Search

Background and objectives The treatment of chronic illnesses requires health care professionals (HCPs) to master several nontechnical skills to meet patient care needs. This article aims to describe the rationale and the inductive process through which a self-assessment tool for the nontechnical skills of hemophilia teams was conceived, developed, and tested. Methods Starting from an explorative analysis of hemophilia HCP work experiences, the process followed 3 phases: an in-depth analysis of hemophilia HCP skills; the questionnaire development; and a pilot study. Results Using the voice of HCPs as a starting point, the tool proved to be able to identify precise cross-professional and intercultural challenges as well as related required and/or acquired skills in the hemophilia field. Conclusion The proposed tool may contribute to providing HCPs with strategic knowledge to successfully perform everyday practices, to improve the effectiveness of hemophilia teams and the care model adopted by their centers, and to implement intercultural research in this field. It may be used to propose ad hoc training courses targeted by challenge, in order to fill the major gaps reported by the teams, or targeted by medical specialty or country (and therefore health care system) specificity.

This study investigates the effect of liquid-type organofluorine additives (OFAs) on the morphology, thermal conductivity and mechanical properties of rigid polyurethane (PU) and polyisocyanurate (PIR) foams. Foams were characterized in terms of their morphology (density, average cell size, anisotropy ratio, open cell content), thermal conductivity and compressive as well as flexural properties. Based on the results, we observed that OFAs efficiently reduced the average cell size of both PU and PIR foams, leading to improved thermal insulating and mechanical properties.

Aims: Embedded system plays a vital role in today’s life. Hence, our interest is in areadelay- energy efficient embedded system design in post-CMOS technology, i.e., QCA. Objectives: The research is focused on efficient area-delay-energy Configurable Logic Block (CLB) design for Field-Programmable Gate Array architecture (FPGA) with successful simulation-based on next-generation technology, Quantum-dot cellular automata. Methods: Each proposed circuit is designed on post CMOS 4 dot 2 electron technology, i.e. QCA (Quantum dot Cellular Automata), is adopted in circuit implementation due to low power dissipation, high clock frequency and high package density. QCADesigner is used to verify the functionality of every circuit. QCAPro tool is used for determining power dissipation. Results: In contrast, a new approach of using de-multiplexer replacing the decoder has been introduced that results in the reduction of the average energy dissipation by almost 57%. A NOR based D flip-flop memory architecture and multiplexer are also used in the lookup table for the configurable logic block. The proposed architecture thus reduces the overall latency. The proposed CLB consists of 6356 QCA cells covering 7.44 um2 area. Write and read latency of proposed CLB are 12 and 7.25 QCA clock, respectively. Conclusion: The present paper concludes that read and write latency reduction occurs; average energy dissipation, leakage, and switching energy dissipation are reduced in a large amount resulting in an advantage of the overall minimization of the latency for the proposed CLB in the process.

Here we show the possibility to forecast the hourly day-ahead electricity consumption mix exploiting a deep learning model. Thus, in the context of the proposed life cycle assessment (LCA) aware scheduling framework, a production scheduling could be optimized to adapt its load profile in those hours that are predicted to have a lower environmental impact. The objective functions of the optimization would therefore be the LCA impacts of the consumed electricity mix. The increase in detail in the accounting can also be exploited to complement the life cycle inventory, allowing the overall assessment to be more adherent to reality.

This study investigates the influence of air bubbles inclusion on the foaming of water blown and water-pentane blown rigid polyurethane and polyisocyanurate foams. It was observed that, when a large number of air bubbles were included in the reacting system during the mixing stage (fast mixing), no further bubble nucleation from water reaction or pentane evaporation occurred. In this case, foam morphology was solely dictated by the mixing stage and by later bubble coarsening. Instead, when no air bubbles were included during mixing (slow mixing), nucleation of new bubbles from CO2 (from water-isocyanate reaction) and pentane was observed. Furthermore, both bubble coalescence and Ostwald ripening were observed as mechanisms responsible for the foam morphology coarsening, the latter being less effective in the case of polyisocyanurate foams.

Background: Assessing the viewpoints of health care professionals concerning their work with chronic patients is a relatively new research topic, widely overlooked in the literature. However, understanding their subjective work experience is highly relevant for identifying problems and perceived resources, enhancing health service organisation, improving relationships or communication with patients, and maintaining well-being. Purpose and method: Qualitative data from the "Haemophilia Experience, Results and Opportunities" Initiative - a research program aimed at investigating the psychosocial aspects of hemophilia - were used to evaluate the experiences of 62 professionals from seven countries around the world. Semi-structured interviews were submitted to thematic analysis of elementary contexts with the aid of T-Lab software. Results: Five dominant themes emerged, identifying the main challenges that professionals have to deal with in their everyday work practice: caring for impaired adult patients; handling policies and stakeholders; providing counselling on diagnosis and reproductive choices; considering the role of family dynamics; coping with adolescent patients. Conclusion: The outcomes of the study provide an opportunity to develop the area of the non-technical skills in the core curriculum of those who work with chronic illnesses by focusing on cross-professional competences and by improving a comprehensive care model for hemophilia patients.

