ski-mountaineering vertical race. Accordingly, training programs should focus on the maximal development of VT2 as well as on increasing GE by technical improvement. [ABSTRACT FROM AUTHOR]

Objective: The positive impact of computerized physician order entry (CPOE) systems on prescription safety must be considered in light of the persistence of certain types of medication-prescription errors. We performed a systematic review, based on the PRISMA statement, to analyze the prevalence of prescription errors related to the use of CPOE systems.Materials and Methods: We searched MEDLINE, EMBASE, CENTRAL, DBLP, the International Clinical Trials Registry, the ISI Web of Science, and reference lists of relevant articles from March 1982 to August 2017. We included original peer-reviewed studies which quantitatively reported medication-prescription errors related to CPOE. We analyzed the prevalence of medication-prescription errors according to an adapted version of the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) taxonomy and assessed the mechanisms responsible for each type of prescription error due to CPOE.Results: Fourteen studies were included. The prevalence of CPOE systems-related medication errors relative to all prescription medication errors ranged from 6.1 to 77.7% (median = 26.1% [IQR:17.6-42,1]) and was less than 6.3% relative to the number of prescriptions reviewed. All studies reported "wrong dose" and "wrong drug" errors. The "wrong dose" error was the most frequently reported (from 7 to 67.4%, median = 31.5% [IQR:20.5-44.5]). We report the associated mechanism for each type of medication described (those due to CPOE or those occurring despite CPOE).Discussion: We observed very heterogeneous results, probably due to the definition of error, the type of health information system used for the study, and the data collection method used. Each data collection method provides valuable and useful information concerning the prevalence and specific types of errors related to CPOE systems.Conclusions: The reporting of prescription errors should be continued because the weaknesses of CPOE systems are potential sources of error. Analysis of the mechanisms behind CPOE errors can reveal areas for improvement. [ABSTRACT FROM AUTHOR]

Background: The burden of Sedative-Hypnotics (SHs) has been known since the 1980s. Yet, their consumption remains high. A systematic review of the literature should help to assess efficient interventions to improve the appropriate use of SHs in sleep disorders. Objectives: To identify and assess regulatory and educational interventions designed to improve the appropriate use of SHs for insomnia treatment. Methods: We conducted a systematic review of the literature according to PRISMA guidelines. A systematic search covering the period 1980–2015 was carried out in Medline, Web of Science, Embase and PsycInfo. We included studies reporting the implementation of regulatory or educational strategies directed towards patients and/or healthcare professionals to improve the appropriate use of SHs to treat insomnia in the community, hospitals and nursing homes. Results: Thirty-one studies were included: 23 assessed educational interventions (recommendations by mail/email, computer alerts, meetings, mass media campaigns, prescription profile), 8 assessed regulatory interventions (prescription rule restriction, end of reimbursement). The most recent was implemented in 2009. Restrictive prescription rules were effective to reduce the consumption of targeted SHs but led to a switch to other non-recommended SHs. Among educational interventions, only 3 studies out of 7 reported positive results of mono-faceted interventions; whereas, 13 out of the 16 multi-faceted interventions were reported as efficient: particularly, the active involvement of healthcare professionals and patients and the spread of information through mass media were successful. The risk of bias was high for 24 studies (mainly due to the design), moderate for 3 studies and weak for 4 studies. Conclusion: Educational multifaceted studies are presented as the most efficient. But further better designed studies are needed to make evidence-based results more generalizable. [ABSTRACT FROM AUTHOR]

An efficient β-functionalization of [5,10,15-tris-(4-methylphenyl)corrolato]cobalt derivatives through a Vilsmeier-type reaction allows the introduction of an acrolein substituent, which is subsequently copolymerized with pure acrolein. The obtained hybrid microspheres are exploited as nanogravimetric chemical sensors. The sensing properties of the developed sensors are tested through exposure to different volatile organic compounds chosen as model analytes. The results show improved sensor sensitivity of the resulting devices for all the tested analytes with respect to sensors functionalized with either corrole or polyacrolein. The enhanced properties are attributed to the accurate and tunable merging of the properties of both exploited materials. [ABSTRACT FROM AUTHOR]

