Search

Bilioenteric anastomoses were common interventions before the rise of minimal invasion procedures, specifically, before endoscopic retrograde cholangiopancreatography. During a choledochoduodenostomy (CDS) the distal part of the common bile duct is excluded from the bile drainage and behaves as a “sump,” a poorly drained part that works as a reservoir which is responsible of the development of complications of the bilio-pancreatic tract. The consequent sump syndrome is a rare medical complication that presents a diversity of symptoms, for which there is no well-defined diagnostic algorithm. We present the case of a 72-year-old male patient with multiple comorbidities. He presented to the ER because of recurrent episodes of cholangitis; after having obtained the patient’s medical records, lab and image studies, the latter showed pneumobilia. After considering all the results plus the pneumobilia we suspect the presence of this uncommon complication of CDS. The patient was subjected to an unsuccessful endoscopic treatment followed by surgery, after which he showed signs of improvement and adequate evolution till hospital discharge.

Sexual assistance services that people with disabilities use for help with sexual activity must be specialized and adapted to the users’ different conditions. Some aspects of sexual assistance have been mentioned in the literature, but the subject is still relatively unexplored, particularly regarding adapted services for people with disabilities. The objective was to create a toolbox with items that might be required in encounters with individuals with disabilities and to think of innovative ideas to improve sexual assistants’ work. This multi-method qualitative study involved two meetings: one workshop and one co-design session. The sample included six future sexual assistants studying at the Italian Institute of Sexology in Rome. The workshop presented two different scenarios so the students could think of what is needed to improve their work. At the end of the workshop, a list of items was developed. The co-design session explored possible design solutions to improve and facilitate their work as sexual assistants. The idea that interested everyone due to its practicality, usability and feasibility was an inflatable sofa/mattress that includes internal divisions so different sections of the mattress can be inflated and/or deflated. The development of projects such as this one provides different perspectives on what still needs to be done within the sexual assistance domain.

In a context of welfare austerity and growing inequalities many citizens ask for public sector reforms in the health sector and for community action as a relevant practice. However, analyse...

There is limited evidence on the strategies, resources, and tools shown to improve winter mobility and community participation. This paper describes a multifaceted approach taken to develop an mHealth application that provides information, resources, and strategies to facilitate winter mobility for mobility device users, service providers, community organisations, and researchers. The study was conducted in three phases: (1) A scoping review of peer-reviewed and grey literature was completed to identify literature that reported on tools, strategies, resources, and recommendations used to promote winter mobility; (2) Online asynchronous focus groups were conducted to identify the type of content that mobility device users wanted to include in the web-based application; and (3) A prototype mHealth application was developed based on the findings from the previous phases. Using a rapid prototyping process that included stakeholder review through an online survey, four cycles of application design and development were undertaken. The scoping review identified 23 peer-reviewed studies and limited grey literature on winter mobility strategies, resources and recommendations. Twenty-four participants from across Canada engaged in one of five focus groups. Focus group analysis led to the development of the content categories for the mHealth application. The initial prototype application developed was reviewed by; 27 mobility device users, 16 health care providers, and seven consumer organisation representatives identified areas of strength and further refinement in regard to application design. The approach used in this study provided a method to develop an application based on the ideas, needs, and interests of a variety of stakeholders. Once fully developed, the application has the potential to fill the gaps related to the lack of a unified collection of winter mobility strategies and resources, and open the dialogue on methods to improve winter participation among mobility device users.IMPLICATIONS FOR REHABILITATIONDespite winter conditions being a common challenge among mobility device users, there is an absence of an organised approach towards helping individuals manage their winter mobility needs.As the development and usage of mHealth applications continues to increase, it is valuable to use methods of designing applications based on the ideas, needs, and interests of a variety of stakeholders.Development of a framework for collating information on winter mobility strategies and resources is the first step towards launching an mHealth application. Despite winter conditions being a common challenge among mobility device users, there is an absence of an organised approach towards helping individuals manage their winter mobility needs. As the development and usage of mHealth applications continues to increase, it is valuable to use methods of designing applications based on the ideas, needs, and interests of a variety of stakeholders. Development of a framework for collating information on winter mobility strategies and resources is the first step towards launching an mHealth application.