Objective The aim of this study was to describe a variation of the breast reconstruction technique with myocutaneous flap of the fat-grafted latissimus dorsi muscle and its outcomes and evaluation of patient satisfaction. Method This prospective cohort study included 18 patients and 19 reconstructed breasts, with 1 bilateral case. There were 7 cases of late reconstruction and 11 cases of immediate reconstruction. The flap was prepared with fat at the time of surgery, which was injected before its preparation. The evaluation of the results regarding shape, volume, and symmetry was performed through a satisfaction scale completed by patients and 2 physicians from 12 to 18 months after reconstruction. Results On average, 171.31 mL of fat was injected (100-275 mL); the average time of unilateral surgery was 3 hours 42 minutes (3 hours to 4 hours 30 minutes). After a mean follow-up of 26.38 months (13-38 months), we did not observe complications of this new technique. In the evaluation performed by patients regarding the shape, volume, and symmetry, more than 80% rated the outcome as excellent and good, and the evaluations by the medical team were also satisfactory. In the comparative analysis between immediate and late reconstruction, patients who underwent immediate reconstruction were more satisfied. Conclusions This reconstruction technique with autologous fat injection was effective, with satisfactory and long-lasting results, and without the requirement for implants to set breast shape and volume.

International audience; Drawing upon a socio-constructivist perspective, this paper aims to gain insight into how two communities in the Italian Apennines region - differentially exposed to severe earthquakes in the past - remember, understand and plan for seismic phenomena. Avezzano was completely devastated in 1915, while the last significant event in Sulmona dates to 1706. However, both communities have indirectly experienced recent serious seismic events (e.g., L'Aquila earthquake in 2009 and Amatrice earthquake in 2016) as well as directly experienced lesser local tremblors. Interviews with citizens (N = 37) and stakeholders (N = 18) were conducted in the two cities and content-analysed with the support of NVivo software. The results show substantial differences in how respondents understand seismic events, access this information and prepare preventive strategies depending on their place of residence and role. The Avezzano community shares a more detached view, while the Sulmona community gives a more concerned picture. Moreover, the stakeholders tend to present an optimistic scenario, while citizens express a more critical viewpoint. Overall, the interview contents may be organised around two main oppositions: fatalism vs. empowerment in the face of an earthquake threat; and the will to forget about this risk vs. the need to remember it. The positioning on these two oppositions is defined by psychological, social and structural characteristics of individuals, and give rise to different representations of seismic risk and management. Such representations have practical implications for how the issue is addressed and faced in the communities' everyday life.

The diffusion of Battery Electric Vehicles (BEVs) is projected to influence the electricity grid operation, potentially offering opportunities for load-shifting policies aimed at higher integration of renewable energy technologies in the electricity system. Moreover, the examined literature emphasizes electricity as a relevant driver of BEVs Life Cycle Assessment (LCA) results. To evaluate LCA impacts associated to future BEVs diffusion scenarios in Italy, we adopt the Consequential Life Cycle Assessment (CLCA) methodology. LCA conventionally assumes a proportional relation between environmental impact indicators and the functional unit. However, such relation may not be representative if the electricity system is significantly affected by the large-scale diffusion of BEVs. Our study couples the conventional CLCA methodology with the EnergyPLAN model through three different approaches, which progressively include BEV-specific dynamics, to capture correlations between additional BEVs fleets and the electricity grid operation, that affectthe mix of electricity consumed in the use phase by BEVs, in Italy in 2030. Here we show that if renewables capacity is not additionally installed in response to additional BEVs electricity demand, the marginal Climate change total indicator of BEVs may increase up to ~40%, with respect to a business-as-usual scenario. Moreover, we quantitatively support the literature indications on how to properly estimate BEVs LCA impacts. Indeed, we weight electricity LCA impacts on hourly BEV charge profiles, finding that this approach best captures BEVs interdependence with the electricity system. At low BEVs diffusion, this approach clearly shows the potential BEVs capability to increase exploitation of renewable energy, whereas at high BEVs diffusion, it fully highlights potential responses of fossil fuel power plants to additional electricity demand. Due to these dynamics, we find that linearly scaling the business-as-usual scenario results would lead to an underestimation of 12.45 Mton CO2-eq of the total impacts of an additional BEVs fleet, under a 100% BEV diffusion scenario. Our methodology could be replicated with different energy system models, or at various geographical scales. Our framework could be coupled with comprehensive assessments of transport systems, to further provide robustness to policymakers by including non-linearities in the mix of electricity consumed during the use phase of BEVs.

This paper investigates the dimensions of trust and the role of information sources and channels in developing differentiated forms of science communication. The discussions from two public consultations carried out in Italy and Slovakia about controversial science-related topics were quali-quantitatively content analysed. The results show that scientific knowledge pervades diverse communication spheres, producing differentiated paths of trust in science. Each path is determined by topics (environment or health-related), information sources and channels preferred, and specific features of the multifaceted notion of trust. The contribution discusses cross-national commonalities and specificities and proposes implications for science communication.

The steel industry is an important engine for sustainable growth, added value, and high-quality employment within the European Union. It is committed to reducing its CO2 emissions due to production by up to 50% by 2030 compared to 1990′s level by developing and upscaling the technologies required to contribute to European initiatives, such as the Circular Economy Action Plan (CEAP) and the European Green Deal (EGD). The Clean Steel Partnership (CSP, a public–private partnership), which is led by the European Steel Association (EUROFER) and the European Steel Technology Platform (ESTEP), defined technological CO2 mitigation pathways comprising carbon direct avoidance (CDA), smart carbon usage SCU), and a circular economy (CE). CE approaches ensure competitiveness through increased resource efficiency and sustainability and consist of different issues, such as the valorization of steelmaking residues (dusts, slags, sludge) for internal recycling in the steelmaking process, enhanced steel recycling (scrap use), the use of secondary carbon carriers from non-steel sectors as a reducing agent and energy source in the steelmaking process chain, and CE business models (supply chain analyses). The current paper gives an overview of different technological CE approaches as obtained in a dedicated workshop called “Resi4Future—Residue valorization in iron and steel industry: sustainable solutions for a cleaner and more competitive future Europe” that was organized by ESTEP to focus on future challenges toward the final goal of industrial deployment.