More than one hundred food complaints, coming from food industries, food stores, and customers, were analyzed over a ten-year period (2004-2013). In the samples of plant products and animal products, the prevalent pests were insects and rodents while in animal products, mites were also found. The highest percentages of stored products' pests in plant products were represented by Coleoptera (62.1) and Lepidoptera (48.2), while Diptera were mainly crop pests (12.5) or species of hygienic concern (33.3). In animal products, the highest number of complaints concerned milk and dairy products, and the contaminations were caused by insects, mites, and mice. [ABSTRACT FROM AUTHOR]

This study aimed to describe injury/illness rates in ultratrail runners competing in a 65-km race to build a foundation for injury prevention and help race organizers to plan medical provision for these events. Prospectively transcribed medical records were analysed for 77 athletes at the end of the race. Number of injuries/illnesses per 1 000 runners and per 1 000-h run, overall injury/illness rate and 90% confidence intervals and rates for major and minor illnesses, musculoskeletal injuries, and skin disorders were analysed. A total of 132 injuries/illnesses were encountered during the race. The overall injuries/illnesses were 1.9 per runner and 13.1 per 1 000-h run. Medical illnesses were the most prominent medical diagnoses encountered (50.3%), followed by musculoskeletal injuries (32.8%), and skin-related disorders (16.9%). Despite the ultra-long nature of the race, the majority of injuries/illnesses were minor in nature. Medical staff and runners should prepare to treat all types of injuries and illnesses, especially the fatigue arising throughout the course of an ultratrail run and injuries to the lower limbs. Future studies should attempt to systematically identify injury locations and mechanisms in order to better direct injury prevention strategies and plan more accurate medical care. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether the fatigue induced by a mountain ultramarathon (MUM) led to changes in energy cost and kinematic during level and graded running. Pre- and post-race, 14 ultratrail runners ran on a level, uphill (5%) and downhill (5%) treadmill at 10 km · h−1. Kinematic data were acquired using a photocell system. Post-race, the downhill energy cost increased by 13.1% (P < 0.001). No change was noted in level and uphill running. Duty factor and stride frequency were increased, whereas swing time, cycle time and stride length were decreased in all conditions (P < 0.05). Contact time was increased and the rate of force generation was decreased only in the uphill and downhill conditions (P < 0.05). Positive correlations were observed between performance time and the pre- to post-changes in the energy cost of level (r = 0.52,P = 0.04) and uphill running (r = 0.50,P = 0.04). MUM-induced fatigue resulted in physiological and spatiotemporal changes, though the response to fatigue varied considerably between running conditions. These changes resulted in a significant increment only in the downhill energy cost. Incorporating downhill locomotion in the training programmes of ultratrailers may help to improve performance-related physiological and biomechanical parameters. [ABSTRACT FROM PUBLISHER]

Purpose: To examine the effects of the world's most challenging mountain ultra-marathon (Tor des Géants 2012) on the energy cost of three types of locomotion (cycling, level and uphill running) and running kinematics. Methods: Before (pre-) and immediately after (post-) the competition, a group of ten male experienced ultra-marathon runners performed in random order three submaximal 4-min exercise trials: cycling at a power of 1.5 W kg body mass; level running at 9 km h and uphill running at 6 km h at an inclination of +15 % on a motorized treadmill. Two video cameras recorded running mechanics at different sampling rates. Results: Between pre- and post-, the uphill-running energy cost decreased by 13.8 % ( P = 0.004); no change was noted in the energy cost of level running or cycling (NS). There was an increase in contact time (+10.3 %, P = 0.019) and duty factor (+8.1 %, P = 0.001) and a decrease in swing time (−6.4 %, P = 0.008) in the uphill-running condition. Conclusion: After this extreme mountain ultra-marathon, the subjects modified only their uphill-running patterns for a more economical step mechanics. [ABSTRACT FROM AUTHOR]

Response to Chaen and Trapellieni re: "Shortening Work-Rest Durations Reduces Physiological and Perceptual Load During Uphill Walking in Simulated Cold High-Altitude Conditions", by Fornasiero et al This letter is in response to the letter by Chaen and Trapellieni. The decision of keeping the treadmill running was not taken to avoid introducing acceleration/deceleration phases, but indeed to avoid some issues related to the time required for stopping and running again the treadmill. [Extracted from the article]

