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This article proposes a power quality (PQ) solution for the compensation of voltage sag on grid fed electric vehicle fast charging stations (EVFCS) using a T-type 5-level inverter based dynamic voltage restorer (DVR). In this work, a lithium-ion battery pack with a rating of 48 V, 10 Ah, and 5 A is used as an electric vehicle (EV) battery. Firstly, the voltage sag shows a significant effect on the performance of EVFCS. The analysis of the effect of voltage sag on different characteristics of EVFCS, such as DC-bus voltage, battery current, state-of-charge (SOC), and battery voltage, is carried out in MATLAB/Simulink and through experimentation. Further, the design of the charging system is carried out using a 1-$ \phi$ rectifier and DC-DC converter with closed loop current control. The performance of a closed loop current controlled buck converter is investigated experimentally for different magnitudes of sag (0%, 25% and 50%). Furthermore, the $ \alpha \beta$ to dq transformation based synchronous reference frame (SRF) theory operated closed loop voltage controller is employed for 1-$ \phi$ DVR to mitigate a voltage sag of 50%. This DVR maintains rated DC-bus voltage (110 V) and rated battery current (5 A) under a severe voltage sag condition of 50%. Also, DVR protects the PCC (grid) from voltage harmonics generated by the EVFCS, reducing the PCC voltage THD to 2.42% from 9.8%. Moreover, the control strategies of both the buck converter and DVR are developed on the hardware platform using the STM32 microcontroller. The simulation results are validated mathematically and experimentally. Lastly, simulation and experimental results confirm the beneficial use of T-type 5-level DVR for better performance of EVFCS.

Phase shift control is one of the most common strategies used for the control of a triple active bridge (TAB) converter, including single-phase shift (SPS) control, extended-phase shift (EPS) control, dual-phase shift (DPS) control, and triple-phase shift (TPS) control. Among them, there are two free variables for the SPS control, three free variables for the EPS and DPS controls, and five free variables for the TPS control, respectively. When the power of TAB is transmitted from port I to port II and port III, some portion will flow from port II and port III back to port I, which is also known as reflux power. The presence of reflux power causes the waste of transmission power and reduces the overall efficiency of a TAB converter. Compared to SPS, EPS, and DPS, TPS has a smaller reflux power, but the traditional mathematical methods adopted to optimize the TAB operation are complex in solving the phase shift ratios of TPS. This article proposes an intelligent control strategy based on online particle swarm optimization combined with exponential weighted moving average (PSO-EWMA) algorithm, which can effectively reduce the reflux power of TAB under TPS control. Simulation and experimental results show that the minimum reduction in reflux power is about 58.1%, and the converter efficiency remains around 95%, verifying the effectiveness of the proposed control algorithm.

ObjectivesThe aim of this study was to investigate how palliative care service structures and processes correlate with their outputs and outcomes, measuring the latter respectively in terms of intensity of care and death at home.MethodsThe Veneto Regional Health Authorities collected a set of 37 quality indicators for the year 2016, covering the following five dimensions: service integration, service structure, accessibility, professional processes and organisational processes. Their validity was assessed by a panel of 29 palliative care experts. A score was assigned to each indicator on the basis of its relevance. Non-parametric correlations between the care quality indicators and the measures of the palliative care outputs and outcomes were investigated, along with the presence of a monotonic trend in the performance of the local health units (LHU) grouped by ‘low’, ‘medium’ or ‘high’ scores and differences between these groups of LHUs.ResultsThe data showed that palliative care service structure and professional processes were the dimensions correlating significantly with the intensity of care coefficient. An increasingly significant statistical trend was found in both the intensity of care coefficient and the proportion of deaths at home for the three groups of LHUs in terms of the professional processes dimension.ConclusionsDespite its limitations, this study brought to light some statistically significant findings that are worth investigating in larger samples. To achieve improvements in the quality of palliative care, it is important for healthcare providers to know which variables most affect the output and especially the outcomes of the services offered.