The application of industrial symbiosis to chemical processes is made possible by considering physical by-products as new sources in spite of potential waste. The by-product acts as a substitution of raw materials in symbiotic chemical companies, possibly taking into account geographical proximity. While advantages appear evident in terms of reduced cost savings and resource consumption, benefits related to other environmental impacts seem to be less clear. This chapter deals with different case studies of industrial symbiosis and how these are treated according to literature, regulatory approaches and main guidelines. Once the different approaches and their range of applications are presented, the chapter describes the main barriers and strengths in the application of these rules to the chemical sector. Finally, the identified approaches are applied to a specific case of industrial symbiosis in the chemical sector by illustrating how the single data can be calculated and can quantitatively change. This chapter aims to guide the LCA practitioner through an agile set of rules in modelling industrial symbiosis in an LCA perspective and to provide a quantitative evaluation of the effects that a modelling choice may produce with respect to another.

Typical EEG-based BCI applications require the computation of complex functions over the noisy EEG channels to be carried out in an efficient way. Deep learning algorithms are capable of learning flexible nonlinear functions directly from data, and their constant processing latency is perfect for their deployment into online BCI systems. However, it is crucial for the jitter of the processing system to be as low as possible, in order to avoid unpredictable behaviour that can ruin the system's overall usability. In this paper, we present a novel encoding method, based on on deep convolutional autoencoders, that is able to perform efficient compression of the raw EEG inputs. We deploy our model in a ROS-Neuro node, thus making it suitable for the integration in ROS-based BCI and robotic systems in real world scenarios. The experimental results show that our system is capable to generate meaningful compressed encoding preserving to original information contained in the raw input. They also show that the ROS-Neuro node is able to produce such encodings at a steady rate, with minimal jitter. We believe that our system can represent an important step towards the development of an effective BCI processing pipeline fully standardized in ROS-Neuro framework., Accepted at the IEEE International Conference on Systems, Man, and Cybernetics (SMC 2020)

In this paper we examine the use of Twitter and Facebook in two dramatic earthquakes that hit Italy: L’Aquila (in 2009) and Emilia (in 2012). Indeed, disasters disrupt everyday life and engage people in meaning-making processes aimed at recovering meaning and control of their world. In these cases, we argue that the use of social media may contribute to social representations processes and functions: cognitive coping, social sharing of emotions, preserving self-efficacy, boosting identity, and community empowerment. Different methods were adopted to examine the use of social media in the immediate aftermath, a few days after, and in the medium-long term. Differences between the events, combined with the differences between Twitter and Facebook, entailed a multiplicity of uses. Nevertheless, the analyses point to the same conclusions: by fostering new forms of communication and encounters, social media played an increasingly important role during and after the earthquakes. First, they were used for providing information and material coping, then they favored the social sharing of emotions and joint remembering, and finally they contributed to claiming voice and control. Results thus suggest that the use of social media favored different representational functions, which progressively contributed to community empowerment.

Biorefining involves the sustainable processing of biomass into a spectrum of marketable food and feed ingredients, bio-based products (chemicals and materials), and bioenergy (biofuels, power, and/or heat). The processing of sugarcane is a successful example of renewable bioenergy being produced on a large industrial scale. As the world largest crop by production quantity, around 1907 millions of tons of sugarcane were globally produced last year. Currently, most of the sugarcane mills produce first generation (1 G) ethanol, sugar, and energy from the burning of bagasse. However, the use of part of the sugarcane bagasse to produce second generation (2 G) ethanol is beginning to move towards an industrial reality. The 2 G ethanol process itself also generates several side-streams, which could be further used to obtain high added-value products. Integrated 1 G-2 G biorefineries, where the whole sugarcane biomass is converted to bioenergy and a suite of bio-based products, can be an attractive investment option for a future scenario of a low-carbon economy. The purpose of this review is to gather together the most recent technologies that have been developed to enable the whole use of feedstocks, byproducts, and side-streams within the sugarcane biorefinery. Possible ways to improve the efficiency of biomass processing are discussed, such as the use of low-cost additives, together with the economic and environmental aspects related to the implementation of a sugarcane biorefinery. Potential applications of sugarcane bagasse and straw to obtain valuable products including enzymes, biofertilizers, nanocellulose and lignin-derived commodities are presented as opportunities to improve the attractiveness of this business model.

Not available

Objective: the purpose of this study was to analyze quantitative sleep changes and their implication in subjective cognitive decline (SCD). Objective sleep pattern was investigated through actigraphy recorded at the baseline and at the follow-up after two years. The aim of the study was to examine specific sleep alterations in SCD. Background: sleep disorders are very common among average elderly adults and an altered sleep pattern is known to be a risk factor for future development of Mild Cognitive Impairment (MCI) and dementia. Recent studies have shown how sleep is objectively altered in average senior adults with Subjective Cognitive Decline (SCD), without any other significant change in cognition and behavior or brain structure. Considering that both SCD and disrupted sleep are risk factors for future MCI and dementia, with sleep only as a modifiable risk factor, further research is required to deeply investigate the interaction between sleep and SCD. Methods: among seventy community-dwelling elderly individuals who had been enrolled at baseline, thirty-five (64.6 5.6 y, 15M/20F) underwent a complete neuropsychological battery and one-week wrist actigraphy recording two years later during the follow-up stage. Individuals were divided into two groups according to their Subjective Cognitive Decline Questionnaire (SCD-Q) score. Sleep hours, sleep efficiency and onset latency, napping and time awake after sleep onset (WASO) were collected. All individuals underwent structural Magnetic Resonance Imaging (MRI) examination to exclude brain disorders. Data collection was performed at baseline and after two years at the follow-up phase. Results: a significantly different night sleep time between the two groups was observed: SCD showed a lower total sleep time (TST) than non-SCD subjects. Moreover, a total time spent in bed (TIB) was significantly lower in SCD subjects over two years of observation. Conclusions: objective changes over time of the sleep pattern, specifically total time spent in bed and total sleep time, are present in SCD individuals. The results of the study show that sleep alterations are common in SCD and underline the clinical importance of screening in order to assess sleep alterations as well as improve sleep in average adults with SCD complaints.