Background: With the spread of COVID-19, telemedicine solutions became crucial to release continuous and remote assistance to chronic patients. The rapid transition to telemedicine solutions did not allow a complete assessment of the user experience by both patients and medical personnel. Despite the well-known benefits in remote care, the lack of usability evaluation of already existing technologies for the vital signs measurement has emerged. A telemedicine platform must match video communication between patients and the medical staff with the possibility to measure vital parameters. Furthermore, technological assistance may overcome the unfamiliarity with telemedicine and drastically reduce the learning time for both patients and medical personnel.Objectives: The research work presents a method to improve the user experience of a telemedicine service based on the combination of televisits and telemonitoring with wearable sensors for heart failure patients. Skilled technological staff is proposed by the presented method to lead the learning process of both medical personnel and patients in order to reach a high level of usability in less than 6 months.Methods: The proposed method is composed of 5 steps: identification of technological staff and end users; selection of the telemedicine platform; design of questionnaires for usability analysis; training of clinicians and patients; final usability evaluation of the telemedicine platform by means of customized satisfaction questionnaires and Post-Study System Usability Questionnaires (PSSUQs). The methodological approach has been tested in collaboration with a heart failure clinic by involving 5 physicians, 5 nurses, 15 heart failure patients, a research engineer and 4 technicians. A platform with 3 wearable sensors has been chosen: a wireless thermometer, a finger pulse-oximeter and an undershirt have been used for the detection of ECG trace. While these devices allowed asynchronous measurements of physiological data, scheduled televisits have been used for direct communication between physicians and patients.Results: Satisfaction questionnaires of patients and clinicians reached respectively 65.18% and 65.83%, while PSSUQ scores were respectively 91.73% and 81.70%. Both groups of end users confirmed a good level of usability and their satisfaction about the ease of use and the perceived quality of the instrumentation. Moreover, 73% of patients did not require help from caregivers to use the kit of sensors. The results have been reached in 5.5 months according to the aim defined initially. Research engineers have played a crucial role in helping clinicians and patients to improve the user experience with the telemedicine platform.Conclusions: The high level of usability and satisfaction confirmed that the proposed methodological approach helps to learn the technological features of the telemedicine platforms, which are based on different types of technology, such as web applications, wearable sensors and virtual calls. The positive results with heart failure patients encouraged to plan further research studies by using the designed method with other categories of chronic patients. [ABSTRACT FROM AUTHOR]

The purpose of the study was to verify the efficacy of a mating-disruption system (MD) applied in a confectionary factory infested by almond moths, Ephestia ( Cadra) cautella (Walker), using pheromone traps and the presence of spermatophores in females caught with water traps. Results obtained confirmed that water is a considerable attractant for E. cautella, as a great number of males and females were caught. The presence of spermatophores in females allowed determination of mating status: most captured females were mated; in the area where MD was applied to the percentage of unmated females was lower as compared to the control area (the proportion of unmated females was much higher in the control area). In an integrated pest management programme, the combined use of MD and water traps eliminates large numbers of male and female almond moths. This information will be useful in developing strategies for suppressing E. cautella infestation. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 outbreak led to the diffusion of several telemedicine solutions. The choice of the correct platform is crucial for ensuring the release of effective assistance. However, there is a lack of an objective method for the assessment of technical features. Objective: This study proposes a methodology for the evaluation of functional requirements of telemedicine platforms. This approach also permits the comparison of solutions in the Italian market by means of defined parameters, thus directing the choice of health care professionals. Methods: The study is divided into three phases. First, a mapping of the telemedicine platforms operating in Italy is performed. Then, the available platforms are selected based on the offered telemedicine activity. Finally, a method for evaluating the investigated platforms is defined. Results: Thirty-three (n = 33) technological systems were identified through an accurate investigation on the web and interviews with IT companies. Fifteen parameters were defined and organized into three categories: (1) usability of the telemedicine platform, (2) security, and (3) technological and organizational aspects. A score between 1 and 4 was assigned to each parameter, proportionally to the completeness of the platform. In particular, 62.96% of platforms reached an average score between 3.01 and 4 points; 33.33% of them had scores between 2.01 and 3, while the remaining 3.70% of solutions obtained a result between 1.01 and 2. Conclusions: The study provides an evaluation approach that is easily usable by health professionals to select the most suitable platform. The number of solutions and quality of information could be updated to obtain a complete tool. [ABSTRACT FROM AUTHOR]