Renewable energy generation becomes the trend of power industry. However, its consumption is hitting a bottleneck. Electric spring (ES) is one of the effective means to solve the issue. A current-fed direct current electric spring (CF-DCES) topology is proposed in this article, which consists of a current-fed three port converter (TPC) and a bidirectional Buck-Boost converter (BBC). The modal analysis of the CF-DCES is carried out by means of the current-type three-port equivalent circuit, and the corresponding small signal model is solved. The input current and critical load voltage are taken as control variables, and the duty ratio on the input side and that on the critical load side are taken as output variables. The output variables are decoupled according to the small signal model. Non-critical load is set to absorb input power fluctuation. A group of batteries is set at BBC port to ensure the power requirements of the critical load. A type of battery energy management system is also proposed. Finally, the proposed CF-DCES is validated by both simulation and experimental results.

Aim: In a world where the aging population and prevalence of chronic degenerative diseases and life-threatening conditions have been increasing, identifying factors that can improve the living conditions of these populations is of paramount importance. The aim of the present research was to conduct a systematic literature review to investigate the impact of religion and spirituality on longevity. Subject and methods: Studies published in English that assessed the association between religiosity or spirituality and survival were identified by searching electronic databases (PubMed, PsycINFO, and CINAHL) and were independently reviewed by two authors. Results: A total of 13 prospective cohort studies were included in this review, including seven that found a negative association between religiosity and mortality and six that showed mixed results. Conclusion: Most studies highlighted the reduction in the risk of mortality, particularly among subjects who engaged in religious activities with an active social component. The linkage between religiosity and longevity might be mediated by the social support of the religious community, better health behavior, and mental health. However, most studies found a reduction in all-cause mortality even after adjusting for these mediating factors, indicating that other important mechanisms might have been involved.

Permanent magnet synchronous motor (PMSM) has been widely used in industry in recent years because of its simple structure, high power density, and high efficiency. Accurate electromagnetic parameters of PMSM are of great significance in many fields, such as control system design, fault diagnosis, and condition monitoring. However, when the motor is in steady-state operation, the traditional identification method will have the issues, such as model accuracy, rank deficient, and the incompletely observable. Therefore, a parameter identification method based on biased triangular wave injection and current differential term is proposed in this article to solve them. In addition, the influence of triangular wave injection and current differential term on motor parameter identification is comparatively analyzed and verified by comparative experiments. Finally, the experimental results show that the proposed method can realize the multiparameter identification of motor resistance, inductance, and flux linkage in steady-state operation.

Dynamic wireless power transfer systems require to supply many transmitting coils deployed under the road surface and arranged along the so-called track. This layout entails the use of a large number of inverters or of devices that switch the power to the proper coils. This article presents a technique that uses a single three-phase inverter to supply two coils with voltages having different and independently adjustable amplitudes of their first harmonic component. Differently from the well-known phase shift technique, the amplitude and the phase of the voltages are not correlated. Moreover, the presented technique has the ability of inherently reducing the phase difference between the two output currents when the supplied loads are partially reactive. This feature enhances the power transfer capability of the inverter when both the track coils are coupled with the same pickup. After presenting this technique, this article analyzes the functioning of the dual-output inverter in different load conditions recognizing the boundaries of four different modes of operation. For each of them the analytical expression of the amplitude and phase of the generated voltages are given. The theoretical findings are validated by experiments performed on a prototypal setup that implements the presented modulation technique.

Renal cell carcinoma (RCC) is the seventh most common neoplasm in high-income countries. New clinical pathways have been developed to deal with this tumor, which includes costly drugs that pose an economic threat to the sustainability of healthcare services. This study provides an estimate of the direct costs of care for patients with RCC by stage of disease (early vs.advanced) at diagnosis, and disease management phase along the pathway recommended by local and international guidelines.