The application of LCA in the energy consumption management can address the sustainability of energy systems. The chapter first aims at summarizing general trends in addressing environmental implication of energy use. Second, LCA methodology is briefly introduced in order to clarify its potentialities and general use in the energy field area. In particular, LCA can contribute to select the best technological choices for an energy system. A challenge in the use of LCA is identified in the representation of a complex system in which the energy producers’ contribution changes on a temporal basis. Two approaches are proposed for the LCA use in the short-term perspective: attributional LCA and consequential LCA. The proposed approach examines the application of LCA in a short-term perspective. Both approaches can be used to analyze an efficient configuration of the system. However, the more the temporal and geographical area is restricted, the more specific issues have to be adopted to provide a reliable analysis. In particular, consequential and attributional approaches should be used under different hypotheses and with proper adaptation. The proposed approach examines the application of consequential LCA in a short-term perspective, defined as the time span in which the market system has not reacted to a change yet. Moreover, it could claim environmental impact savings in the presence of an accurate model that is able to predict the hourly marginal technology of the near future (one day to 1 week). The future application of the proposed approach would be a tool that manages to assess the best hourly consumption trajectory in order to minimize environmental impacts.

[EN] Mass-customization of wearable products are offered as a higher added value to the broad public and have to compete with ready-to-wear offer. However, people with specific requirements are not covered by the current mass-customised products. This is the case of the elderly, disabled, diabetic and obese population groups when wearing textiles, clothing, footwear and textile-based orthotic goods. Further, at present, available knowledge and flexibility of production equipment and machinery of small and medium-sized enterprises operating in these traditional industries (even those that already offer made-to-measure products to the mass public) is unable to respond to the individual needs among such heterogeneous groups. The FASHION-ABLE project has solved this problem with a comprehensive set of solutions., This work was supported by the European Commission [project number FP7.FoF.NMP.2011-4 Project 284 871] under FASHION-ABLE project (http://www.fashionable-project.eu/) Area: 'High tech solutions in production [...] for [...] healthy consumer goods'.

The paradigm of sustainable manufacturing equally implies the implementation of new technologies and their proper use within supply networks along product life cycle. In particular, this paper analyses the case of WEEE which requires the configuration of dedicated de/re-production networks to change the state-of-the-art processes thanks to the introduction of new production systems to improve capability of a region to treat this particular kind of waste. A modular approach is here proposed to evaluate the impact of each EOL process creating what-if scenarios for the network configuration. Using discrete-event simulation it was evaluated how the implementation of innovative de/re-manufacturing centers to re-work WEEE components (i.e. Printed Circuit Boards-PCBs) can change the sustainability of a certain geographical area taking into consideration the management of flows from pre-treatment centers to the new plants.

We present a method to perform imaging of GCaMP6 signals with high accuracy for single action potential detection over populations of neurons in the mouse brain using galvanometric mirrors and fast smart line scan trajectories.

Cerebral sinus venous thrombosis (CSVT) is a rare condition representing the 0.5-1% of all stroke cases which can have serious consequences. Early diagnosis and complete screening for acquired or inherited risk factors is crucial for decreasing morbidity and mortality. We have investigated clinical and aetiological factors in an Italian cohort of 43 patients with cerebral sinus venous thrombosis. Common presentation complaints were headache (81.4%), focal signs (20.9%), vomiting (11.6%) and seizures (6.9%). Acquired or inherited conditions were observed in more than 80% of cases. The commonest aetiological factors were contraceptives (74.1% of women), congenital thrombophilia (34.9%), infections and dysthyroidism (16.3%), hyperhomocysteinemia (9.3%), migraine (11.6%), cranial trauma (9.3%) and chronic myeloproliferative diseases (11.6%). Outcome was favourable in more than 80% of patients. Early diagnosis and anticoagulant treatment may decrease mortality and/or morbidity rates related with CVST in these patients. Thrombophilic abnormalities, either inherited or acquired, are worthy to be widely investigated.

The increasing level of customisation within manufacturing industry introduces a new degree of complexity in assessing the environmental impact on the product chain. In particular, when such assessments are devoted to complex effects, traditional methodologies require new developments. The aim of the present article is to propose a new assessment method combing life-cycle assessment (LCA) with discrete simulation to evaluate the sustainability of a company aiming to integrate different customisation policies in a networked context. In particular, a modular LCA can assess the environmental impact of a supply chain (SC) with different configurations. Then, based on different supply chain management (SCM) strategies, simulation is run creating scenarios by introducing variation of performance drivers such lead time to the customer, quality in terms of scraps and level of sustainability of the suppliers to support comparison of different kind of customisation. The preliminary results of the LCA-SCM model applied to the customisation case in the fashion sector highlights as specific decisional areas under the control of supply managers (e.g. supplier selection and manufacturing defects) can significantly affect the environmental impact of the whole SC.

