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International audience; This letter introduces the new European Settlement Map (ESM) production workflow, presents some indicatory results, and discusses the validation process. Unlike the previous ESM versions, the built-up (BU) extraction is realized through supervised learning (not only by means of image filtering and processing techniques) based on textural and morphological features. Input data are the Copernicus very-high-resolution image collection for the reference year 2015 coming from a variety of sensors. The workflow is fully automated, and it does not include any postprocessing. For the first time, a new layer containing nonresidential buildings was derived by using only remote sensing imagery and training data. The produced BU map is delivered at 2-m-pixel resolution (level-1 layer), while the residential/nonresidential layer (level 2) is delivered at 10-m spatial resolution. More than 46,000 scenes were processed, and around 6 million km² of the European territory was mapped. The workflow was executed on the JRC Big Data platform. The validation showed a balanced accuracy of 0.81 and 0.91 for level 1 and 2 layers, respectively, and 0.71 for only the nonresidential layer.

The present paper presents the planning, implementation, observation and analysis of both quantitative and qualitative data of a participatory action research, aiming to study the potential role, value and uses of MOOCs in secondary education. Within the context of this research, a computer programming hybrid MOOC (named PROG15) which combined aspects of both x- and c-MOOCs architecture and pedagogy was designed, implemented and openly provided to Greek Secondary Education students.The MOOC completion rate (xMOOC dimension) was relatively low, but similar to that of typical xMOOCs for adults, while the degree of collaboration with other students and contribution to the course content (the cMOOC dimension) was relatively average. Before their involvement in the MOOC, the participating students recorded particularly high learning expectations from the specific course and from the collaborative learning model it proposed and quite positive views regarding the impact of this new educational tool on secondary education. Their attitude towards these issues was even more positive after their involvement in the MOOC, while their overall experience was particularly positive.The above findings, although they resulted from a comparatively small sample of students for the measures of MOOCs and within a very specific educational context, they form a particularly promising background for the utilization of this new tool in secondary education in general and specifically for the preparation of students for higher education studies, in subjects related to computer programming. Of course, further research and investigation is required on the design, development and implementation of the next generation of MOOCs and the practical and theoretical research outcomes resulted from this research can be a quite valuable input.

This work presents a novel method for detecting newly built-up areas in Very High Resolution satellite imagery using Fully Convolutional Neural Networks. The architecture builds on Early Fusion concept where the pairs of image patches are concatenated before inputting into the network as different color channels. The model was trained on different sensors (Pleiades, Kompsat and Superview) using the labels from the Urban Atlas change maps (2012-2018). The results demonstrate the potential of the proposed method for a pan-European mapping of changes in built-up areas at a spatial resolution of 2 meters in the framework of the European Settlement Map of the Joint Research Centre.

For critically ill patients with coronavirus disease 2019 (COVID-19) who require intensive care unit (ICU) admission, extremely high mortality rates (even 97%) have been reported. We hypothesized that overburdened hospital resources by the extent of the pandemic rather than the disease per se might play an important role on unfavorable prognosis. We sought to determine the outcome of such patients admitted to the general ICUs of a hospital with sufficient resources. We performed a prospective observational study of adult patients with COVID-19 consecutively admitted to COVID&mdash, designated ICUs at Evangelismos Hospital, Athens, Greece. Among 50 patients, ICU and hospital mortality was 32% (16/50). Median PaO2/FiO2 was 121 mmHg (interquartile range (IQR), 86&ndash, 171 mmHg) and most patients had moderate or severe acute respiratory distress syndrome (ARDS). Hospital resources may be an important aspect of mortality rates, since severely ill COVID-19 patients with moderate and severe ARDS may have understandable mortality, provided that they are admitted to general ICUs without limitations on hospital resources.