Objective: To identify the knowledge, products, and strategies for individuals with mobility-related disabilities used to address challenging winter conditions. Data Sources: AgeLine, OVID, Scopus, and CIHAHL were searched for studies that met the inclusion criteria, from inception to April 2018. Sources for gray literature, or information outside commercial publishing, included ProQUEST, government websites, and manufacturers, vendors, and consumer organization websites. Source Selection: Population of people with limited or reduced mobility or mobility device users involved in winter-related environmental conditions; aim was to increase activity, participation, or safety. Data Extraction: Two reviewers independently applied the inclusion criteria to select eligible sources. Two reviewers independently extracted the data from each source. Data Synthesis: Twenty-three published peer-reviewed papers were located. Study populations were predominantly those who used wheelchairs (mixed wheelchair type, n=7; power, n=4; manual, n=2), canes (n=3), or specialized winter footwear (n=2). The primary focus of these papers was determined to be tool or device (n=10), recommendations (n=9), strategy (n=2), or resource (n=2). Civic policy documents were variable in citizen responsibility for snow clearing. Limited winter-related supports were identified on consumer organization websites. Although some winter-specific products exist, very few studies have examined the effectiveness of any of these products. Conclusions: Despite the common experience of challenging winter conditions, a paucity of winter-specific research and innovation relevant for individuals who use mobility devices exists. Researchers, consumers, and industry need to partner to develop novel tools, strategies, resources, and evidence-based recommendations. Keywords: Cold climate, Community participation, Rehabilitation, Self-help devices, Wheelchairs

Purpose The purpose of this paper is to verify whether the horizontal grab bar for the toilet and the bathtub suggested by the Code du bâtiment du Québec conform to users’ preferences. Perceived effort, comfort and safety were considered. Design/methodology/approach In total, 31 adults and seniors using manual and powered wheelchairs were asked to test different grab bar configurations for both the toilet and bathtub. A questionnaire was designed to evaluate participants’ perceptions and preferences after the trials with each grab bar. Effort was measured using the ten-level Borg scale, while participants’ comfort and safety were assessed with a five-point Likert scale. Participants were finally invited to express an overall personal preference between the two grab bar used in each setup. Findings Participants showed preference for an L-shaped grab bar for the toilet, and a horizontal grab bar for the bathtub. The authors’ results differ from the recommendations of the barrier-free design standards of the province of Quebec’s construction code, which states that horizontal grab bars should be used for the toilet and bathtub. Originality/value This study suggest that despite the limited sample, there is an undeniable need for testing norms for public spaces, whenever is possible and has a direct effect on end-users, before publishing them.

Background A clinical algorithm (Algo) in paper form is used in Quebec, Canada, to allow health care workers other than occupational therapists (OTs) to make bathroom adaptation recommendations for older adults. An integrated knowledge transfer process around Algo suggested an electronic version of this decision support system (electronic decision support system [e-DSS]) to be used by older adults and their caregivers in search of information and solutions for their autonomy and safety in the bathroom. Objective This study aims to (1) create an e-DSS for the self-selection of bathroom-assistive technology by community-dwelling older adults and their caregivers and (2) assess usability with lay users and experts to improve the design accordingly. Methods On the basis of a user-centered design approach, the process started with content identification for the prototype through 7 semistructured interviews with key informants of various backgrounds (health care providers, assistive technology providers, and community services) and 4 focus groups (2 with older adults and 2 with caregivers). A thematic content transcript analysis was carried out and used during the creation of the prototype. The prototype was refined iteratively using think-aloud and observation methods with a clinical expert (n=1), researchers (n=3), OTs (n=3), older adults (n=3), and caregivers (n=3), who provided information on the usability of the e-DSS. Results Overall, 4 themes served as the criteria for the prototype of the electronic Algo (Hygiene 2.0 [H2.0]): focus (safety, confidentiality, well-being, and autonomy), engage, facilitate (simplify, clarify, and illustrate), and access. For example, users first pay attention to the images (engage and illustrate) that can be used to depict safe postures (safety), illustrate questions embedded in the decision support tool (clarify and illustrate), and demonstrate the context of the use of assistive technology (safety and clarify). Conclusions The user-centered design of H2.0 allowed the cocreation of an e-DSS in the form of a website, in line with the needs of community-dwelling older adults and their caregivers seeking bathroom-assistive technology that enables personal hygiene. Each iteration improved usability and brought more insight into the users’ realities, tailoring the e-DSS to the implementation context.