The traditional tools used in steam-chest moulding technologies for the shaping of expanded polymers can be replaced today by lighter moulds, accurately designed and produced exploiting the additive manufacturing technology. New paradigms have to be considered for mould design, assuming that additive manufacturing enables the definition of different architectures that are able to improve the performance of the moulding process. This work describes the strategies adopted for the design and manufacturing by Laser powder bed fusion of the moulds, taking into specific consideration their functional surfaces, which rule the heat transfer to the moulded material, hence the quality of the products and the overall performance of the steam-chest process. The description of a case study and the comparison between the performance of the traditional solution and the new moulds are also presented to demonstrate the effectiveness of the new approach. This study demonstrates that the re-design and optimization of the mould shape can lead to a significant reduction of the energy demand of the process, thanks to a homogeneous delivery of the heating steam throughout the part volume, which also results in a remarkable cutting of the cycle time. [ABSTRACT FROM AUTHOR]

J Clin Hypertens (Greenwich). 2012; 14:429-434. © 2012 Wiley Periodicals, Inc. The aim of this study was to validate a French translation of the structured self-report 8-item Morisky Medication Adherence Scale (MMAS-8) and determine its psychometric properties in patients taking antihypertensive medication. An observational cross-sectional study was conducted in the hypertensive unit of a French university hospital. The MMAS-8 was translated according to international guidelines. Internal consistency was assessed using Cronbach α coefficient, construct validity using principal component and confirmatory factor analyses, and the test-retest reliability at 1-month interval using the intraclass correlation coefficient (ICC). Three levels of adherence were considered (low: scores of 0 to <6; medium: 6 to <8; high: 8) and risk factors were explored in ordinal logistic regression models. A total of 199 patients were included: mean age, 55.7±14.6 years, 57.3% men (114 of 199), and 39.5% (66 of 167) had uncontrolled blood pressure. The French MMAS was moderately reliable (α=0.54), one-dimensional, and reproducible (ICC=0.68). The mean score was 6.96 (standard deviation 1.25) and 17.6% (35 of 199), 37.7% (75 of 199), and 43.7% (87 of 199) of patients had low, medium, and high adherence, respectively. The only factor significantly associated with adherence was age. The French MMAS has acceptable psychometric effects to measure medication adherence in hypertensive patients and may be useful in detecting nonadherent hypertensive patients. [ABSTRACT FROM AUTHOR]

Purpose: This study aims at analysing the stresses distribution in the temporomandibular joint (TMJ) using a complete high-resolution finite element model (FE Model). This model is used here to analyse the stresses distribution in the discs during a closing jaw cycle. In the end, this model enables the prediction of the stress evolution in the TMJ disc submitted to various loadings induced by mandibular trauma, surgery or parafunction. Materials and methods: The geometric data for the model were obtained from MRI and CT scans images of a healthy male patient. Surface and volume meshes were successively obtained using a 3D image segmentation software (AMIRA). Bone components of skull and mandible, both of joint discs, temporomandibular capsules and ligaments and dental arches were meshed as separate bodies. The volume meshes were transferred to the FE analysis software (FORGE). Material properties were assigned for each region. Boundary conditions for closing jaw simulations were represented by different load directions of jaws muscles. The von Mises stresses distribution in both joint discs during closing conditions was analyzed. Results: The pattern of von Mises stresses in the TMJ discs is non-symmetric and changed continuously during jaw movement. Maximal stress is reached on the surface disc in areas in contact with others bodies. Conclusions: The three-dimension finite element model of masticatory system will make it possible to simulate different conditions that appear to be important in the cascade of events leading to joint damage. [ABSTRACT FROM AUTHOR]