This paper presents the work related to the 3D reconstruction of the scene depicted in the famous Piero della Francesca's fresco “The Resurrection”. The work has presented many challenges due to the fact that deliberate alterations to a mathematically correct perspective were introduced by the artist in order to visibly underline the contrast between the divine plane (Christ resurrected) and the human plane (a group of soldiers witnessing the scene). The reconstructed 3D model has been used in an interactive application enabling the virtual visit of the scene as seen from relevant viewpoints corresponding to the different perspectives and to details of the depicted figures. The application also allows to change in real-time the lighting conditions of the scene in order to compare the virtual illumination with the one present in the fresco so as to illustrate possible alternatives about the debated original collocation of the artwork.

SummaryBackground Compression ultrasonography (CUS) has been recognized as the diagnostic procedure of choice for the investigation of patients with suspected deep vein thrombosis (DVT); the aim of this study was to assess the diagnostic accuracy of nurse-performed CUS for symptomatic proximal DVT of the lower limb. Material and Methods We prospectively evaluated all consecutive outpatients referred for suspected DVT from January 2011 to December 2012. All patients underwent bilateral proximal lower limb CUS, first by trained nurses and then by physicians expert in vascular ultrasonography, with every group blinded with respect to each other. This test was repeated after 5–7 days in all negative or unclear examinations. Interobserver agreement and accuracy of nurse-performed CUS were calculated, considering the physician's final diagnosis as the reference test. Results Six hundred ninety-seven patients were included in the study. DVT was diagnosed in 122 patients by expert ultrasound physicians with an overall prevalence of 17.5% (95% confidence interval [CI] 15.8%–20.6%). Nurse agreement with the physician in DVT diagnosis was excellent (Cohen's κ 0.82, 95% CI 0.79–0.85). Nurse-performed CUS had a sensitivity of 84.4% (95% CI 81.7%–87.1%) and a specificity of 97.0% (95% CI 95.8%–98.3%) with a diagnostic accuracy of 94.8% (95% CI 93.2%–96.5%). Conclusion Our results suggest that nurse-performed CUS may be a potential useful alternative to physician performed CUS with a good accuracy. However, sensibility of nurse-performed CUS appeared suboptimal and future studies should incorporate in the evaluation of this technique other pretest tools that may increase its accuracy.

WOS: 000300864200005, The Advanced GAmma Tracking Array (AGATA) is a European project to develop and operate the next generation gamma-ray spectrometer. AGATA is based on the technique of gamma-ray energy tracking in electrically segmented high-purity germanium crystals. This technique requires the accurate determination of the energy, time and position of every interaction as a gamma ray deposits its energy within the detector volume. Reconstruction of the full interaction path results in a detector with very high efficiency and excellent spectral response. The realisation of gamma-ray tracking and AGATA is a result of many technical advances. These include the development of encapsulated highly segmented germanium detectors assembled in a triple cluster detector cryostat, an electronics system with fast digital sampling and a data acquisition system to process the data at a high rate. The full characterisation of the crystals was measured and compared with detector-response simulations. This enabled pulse-shape analysis algorithms, to extract energy, time and position, to be employed. In addition, tracking algorithms for event reconstruction were developed. The first phase of AGATA is now complete and operational in its first physics campaign. In the future AGATA will be moved between laboratories in Europe and operated in a series of campaigns to take advantage of the different beams and facilities available to maximise its science output. The paper reviews all the achievements made in the AGATA project including all the necessary infrastructure to operate and support the spectrometer. (C) 2011 Elsevier B.V. All rights reserved., EU [RII3-CT-2004-506065]; German BMBF [06K-167, 06KY2051]; Swedish Research Council; Knut and Alice Wallenberg Foundation; UK EPSRC Engineering and Physical Sciences Research Council; UK STFC Science and Technology Facilities Council; AWE plc; Scientific and Technological Research Council of Turkey [106T055]; Ankara University [05B4240002]; Polish Ministry of Science and Higher Education [DPN/N190/AGATA/2009]; Spanish MICINN [FPA2008-06419, FPA2009-13377-C02-02]; Spanish Consolider-Ingenio Programme CPAN [CSD2007-00042]; Generalitat Valenciana [PROMETEO/2010/101]; MICINN, Spain; INFN, Italy [AIC10-D-000568]; Science and Technology Facilities Council [ST/F012039/1, ST/J000094/1, ST/F004192/1, ST/J000159/1, ST/I504940/1, NuSTAR, ST/F006950/1, ST/I504916/1, ST/G000670/1, ST/F004060/1, ST/J000051/1, ST/J000108/1, ST/G000670/1 NuSTAR, ST/I504959/1, ST/G000727/1, ST/F004052/1, ST/F004184/1], AGATA and this work is supported by the European funding bodies and the EU Contract RII3-CT-2004-506065, the German BMBF under Grants 06K-167 and 06KY2051, the Swedish Research Council and the Knut and Alice Wallenberg Foundation, UK EPSRC Engineering and Physical Sciences Research Council, UK STFC Science and Technology Facilities Council, AWE plc, Scientific and Technological Research Council of Turkey (Proj. nr. 106T055) and Ankara University (BAP Proj. nr. 05B4240002), the Polish Ministry of Science and Higher Education under Grant DPN/N190/AGATA/2009, the Spanish MICINN under grants FPA2008-06419 and FPA2009-13377-C02-02, the Spanish Consolider-Ingenio 2010 Programme CPAN (contract number CSD2007-00042) the Generalitat Valenciana under Grant PROMETEO/2010/101, and research performed in the frame of the GSI-IN2P3 collaboration agreement number 02-42. A. Gadea and E. Farnea acknowledge the support of MICINN, Spain, and INFN, Italy, through the AIC10-D-000568 bilateral action.