International standards govern the installation of detectable warning surfaces in urban environments. However, the application of these standards at the local level poses many challenges due to contextual differences. The aim of this qualitative cross-sectional study was to evaluate the usability of detectable warning surfaces installed in Quebec City (Canada) with people with visual impairments. Nineteen participants with various profiles visited two sites where the detectable warning surfaces had been installed. They tested the surfaces as well as adjacent urban facilities following a pedestrian route. They were then interviewed about what they thought of the detectable warning surfaces: their usefulness, messages transmitted, locations chosen, how safe they make users feel, types of environment in which they should be installed, how detectable they are, their advantages and disadvantages, and any desired improvements. Generally, the participants understood the messages transmitted by the warning surfaces and were in favor of their installation. They identified some disadvantages and suggested various improvements. The results of this study provide important information concerning the usability of detectable warning surfaces for partners and stakeholders in Quebec City and also contribute to the international literature in this field.Implications for rehabilitationDetectable warning surfaces increase the readability or use of road infrastructures by people with visual impairments. They make it easier for them to get around independently.This project supports the importance of establishing an effective communication plan, particularly with the aim of clarifying the contexts of implantation and the messages transmitted by the detectable warning surfaces to the people with visual impairments. Training could systematically be offered to them by an orientation and mobility specialist.It is also important to inform and educate the general public and bus drivers about the presence of detectable warning surfaces. Information could be transmitted via some community organizations and the public transit networks.In order to effectively coordinate the implantation process of detectable warning surfaces, communication and consultation between the various stakeholders are essential, including the designers, the municipalities and the concerned government authorities. Detectable warning surfaces increase the readability or use of road infrastructures by people with visual impairments. They make it easier for them to get around independently. This project supports the importance of establishing an effective communication plan, particularly with the aim of clarifying the contexts of implantation and the messages transmitted by the detectable warning surfaces to the people with visual impairments. Training could systematically be offered to them by an orientation and mobility specialist. It is also important to inform and educate the general public and bus drivers about the presence of detectable warning surfaces. Information could be transmitted via some community organizations and the public transit networks. In order to effectively coordinate the implantation process of detectable warning surfaces, communication and consultation between the various stakeholders are essential, including the designers, the municipalities and the concerned government authorities.

In the present images we allude to a syndrome of low incidence, characterized by pink urine, being related to factors such as obesity, and being triggered by abdominal surgeries, use of propofol, among others. Being favoured by the presence of abundant crystals of uric acid in the urine confers the typical pink coloration.

Despite scientific evidence of the safety, efficacy, and in some cases superiority of minimally invasive surgery in hepato-pancreato-biliary procedures, there are scarce publications about bile duct repairs. The aim of this study was to compare the outcomes of robotic-assisted surgery versus laparoscopic surgery on bile duct repair in patients with post-cholecystectomy bile duct injury. This is a retrospective comparative study of our prospectively collected database of patients with bile duct injury who underwent robotic or laparoscopic hepaticojejunostomy. Seventy-five bile duct repairs (40 by laparoscopic and 35 by robotic-assisted surgery) were treated from 2012 to 2018. Injury types were as follows: E1 (7.5% vs. 14.3%), E2 (22.5% vs. 14.3%), E3 (40% vs. 42.9%), E4 (22.5% vs. 28.6%), and E5 (7.5% vs. 0), for laparoscopic hepaticojejunostomy (LHJ) and robotic-assisted hepaticojejunostomy (RHJ) respectively. The overall morbidity rate was similar (LHJ 27.5% vs. RHJ 22.8%, P = 0.644), during an overall median follow-up of 28 (14–50) months. In the LHJ group, the actuarial primary patency rate was 92.5% during a median follow-up of 49 (43.2–56.8) months. While in the RHJ group, the actuarial primary patency rate was 100%, during a median follow-up of 16 (12-22) months. The overall primary patency rate was 96% (LHJ 92.5% vs. RHJ 100%, log-rank P = 0.617). Our results showed that the robotic approach is similar to the laparoscopic regarding safety and efficacy in attaining primary patency for bile duct repair.