Heart or lung transplantation is a complex intervention requiring medication adherence. The objective of this systematic review is to estimate the prevalence of non-adherence (NA) with post-transplantation medication in heart or lung recipients and to assess its clinical impact. We examined in the selected studies if the authors considered the patient''s perspective in their evaluations. Methods: The electronic database MEDLINE, EMBASE and The Cochrane Central Register were searched. Only studies that reported the number of non-adhere subjects were eligible. The different methods of measurement, the ways in which authors defined NA and if authors had integrated patient''s perspective in their secondary objectives were also assessed. Results: The range frequency of NA was 1–42.9% for all drugs. Non-adherent patients tend to experience worse outcomes compared to adherent patients. The patient''s perception of drug side-effects is the most reported patient-related factor for impairing adherence. Conclusion: NA after heart or lung transplantation is an important issue and concerns not only immunosuppressant treatments. The main striking point of the selected studies is the lack of patient perspective and the omission of patients–healthcare providers’ relationship. Practice implications: Future research must focus on patients’ motivation for the medication-taking behaviour. [Copyright &y& Elsevier]

Abstract: Development of a numerical model applicable to clinical practice, and in particular oral implantology, requires knowledge of the mechanical properties of mandibular bone. The wide range of mechanical parameters found in the literature prompted us to develop an inverse analysis method that takes into account the exact geometry of each specimen tested, regardless of its shape. The Young''s modulus of 3000MPa we determined for mandibular bone using this approach is lower than the values reported in the literature. This difference can be explained by numerous experimental factors, related in particular to the bone specimens used. However, the main reason is that, unlike most previously published papers on the subject, the heterogeneity of bone led us to select a specimen size at the upper end of the scale, close to clinical reality. [Copyright &y& Elsevier]

DKA is a severe metabolic derangement characterized by dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness that results from severe insulin deficiency combined with the effects of increased levels of counterregulatory hormones (catecholamines, glucagon, cortisol, growth hormone). The biochemical criteria for diagnosis are: blood glucose > 200 mg/dl, venous pH <7.3 or bicarbonate <15 mEq/L, ketonemia >3 mmol/L and presence of ketonuria. A patient with DKA must be managed in an emergency ward by an experienced staff or in an intensive care unit (ICU), in order to provide an intensive monitoring of the vital and neurological signs, and of the patient's clinical and biochemical response to treatment. DKA treatment guidelines include: restoration of circulating volume and electrolyte replacement; correction of insulin deficiency aiming at the resolution of metabolic acidosis and ketosis; reduction of risk of cerebral edema; avoidance of other complications of therapy (hypoglycemia, hypokalemia, hyperkalemia, hyperchloremic acidosis); identification and treatment of precipitating events. In Brazil, there are few pediatric ICU beds in public hospitals, so an alternative protocol was designed to abbreviate the time on intravenous infusion lines in order to facilitate DKA management in general emergency wards. The main differences between this protocol and the international guidelines are: intravenous fluid will be stopped when oral fluids are well tolerated and total deficit will be replaced orally; if potassium analysis still indicate need for replacement, it will be given orally; subcutaneous rapid-acting insulin analog is administered at 0.15 U/kg dose every 2-3 hours until resolution of metabolic acidosis; approximately 12 hours after treatment initiation, intermediate-acting (NPH) insulin is initiated at the dose of 0.6-1 U/kg/day, and it will be lowered to 0.4-0.7 U/kg/day at discharge from hospital. [ABSTRACT FROM AUTHOR]