SummaryBleeding is a common and feared complication of oral anticoagulant therapy. Several prediction models have been recently developed, but there is a lack of evidence in patients with venous thromboembolism (VTE). The aim of this study was to validate currently available bleeding risk scores during long-term oral anticoagulation for VTE. We retrospectively included adult patients on vitamin K antagonists for VTE secondary prevention, followed by five Italian Anticoagulation Clinics (Cuneo, Livorno, Mantova, Napoli, Varese), between January 2010 and August 2012. All bleeding events were classified as major bleeding (MB) or clinically-relevant-non-major-bleeding (CRNMB). A total of 681 patients were included (median age 63 years; 52.0% female). During a mean follow-up of 8.82 (± 3.59) months, 50 bleeding events occurred (13 MB and 37 CRNMB), for an overall bleeding incidence of 9.99/100 patient-years. The rate of bleeding was higher in the first three months of treatment (15.86/100 patient-years) than afterwards (7.13/100 patient-years). The HAS-BLED showed the best predictive value for bleeding complications during the first three months of treatment (area under the curve [AUC] 0.68, 95% confidence interval [CI] 0.59–0.78), while only the ACCP score showed a modest predictive value after the initial three months (AUC 0.61, 95%CI 0.51–0.72). These two scores had also the highest sensitivity and the highest negative predictive value. None of the scores predicted MB better than chance. Currently available bleeding risk scores had only a modest predictive value for patients with VTE. Future studies should aim at the creation of a new prediction rule, in order to better define the risk of bleeding of VTE patients.

This contribution examines levels and components of consciousness (knowledge, experiences, awareness, concerns, values) invoked by decision makers and key informants in their speeches on energy sustainability at the Italian parliament in the years 2009–2012. A socioconstructivist approach, indeed, suggests that meaning-making and negotiation processes involved in the creation of laws affect the cultural shift required for successful energy transitions. Discussions among decision makers (n = 90) and consultation with key informants (n = 93) were submitted to content analysis. Results show that levels of consciousness are low, and their increase is due to external events, but they rapidly return to the baseline when the events in question leave the agenda. Cognitive components largely prevail over affects and values. Concerns are associated with all the energy sources. The observed unbalance among the components of consciousness, although being a pragmatic rhetorical choice, opens several questions ...

Public engagement is considered a crucial process in the transition towards sustainable energy systems. However, less space has been devoted to understand how policy makers and stakeholders view citizens and their relationship with energy issues. Nonetheless, together with technological advancements, policies and political debates on energy affect public engagement as well as individual practices. This article aims at tackling this issue by exploring how policy makers and stakeholders have socially constructed sustainable energy in Italian parliamentary debates and consultations during recent years (2009–2012). Results show that societal discourses on sustainable energy are oriented in a manner that precludes public engagement. The political debate is characterised by argumentative ‘short-circuits’ that constrain individual and community actions to the acceptance or the refusal of top-down decisions and that leave little room for community empowerment and bottom-up innovation.

In clinical practice lung ultrasound (LUS) is becoming an easy and reliable noninvasive tool for the evaluation of dyspnea. The aim of this study was to assess the accuracy of nurse-performed LUS, in particular, in the diagnosis of acute cardiogenic pulmonary congestion. We prospectively evaluated all the consecutive patients admitted for dyspnea in our Medicine Department between April and July 2014. At admission, serum brain natriuretic peptide (BNP) levels and LUS was performed by trained nurses blinded to clinical and laboratory data. The accuracy of nurse-performed LUS alone and combined with BNP for the diagnosis of acute cardiogenic dyspnea was calculated. Two hundred twenty-six patients (41.6% men, mean age 78.7 ± 12.7 years) were included in the study. Nurse-performed LUS alone had a sensitivity of 95.3% (95% CI: 92.6-98.1%), a specificity of 88.2% (95% CI: 84.0-92.4%), a positive predictive value of 87.9% (95% CI: 83.7-92.2%) and a negative predictive value of 95.5% (95% CI: 92.7-98.2%). The combination of nurse-performed LUS with BNP level (cut-off 400 pg/mL) resulted in a higher sensitivity (98.9%, 95% CI: 97.4-100%), negative predictive value (98.8%, 95% CI: 97.2-100%), and corresponding negative likelihood ratio (0.01, 95% CI: 0.0, 0.07). Nurse-performed LUS had a good accuracy in the diagnosis of acute cardiogenic dyspnea. Use of this technique in combination with BNP seems to be useful in ruling out cardiogenic dyspnea. Other studies are warranted to confirm our preliminary findings and to establish the role of this tool in other settings.