La Unidad Bridge is located in the south of the Gulf of Mexico, in the state of Campeche, Mexico. The new La Unidad Bridge will replace the existing bridge which was built in the 1980´s and presents several pathologies. The bridge is placed in a very important road parallel to the coast, in the heart of the Mexico´s oil industry, and allows the connection between the “El Carmen” Island and the continent. The new “La Unidad” bridge has a total length of 3285 m, and crosses over the sea with water heights comprised between 4 and 15 m. The bridge has 73 spans of 45 m; the deck is formed by 6 “I” beams of prestressed concrete, with concrete slab. The piers are composed by battered piles formed by steel pipes filled with reinforced concrete. The pile cap is placed directly over the piles. The design and construction of the bridge presented several challenges: the area where the bridge is located is prone to hurricanes and earthquakes, and the soil of the bridge site is relatively soft (formed by sands and clays) and an amplification of the seismic response occurs due to site effects. This paper presents the main aspects of the design and the construction of the New “La Unidad” Bridge. The bridge is now under construction and will be finished at the end of 2018.

Social welfare systems face major challenges, particularly in a context of social transformation, austerity and growing inequalities. This process is highly visible in the health sector. In this context, many voices ask for public sector reforms and community action for health as a relevant practice. However, analyses and evaluations of this kind of practices are still limited, particularly beyond the cases of single community health actions or interventions. We still need to identify key indicators for measuring and characterising what community action for health consists of, as well as to what degree this kind of intervention has been developed across a city. Based on a research about 49 neighborhoods in Barcelona, this paper creates an index to measure and characterize community action for health, using different indicators: citizen engagement programs in community health, organizational transformation of the health and social protection systems, stable participatory structures with specific teams, and urban health policies. We apply the index to the case of Barcelona and build a map of community action for health in the city using 4 categories: strong community health development (one neighbourhood), middle (9 neighborhoods), emergent (25 neighborhoods) and without specific community health promotion (14 neighbourhoods). We find that community action for health is extensive within the city of Barcelona, have great potential as a response to the need for change in the relationship between the public (health) sector and the citizenry, but is still implemented unequally across the urban territory in terms of types and methods.

The incidence of bile duct injuries (BDI) after cholecystectomy, which is a life-threatening condition that has several medical and legal implications, currently stands at about 0.6 %. The aim of this study is to describe our experience as the first center to use a laparoscopic approach for BDI repair. A prospective study between June 2012 and September 2014 was developed. Twenty-nine consecutive patients with BDI secondary to cholecystectomy were included. Demographics, comorbidities, presenting symptoms, details of index surgery, type of lesion, preoperative and postoperative diagnostic work-up, and therapeutic interventions were registered. Videos and details of laparoscopic hepaticojejunostomy (LHJ) were recorded. Injuries were staged using Strasberg classification. A side-to-side anastomosis with Roux-en-Y reconstruction was always used. In patients with E4 and some E3 injuries, a segment 4b or 5 section was done to build a wide anastomosis. In E4 injuries, a neo-confluence was performed. Complications, mortality, and long-term evolution were recorded. Twenty-nine patients with BDI were operated. Women represented 82.7 % of the cases. The median age was 42 years (range 21–74). Injuries at or above the confluence occurred in 62 %, and primary repair at our institution was performed at 93.1 % of the cases. Eight neo-confluences were performed in all E4 injuries (27.5 %). The median operative time was 240 min (range 120–585) and bleeding 200 mL (range 50–1100). Oral intake was started in the first 48 h. Bile leak occurred in 5 cases (17.2 %). Two patients required re-intervention (6.8 %). No mortality was recorded. The maximum follow-up was 36 months (range 2–36). One patient with E4 injury developed a hepaticojejunostomy (HJ) stenosis after 15 months. This was solved with endoscopic dilatation. The benefits of minimally invasive approaches in BDI seem to be feasible and safe, even when this is a complex and catastrophic scenario.

With the growing interest worldwide in making communities more age-friendly, it is becoming increasingly important to understand the factors that help or hinder communities in attaining this goal. In this article, we focus on rural and remote communities and present perspectives of 42 experts in the areas of aging, rural and remote issues, and policy who participated in a consensus conference on age-friendly rural and remote communities. Discussions highlighted that strengths in rural and remote communities, such as easy access to local leaders and existing partnerships, can help to further age-friendly goals; however, addressing major challenges, such as lack of infrastructure and limited availability of social and health services, requires regional or national government buy-in and funding opportunities. Age-friendly work in rural and remote communities is, therefore, ideally embedded in larger age-friendly initiatives and supported by regional or national policies, programs, and funding sources.