Direct current electric spring (DCES), as a new solution for the power quality issue caused by the unstable output of photovoltaic (PV) and wind power integrated into the DC microgrid, has the advantages of flexible configuration, smart and small size. This paper proposes an improved topology based on the recent proposed DCES with parallel structure, defined as DCES-3, for residential rooftop PV power generation, and proposes a control strategy based on the small-signal modeling. The proposed topology consists of a triple active bridge (TAB) and a Buck-Boost converter (BBC), and adopts the overall control scheme of three-dimensional decoupling based on single phase-shifting (SPS) control, and uses the BBC to connect the non-critical load (NCL) in parallel to form an equivalent variable load. The DCES passes the power fluctuations to this variable load by changing the duty cycle of the BBC, while ensuring the power on the CL stable. Compared with DCES-3, it has the advantages of clearer concept of ‘spring’, easier analysis of transmission power and zero-voltage switching condition, controllable power quality of the NCL, lower scene transformation and production costs. Finally, the correctness and effectiveness of the proposed DCES topology and its control have been validated by both simulation and experimental results.

In this article, a novel diagnosis strategy including both open-circuit faults (OCFs) and short-circuit faults (SCF) is proposed for the switches in modular multilevel converter topology based on half-bridge energy storage submodules. The OCF diagnosis strategy is to analyze the current flow path of the open-circuit submodule in each OCF state, and then deduce the output voltage expression of the submodule under each OCF state. Finally, by analyzing the expression of output voltage, the average value of half cycle of sampled output voltage is proposed to diagnose all OCF states. The SCF diagnosis strategy is based on the carrier phase-shift (CPS) modulation strategy, using the characteristics that the fault of the power switching device mainly occurs at the turn-on and turn-off instants, combined with redundant submodules to replace the diagnosed submodule and interrupt its driving signal. Finally, the SCF diagnosis is carried out according to the output voltage of the submodule measured under the condition of interrupted drive signal. The diagnosis of SCF is transformed into a diagnosis similar to OCF, which greatly improves the security of the system. In addition, the interruption time point of the drive signal of each diagnosed submodule of the converter is deduced according to the improved CPS modulation diagram. besides, the corresponding fault-tolerant control strategy is also proposed, which uses redundant sub modules to replace fault submodules. Finally, the simulation and experimental results verify the feasibility of the fault diagnosis strategy.

Currently, as more and more new energy sources are connected to the power grid, the pressure on the frequency regulation (FR) of thermal power units (TPU) is increasing. The battery energy storage system (BESS) is used in the scene of auxiliary TPU-FR with its rapid response and accuracy, which has attracted many scholars to study it. However, most scholars only studied the system under normal operating conditions, and did not involve too much on the operating strategy of the system in the event of a failure. In this article, a simulation model of energy storage battery auxiliary FR is built in MATLAB/Simulink, which not only analyzes the response characteristics of the system during normal operation, but also verifies the operation strategy of the system during faults. It is revealed that the existence of energy storage battery reduces the grid frequency offset by 38.1% and increases the power response speed by at least 25 times at normal operation. In addition, the total harmonic distortion of grid-connected voltage and current are 2.54% and 1.72%, respectively, which implies high power quality. When a fault occurs, the energy storage battery is protected by reasonably connecting or removing the BESS based on certain boundary conditions to prolong its life and reduce equipment maintenance costs.

The prognosis of cutaneous malignant melanoma (CMM) is based on disease progression. The highly heterogeneous clinical-pathological characteristics of CMM necessitate standardized diagnostic and therapeutic interventions tailored to cancer’s stage. This study utilizes clinical performance indicators to assess the quality of CMM care in Veneto (Northeast Italy). This population-based study focuses on all incidences of CMMs registered by the Veneto Cancer Registry in 2015 (1279 patients) and 2017 (1368 patients). An interdisciplinary panel of experts formulated a set of quality-monitoring indicators for diagnostic, therapeutic, and end-of-life clinical interventions for CMM. The quality of clinical care for patients was assessed by comparing the reference thresholds established by experts to the actual values obtained in clinical practice. The prevalence of stage I-CMM decreased significantly from 2015 to 2017 (from 71.8 to 62.4%; P< 0.001), and almost all the pathology reports mentioned the number of nodes dissected during a lymphadenectomy. More than 90% of advanced CMMs were promptly tested for molecular BRAF status, but the proportion of patients given targeted therapies fell short of the desired threshold (61.1%). The proportion of stage I–IIA CMM patients who inappropriately underwent computerized tomography/MRI/PET dropped from 17.4 to 3.3% (P< 0.001). Less than 2% of patients received medical or surgical anticancer therapies in the month preceding their death. In the investigated regional context, CMM care exhibited both strengths and weaknesses. The evaluated clinical indicators shed essential insight on the clinical procedures requiring corrective action. It is crucial to monitor clinical care indicators to improve care for cancer patients and promote the sustainability of the healthcare system.

