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Images provided by the ESA Sentinel-2 mission are rapidly becoming the main source of information for the entire remote sensing community, thanks to their unprecedented combination of spatial, spectral and temporal resolution, as well as their associated open access policy. Due to a sensor design trade-off, images are acquired (and delivered) at different spatial resolutions (10, 20 and 60 m) according to specific sets of wavelengths, with only the four visible and near infrared bands provided at the highest resolution (10 m). Although this is not a limiting factor in general, many applications seem to emerge in which the resolution enhancement of 20 m bands may be beneficial, motivating the development of specific super-resolution methods. In this work, we propose to leverage Convolutional Neural Networks (CNNs) to provide a fast, upscalable method for the single-sensor fusion of Sentinel-2 (S2) data, whose aim is to provide a 10 m super-resolution of the original 20 m bands. Experimental results demonstrate that the proposed solution can achieve better performance with respect to most of the state-of-the-art methods, including other deep learning based ones with a considerable saving of computational burden.

Rehabilitation Specialized Medicine offers new developments in relation to the new technologies, new demography, life expectation and chronicity. The same attention that in modern health systems is given to quality process and outcome, should also concern the hospital structural aspects, in order to humanize these spaces. In this perspective, the definition of a structure easy to access with well-defined areas within it, such us an external waiting area, reception area and work area, represents an integration which allows to achieve the goal of providing quality performance. The need of a new concept of rehabilitation space in the cardio-respiratory area, especially that of the Gymnasium, must be developed keeping in consideration the main scientific guidelines in cardio-respiratory field. Consequently, this will have four dedicated areas respectively to evaluation, aerobic training, strength training and educational, each one characterized by different colors. The abstract idea of "digital comprehensive rehabilitation", in which are inserted all rehabilitative services facilitated by the gym digitalization, are located in this context, and their main aim is to answer to the patient needs.Il mondo della Medicina Specialistica Riabilitativa delle cure correlate offre nuovi sviluppi connessi alle nuove tecnologie, alla nuova demografia, all’aspettativa di vita, alla cronicità. La stessa attenzione che nei sistemi sanitari moderni viene dedicata al tema della qualità in termini di processo ed esito, dovrebbe riguardare anche gli aspetti strutturali ospedalieri con il fine di umanizzare questi spazi. In quest’ottica, la definizione di una struttura facilmente accessibile con al suo interno aree ben delineate, quali zona di attesa esterna, area di ricevimento e zona di lavoro, rappresenta un’integrazione per raggiungere l’obiettivo di erogazione di prestazioni di qualità. La necessità di un nuovo concetto di spazio riabilitativo dell’area cardio-respiratoria, in particolare quello della Palestra, dovrà essere elaborata tenendo conto delle principali linee guida in ambito cardio-respiratorio. Di conseguenza, quest’ultima, disporrà di quattro aree dedicate rispettivamente alla valutazione, all’allenamento aerobico, all’allenamento della forza e all’educazione sanitaria/formazione, ciascuna distinta da un diverso colore. In questo contesto si inserisce il concetto (astratto) di “palestra digitale”, contenitore di tutte le prestazioni riabilitative, facilitato dalla digitalizzazione della palestra, il cui scopo principale è di rispondere in modo completo alle esigenze e ai bisogni dei pazienti.

Background AtrioVentricular (AV) and InterVentricular (VV) delay optimization can improve ventricular function in Cardiac Resynchronization Therapy (CRT) and is usually performed by means of echocardiography. St Jude Medical has developed an automated algorhythm which calculates the optimal AV and VV delays (QuickOpt™) based on Intracardiac ElectroGrams, (IEGM), within 2 min. So far, the efficacy of the algorhythm has been tested acutely with standard lead position at right ventricular (RV) apex. Aim of this project is to evaluate the algorhythm performance in the mid- and long-term with RV lead located in mid-septum. Methods AV and VV delays optimization data were collected in 13 centers using both echocardiographic and QuickOpt™ guidance in CRTD implanted patients provided with this algorhythm. Measurements of the aortic Velocity Time Integral (aVTI) were performed with both methods in a random order at pre-discharge, 6-month and 12-month follow-up. Results Fifty-three patients were studied (46 males; age 68 ± 10y; EF 28 ± 7%). Maximum aVTI obtained by echocardiography at different AV delays, were compared with aVTI acquired at AV delays suggested by QuickOpt. The AV Pearson correlations were 0.96 at pre-discharge, 0.95 and 0,98 at 6- and 12- month follow-up respectively. After programming optimal AV, the same approach was used to compare echocardiographic aVTI with aVTI corresponding to the VV values provided by QuickOpt. The VV Pearson Correlation were 0,92 at pre-discharge, 0,88 and 0.90 at 6-month and 12- month follow-up respectively. Conclusions IEGM-based optimization provides comparable results with echocardiographic method (maximum aVTI) used as reference with mid-septum RV lead location.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Collaboration between teachers and OTs improves student performance and promotes positive student outcomes in school-based OT (Kennedy & Stewart, 2012). Collaboration with OTs was valued by 85.1% of respondents, and 62% of respondents considered OT's goal in the schools to be focused on fine motor skills. This survey shows that general education teachers value collaboration with OTs but do not fully understand the role of OT, which may limit the effectiveness of collaboration. Primary Author and Speaker: Erin E. Bradley Contributing Authors: Elizabeth Hassett, Antonio Mazza, and Gifty Abraham