Spontaneous biliary-enteric fistula after laparoscopic cholecystectomy bile duct injury is an extremely rare entity. Y-en-Roux hepaticojejunostomy has been demonstrated to be an effective surgical technique to repair iatrogenic bile duct injuries. Seven consecutive patients underwent robotic-assisted (n = 5) and laparoscopic (n = 2) biliary-enteric fistula resection and bile duct repair at our hospital from January 2012 to May 2017. We reported our technique and described post-procedural outcomes. The mean age was 52.4 years, mostly females (n = 5). The mean operative time was 240 min for laparoscopic cases and 322 min for robotic surgery, and the mean estimated blood loss was 300 mL for laparoscopic and 204 mL for robotic cases. In both groups, oral feeding was resumed between day 2 or 3 and hospital length of stay was 4–8 days. Immediate postoperative outcomes were uneventful in all patients. With a median of 9 months of follow-up (3–52 months), no patients developed anastomosis-related complications. We observed in this series an adequate identification and dissection of the fistulous biliary-enteric tract, a safe closure of the fistulous orifice in the gastrointestinal tract and a successful bile duct repair, providing the benefits of minimally invasive surgery.

The Cuernavaca city is located 80 KM, south of Mexico City. The highway Mexico-Acapulco pass through the Cuernavaca city, and traffic jams are very important, particularly during weekends and holydays. For that reason the Ministry of Transports of Mexico started a program to expand the highway from 4 to 10 circulation lanes in the 14.5 KM of the highway zone that crosses the city of Cuernavaca. In that context 10 footbridges, placed over the highway were demolished and replaced with new ones with spans from 37 to 47 m. The bridges are arch type in steel. This type of structure was selected for aesthetic and structural reasons. Due to the high flexibility of the bridges, the dynamic behavior under pedestrian loading was studied and modifications to the original design were made in order to avoid unacceptable vibrations. The bridges are also placed in a high seismic region, and time history calculations considering non-linear behavior of the concrete piers were made in order to evaluate the dynamic response of the bridges under strong earthquakes. This paper presents the main issues of the design process of the bridges, and some important results concerning the dynamic and seismic design of them.

Background Choledocholithiasis presents in 5-10% of the patients with biliary lithiasis. Numerous treatment algorithms have been considered for this disease, however, up to 10% of these therapeutic procedures may fail. Intraoperative choledochoscopy has become a useful tool in the treatment of patients with difficult-to-manage choledocholithiasis. Objectives To determine the usefulness of intraoperative choledochoscopy in the laparoendoscopic treatment of difficult stones that was carried out in our service. Patients and methods A cross-sectional study was conducted. The case records were reviewed of the patients that underwent intraoperative choledochoscopy during biliary tree exploration plus laparoscopic choledochoduodenal anastomosis within the time frame of March 1, 2011 and May 31, 2012, at the Hospital General Dr. Manuel Gea Gonzalez. Transabdominal choledochoscopies were performed with active stone extraction when necessary, followed by peroral choledochoscopies through the recently formed bilioenteric anastomosis. The data were analyzed with descriptive statistics and measures of central tendency. Results The mean age was 71 years, 57% of the patients were women, and the ASA III score predominated. Active extraction of stones with 7 to 35 mm diameters was carried out in 4 of the cases and the absence of stones in the biliary tract was corroborated in all the patients. The mean surgery duration was 18 minutes (range: 4 to 45 min). Conclusions Choledochoscopy is a safe and effective minimally invasive procedure for the definitive treatment of difficult stones.

Seniors may have difficulties interacting with their environment due to emerging motor disabilities. The bathroom is probably the first space where this can be observed, yet retirement residences continue to build bathrooms designed for adults without disabilities. This qualitative study aimed to shed light on the relationship between users (seniors with motor disabilities and caregivers) and their bathrooms in retirement residences, and on how users imagine their ideal bathroom. Most interviewees claimed to have no problems using this space; however, a decrease in both the frequency of hygiene habits and the need for privacy was observed.

The objective of this research was to determine the most difficult areas of the home for adults with motor disabilities. Descriptive analyses were developed using the database (n = 66) of the Home Assessment of Environment Interaction instrument in the cities of Quebec and Montreal and their suburbs. Despite the general belief that the bathroom is the most difficult space, the results showed the entrance to a home to be the most difficult area, followed by exterior components (mailbox, car, garbage cans). This paper highlights the significant problems that modern homes in this region of Canada present for adults with motor disabilities.