Regular physical exercise lowers the risk of all-cause mortality and various chronic diseases. New technologies, such as smartphones and social media, have been used successfully as health promotion tools in college populations. The purpose of this study was to conduct a systematic review of studies examining the effectiveness of interventions that used modern technologies, as with social media or text messaging, to promote physical activity or reducing sedentary behavior in college students. The systematic review was conducted on the PubMed and SCOPUS databases, considering studies published from 2012 to 2022. For a total of 19 articles selected, an evidence table was drawn up, and the quality of the studies was assessed using the PRISMA checklist. The interventions differed enormously in design, from the strategies implemented to the types of outcome considered. Fifteen of the 19 studies demonstrated an improvement in participants’ physical activity levels, 3 studies found no such improvement, and 1 reported a worsening of baseline activity levels. Interventions to improve college students’ physical activity levels through the use of social media and/or text messaging tend to be effective. However, many factors can influence the effectiveness of such interventions. For example, a gender-related difference emerged in student participation, and the interventions proved more effective if they were accompanied by the creation of social groups.

Two separate schools of thought to measure software engineers' productivity have coexisted: for a long time: on the one hand, using automated product or process measures and, on the other hand, using self-reported or perceived productivity. In this article, we start to bridge the gap between them with an empirical study of 81 software developers at Microsoft.

We present a miniaturized waveguide-based absorption measurement system operating at a wavelength of 635 nm, based on a silicon nitride integrated photonic platform, suitable for lab-on-chip applications. We experimentally demonstrate a high correlation between the bulk dye concentration and the measured absorption loss levels in the waveguides. We explain a photonic design process for choosing the ideal waveguide to minimize the coefficient of variation on the analyte concentration. The approach is designed for camera readout, allowing multiple readouts and easy integration for lab-on chip cartridge approach.

AbstractIn 1921, 16 Texas pathologists gathered in Dallas, Texas, to found the Texas Society of Pathologists (TSP). The TSP is now the oldest state pathology society in the USA with continuity traced back to its founding 100 years ago. This article aims to both commemorate the TSP centennial and to provide context for the remarkable success of the society. The article takes a look back and a look forward from 1921. The look back focuses on the development of the field of pathology and the maturation of medicine and pathology in the USA and Texas. The look forward encompasses developments in science, technology, American health care policy, and medicine that have impacted Texas pathologists and influenced proactive initiatives of the TSP. The review of the life and times of the TSP highlights the importance of leaders and leadership in shaping outcomes. Complexities and uncertainties of the contemporary health care scene point to the need for continued strong leadership. The successful past century and hopeful future of the TSP are inextricably linked to the guiding principle of the TSP, which is a focus on continual striving for excellence in medicine.