Background: For critically ill patients with coronavirus disease 2019 (COVID-19) who require intensive care unit (ICU) admission, mortality rates vary widely depending on many factors, among which hospital resources and clinical setting seem important. We sought to determine the outcome of critically ill patients admitted in the usual multidisciplinary ICUs of a big referral for COVID-19 tertiary-care hospital with adequate resources.Methods: We performed a prospective observational study of all adult patients with COVID-19 consecutively admitted to four COVID-designated ICUs at Evangelismos Hospital, Athens, Greece, from March 11 to April 27, 2020.Results: Among 50 critically ill patients, ICU and hospital mortality for the entire cohort was 32% (16/50), whereas 66% (33/50) of patients were discharged alive from the ICU and 2% (1/50) were still treated in the ICU until June 16, 2020. ICU and hospital mortality for those who received invasive mechanical ventilation was 39% (16/41). Patients who eventually died had already increased risk of death on ICU admission, as suggested by the high values of the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, the presence of current malignancy and occurrence of cardiac arrest in 44% (7/16) of patients, and the general need for circulatory support by noradrenaline. Median PaO2/FiO2 on ICU admission for the entire cohort was 121 mmHg [interquartile range (IQR), 86-171 mmHg] and most patients had moderate and severe acute respiratory distress syndrome (ARDS) according to the Berlin Definition. The primary cause of death of all patients was multi-organ failure, most commonly due to sepsis, whereas none died from refractory hypoxemia, neurologic dysfunction or withdrawal of life support. Hospital stay was long in patients who survived [median 24 days (IQR, 15-35 days)] and was frequently complicated by bacteremias [36% (12/33)].Conclusion: Severely ill COVID-19 patients with moderate and severe ARDS may have equal or even lower mortality rates compared to ARDS due to other causes, when they are admitted in general ICUs with experienced and adequate staff without limitations in hospital resources, where established ARDS therapies are used.

Large-scale land cover classification from satellite imagery is still a challenge due to the big volume of data to be processed, to persistent cloud-cover in cloud-prone areas as well as seasonal artefacts that affect spatial homogeneity. Sentinel-2 times series from Copernicus Earth Observation program offer a great potential for fine scale land cover mapping thanks to high spatial and temporal resolutions, with a decametric resolution and five-day repeat time. However, the selection of best available scenes, their download together with the requirements in terms of storage and computing resources pose restrictions for large-scale land cover mapping. The dataset presented in this paper corresponds to global cloud-free pixel based composite created from the Sentinel-2 data archive (Level L1C) available in Google Earth Engine for the period January 2017- December 2018. The methodology used for generating the image composite is described and the metadata associated with the 10 m resolution dataset is presented. The data with a total volume of 15 TB is stored on the Big Data platform of the Joint Research Centre. It can be downloaded per UTM grid zone, loaded into GIS clients and displayed easily thanks to pre-computed overviews.

Continuous global-scale mapping of human settlements in the service of international agreements calls for massive volume of multi-source, multi-temporal, and multi-scale earth observation data. In ...

The main purpose of this study was to investigate and compare the attitudes of freshmen and senior students of the Department of Primary Education, University of Thessaly, Greece, towards Information and Communications Technology (ICT) in Education. Moreover, this study explored the possible existence of correlations between the variables of the attitudes and the influence of various factors related to their formation. The research project has adopted the characteristics of a comparative study. The survey results have showed that the freshmen students of the specific sample display a more positive attitude towards the computer as an essential teaching tool; they also recognize to a greater degree the necessity of consistent ICT use in contemporary education and are more willing to incorporate computer use in their future teaching assignments. Last, the most powerful factor that affects the attitudes of prospective teachers is the viewpoint of their university professors who teach ICT-related courses.

The Gerbode defect is characterized by a perimembranous ventricular septal defect between the left ventricle and the right atrium. This intracardiac shunt is a congenital defect but may be iatrogenic after valve surgery or atrioventricular node ablation, may be the result of endocarditis or may be traumatic. It is really rarely encountered as sequelae of non-penetrating heart trauma, and their clinical manifestations may often be unrecognized in the multi-injured patient. However, they are serious complications, and their diagnostic approach is not always feasible. We hereby present a case of a young man with the left ventricle to the right atrium communication after blunt thoracic trauma due to a car accident and concomitant rupture of the thoracic aorta. We present also the case and the ways of treatment according to the international bibliography.

Summary We report the life-saving administration of thrombolysis during cardiopulmonary resuscitation in a patient with recent intracerebral haemorrhage. A 53-year-old male with intracerebral haemorrhage was admitted to the intensive care unit. On the 24th day of treatment he suffered cardiac arrest with pulseless electrical activity. Transoesophageal echocardiography was performed during ongoing cardiopulmonary resuscitation. Thrombi in the right heart cavities with excessive right ventricular dysfunction confirmed the diagnosis of fulminant pulmonary embolism. Permanent restoration of a spontaneous rhythm was feasible only after administration of systemic thrombolysis with recombinant tissue plasminogen activator. Neurological examination and a computed tomogram of the brain did not show rebleeding. We conclude that under extreme circumstances absolute contraindications to thrombolysis should be weighed against the potential benefit.