We describe a novel post mortem technique that makes it possible to visualise the nerve structure of the brachial plexus using imaging. We dissected in situ the brachial plexus of a cadaver preserved by formaldehyde. A preparation composed of a mixture of baryte powder, water and colorant, was applied to all sides of the brachial plexus and blood vessels of the region under study. A high resolution CT scan was performed. With the aid of Mimics (Materialise) software, segmentation of all the nerve and vascular structures on each of the 650 slices obtained was performed. The Mimics software then compiled all the slices to generate a 3-dimensional STL image. The image obtained was printed with a stereolythography printer, to produce a plastic model representing part of the cervico-thoracic spinal cord, the ribs, sternum, scapula, humerus, and clavicle, with the left brachial plexus and the subclavian, axillary and brachial veins and arteries. This technique has the potential for a wide range of uses: for teaching anatomy, to improve teaching of medical techniques, 3-dimensional modelisation of other nerve structures. The advantage is that the model obtained is a faithful and realistic reproduction. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous studies have indicated that fiberoptic orotracheal intubation (FOI) skills can be learned outside the operating room. The purpose of this study was to determine which of two educational interventions allows learners to gain greater capacity for performing the procedure. METHODS: Respiratory therapists were randomly assigned to a low-fidelity or high-fidelity training model group. The low-fidelity group was guided by experts, on a nonanatomic model designed to refine fiberoptic manipulation skills. The high-fidelity group practiced their skills on a computerized virtual reality bronchoscopy simulator. After training, subjects performed two consecutive FOIs on healthy, anesthetized patients with predicted 'easy' intubations. Each subject's FOI was evaluated by blinded examiners, using a validated global rating scale and checklist. Success and time were also measured. RESULTS: Data were analyzed using a two-way mixed design analysis of variance. There was no significant difference between the low-fidelity (n = 14) and high-fidelity (n = 14) model groups when compared with the global rating scale, checklist, time, and success at achieving tracheal intubation (all P = not significant). Second attempts in both groups were significantly better than first attempts (P < 0.001), and there was no interaction between 'fidelity of training model' and 'first versus second attempt' scores. CONCLUSIONS: There was no added benefit from training on a costly virtual reality model with respect to transfer of FOI skills to intraoperative patient care. Second attempts in both groups were significantly better than first attempts. Low-fidelity models for FOI training outside the operating room are an alternative for programs with budgetary constraints. [ABSTRACT FROM AUTHOR]

Several indirect laryngoscopes have recently been developed, but relatively few have been formally compared. In this study we evaluated the efficacy and the usability of the Macintosh, the Glidescope®, the McGrath® and the Airtraq® laryngoscopes. Sixty anaesthesia providers (20 staff, 20 residents, and 20 nurses) were enrolled into this study. The volunteers intubated the trachea of a Laerdal SimMan® manikin in three simulated difficult airway scenarios. In all scenarios, indirect laryngoscopes provided better laryngeal exposure than the Macintosh blade and appeared to produce less dental trauma. In the most difficult scenario (tongue oedema), the Macintosh blade was associated with a high rate of failure and prolonged intubation times whereas indirect laryngoscopes improved intubation time and rarely failed. Indirect laryngoscopes were judged easier to use than the Macintosh. Differences existed between indirect devices. The Airtraq® consistently provided the most rapid intubation. Laryngeal grade views were superior with the Airtraq® and McGrath® than with the Glidescope®. [ABSTRACT FROM AUTHOR]

Abstract: The Airtraq laryngoscope (Prodol Meditec S.A., Vizcaya, Spain) is a new disposable optical laryngoscope designed to facilitate intubation in an uncomplicated or difficult airway. Its distinctive shape and its optical system can provide a full view of the glottis without the need to align the oropharyngeal axis. The use of this device as the primary technique to manage the airway of three patients with a previous history of difficult intubation related to difficult laryngoscopy is presented. [Copyright &y& Elsevier]

Abstract: Procyanidolic oligomers (PCO) are mainly used for their therapeutic effect on the vascular wall. We could show that the mechanism of this effect involves interactions with mesenchymal cells and extracellular matrix (ECM). Recently we demonstrated in vitro that they also act on cornea, a tissue rich in ECM. For instance they stimulate the corneal biosynthesis of type VI collagen and proteoglycans. A potent antiprotease effect also could be demonstrated on corneas. In our present work we examined in vivo action of PCO on corneas. A group of rabbits received during 1 week on their right eye a treatment by procinaidolic oligomers, the left eyes were kept as controls. After 1 week both eyes underwent excimer laser photobalation. Another group of rabbits also received the PCO treatment on the right eye, not on the left, but was not treated by photoablation. One week after the surgical intervention corneas were collected and biochemical and morphological observations were carried out. Ocular administration of PCO was well tolerated and no toxic or inflammatory side-effects could be seen. In the control group photoablation was followed by a decrease of the content of corneas in type I collagen and a strong increase in type III collagen. On the corneas treated by PCO these alterations of the composition were not observed. These results indicate that PCO treatment before excimer laser photoablation maintains within normal limits the biochemical composition of the operated corneas. [Copyright &y& Elsevier]