Cardiac rehabilitation (CR) represents a cardiology subspecialty that is devoted to the care of cardiac patients, early and long term after an acute event. CR aims at improving both quality of life and prognosis through risk and prognostic stratification, clinical stabilization and optimization of therapy, management of comorbidities, treatment of disability, and the provision of sustained long-term preventive and rehabilitative services.The mission of CR has changed over time. From being centred on the acute phase, health care of cardiac patients is increasingly involving the long-term chronic phase. The aim of the present position paper is to provide the state of the art of CR in Italy, discussing strengths and weaknesses as well as future perspectives.

Cardiac rehabilitation (CR) is the subspecialty of clinical cardiology dedicated to the treatment of cardiac patients, early and in the long term after an acute event. The aim of CR is to improve both quality of life and prognosis through prognostic stratification, clinical stabilization and optimization of therapy (pharmacological and non), management of comorbidities, treatment of disability, as well as through the provision and reinforcement of secondary prevention interventions and maintenaince of adherence to treatment. The mission of CR has changed over time. Once centered on the acute phase, aimed primarily at short-term survival, the healthcare of cardiac patients now increasingly involves the chronic phase where the challenge is to guarantee continuity and quality of care in the medium and long-term. The aim of the present position paper is to provide the state-of-the-art of CR in Italy, discussing its trengths and weaknesses as well as future perspectives.

Background In cardiovascular prevention and rehabilitation, care activities are carried out by different professionals in coordination, each with their own specific competence. This GICR–IACPR position paper has analysed the interventions performed by the nurse, physiotherapist, dietician and psychologist in order to identify what constitutes minimal care, and it lists the activities that are fundamental and indispensable for each team member to perform in clinical practice. Results In analysing each type of intervention, the following dimensions were considered: the level of clinical care complexity, determined both by the disease and by environmental factors; the ‘area’ complexity, i.e. the specific level of competence required of the professional in each professional section; organisational factors, i.e. whether the care is performed in an inpatient or outpatient setting; duration of the rehabilitation intervention. The specific contents of minimal care have been identified for each professional area together with the specific goals, the assessment tools and the main essential interventions. For the assessments, only a few validated tools have been indicated, leaving the choice of which instrument to use to the individual professional based on experience and usual practice. Conclusion For the interventions, attention has been focused on conditions of major complexity requiring special care, taking into account the different care settings, the clinical conditions secondary to the disease event, and the distinct tasks of each area according to the operator's specific role. The final report performed by each professional has also been included.

Sentinel-2 data represent a rich source of information for the community due to the free access and to the temporal-spatial coverage assured. However, some of the spectral bands are sensed at reduced resolution due to a compromise between technological limitations and Copernicus program's objectives. For this reason in this work we present a new super-resolution method based on Convolutional Neural Networks (CNNs) to rise the resolution of the short wave infra-red (SWIR) band from 20 to 10 meters, that is the highest resolution provided. This is accomplished by fusing the target band with the finer-resolution ones. The proposed solution compares favourably against several alternative methods according to different quality indexes. In addition we have also tested the use of the super-resolved band from an applicative perspective by detecting water basins through the Modified Normalized Difference Water Index (MNDWI).