ABSTRACTHPV is involved in cervical, anal, penile, vulvar and oropharyngeal cancers, as well as genital warts. It is important to investigate knowledge and attitudes among university students, considering in this age a shift in healthcare decision-making from parents to students themselves. The aim of this study was to estimate knowledge and perception of HPV in terms of potential shame for HPV-related conditions, trust in vaccine efficacy and worry for potential side effects.The study involved students (18–25 years old) from the Universities of Padua and Verona, Italy. Socio-demographic and behavioural characteristics were collected with a questionnaire (n = 9988).Female gender and older age were positively associated with higher knowledge. The adjusted logistic regression showed an association between the set of perceptions investigated and the vaccination status, while a direct connection with knowledge was not found. However, another adjusted linear regression showed that a good set of perceptions could be partially explained by a high level of knowledge. Perceptions seem to fill an intermediate position between the knowledge and the decision to get vaccinated. The potential shame deriving from asking for HPV-vaccination was not identified as a relevant barrier. Having received information from healthcare workers, family and school showed to be positively associated with the adhesion to the vaccination policy.This study identifies university students as a possible target for HPV vaccination and pinpoints specific areas that might be targeted as first to encourage vaccine uptake. Primary prevention together with screening programmes remains essential in further reducing the burden of HPV-related diseases.

Introduction: To assess the burden of herpes zoster (HZ) by analyzing HZ-related hospital admissions. Methods: We conducted a population-based descriptive cross-sectional study on all hospitalizations for HZ among the resident population admitted to all public and accredited private hospitals in the Veneto Region (north-east Italy) during the years 2008–2016. HZ hospitalizations were identified from the International Classification of Diseases codes in the hospital discharge records. Results: During the period considered, we identified 3566 HZ-associated admissions, 194 (5.4%) of which were readmissions within 30 days. A complicated HZ diagnosis was mentioned for 44.4% of the patients admitted once and for 65.9% of those admitted twice. In the sample as a whole, 27.0% of patients had at least one comorbidity. Overall, our analysis revealed a gradual increase in hospitalizations with age for both genders, reaching a hospitalization rate for the population over 80 years old of 51.2 × 100,000 for males and 52.8 × 100,000 for females. The average hospitalization rate for HZ-related conditions during the years 2008–2016 was 7.7 per 100,000 population. Postherpetic neuralgia was diagnosed in 8.2% of hospitalizations, with no difference between the genders. The estimated overall cost of HZ-related conditions was approximately €2.7 million a year. Conclusions: This study suggests that the burden of HZ and its impact on quality of life are of critical relevance to public health decision-making.

Abstract.Background:Peripheral arterial disease (PAD) is a common cardiovascular pathology affecting mobility in elderly. Osteoarticular diseases (ODs), responsible for functional limitations and confounding leg symptoms, may interfere with exercise therapy. This study evaluates the feasibility and effectiveness of a structured home-based exercise programme on rehabilitative outcomes in a cohort of elderly PAD patients with and without coexisting ODs. Patients and methods:Patients were enrolled from 2002 to 2016 in an exercise programme prescribed and controlled at the hospital and based on two daily 10-minute home walking sessions below the self-selected speed. The presence and localization of ODs at baseline were derived from consultation of medical documents. The ankle-brachial index and functional outcomes, defined as speed at the onset of claudication and attainable maximal speed by an incremental treadmill test, were assessed at baseline and discharge. Feasibility was determined according to dropout rate, number of visits, duration of the programme, and adherence. Results:A total of 1,251 PAD patients were enrolled (931 men; 71 ± 9 years; 0.63 ± 0.19 ankle-brachial index). Eight hundred sixty-four patients were free of ODs (ODfreePAD, 69 %), whereas 387 were affected by ODs (ODPAD, 31 %), predominantly located in the spine (72 %). In the logistic regression models, the presence of ODs was associated with female sex, overweight, sedentary and/or driving professions. At discharge, ODPADand ODfreePADdid not differ in dropout rates (12 % each), programme duration (378 ± 241 vs. 390 ± 260 days), number of visits (7 ± 3 each), and adherence (80 % each). Similar improvements for ODPADand ODfreePADwere observed for the ankle-brachial index (0.06 ± 0.12 each), the speed at onset of claudication (0.7 ± 0.7 vs. 0.7 ± 0.8 kmh-1; p = 0.70), and maximal speed (0.4 ± 0.6 vs. 0.4 ± 0.6 kmh-1; p = 0.77). Conclusions:Equally satisfactory rehabilitative outcomes were observed in elderly patients with claudication limited by ODs who completed a well-tolerated, low-impact structured exercise programme.

