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The state of road infrastructures in many advanced countries is rapidly changing under the impulse of massive funding from governments, eager to have more efficient and safer transportation systems. The use of well-known materials such as fibre-reinforced concrete (FRC) is finding a growing space for structural rehabilitation of bridges; the adopted material is often defined as High performance fibre reinforced concrete (HPFRC) due to its enhanced performance. The paper presents the principal findings of an EU-funded project that involved the repair of two road bridges in Italy using HPFRC. The project has successfully carried out the jacketing of bridge piers and cap-beams, heavily damaged by corrosion, with a new HPFRC layer of reduced thickness (40-60 mm) and limited use of steel reinforcements. Experimental tests carried out in the laboratory of the University of Brescia on 1:2 scaled specimens have shown the possibility to increase the load bearing capacity of the cap beams (with respect to vertical loading) up to 73%, with moderate effects on the change in stiffness and ductility of the existing structure. Based on field and laboratory experience, the article eventually presents some new challenges for the use of HPFRC in the reduction of environmental impact of construction industry.

A modular robotic system and its fuzzy logic based controller are proposed for use in logging operations in forest environments with steep slopes. The Log-Carrying Robot (LCR) concept is composed of two modular wheeled robotic agents with individual wheel steering that connect to the ends of a log to a form a centrally controlled robot. A fuzzy controller specifies the desired direction of travel using four factors: the presence of obstacles, boundaries limiting the robot’s travel space, the heading of the goal position relative to the robot, and the slope of the terrain. The capabilities of the proposed controller are demonstrated in simulation using a rectangular robot with four individually actuated and steered wheels. Results indicate that the controller successfully steers the robot towards the goal position while avoiding obstacles using only eleven fuzzy rules. Additionally, the simple rules are shown to be effective at automatically compensating for sloped terrain by avoiding direct travel down hills, as well as adapting for various robot lengths.

The increasing number of road infrastructures needing repair and retrofit is raising the problem of how to improve seismic behaviour for all those structures for which substitution is unlikely. This work deals with the application of a retrofitting technique for Reinforced Concrete (RC) elements based on the use of Ultra High Performance Fibre Reinforced Concrete (UHPFRC). A thin layer of UHPFRC, cast around an existing RC element, can both improve its structural performance and enhance its durability against environmental actions. This kind of rehabilitation intervention may represent, in many practical cases, a cost effective solution compared with the replacement of the entire structure. The aim of this paper is the definition of a reinforcement strategy and the presentation of a 1:4 scale laboratory test of a highway bridge pier reinforced with a 30 mm layer of UHPFRC.

The compositional nutrient diagnosis (CND) method considers the multiple relationships among nutrients and has been proposed to evaluate the nutritional status of plants in place of the univariate and bivariate methods. As it is mathematically based and considers the interactions among all nutrients at the same time, it avoids the errors and trends observed in the calculations of other methods estimating nutritional status, enabling a greater relationship with productivity. The objective of this study was to obtain the CND norms for high-yielding populations of potato crops. For this, 587 samples were used from 21 experimental areas in the state of São Paulo, Brazil to correlate the leaf nutrient contents and the yields of potato crops. Crops with yields higher than 48,993.24 kg ha−1 were considered to have high yields, and the Mahalanobis distance separated the balanced samples from the nutritionally unbalanced ones. Thus, the CND-ilr method generated the norms and classified the 587 samples as nutritionally balanced with a high yield (5% of the total), nutritionally unbalanced with a low yield (92%), nutritionally unbalanced with a high yield (0.3%), or nutritionally balanced with a low yield (2.7%), with accuracy, sensitivity, specificity, NPV, and PPV scores of 96.9, 97.1, 93.6, 64.4, and 99.6%, respectively.