Sensitivity to weather conditions, and specially to clouds, is a severe limiting factor to the use of optical remote sensing for Earth monitoring applications. A possible alternative, is to resort to weather-insensitive synthetic aperture radar (SAR) images. However, in many real-world applications, critical decisions are made based on some informative spectral features, such as water, vegetation or soil indices, which cannot be extracted from SAR images. In the absence of optical sources, these data must be estimated. The current practice is to perform linear interpolation between data available at temporally close time instants. In this work, we propose to estimate missing spectral features through data fusion and deep-learning. Several sources of information are taken into account - optical sequences, SAR sequences, DEM - so as to exploit both temporal and cross-sensor dependencies. Based on these data, and a tiny cloud-free fraction of the target image, a compact convolutional neural network (CNN) is trained to perform the desired estimation. To validate the proposed approach, we focus on the estimation of the normalized difference vegetation index (NDVI), using coupled Sentinel-1 and Sentinel-2 time-series acquired over an agricultural region of Burkina Faso from May to November 2016. Several fusion schemes are considered, causal and non-causal, single-sensor or joint-sensor, corresponding to different operating conditions. Experimental results are very promising, showing a significant gain over baselines methods according to all performance indicators.

Purpose – The aim of the present work is to provide a case study where lean production (LP) techniques are implemented in a semi-automated assembly line with O-shaped (closed-loop) layout configuration. The action research has been conducted within an assembly line for automotive components. The work aims to provide insights on the impact of loop layout features with respect to lean principles’ application; operative solutions related to some logistic limit of loop layout; and how kanban technique can be adapted to an O-shaped layout. Design/methodology/approach – The main research methodology is based on action research within an assembly line of oil pumps. The two research questions find answer through literature analysis and implementation of LP in the O-shaped layout. In the A3 step, we identify the main weak points of a loop layout also under the perspective of operators’ feeling. The analysis of the main constraints is conducted in this step, with respect to the most common layout used within LP adoption. Steps A4 and A5 answer to RQ2 by an on-field results’ analysis. Findings – The use of an O-shaped layout may allow to improve ergonomic conditions for workers; to better organize parts feeding through slides and chutes because of the presence of operators outside the line. The new approach to determine the number of withdrawal kanban potentially extends the findings of Tardif et al. (2012): the minimum of the objective function is reached with a higher number of withdrawal kanbans. Research limitations/implications – The approach is applied within a stand-alone line, while in several industrial contexts, we may find several of these lines in the same shop floor. In this case, LP implementation would cope with the several kanban cards circulating, the over-saturation of the logistic operator in supplying all the lines with smaller quantities of materials. Practical implications – The action research resulted in the introduction of a new concept of supermarket, conceived as a decoupling buffer that lies near the line and in the review feeding devices, with the adoption of bins and operators’ feeding chutes. Parts’ feeding systems is reorganized with a two levels of withdrawal kanban. The introduction of line supermarket and the change of supply policies from pallets to bins contributed to the strong reduction of average work-in-progress. Yet, the double-withdrawal kanban and the small quantities supplied may cause an increase of material handling times and meters covered by operators. Social implications – Better working condition of the line operators because of the presence of ergonomic chutes for parts’ feeding. In contrast, we observed a high saturation of logistic operator because of the small quantities of components supplied on the line, with an increased stress of this worker. Originality/value – A decoupled withdrawal kanban (DWK) is developed. In DWK, the first withdrawal is issued to the supermarket that serves the line. The second withdrawal kanban is issued from the supermarket to the central warehouse. Within DWK, we propose a modified dimensioning formula through minimization of the objective function Z(k). Parts’ feeding is now organized with sliding chutes on operators’ workstations to collect components in accordance to kanban dimensioning.

Aortic arch interruption or atresia consists in a complete loss of anatomical and luminal continuity between the ascending and descending thoracic aorta. It is usually diagnosed in newborn babies but may also be present in young children, adolescents, adults and elderly patients. In these cases, it can be congenital or more frequently acquired. This latter type of aortic arch atresia is a challenge, and surgery is usually the treatment of choice. Percutaneous approaches are also possible today. We describe a case of percutaneous aortic arch reconstruction in a 9-year-old boy.