Compact wavelength splitters based on angled multimode interferometers (AMMIs) on silicon nitride platforms working in visible lights are reported for fluorescence sensing applications. A diplexer and triplexer with different footprints are designed and experimentally demonstrated. The diplexer and triplexer have the insertion loss of ∼1.7 and ∼2.7  dB/channel with cross talks of less than −22  dB and −17  dB on target wavelengths, respectively. These splitters are used to distinguish the signals collected from two fluorescent dyes that give different emission spectra when excited with an excitation source, due to their different Stokes shifts. In the case of the triplexer, a third port is to collect the excitation light, both to monitor the remaining excitation power and to reduce the interference at the signal ports. A termination structure at the end of the AMMIs and input and output tapering waveguides as a part of the wavelength splitters are designed and their performances are presented.

Rectal resection is technically one of the most demanding laparoscopic procedures, requiring additional training and expertise of both surgeons and institutions. The literature has shown that laparoscopic procedures can be appropriate for the treatment of rectal cancer (RC), in terms of safety, outcome and efficiency, but results may not always be directly transferable to the general population. This study aimed to investigate the use of laparoscopic rectal cancer resections in a north-eastern Italian region (the Veneto) and to see how the characteristics of patients and hospitals are associated with the use of laparoscopy. This was a retrospective cohort study based on administrative data collected from 2007 to 2014 in the Veneto region (north-east Italy). In the period considered (2007–2014), 4953 rectal resections were performed for RC in Veneto hospitals, accounting for 35% of the total 14,243 surgical procedures involving the rectum, and resulting in 76,739 days in hospital [mean length of stay—post-operative (MLOS) 15.5 ± 11.1 days]. Patients were a mean 67.9 ± 11.7 years old (68 ± 12.7 for women, 67.9 ± 11 for men), while the subgroup of patients undergoing laparoscopic procedures was on average 2 years younger (66.5 ± 11.8 vs 68.8 ± 11.5; p< 0.05). The four main findings of this study are: (1) the increasing rates of laparoscopic procedures for RC resection at all the hospitals in our geographical area, rising up to 52% in 2014. This is probably related to not only to availability of better equipment but surely to a growing expertise of surgeons; (2) the esteem of proportion of laparoscopically treated RC; (3) the significant difference between the laparoscopic and open surgical approach in terms of mean length of hospital stay after RC resection, making the laparoscopic approach cost-effective generally speaking; and (4) the disparities in hospitals’ use of laparoscopy by patients’ age group: Laparoscopic surgery is safe also in the elderly population but it is not so widely offers in Veneto Region hospitals, and it’s probably due to the lack of experience about this approach in frail/old patients.

Although the effects of air pollution on mortality have been clearly shown in many epidemiological and observational studies, the pro-arrhythmic effects remain unknown. We aimed to assess the short-term effects of air pollution on ventricular arrhythmias in a population of high-risk patients with implantable cardioverter-defibrillators (ICDs) or cardiac resynchronisation therapy defibrillators (ICD-CRT).

Malignancy following solid organ transplant remains a significant threat to the survival of cardiac transplant recipients. Plasma cell dyscrasias including multiple myeloma have been encountered in this population, and medication treatments traditionally used to treat these disorders demonstrate immunomodulatory effects that may have implications on the transplanted allograft. Lenalidomide is an immunomodulatory agent that has been used to treat plasma cell disorders, including light-chain amyloidosis (AL) and multiple myeloma, and represents such a class of medications in which the risks and benefits in the solid organ transplant population remain to be fully elucidated. This report highlights a clinical practice issue where the treatment of a patient’s multiple myeloma with lenalidomide may have potentiated an episode of severe acute cellular rejection and further demonstrates the need for future investigation of the optimal treatment of plasma cell disorders including AL amyloidosis and multiple myeloma following solid organ transplantation.