BackgroundChikungunya virus (CHIKV) has spread across Brazil with varying incidence rates depending on the affected areas. Due to cocirculation of arboviruses and overlapping disease symptoms, CHIKV infection may be underdiagnosed. To understand the lack of CHIKV epidemics in São José do Rio Preto (SJdRP), São Paulo (SP), Brazil, we evaluated viral circulation by investigating anti-CHIKV IgG seroconversion in a prospective study of asymptomatic individuals and detecting anti-CHIKV IgM in individuals suspected of dengue infection, as well as CHIKV presence in Aedes mosquitoes. The opportunity to assess two different groups (symptomatic and asymptomatic) exposed at the same geographic region aimed to broaden the possibility of identifying the viral circulation, which had been previously considered absent.Methodology/principal findingsBased on a prospective population study model and demographic characteristics (sex and age), we analyzed the anti-CHIKV IgG seroconversion rate in 341 subjects by ELISA over four years. The seroprevalence increased from 0.35% in the first year to 2.3% after 3 years of follow-up. Additionally, we investigated 497 samples from a blood panel collected from dengue-suspected individuals during the 2019 dengue outbreak in SJdRP. In total, 4.4% were positive for anti-CHIKV IgM, and 8.6% were positive for IgG. To exclude alphavirus cross-reactivity, we evaluated the presence of anti-Mayaro virus (MAYV) IgG by ELISA, and the positivity rate was 0.3% in the population study and 0.8% in the blood panel samples. In CHIKV and MAYV plaque reduction neutralization tests (PRNTs), the positivity rate for CHIKV-neutralizing antibodies in these ELISA-positive samples was 46.7%, while no MAYV-neutralizing antibodies were detected. Genomic sequencing and phylogenetic analysis revealed CHIKV genotype ECSA in São José do Rio Preto, SP. Finally, mosquitoes collected to complement human surveillance revealed CHIKV positivity of 2.76% of A. aegypti and 9.09% of A. albopictus (although it was far less abundant than A. aegypti) by RT-qPCR.Conclusions/significanceOur data suggest cryptic CHIKV circulation in SJdRP detected by continual active surveillance. These low levels, but increasing, of viral circulation highlight the possibility of CHIKV outbreaks, as there is a large naïve population. Improved knowledge of the epidemiological situation might aid in outbreaks prevention.

The compositional nutrient diagnosis (CND) method considers the multiple relationships among nutrients and has been proposed to evaluate the nutritional status of plants in place of the univariate and bivariate methods. As it is mathematically based and considers the interactions among all nutrients at the same time, it avoids the errors and trends observed in the calculations of other methods estimating nutritional status, enabling a greater relationship with productivity. The objective of this study was to obtain the CND norms for high-yielding populations of potato crops. For this, 587 samples were used from 21 experimental areas in the state of São Paulo, Brazil to correlate the leaf nutrient contents and the yields of potato crops. Crops with yields higher than 48,993.24 kg ha−1 were considered to have high yields, and the Mahalanobis distance separated the balanced samples from the nutritionally unbalanced ones. Thus, the CND-ilr method generated the norms and classified the 587 samples as nutritionally balanced with a high yield (5% of the total), nutritionally unbalanced with a low yield (92%), nutritionally unbalanced with a high yield (0.3%), or nutritionally balanced with a low yield (2.7%), with accuracy, sensitivity, specificity, NPV, and PPV scores of 96.9, 97.1, 93.6, 64.4, and 99.6%, respectively. [ABSTRACT FROM AUTHOR]

Abstract Background Multidisciplinary teams (MDT) formulate expert informed treatment recommendations for people with cancer. We set out to examine how the factors proposed by the functional perspective of group decision making (DM), that is, interaction process, internal factors (factors emanating from within the group such as group size), external circumstances (factors coming from the outside of the team), and case‐complexity affect the quality of MDT decision making. Methods This was a cross‐sectional observational study. Three cancer MDTs were recruited with 44 members overall and 30 of their weekly meetings filmed. Validated observational instruments were used to measure quality of DM, interactions, and complexity of 822 case discussions. Results The full regression model with the variables proposed by the functional perspective was significant, R2 = 0.52, F(20, 801) = 43.47, P