Background. Delays detecting treatment failure and switching to second-line combination antiretroviral therapy (cART) are often observed in human immunodeficiency virus (HIV)–infected children of low-middleincome countries (LMIC). Methods. An observational study included HIV-infected children attending the Beira Central Hospital (Mozambique) and the Nsambya Hospital, Home Care Department (Uganda) evaluated clinical and immunological failure according to World Health Organization (WHO) 2006 guidelines. Baseline predictors for cART failure and for drug substitution were explored in unadjusted and adjusted Cox proportional hazard models. Results. Two hundred eighteen of 740 children with at least 24 weeks follow-up experienced treatment failure (29%; 95% confidence interval [CI] 26–33), with crude incidence of 20.0 events per 100 person-years (95% CI 17.5–22.9). Having tuberculosis co-infection or WHO stage 4, or starting a nontriple cART significantly increased risk of failure. Two hundred two of 769 (26.3%) children receiving cART substituted drug(s), with crude incidence of 15.4 events per 100 person-years (95% CI 13.4–17.7). Drug toxicity (18.3%), drug availability (17.3%), and tuberculosis drugs interaction (52, 25.7%) were main reported reasons, while only 9 (4%) patients switched cART for clinical or immunological failure. Children starting lamivudine-zidovudine-nevirapine or lamivudine-stavudineefavirenz or lamivudine-zidovudine-efavirenz were more likely to have substitute drugs. Increased substitution was found in children with mild immunosuppression and tuberculosis co-infection at cART initiation as well as poor adherence before drug substitution. Conclusions. Considerable delay in switching to second-line cART may occur despite an observed high rate of failure. Factors including WHO clinical stage and tuberculosis co-infection should be evaluated before starting cART. Toxicity and drug adherence should be monitored to minimize drug substitution in LMIC.

Community Home-Based Care (CHBC) has evolved in resource-limited settings to fill the unmet needs of people living with HIV/AIDS (PLHA). We compare HIV and tuberculosis (TB) outcomes from the Nsambya CHBC with national averages in Kampala, Uganda. This retrospective observational study compared HIV and TB outcomes from adults and children in the Nsambya CHBC to national averages from 2007 to 2011. Outcomes included numbers of HIV and TB patients enrolled into care, retention, loss to follow-up (LTFU), and mortality among patients on antiretroviral therapy (ART) at 12 months from initiation; new smear-positive TB cure and defaulter rates; and proportion of TB patients tested for HIV. Chi-square test and trends analyses were used to compare outcomes from Nsambya CHBC with national averages. By 2011, approximately 14,000 PLHA had been enrolled in the Nsambya CHBC, and about 4,000 new cases of TB were detected and managed over the study period. Overall, retention and LTFU of ART patients 12 months after initiation, proportion of TB patients tested for HIV, and cure rates for new smear-positive TB scored higher in the Nsambya CHBC compared to national averages. The findings show that Nsambya CHBC complements national HIV and TB management and results in more positive outcomes.

In the last decade, industrial research for sustainable development and environment has become more strategically oriented, due to increasing of environmental pressures coming from local laws, stakeholders, and final customers. The goal of this research is to create a methodical approach for integrating the development of environmental and quality audits by prioritizing corrective actions (CA). The work starts and develops within a firm that produces smartcards for mobile phones, where environmental audits have been integrated with quality audits by a fuzzy inference engine that addresses gravity determinations of environmental and quality nonconformities. The findings of this study provided some general principles to integrate environmental management system (EMS) in quality management system (QMS) development and suggested an implementation of Continuous Improvement, which addresses, analyzes, prioritizes, and measures activities within the Deming wheel.

Background: Celiac disease (CD) is an immunologically-mediated disorder characterized by duodenal mucosa villi atrophy. Iron absorption is usually reduced in celiac patients making every kind of oral iron treatment unhelpful because of malasorption. Feralgine™ is a new product that has been demonstrated to be more bioavailable. As such, the aim of our study was to evaluate the absorption of Feralgine™ in adult patients with CD. Methods: Twenty-six adults affected by Iron Deficiency Anemia (IDA), of which 14 were also affected by CD and 12 were not affected by CD, were enrolled. An oral iron absorption test (OIAT) was performed in each patient by administrating Feralgine™, and serum iron was evaluated at baseline (T0) and after 2 h (T1) from the oral iron ingestion. Results: The OIAT was well tolerated in all patients, and, surprisingly, an equivalent statistically significant improvement in serum iron occurred in the two groups of patients (IDA plus CD: T0 = 28.21 µg/dL vs. T1 = 94.14 µg/dL p = 0.004 and IDA without CD: T0 = 34.91 µg/dL vs. T1 = 118.83 µg/dL, p = 0.0003). Conclusions: These results demonstrated the high absorption of Feralgine™ in celiac patients, confirming our previous data obtained with Ferrous Bysglicinate in children with CD.