Primary small cell bladder carcinoma is an extremely rare and highly aggressive tumor. Unfortunately, the optimal therapeutic strategy for the tumor is still unknown. Recently, a two-stage system for limited and extensive small cell bladder carcinoma has been suggested in analogy to the practiced staging and treatment of small cell lung carcinoma. We present a new case of small cell bladder carcinoma and discuss relevant current literature.

Logic reasoning presents notable difficulties for young children. This paper presents Logic Model Creator (LMC), a new environment that supports building and exploration of intuitive visual representation of logic models by young children. LMC logic models are structured as hypothesis, decision and / or counter decision components. These models are built using visual entities which represent the learning concepts of a specific domain. In this paper we focus on the architecture of LMC and the basic functionality of the environment. In particular we describe the the dynamic creation of equivalent logic models according to the so-called Reference Logic Model, constructed by the students’ tutor. Furthermore an assessment module which provides immediate advice to the student in order to help them create a valid logic model is presented. Through experimentation it is demonstrated that the users of LMC can have rich interaction and assessment while exploring decision making logic constructs.

Mechanically ventilated patients in the intensive care unit cannot cooperate to perform the Valsalva maneuver during echocardiography for detection of patent foramen ovale. We evaluated the effectiveness of the end-inspiratory occlusion maneuver to enhance detection of patent foramen ovale in this patient population. Prospective interventional study. The 40-bed intensive care unit of a university hospital. Twenty five sedated and mechanically ventilated intensive care unit patients referred by their attending physician for bedside transesophageal echocardiography and agitated saline contrast study for detection of patent foramen ovale. Agitated saline contrast study with end-inspiratory occlusion maneuver. All patients underwent a complete transesophageal echocardiographic study without any complications. Reduction in right atrial cross-sectional area (from 15.80 ± 6.08 cm2 to 12.40 ± 4.63 cm2; p

This paper presents the main characteristics of Logic Models Creator (LMC). LMC is a new educational environment for young students to build and explore logic models in graphical form. LMC allows visual representation of logic models using IF/THEN/ELSE constructs. In this paper we provide an overview of LMC architecture and discuss briefly an example of use of LMC. As discussed, LMC users in the reported case study managed to achieve effective communication and task evaluation during exploration of problems involving decision making.

We report the use of endoscopic techniques for successful diagnosis in a case of atypical esophageal tuberculosis. Tuberculosis of the esophagus is an unusual presentation of this disease, having been estimated to occur in 0.15% of the people who die of tuberculosis. A few cases of possible primary tuberculous esophagitis have been described. This report describes a patient with dysphagia who appeared to have esophageal tuberculosis without HIV and in the absence of other signs of tuberculosis. The patient responded promptly to treatment with tuberculostatics.

Introduction Bedside lung sonography is a useful imaging tool to assess lung aeration in critically ill patients. The purpose of this study was to evaluate the role of lung sonography in estimating the nonaerated area changes in the dependent lung regions during a positive end-expiratory pressure (PEEP) trial of patients with early acute respiratory distress syndrome (ARDS). Methods Ten patients (mean ± standard deviation (SD): age 64 ± 7 years, Acute Physiology and Chronic Health Evaluation II (APACHE II) score 21 ± 4) with early ARDS on mechanical ventilation were included in the study. Transthoracic sonography was performed in all patients to depict the nonaerated area in the dependent lung regions at different PEEP settings of 5, 10 and 15 cm H2O. Lung sonographic assessment of the nonaerated lung area and arterial blood gas analysis were performed simultaneously at the end of each period. A control group of five early ARDS patients matched for APACHE II score was also included in the study. Results The nonaerated areas in the dependent lung regions were significantly reduced during PEEP increases from 5 to 10 to 15 cm H2O (27 ± 31 cm2 to 20 ± 24 cm2 to 11 ± 12 cm2, respectively; P < 0.01). These changes were associated with a significant increase in arterial oxygen partial pressure (74 ± 15 mmHg to 90 ± 19 mmHg to 102 ± 26 mmHg; P < 0.001, respectively). No significant changes were observed in the nonaerated areas in the dependent lung regions in the control group. Conclusions In this study, we show that transthoracic lung sonography can detect the nonaerated lung area changes during a PEEP trial of patients with early ARDS. Thus, transthoracic lung sonography might be considered as a useful clinical tool in the management of ARDS patients.