Abstract Background and Objective There is increasing emphasis in cancer care globally for care to be reviewed and managed by multidisciplinary teams (ie, in tumor boards). Evidence and recommendations suggest that the complexity of each patient case needs to be considered as care is planned; however, no tool currently exists for cancer teams to do so. We report the development and early validation of such a tool. Methods We used a mixed‐methods approach involving psychometric evaluation and expert review to develop the Measure of case‐Discussion Complexity (MeDiC) between May 2014 and November 2016. The study ran in six phases and included ethnographic interviews, observations, surveys, feasibility and reliability testing, expert consensus, and multiple expert‐team reviews. Results Phase‐1: case complexity factors identified through literature review and expert interviews; Phase‐2: 51 factors subjected to iterative review and content validation by nine cancer teams across four England Trusts with nine further items identified; Phase 3: 60 items subjected to expert review distilled to the most relevant; Phase 4: item weighing and further content validation through a national UK survey; Phases 5 and 6: excellent interassessor reliability between clinical and nonclinical observers, and adequate validity on 903 video case discussions achieved. A final set of 27 factors, measuring clinical and logistical complexities were integrated into MeDiC. Conclusions MeDiC is an evidence‐based and expert‐driven tool that gauges the complexity of cancer cases. MeDiC may be used as a clinical quality assurance and screening tool for tumor board consideration through case selection and prioritization.

BackgroundContinuous vital sign monitoring by using wearable sensors may result in the earlier detection of patient deterioration and sepsis. Few studies have explored the perspectives of surgical team members on the use of such sensors in surgical patients. ObjectiveThis study aims to understand the views of surgical team members regarding novel wearable sensors for surgical patients. MethodsWearable sensors that monitor vital signs (heart rate, respiratory rate, and temperature) continuously were used by acute surgical patients. The opinions of surgical staff who were treating patients with these sensors were collated through in-depth semistructured interviews to thematic saturation. Interviews were audio recorded, transcribed, and analyzed via thematic analysis. ResultsA total of 48 interviews were performed with senior and junior surgeons and senior and junior nurses. The main themes of interest that emerged from the interviews were (1) problems with current monitoring, (2) the anticipated impact of wearables on patient safety, (3) the impact on staff, (4) the impact on patients overall, (5) potential new changes, and (6) the future and views on technology. ConclusionsOverall, the feedback from staff who were continuously monitoring surgical patients via wearable sensors was positive, and relatively few concerns were raised. Surgical staff members identify problems with current monitoring and anticipate that sensors will both improve patient safety and be the future of monitoring.

Introduction: Functional perspective of team decision-making highlights the importance of understanding the relationship between team interaction/communication during a given task, the internal factors that emanate from within a group (e.g., team composition), and the external circumstances (e.g., workload and time pressures). As an underexplored area, we explored these relationships in the context of multidisciplinary team (MDT) meetings (aka tumor boards).Materials and methods: Three cancer MDTs with 44 team members were recruited from three teaching hospitals in the United Kingdom. Thirty of their weekly meetings encompassing 822 case reviews were filmed. Validated instruments were used to assess each case: Bales' Interaction Process Analysis that captures frequency of task-oriented and socio-emotional interactions/communication; and Measure of case-Discussion Complexity that captures clinical and logistic complexities. We also measured team size, disciplinary diversity, gender, time-workload pressure, and time-on-task. Partial correlation analysis controlling for team/tumor type and case complexity was used for analysis.Results:Clinical complexity positively correlated with task-oriented communication, e.g., gives opinion (r = 0.51, p < 0.001), and logistical issues with negative socio-emotional interactions, e.g., antagonism (r = 0.14, p < 0.01). Time-workload pressure correlated with reduced task-oriented communication, e.g., gives opinion (r = −0.15, p < 0.01), and positive socio-emotional interactions, e.g., solidarity (r = −0.17, p < 0.001). Time-on-task negatively correlated with task-oriented communication, e.g., asks for orientation (r = −0.16, p < 0.001), and positive socio-emotional interactions, e.g., agrees (r = −0.21, p < 0.001). Team size and disciplinary diversity positively correlated with task-oriented communication, e.g., asks for orientation (r = 0.13, p < 0.001; r = 0.09, p < 0.05), and negative socio-emotional interactions, e.g., antagonism (r = 0.10, p < 0.01; r = 0.08, p < 0.05). Gender balance had no significant relationships (all p > 0.05), however, case reviews with more males present were associated with more tension (r = 0.09, p < 0.01) and less disagreements (r = −0.11, p < 0.01), while when more females present there were more disagreements (r = 0.10, p < 0.01) and less tension (r = −0.11, p < 0.01).Discussion: To the best of our knowledge, this is the first study to assess the relationship between MDT interaction/communication and the external/internal factors. Smaller size, gender balanced teams with core disciplines present, and streamlining workload to reduce time-workload pressure, time-on-task effects, and logistical issues appear more conducive to building and maintain optimal MDTs. Our methodology could be applied to other MDT-driven areas of healthcare.