Since different pedologists will draw different soil maps of a same area, it is important to compare the differences between mapping by specialists and mapping techniques, as for example currently intensively discussed Digital Soil Mapping. Four detailed soil maps (scale 1:10.000) of a 182-ha sugarcane farm in the county of Rafard, São Paulo State, Brazil, were compared. The area has a large variation of soil formation factors. The maps were drawn independently by four soil scientists and compared with a fifth map obtained by a digital soil mapping technique. All pedologists were given the same set of information. As many field expeditions and soil pits as required by each surveyor were provided to define the mapping units (MUs). For the Digital Soil Map (DSM), spectral data were extracted from Landsat 5 Thematic Mapper (TM) imagery as well as six terrain attributes from the topographic map of the area. These data were summarized by principal component analysis to generate the map designs of groups through Fuzzy K-means clustering. Field observations were made to identify the soils in the MUs and classify them according to the Brazilian Soil Classification System (BSCS). To compare the conventional and digital (DSM) soil maps, they were crossed pairwise to generate confusion matrices that were mapped. The categorical analysis at each classification level of the BSCS showed that the agreement between the maps decreased towards the lower levels of classification and the great influence of the surveyor on both the mapping and definition of MUs in the soil map. The average correspondence between the conventional and DSM maps was similar. Therefore, the method used to obtain the DSM yielded similar results to those obtained by the conventional technique, while providing additional information about the landscape of each soil, useful for applications in future surveys of similar areas.

BACKGROUND Celiac disease (CD) is an immunologically-mediated enteropathy resulting in small-bowel mucosal villous atrophy with crypt hyperplasia. Iron malabsorption is usually observed in CD. Only few studies investigated oral iron absorption in subjects with gastrointestinal diseases and Iron Deficiency Anemia (IDA), using the oral iron absorption test (OIAT). We considered useful to investigate the OIAT, using ferrous bisglycinate chelate (FBC), in patients with CD at diagnosis or on gluten free diet (GFD) from at least 1 year. METHODS A total of 25 patients with CD (3-18 years old) and iron depletion, at diagnosis of CD (N.=12) or on GFD from at least 12 months (N.=13), were considered. Serum iron was evaluated at baseline (T0) and after 3 hours (T1) from the oral iron ingestion. Statistical analyses were conducted using SPSS 21.0 software for Mac. RESULTS OIAT was well tolerated by all patients. An important increase of the serum iron at T1, of at least twice the baseline values, occurred in all patients except in one (P value

The rate of over-70 year post-surgery patients referred to the Cardiac Rehabilitation Units is increasing. Strategies designed to encourage and facilitate participation in rehabilitation programs in the elderly should be developed. Aim of this paper is to present our elderly-centered program, specifically designed on patient’s needs and frailty, and its short- and medium-term results in 160 consecutive over-70 year patients, admitted in our Cardiac Rehabilitation Unit soon after cardiac surgery. The program was safe, well accepted by the patients, and effective in improving objective and subjective functional status.

Background Intensified tuberculosis (TB) case finding and isoniazid preventive therapy (IPT) are strongly recommended for children who are HIV infected. Data are needed to assess the feasibility of the WHO 2011 intensified tuberculosis case finding/IPT clinical algorithm. Methods Children who are HIV infected and attending Nsambya Home Care at Nsambya Hospital, Uganda, were screened for TB following WHO recommendations. IPT was given for 6 months after excluding TB. Factors associated with time to IPT initiation were investigated by multivariate Cox proportional hazard regression. Health care workers were interviewed on reasons for delay in IPT initiation. Results Among the 899 (49% male) children with HIV, 529 (58.8%) were screened for TB from January 2011 to February 2013. Children with active TB were 36/529 (6.8%), 24 (4.5%) were lost to follow-ups and 280 (52.9%) started IPT, 86/280 (30.7%) within 3 months of TB screening and 194/280 (69.3%) thereafter. Among the 529 children screened for TB, longer time to IPT initiation was independently associated with cough at TB screening (hazard ratio 0.62, P = 0.02, 95% confidence interval: 0.41 to 0.94). Four children (1% of those starting treatments) interrupted IPT because of a 5-fold increase in liver function measurements. In the survey, Health care workers reported poor adherence to antiretroviral therapy, poor attendance to periodic HIV follow-ups, and pill burden as the 3 main reasons to delay IPT. Conclusion In resource-constrained settings, considerable delays in IPT initiation may occur, particularly in children with HIV who are presenting with cough at TB screening. The good safety profile of isoniazid in antiretroviral-therapy-experienced children provides further support to IPT implementation in this population.