Both experimental and clinical data give convincing evidence to acute cardiac dysfunction as the origin or a cofactor of weaning failure in patients with chronic obstructive pulmonary disease. Therefore, treatment targeting the cardiovascular system might help the heart to tolerate more effectively the critical period of weaning. This study aims to assess the hemodynamic, respiratory and clinical effects of nitroglycerin infusion in difficult-to-wean patients with severe chronic obstructive pulmonary disease. Twelve difficult-to-wean (failed ≥ 3 consecutive trials) chronic obstructive pulmonary disease patients, who presented systemic arterial hypertension (systolic blood pressure ≥ 140mmHg) during weaning failure and had systemic and pulmonary artery catheters in place, participated in this prospective, interventional, non-randomized clinical trial. Patients were studied in two consecutive days, i.e., the first day without (Control day) and the second day with (Study day) nitroglycerin continuous intravenous infusion starting at the beginning of the spontaneous breathing trial, and titrated to maintain normal systolic blood pressure. Hemodynamic, oxygenation and respiratory measurements were performed on mechanical ventilation, and during a 2-hour T-piece spontaneous breathing trial. Primary endpoint was hemodynamic and respiratory effects of nitroglycerin infusion. Secondary endpoint was spontaneous breathing trial and extubation outcome. Compared to mechanical ventilation, mean systemic arterial pressure, rate-pressure product, mean pulmonary arterial pressure, and pulmonary artery occlusion pressure increased [from (mean ± SD) 94 ± 14, 13708 ± 3166, 29.9 ± 4.8, and 14.8 ± 3.8 to 109 ± 20mmHg, 19856 ± 4877mmHg b/min, 41.6 ± 5.8mmHg, and 23.4 ± 7.4 mmHg, respectively], and mixed venous oxygen saturation decreased (from 75.7 ± 3.5 to 69.3 ± 7.5%) during failing trials on Control day, whereas they did not change on Study day. Venous admixture increased throughout the trial on both Control day and Study day, but this increase was lower on Study day. Whereas weaning failed in all patients on Control day, nitroglycerin administration on Study day enabled a successful spontaneous breathing trial and extubation in 92% and 88% of patients, respectively. In this clinical setting, nitroglycerin infusion can expedite the weaning by restoring weaning-induced cardiovascular compromise.

The purpose of this study was to determine the efficacy of ultrasonography (US) in the detection of alveolar-interstitial syndrome and pleural effusion in critically ill patients, compared with the results of the gold standard computed tomography (CT).

Introduction Critically ill patients are characterized by increased loss of muscle mass, partially attributed to sepsis and multiple organ failure, as well as immobilization. Recent studies have shown that electrical muscle stimulation (EMS) may be an alternative to active exercise in chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients with myopathy. The aim of our study was to investigate the EMS effects on muscle mass preservation of critically ill patients with the use of ultrasonography (US). Methods Forty-nine critically ill patients (age: 59 ± 21 years) with an APACHE II admission score ≥13 were randomly assigned after stratification upon admission to receive daily EMS sessions of both lower extremities (EMS-group) or to the control group (control group). Muscle mass was evaluated with US, by measuring the cross sectional diameter (CSD) of the vastus intermedius and the rectus femoris of the quadriceps muscle. Results Twenty-six patients were finally evaluated. Right rectus femoris and right vastus intermedius CSD decreased in both groups (EMS group: from 1.42 ± 0.48 to 1.31 ± 0.45 cm, P = 0.001 control group: from 1.59 ± 0.53 to 1.37 ± 0.5 cm, P = 0.002; EMS group: from 0.91 ± 0.39 to 0.81 ± 0.38 cm, P = 0.001 control group: from 1.40 ± 0.64 to 1.11 ± 0.56 cm, P = 0.004, respectively). However, the CSD of the right rectus femoris decreased significantly less in the EMS group (-0.11 ± 0.06 cm, -8 ± 3.9%) as compared to the control group (-0.21 ± 0.10 cm, -13.9 ± 6.4%; P < 0.05) and the CSD of the right vastus intermedius decreased significantly less in the EMS group (-0.10 ± 0.05 cm, -12.5 ± 7.4%) as compared to the control group (-0.29 ± 0.28 cm, -21.5 ± 15.3%; P < 0.05). Conclusions EMS is well tolerated and seems to preserve the muscle mass of critically ill patients. The potential use of EMS as a preventive and rehabilitation tool in ICU patients with polyneuromyopathy needs to be further investigated. Trial Registration clinicaltrials.gov: NCT00882830