No Brasil, os campeonatos de futebol para crianças e adolescentes são geralmente organizados e divididos por categorias relacionadas a faixas etárias (normalmente a cada dois anos), com o objetivo de promover maior equilíbrio e justiça na competição. Embora produzam certo cenário de proximidade de capacidades de desempenho entre os participantes, por outro lado, tal divisão comporta e sustenta algumas condições de desigualdade de ofertas de oportunidades de aprendizagem. Isso somado a questões de ordem sociocultural e pedagógica, estrutura um fenômeno denominado Efeito da Idade Relativa (EIR). O objetivo deste estudo foi analisar a ocorrência do EIR em goleiros e goleiras dos Campeonatos Brasileiros de futebol masculino e feminino da Série A no ano de 2018. As informações sobre as datas de nascimento dos(a) atletas foram coletadas através do site oficial da Confederação Brasileira de Futebol. O grupo masculino foi composto por 68 goleiros dentro de uma população de 73 indivíduos, enquanto o grupo feminino foi composto por 39 de um total de 43 goleiras. Para a análise estatística foi utilizado o teste qui-quadrado. Os resultados revelam que o EIR não acontece nesta população, em nenhum dos gêneros. Isso pode ocorrer por existir menor concorrência por vagas de goleiros e goleiras em equipes de futebol. Conclui-se que, para o gênero masculino e feminino, a data de nascimento não parece influenciar a oferta de oportunidades para goleiros atingirem a elite do futebol brasileiro.

Background Efforts to involve patients in patient safety continue to revolve around professionally derived notions of minimising clinical risk, yet evidence suggests that patients hold perspectives on patient safety that are distinct from clinicians and academics. This study aims to understand how hospital inpatients across three different specialties conceptualise patient safety and develop a conceptual model that reflects their perspectives. Methods A qualitative semi- structured interview study was conducted with 24 inpatients across three clinical specialties (medicine for the elderly, elective surgery and maternity) at a large central London teaching hospital. An abbreviated form of constructivist grounded theory was employed to analyse interview transcripts. Constant comparative analysis and memo- writing using the clustering technique were used to develop a model of how patients conceptualise patient safety. Results While some patients described patient safety using terms consistent with clinical/academic definitions, patients predominantly conceptualised patient safety in the context of what made them 'feel safe'. Patients' feelings of safety arose from a range of care experiences involving specific actors: hospital staff, the patient, their friends/family/carers, and the healthcare organisation. Four types of experiences contributed to how patients conceptualise safety: actions observed by patients; actions received by patients; actions performed by patients themselves; and shared actions involving patients and other actors in their care. Conclusions Our findings support the need for a patient safety paradigm that is meaningful to all stakeholders, incorporating what matters to patients to feel safe in hospital. Additional work should explore and test how the proposed conceptual model can be practically applied and implemented to incorporate the patient conceptualisation of patient safety into everyday clinical practice. [ABSTRACT FROM AUTHOR]