Background Children with HIV will be on antiretroviral therapy (ART) longer than adults, and therefore the durability of first-line ART and timing of switch to second-line are key questions. We assess the long-term outcome of protease inhibitor and non-nucleoside reverse transcriptase inhibitor (NNRTI) first-line ART and viral load switch criteria in children. Methods In a randomised open-label factorial trial, we compared effectiveness of two nucleoside reverse transcriptase inhibitors (NRTIs) plus a protease inhibitor versus two NRTIs plus an NNRTI and of switch to second-line ART at a viral load of 1000 copies per mL versus 30,000 copies per mL in previously untreated children infected with HIV from Europe and North and South America. Random assignment was by computer-generated sequentially numbered lists stratified by age, region, and by exposure to perinatal ART. Primary outcome was change in viral load between baseline and 4 years. Analysis was by intention to treat, which we defined as all patients that started treatment. This study is registered with ISRCTN, number ISRCTN73318385. Findings Between Sept 25, 2002, and Sept 7, 2005, 266 children (median age 6.5 years; IQR 2.8-12.9) were randomly assigned treatment regimens: 66 to receive protease inhibitor and switch to second-line at 1000 copies per mL (PI-low), 65 protease inhibitor and switch at 30,000 copies per mL (PI-higher), 68 NNRTI and switch at 1000 copies per mL (NNRTI-low), and 67 NNRTI and switch at 30,000 copies per mL (NNRTI-higher). Median follow-up was 5.0 years (IQR 4.2-6.0) and 188 (71%) children were on first-line ART at trial end. At 4 years, mean reductions in viral load were -3.16 log(10) copies per mL for protease inhibitors versus -3.31 log(10) copies per mL for NNRTIs (difference -0.15 log(10) copies per mL, 95% CI -0.41 to 0.11; p=0.26), and -3.26 log(10) copies per mL for switching at the low versus -3.20 log(10) copies per mL for switching at the higher threshold (difference 0.06 log(10) copies per mL, 95% CI -0.20 to 0.32; p=0.56). Protease inhibitor resistance was uncommon and there was no increase in NRTI resistance in the PI-higher compared with the PI-low group. NNRTI resistance was selected early, and about 10% more children accumulated NRTI mutations in the NNRTI-higher than the NNRTI-low group. Nine children had new CDC stage-C events and 60 had grade 3/4 adverse events; both were balanced across randomised groups. Interpretation Good long-term outcomes were achieved with all treatments strategies. Delayed switching of protease-inhibitor-based ART might be reasonable where future drug options are limited, because the risk of selecting for NRTI and protease-inhibitor resistance is low. Funding Paediatric European Network for Treatment of AIDS (PENTA) and Pediatric AIDS Clinical Trials Group (PACTG/IMPAACT).

Correlations between clinical/immunological treatment failure and viral load (VL) detected by dried blood spot (DBS) sampling were explored in HIV-1-infected children in Uganda. Of 104 children on combined antiretroviral treatment (cART), 12.5% experienced clinical and/or immunological failure, while 28.8%, 44.2%, and 26.9% had VLs of 5,000 copies/ml, respectively. Clinical/immunological failure poorly predicted virological failure.

Early post-surgery in-hospital rehabilitation in elderly patients should be aimed at accelerating the recovery of the highest level of functional autonomy and reducing the hospital stay.We designed a personalized physiotherapy program tailored to the frailty level of over-70-year-old patients soon after cardiac surgery. The aims of this study were (a) to validate our frailty-based approach for functional stratification of the patients, and (b) to assess the effect of the individualized program on independence and mobility, and compare it with our usual program.We followed 224 consecutive patients aged 70-87 years, who followed either the personalized (n= 150) or usual (n= 74) program. All patients underwent a comprehensive physical functioning evaluation at the baseline and at the end of hospitalization.The frailty-based stratification was successful in identifying those patients at higher risk of falls, with heavy nursing needs, greater dependency, and poorer heath status perception. On discharge, both groups had significantly improved on all measures of independence and mobility, but most of these changes (nursing needs, mobility, balance, and muscle strength) were significantly greater (P0.05) in the intervention group. These patients also had a significantly shorter length of stay (17.5 ± 8 vs. 21 ± 4 days, P = 0.0002), and 91% of them could be discharged in a state of substantial independence.An elderly-centered stratification based on functional frailty is useful to identify patients with more dependency and greater needs. A consequent personalized physiotherapy program designed to enhance independent mobility soon after cardiac surgery is safe and well accepted, and is more effective then usual physiotherapy.