The 40–year anniversary of the United Nations ‘International Women’s Day,’ was celebrated on 8 March 2015. As we approach the end of the Millennium Development Goals (MDGs), we reflect on the gender debate that has arose amidst tackling MDG4 and highlight the need for greater gender equality in measuring child health outcomes in the post–MDG era in line with MDG 3 (see Box 1). Box 1 Summary of Millennium Development Goals 3 and 4 Goal 3: Promote gender equality and empower women Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015 3.1 Ratios of girls to boys in primary, secondary and tertiary education 3.2 Share of women in wage employment in the non–agricultural sector 3.3 Proportion of seats held by women in national parliament Goal 4: Reduce child mortality rates Reduce by two–thirds, between 1990 and 2015, the under–five mortality rate 4.1 Under–five mortality rate 4.2 Infant mortality rate 4.3 Proportion of 1 year–old children immunised against measles NEED TO PROFILE GENDER AS A DETERMINANT OF CHILD HEALTH INEQUITY In recent years, several key UN reports and articles have begun to articulate the gender gap that exists in child health outcomes [1–3]. Indeed, it has been the UN which has taken a lead in promoting gender equality internationally by requiring all UN entities to mainstream gender and promote gender equality as mandated by the Beijing Platform for Action (1995) and ECOSOC resolutions 1996, 1997, 2006 and consolidated by the quadrennial comprehensive policy review 2012 (General Assembly Resolution 67/226). According to the 2012 World Development Report, gender equality is at the heart of development and “…too many girls and women are still dying in childhood and in the reproductive ages” [4]. Perhaps it is a reflection on the relative success of MDG 3 and 4 (despite it not being likely that the numerical targets will be achieved in time) that it has helped to raise the issue of gender in child health and the need for more equitable goals in the future. Leading international organisations have developed organisation specific gender action plans, policies or guidelines in the past two decades in order to tackle gender imbalance issues in its organisational activities (see Box 2). Box 2 Organisations identified through a Google Scholar search of ‘gender’ or ‘sex’ and ‘policy’ or ‘guideline’ or ‘framework’ African Development Bank Asian Development Bank Bill and Melinda Gates Foundation Council of Europe Department for International Development (DFID) European Union Global Alliance for Vaccines and Immunisation (GAVI) Global Fund The International Federation of Red Cross and Red Crescent Societies (IFRC) Organisation for Economic Co–operation and Development (OECD) Save the Children The United Nations Children's Fund (UNICEF) World Bank World Health Organisation (WHO) The authors congratulate recent efforts to collect gender disaggregated child health outcomes data by Inter-Agency Group for Child Mortality Estimation (IGME) and Countdown 2015 as the first step to enable the profiling of gender as a determinant of child health inequity. Nevertheless, if gender is to be mainstreamed as a determinant of child health, future country achievement profiles should require nations to highlight sex disparities in coverage of life saving interventions, especially in countries where girls are known to be subject to discrimination in health care access and outcomes. In other words, it should become the norm, rather than the exception, to report sex–differentiated data for child health indicators. In addition, reporting health interventions which have been proven to reduce maternal, newborn and child mortality rates by gender would prove valuable to better realign services and make targeted policy steps. In response to the challenge of collecting better gender data and developing an effective response, we discuss some of the challenges reported in the literature of researching gender and child health and their potential solutions. We also look briefly at the example of India; one country in which there is evidence of severe discrimination against girls in child health care outcomes, to provide a perspective of the challenge that remains ahead.

Acute lower respiratory illnesses (ALRI) are the leading cause of death among children

O Cardiac Patients Learning Needs Inventory (CPLNI) foi construído com o intuito de avaliar a necessidade de aprendizagem de pacientes com doença cardíaca. Este estudo teve como objetivo comparar resultados das validações semânticas da versão adaptada para o português do instrumento CPLNI, realizadas por meio da avaliação de 40 pacientes brasileiros e 16 portugueses internados para tratamento da doença arterial coronariana. Os participantes foram entrevistados individualmente e responderam os instrumentos para caracterização sócio-demográfica e clínica, a versão adaptada do CPLNI e o instrumento de validação semântica. Na avaliação geral do CPLNI, a maioria dos pacientes, tanto brasileiros como portugueses, considerou o instrumento adequado, de fácil compreensão e preenchimento. A validação semântica do CPLNI mostrou necessidade de algumas alterações na sua redação visando à adequação semântica do instrumento para seu uso em Portugal e no Brasil.

The development of new methodologies and tools supporting the design and management of eco-effective manufacturing systems represents a major challenge for the emerging sustainable production paradigm. Novel methodologies based on Life Cycle Assessment will be powerful tools to quantify the environmental impacts of factories and manufacturing system operations. The full exploitation of Life Cycle Assessment tools within frameworks for production process development still needs significant research efforts. A modular calculation of Environmental Profiles for a Production Line is proposed as a structured approach. An industrial application is described, with reference to a woodworking production line, outlining the major benefits of the approach. © 2011 CIRP.

For the first time the 4π γ-ray spectrometer EUROGAM II has been coupled to a 4π light charged particle detector array, DIAMANT, during a test experiment on the reaction 32 S + 58 Ni at 120 MeV beam energy. A very large improvement in the peak-to-background ratio of the γ-spectra has been found when EUROGAM II is triggered by DIAMANT to select an exit channel. A simple algebra has been developed which provides theoretical estimates in good agreement with these experimental results. It is demonstrated that, depending on both the γ-spectrometer and ancillary detector performances, much better peak-to-background can be obtained by such a coupling. For the same peak-to-background ratio, the use of an ancillary detector allows for a lower γ-ray coincidence level and therefore improves the statistics. Ways to select the most appropriate ancillary detector are given. The ability of the ancillary detector to provide a total Doppler shift correction is crucial for the improvement of the peak-to-background ratio.

The 3 MV tandem accelerator of the Naples University is used for research activities and applications in many fields. At the beginning of operation (1977) the main utilization was in the field of nuclear physics. Later, the realization of new beam lines allowed the development of applied activities as radiocarbon dating, ion beam analysis, biophysics, ion implantation etc. At present, the availability of different ion sources and many improvements on the accelerator allow to run experiments in a wide range of subjects. An overview of the characteristics and major activities of the laboratory is presented.