Purpose Since the mid-1990s, the social model of disability has come under scrutiny. Several researchers have examined the role of ontology (philosophical ideas about the nature of what it means to be human) in relation to disability. In this paper, we situate this burgeoning understanding of disability within the set of post-cartesian ontologies, which disrupt the separation of the mind from the body and its attendant dichotomies. Furthermore, we seek to show how such a change can carry through to the research paradigm and therefore affect tangible outcomes of disability research. Design/methodology/approach A commitment to an embodied ontology requires first and foremost that researchers rethink what is being studied by focusing on the diverse characteristics of being and its actualization within the world. This will involve an emphasis on the lived experience of the body, including issues of affect, identity and movement, as well as broader issues of embodied being. Findings Using a research program currently underway at the Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) as a detailed example, we draw on the ontological framework to help articulate the way research can be re-organized. We show how projects at different scales can be brought to work together, and highlight how a focus on embodiment issues facilitates such multi-disciplinary, inter-project collaboration. We note that adopting such an ontology-based framework will accomplish three major outcomes: (1) increase the relevance and effectiveness of new projects with regard to the overall vision; (2) enhance cross-project synergies and ensure stronger ties between research and practice; and (3) contribute to shifting the underlying ontology from a more cartesian approach to a post-cartesian embodied perspective. Originality/value The new ontologies embrace, integrate and extend the earlier social and biomedical perspectives, and offer a critical perspective on technology. The embodied approach recognizes not only the embodiment of research subjects, but also the embodied experience of the researchers themselves. In addition, the approach leads to a more holistic organization of research within a global, interconnected structure of projects rather than simply a collection of separate projects organized into thematic areas, as was done in previous decades. This reorganization of research enhances the ability to engage academic researchers with practitioners not just in the hospital and clinical settings, but also within the wider community.

The Baluarte is the most remarkable bridge on the new Durango-Mazatlán highway, and was opened to traffic in October 2013. The bridge is cable-stayed with a total length of 1124 m, the main span is 520 m long. It is the highest cable-stayed bridge in the world, with a maximum drop of 402.5 m from the deck level to the bottom of the Baluarte river. The access viaducts have a concrete deck, and were built by the symmetrical cantilever method. The highest pile of the viaduct is 147.5 m high. The main deck is made of composite material (steel/concrete), and was erected by the cantilever method. The bridge’s site is very complex from the topographical and geotechnical points of view. It crosses the steepest part of the Sierra Madre Oriental in the north of Mexico. This region is also prone to high-speed winds caused by hurricanes. This paper presents the main characteristics of the bridge, the technical challenges and main stages of its construction. The erection methods and geometric control of its deck are also presented. And lastly, a comparison between the results of analytical models of staged construction, and the actual measurements of the bridge’s deflections, is made.

In recent years, the effects of the physical environment on the healing process and well-being have proved to be increasingly relevant for patients and their families (PF) as well as for healthcare staff. The discussions focus on traditional and institutionally designed healthcare facilities (HCF) relative to the actual well-being of patients as an indicator of their health and recovery. This review investigates and structures the scientific research on an evidence-based healthcare design for PF and staff outcomes. Evidence-based design has become the theoretical concept for what are called healing environments. The results show the effects on PF and staff from the perspective of various aspects and dimensions of the physical environmental factors of HFC. A total of 798 papers were identified that fitted the inclusion criteria for this study. Of these, 65 articles were selected for review: fewer than 50% of these papers were classified with a high level of evidence, and 86% were included in the group of PF outcomes. This study demonstrates that evidence of staff outcomes is scarce and insufficiently substantiated. With the development of a more customer-oriented management approach to HCF, the implications of this review are relevant to the design and construction of HCF. Some design features to consider in future design and construction of HCF are single-patient rooms, identical rooms, and lighting. For future research, the main challenge will be to explore and specify staff needs and to integrate those needs into the built environment of HCF.

The architecture, engineering and construction (AEC) sector can make an essential contribution to needed breakthroughs and provide new solutions for the improvement of independent and active living in the built environment, including for older adults. This is related to (i) reducing impediments of immobility and maintaining autonomy at home, (ii) reducing the number of accidents and increasing health, (iii) developing integrated care and cure of disabled and aging people, (iv) providing a setting that enables physical, environmental, and social integration, and (v) meeting personal needs, e.g. by realizing new forms of living arrangements that reduce loneliness and improve communication and social expectations in the built environment.