Fuel cell power systems are emerging as promising means of electrical power generation on account of the associated clean electricity generation process, as well as their suitability for use in a wide range of applications. During the design stage, the development of a computer model for simulating the behaviour of a system under development can facilitate the experimentation and testing of that system's performance. Since the electrical power output of a fuel cell stack is seldom at a suitable fixed voltage, conditioning circuits and their associated controllers must be incorporated in the design of the fuel cell power system. This paper presents a MATLAB/Simulink model that simulates the behaviour of a Proton Exchange Membrane Fuel Cell (PEMFC), conditioning circuits and their controllers. The computer modelling of the PEMFC was based on adopted mathematical models that describe the fuel cell's operational voltage, while accounting for the irreversibilities associated with the fuel cell stack. The conditioning circuits that are included in the Simulink model are a DC–DC converter and DC–AC inverter circuits. These circuits are the commonly utilized power electronics circuits for regulating and conditioning the output voltage from a fuel cell stack. The modelling of the circuits is based on relationships that govern the output voltage behaviour with respect to their input voltages, switching duty cycle and efficiency. In addition, this paper describes a Fuzzy Logic Controller (FLC) design that is aimed at regulating the conditioning circuits to provide and maintain suitable electrical power for a wide range of applications. The model presented demonstrates the use of the FLC in conjunction with the PEMFC Simulink model and that it is the basis for more in-depth analytical models.

We have reviewed more than 100 references that are related to water management in proton exchange membrane (PEM) fuel cells, with a particular focus on the issue of water flooding, its diagnosis and mitigation. It was found that extensive work has been carried out on the issues of flooding during the last two decades, including prediction through numerical modeling, detection by experimental measurements, and mitigation through the design of cell components and manipulating the operating conditions. Two classes of strategies to mitigate flooding have been developed. The first is based on system design and engineering, which is often accompanied by significant parasitic power loss. The second class is based on membrane electrode assembly (MEA) design and engineering, and involves modifying the material and structural properties of the gas diffusion layer (GDL), cathode catalyst layer (CCL) and membrane to function in the presence of liquid water. In this review, several insightful directions are also suggested for future investigation.

High contents of plant-available selenium in the soil in the form of selenate, resulting from natural or anthropogenic action, jeopardizes agricultural areas and requires research for solutions to establish or re-establish agricultural or livestock operation, avoiding the risk of poisoning of plants, animals and humans. The purpose was to evaluate sulfur sources in the form of sulfate, e.g., ammonium sulfate, calcium sulfate, ferric sulfate, in the remediation of tropical soils anthropogenically contaminated with Se under the tropical forage grass Brachiaria brizantha (Hochst. ex A. Rich.) Stapf cv. Marandu. More clayey soils are less able to supply plants with Se, which influences the effects of S sources, but it was found that high soil Se concentrations negatively affected forage biomass production, regardless of the soil. Of the tested S sources, the highly soluble ammonium sulfate and ferric sulfate reduced plant Se uptake and raised the available sulfur content in the soil. RESUMO A existência de elevado teor de selênio disponível nos solos na forma de selenato, originado de forma natural ou por ação antropogênica, condena áreas agrícolas e exige a procura de soluções para estabelecer ou restabelecer a exploração agrícola ou agropecuária, evitando riscos de intoxicação das plantas, dos animais e dos seres humanos. Avaliaram-se fontes de enxofre na forma de sulfato, como o sulfato de amônio, sulfato de cálcio, sulfato férrico, na remediação de solos tropicais contaminados antropogenicamente com Se, cultivados com a gramínea forrageira de clima tropical Brachiaria brizantha (Hochst. ex A. Rich.) Stapf cv. Marandu. Os solos mais argilosos apresentaram menor capacidade em disponibilizar Se às plantas. Tal fato influenciou nos efeitos das fontes de S, porém verificou-se que os elevados teores de Se dos solos influenciaram negativamente a produção de biomassa da planta forrageira, independentemente do solo. Entre as fontes de S avaliadas, as elevadas solubilidades do sulfato de amônio e do sulfato férrico proporcionaram redução na absorção desse elemento pelas plantas, bem como aumentaram os teores de S disponível no solo.

Rehabilitative and preventive cardiology (CRP) is configured as intervention prevention to “gain health” through a process of multifactorial care that reduces disability and the risk of subsequent cardiovascular events. It makes use of an interdisciplinary team in which every professional needs to have multiple intervention paths because of the different levels of clinical and functional complexity of cardiac patients who currently have access to the rehabilitation. The document refers to the use of interventions by nurses, physiotherapists, dietitians and psychologists that are part of the rehabilitation team of CRP. Interventions of which have been documented, on scientific bases and clinical practice, empirical effectiveness and organizational efficiency. The methodological approach of this paper is a first attempt to define, through the model of consensus, the minimum standards for a CRP evidence based characterized by clearly defined criteria that can be used by operators of CRP. The document describes the activities to be carried out in each of the phases included in the pathways of care by nurses, physiotherapists, dietitians and psychologists. The routes identified were divided, according to the type of patients who have access to the CRP and to the phases of care, including the initial assessment, intervention, evaluation and final reporting, in high medium and low complexity. Examples of models of reporting, used by the operators of the team according to the principles of good clinical practice, are provided. This is made to allow traceability of operations, encourage communication inside the working group and within the patient and the caregiver. Also to give any possible indication for the post-rehabilitation.