Background Stroke may be a clinical expression of several inherited disorders in humans. Recognition of the underlined genetic disorders causing stroke is important for a correct diagnosis, for genetic counselling and, even if rarely, for a correct therapeutic management. Moreover, the genetics of complex diseases such the stroke, in which multiple genes interact with environmental risk factors to increase risk, has been revolutionized by the Genome-Wide Association Study (GWAS) approach. Scope of review Here we review the single-gene causes of ischemic stroke, bringing the reader from the candidate gene method toward the exciting new horizons of genetic technology. Major conclusions The aetiological diagnosis of ischemic stroke in young adults is more complex than in the elderly. The identification of a genetic cause is important to provide appropriate counseling and to start a correct therapy, when available. The advent of GWAS technology, such as for other complex pathological conditions, has contributed enormously to the understanding of many of these genetic bases. For success large, well phenotyped case cohorts are required, and international collaborations are essential. General significance This review focuses on the main causes of genetically-based ischemic stroke in young adults, often classified as indeterminate, investigating also the recent findings of the GWAS, in order to improve diagnostic and therapeutic management., Highlights • The aetiological diagnosis of stroke in young adults needs a different and more complex diagnostic work up than in older adults. • Stroke may be a clinical expression of several inherited disorders in humans. • The most common genetic causes of stroke are CADASIL, Fabry and mitochondrial diseases. • Recognition of the underlined genetic disorders causing stroke is important for the correct management of the patient.

Augmented Reality AR has proven to provide effective tools to assist the human work in a wide range of sectors. Many examples can be found in literature of innovative AR tools used in medicine, industry and the military fields. Recently AR has been successfully applied also to cultural heritage, mainly for communication and educational purposes. Nevertheless, we argue that also the activity of professional operators dealing with cultural heritage, such as conservators and restorers, can benefit from the use of AR-systems. The restoration process commonly builds on the analysis and study of prior interventions and, very often, on the results of pre-operative diagnoses performed on the artwork. All the information gathered during these stages is necessary during the restoration and, using AR, it can be directly overlaid on top of the artwork avoiding the necessity of a continuous visual switch between the artwork and the documentation. Moreover, through an AR-system, new digital information can be produced directly while working, fostering also new forms of documentation. We hereby present ARTworks, an AR-system intended to assist the restorer both during the operating phases, providing contextualized information, and during documentation, allowing the insertion of new registered digital information. The system, composed by a mechanical interface and an Android tablet, has been purposely designed taking into account the particular application field of restoration.

Polycystic ovary syndrome (PCOS) is a prevalent disease affecting women of reproductive age. It may be associated with metabolic disorders such as insulin resistance (IR) and obesity. The anti-Mullerian hormone (AMH) levels seem to be higher in patients with PCOS.The present study was designed to evaluate the association between AMH and insulin in women with PCOS with and without IR.Cross-sectional study, including 86 patients, selected and divided into three groups: Group A: 26 women with PCOS and IR; Group B: 30 women with PCOS and without IR; and Group C: 30 controls without PCOS.We found significant difference between serum AMH levels in the group of women with PCOS and without IR when compared to the control group, thus showing that PCOS and IR play an important role in elevating the levels of this hormone. When the groups were compared with each other following adjustment for BMI, serum AMH levels were significantly higher in the group of women with PCOS and IR.AMH levels are significantly higher in patients with PCOS, particularly in those women with PCOS and IR. Nevertheless, larger samples are required to confirm these findings.

Augmented Reality (AR) has proven to provide effective tools to assist the human work in a wide range of sectors. Many examples can be found in literature of innovative AR tools used in medicine, industry and the military sector. We argue that also the activity of professional operators dealing with cultural assets, such as restorers, can benefit from the use of AR system. We have carried out a series of interviews in the field of restoration in order to identify the real needs of restorers addressable by an Augmented Reality system. We have identified two AR-based devices, exemplary of two classes of AR systems, which we believe can provide a valuable support to the restoration activities and can foster communication and collaboration among restorers. The two systems have been evaluated by the restoration professionals in the survey.

The aim of this present paper is to evaluate network sustainability applying a quantitative model based on the integration of LCA data with discrete simulation. For this purpose, different scenarios have been defined by collecting several product-chain data as an attempt to develop a formalized approach to share information within a network cluster. As preliminary approach, the supply chain environmental impact is assessed through a static modular LCA. Then the paper presents different supply chain configurations in which the variations of three important drivers, like lead-time to the customer, level of sustainability of the suppliers and target Global Warming Potential (GWP) value per product, can influence each other. By collecting data from a footwear company case, the model assesses the environmental sustainability of the supply chain (SC) taking into consideration the following environmental impact: materials and components suppliers, transport and logistics from suppliers to producer or contractors, and producer or contractors. According to the proper data reliability required at inventory level, it was possible to simulate scenarios considering different degree of variability of the GWP. The preliminary results highlighted as specific decisional areas under the control of product managers (e.g. supplier selection and manufacturing defects) can significantly affect the environmental impact of the whole supply chain.

Objective Healthcare Workers (HCWs) have a higher frequency of TB exposure than the general population and have therefore an occupational TB risk that infection prevention and control (IPC) measures aim to reduce. HCWs are crucial in the implementation of these measures. The objective of the study was to investigate Mozambican HCWs' perceptions of their occupational TB risk and the measures they report using to reduce this risk. In addition, we explored the challenges HCWs encounter while using these TBIPC measures. Methods Focus group discussion. Analysis according content method. Participants Four categories of HCWs: auxiliary workers, medical (doctors and clinical officers), nurses and TB program staff. Results HCWs are aware of their occupational TB risk and use various measures to reduce their risk of infection. HCWs find it challenging to employ measures that minimize such risks and a lack of clear guidelines contributes to these challenges. HCWs' and patient behavior further complicate the use of TBIPC measures. Conclusion HCWs in Mozambique perceive a high occupational risk of TB infection. They report several challenges using measures to reduce this risk such as shortage of material, lack of clear guidelines, insufficient motivation and inadequate training. Robust training with motivational approaches, alongside supervision and support for HCWs could improve implementation of TBIPC measures. Healthcare management should address the areas for improvement that are beyond the individual HCW's control.