During the last two decades a lot of methodology research has been conducted for the design of software user interfaces (Kirisci, Thoben 2009). Despite the numerous contributions in this area, comparatively few efforts have been dedicated to the advancement of methods for the design of context-aware mobile platforms, such as wearable computing systems. This chapter investigates the role of context, particularly in future industrial environments, and elaborates how context can be incorporated in a design method in order to support the design process of wearable computing systems. The chapter is initiated by an overview of basic research in the area of context-aware mobile computing. The aim is to identify the main context elements which have an impact upon the technical properties of a wearable computing system. Therefore, we describe a systematic and quantitative study of the advantages of context recognition, specifically task tracking, for a wearable maintenance assistance system. Based upon the experiences from this study, a context reference model is proposed, which can be considered supportive for the design of wearable computing systems in industrial settings, thus goes beyond existing context models, e.g. for context-aware mobile computing. The final part of this chapter discusses the benefits of applying model-based approaches during the early design stages of wearable computing systems. Existing design methods in the area of wearable computing are critically examined and their shortcomings highlighted. Based upon the context reference model, a design approach is proposed through the realization of a model-driven software tool which supports the design process of a wearable computing system while taking advantage of concise experience manifested in a well-defined context model.

Autonomous logistics is in the centre of attraction of the logistics research domain. Several insights were gained in recent years. In order to facilitate the introduction of autonomous control methods into transport and production systems, existing technological control systems have to be considered. Up to now research neglected the question of how to include autonomous processes operationally into existing logistics systems. This contribution describes potential implementations of autonomous processes from the viewpoint of automation and control while considering IT systems that represent state of the art systems like Enterprise Resource Planning (ERP), Manufacturing Execution System (MES) and Programmable Logic Controller (PLC).

This chapter discusses the contribution of the Internet of Things for providing a fine-grained information infrastructure within collaborative production environments. Such infrastructure makes up-to-date information available to autonomous objects to render contextual decisions that evolve elemental agility. A technical discussion illustrates the feasibility of autonomous objects as well as their possible involvement in the Internet of Things. Additionally, a demonstrator is described, which exemplifies the effects of autonomous objects on agile processes within the automotive industry. Concluding, the chapter relevant research questions in the field of the Internet of Things and collaborative production environments are specified.

The aim of this study is to determine the safety and efficacy of Transfer Factor (TF) in accelerating the haematopoietic recovery in patients with acute leukaemias (AL), following intensive therapy to induce remission of the disease. Twenty-two patients with different types of AL (16 AML, three BC-CML and three ALL) were studied. The patients were divided in two groups. Group 1 (eight AML, two BC-CML and one ALL) received, after myelosuppression induced by chemotherapy, TF (1 unit daily, subcutaneous) until leucocyte count was > 2.5 x 10(9)/l and platelet count > 80 x 10(9)/l. Group 2 was considered the control group and did not receive TF. Treatment with TF accelerated the recovery of neutrophils, leucocytes, platelets (P < 0.001) and haemoglobin (P < 0.01). As a logical consequence, incidence and severity of infection and haemorrhage were lesser in the TF group than in the control group. There was no evidence that TF accelerated the re-growth of leukaemic cells. It seems that TF is safe in AL, accelerating haematopoietic recovery. However, it should be used with caution until results of additional trials become available.

Interfaces for wearable computing applications have to be tailored to task and usability demands. Critical information has to be presented in a way allowing for fast absorption by the user while not distraction from the primary task. In this work we evaluated the impact of different information presentation methods on the performance of users in a wearable computing scenario. The presented information was critical to fulfill the given task and was displayed on two different types of head mounted displays (HMD). Further the representations were divided into two groups. The first group consisted of qualitative representations while the second group focused on quantitative information. Only a weak significance could be determined for effect the different methods used have on the performance but there is evidence that familiarity has an effect. A significant effect was found for the type of HMD.

Previous chapters described among others the application of autonomous cooperation on embedded systems, in sensor networks, transport planning and communication systems. For practical demonstration of the implications of the described studies the prototype of the intelligent container was linked to an agent system for transport coordination including communication gateway and vehicle location. We arranged a demonstration scenario that illustrates the cooperation of these system components by displaying the processes that are related to one selected freight item and one transport vehicle.