International audience; This article studies a multiple-objective flow-shop modelling and scheduling problem by multi-agent system (MAS) in a production context characterized by diversified, high-volume production mix. The analysed flow shop is characterised by multi-machine workstations, transfer batches, sequence-dependent setup times and possible re-entrant jobs. The agent-based model is structured from the current flow-shop configuration, defining the main entities and related events to realize the most possible flexible model. After a description of entities and their states, the agent framework with state diagrams is implemented through Jade platform. The system is provided with a simulation-based environment to test it in two main production scenarios including re-entrant jobs and failures. A coordination mechanism between agents and a dedicated scheduling algorithm managed by the MAS allowed to front this kind of events optimising concurrent objectives like work in process, Makespan and buffer queues.

Background. Epstein-Barr Virus (EBV) is involved in a wide range of malignancies, particularly in immunocompromised subjects. In Africa, EBV primary infection occurs during early childhood, but little is known about the EBV load in Human Immunodeficiency Virus type 1 (HIV-1)-infected children. Methods. Blood samples from 213 HIV-1-infected children, 140 of whom were receiving antiretroviral therapy (ART), were collected at the Nsambya Hospital in Kampala, Uganda, and obtained for dried blood spot analysis. Nucleic acids were extracted and analyzed for quantification of EBV types 1 and 2; 16S ribosomal DNA (rDNA), a marker of microbial translocation; and HIV-1 RNA. Results. Ninety-two of 140 children (66%) receiving ART and 57 of 73 ART-naive children (78%) had detectable EBV DNA levels. Coinfection with both EBV types was less frequent in ART-treated children than in ART-naive children (odds ratio, 0.54 [95% confidence interval {CI},.30-.98]; P = .042). Mean EBV DNA levels (+/- standard deviation) were lower in the former (3.99 +/- 0.59 vs 4.22 +/- 0.54 log(10) copies/mL; P = .006) and tended to be inversely associated with ART duration. EBV DNA levels were higher in children with an HIV-1 RNA load of > 3 log(10) copies/mL of blood (regression coefficient, 0.32 [95% CI,.05-. 59]; P = .020) and correlated with circulating 16S rDNA levels (r(s) = 0.25 [95% CI,.02-.46]; P = .031). Conclusions. These findings suggest that ART, by limiting HIV-1 replication, microbial translocation, and related immune activation, prevents superinfection with both EBV types and keeps EBV viremia down, thus potentially reducing the risk of EBV-associated lymphomas.

Neutrophilia in adults refers to an alteration in the total number of blood neutrophils that is in excess of about 7500 cells/μL. This definition is restrictive in childhood as neutrophil count is age-dependent. Chronic Idiopathic Neutrophilia (CIN) refers to a condition that persists for many years in individuals who appear otherwise healthy. CIN is rarely mentioned in scientific literature and in academic books of hematology; only few words are dedicated to this topic. We report a case study of two twins with CIN followed from the first year of life to 24 years of age. To the best of our knowledge this is the first case report of two twins with CIN followed through a long period of time. We believe that our observation may contribute to better understand and characterize this hematologic abnormality.

We describe factors determining retention and survival among HIV-infected children and adolescents engaged in two health care delivery models in Kampala, Uganda: one is a community home-based care (CHBC) and the other is a facility-based family-centred approach (FBFCA). This retrospective cohort study reviewed records from children aged from 0 to 18 years engaged in the two models from 2003 to 2010 focussing on retention/loss to follow-up, mortality, use of antiretroviral therapy (ART), and clinical characteristics. Kaplan Meier survival curves with log rank tests were used to describe and compare retention and survival. Overall, 1,623 children were included, 90.0% (1460/1623) from the CHBC. Children completed an average of 4.2 years of follow-up (maximum 7.7 years). Median age was 53 (IQR: 11–109) months at enrolment. In the CHBC, retention differed significantly between patients on ART and those not (log-rank test, adjusted, P<0.001). Comparing ART patients in both models, there was no significant difference in long-term survival (log-rank test, P=0.308, adjusted, P=0.489), while retention was higher in the CHBC: 94.8% versus 84.7% in the FBFCA (log-rank test, P<0.001, adjusted P=0.006). Irrespective of model of care, children receiving ART had better retention in care and survival.