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Study design Multicentre cross-sectional study. Objective The objective of this study is to evaluate prevalence, location and characteristics of pain in hospital inpatients people with spinal cord injury (SCI). Setting Ten Italian rehabilitation centres specialized in spinal injury care, where inpatients are admitted both after the acute lesion and for late complications (time since injury, median [IQR]: 0.8 [0.2-8.2] years). Methods All the persons were submitted to AIS scale assessment [1] and modified Ashworth scale [2]; personal data and anamnesis were recorded; any pain within 1 week was investigated and the International Spinal Cord Injury Pain Basic Data Set (ISCIPBDS) Italian version [3] was administered by physicians expert in type of pain definition. Results Of 385 included persons, 275 (72%) suffered pain, with the score value median [IQR]: 6 [4-8]. The worst pain of the person was nociceptive in 52% and neuropathic in 48% of the cases; 46% of nociceptive pain was located in the neck-shoulder region, whereas 67% of neuropathic pain was located in the sublesional part of the body. In 48% of the whole population, spasticity was observed but only 74% of them had pain. Being old and female are associated with high pain development, OR (95% CI): 1.24 (1.01-1.04) and 1.83 (1.05-3.20), respectively. Conclusions A high prevalence of pain is confirmed in persons with SCI, with both nociceptive and neuropathic pain characteristics. Only old age and female sex resulted as variables highly associated with pain.

Palliative care (PC) and hospice services have experienced shortages before 2020, and during the initial phases of the current pandemic, more critical gaps are expected with future surges, much as scarcity in intensive care unit services may recur during the COVID-19 pandemic. Although ethical allocation of ventilators and intensive care unit care is the subject of important discussions during this pandemic, caring for those at the end of life and those not desiring or qualifying for critical interventions must not be neglected, as critical care and comfort-focused care are intertwined. We review state and regional gaps already recognized in planning for scarcity in PC and hospice services during this pandemic and describe the planning initiatives Colorado has developed to address potential scarcities for this vulnerable and diverse group of people. We hope to encourage other state and regional groups to anticipate needs in the coming surges of this pandemic or in public health crises to come. Such planning is key to avoid the degradation of care that may result if it is necessary to invoke crisis standards of care and ration these essential services to our communities.

Background Arthroplasties in elderly patients are surgeries performed to ensure their quality of life. Perioperative care with specific nutrients can improve nutrition status and metabolic response to orthopedic surgeries, such as total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods Retrospective study with elderly patients divided into 2 groups: control and immunonutrition. The immunonutrition group was instructed to start oral intake of the nutrition supplement 5 days before and to resume it 5 days after arthroplasty (200 mL, 3 times per day). The following were analyzed as primary and secondary outcomes: length of stay (LOS), infectious and noninfectious complications, need for intensive care unit (ICU), transfusion requirement, and C‐reactive protein. Results A total of 3015 elderly patients met the inclusion criteria: control group (n = 1398) and immunonutrition group (n = 1617). Overall, 81.2% were women and mean age was 72.6 ± 6.9 years. Immunonutrition group had a shorter LOS in hours (32.0 ± 19.4 vs 56.0 ± 26.4; P < .001) and lower rates of infectious complications (2.2% vs 4.6%; P < .001). Noninfectious complications and need for ICU also had lower rates in the immunonutrition group. In the logistic regression analysis, immunonutrition reduced the chance of infectious complications by 55% (odds ratio [OR], 0.45; 95% CI, 0.30–0.68; P < .001) even after adjusting for variables (OR, 0.45; 95% CI, 0.28–0.71; P < .001). Conclusion Perioperative immunonutrition in elderly patients undergoing THA or TKA may shorten postoperative LOS and reduce infectious and noninfectious complications and transfusion requirement.

Background Increasing hospice need, a growing shortage of hospice providers, and concerns about in-person services because of coronavirus disease 2019 (COVID-19) require hospices to innovate care delivery. Measures This project compared outcomes between hospice reauthorization visits conducted via telehealth and in person. After each visit, providers, patients, and caregivers completed telehealth acceptance surveys, and providers recorded reauthorization recommendations. Intervention Providers conducted 88 concurrent in-person and telehealth visits between June and November 2019. Outcomes No statistically significant differences in reauthorization recommendations were found between telehealth and in-person visits. Satisfaction with telehealth was high; 88% of patients/caregivers and 78% of providers found telehealth services as effective as in-person visits. Conclusions/Lessons Learned Results indicate that telehealth can successfully support clinical decision making for hospice reauthorization. These findings show telehealth to be reliable and acceptable for certain types of hospice care even before COVID-19, which emphasizes its importance both during and after the current public health emergency.

Groundwater plays a substantial role in resource supply, in ecosystem functioning and human well-being. The aim of this study is develop a tool to assess the groundwater vulnerability through of fuzzy predicates in an area in the Pampas Plain in Argentina. Knowledge is represented as a main fuzzy predicate whose degree of truth is computed by means of numerical variables to determine a degree of groundwater vulnerability. Thematic Fuzzy System (TFS) software has been developed using MATLAB® to design and optimize a fuzzy predicates based model. The results in the final fuzzy map identified the middle and lower basin as areas with high and very high truth values for the main predicate “Groundwater is vulnerable”, thus, these sectors were defined as the main areas of greatest vulnerability. This study showed that fuzzy models are more efficient computer-base tools for decision-makers in the water resources management due to high discrimination of the territory, producing successful results using fewer variables than other ordinary approaches.

Diagnosis of early invasive breast cancer relies on radiology and clinical evaluation, supplemented by biopsy confirmation. At least three issues burden this approach: a) suboptimal sensitivity and suboptimal positive predictive power of radiology screening and diagnostic approaches, respectively; b) invasiveness of biopsy with discomfort for women undergoing diagnostic tests; c) long turnaround time for recall tests. In the screening setting, radiology sensitivity is suboptimal, and when a suspicious lesion is detected and a biopsy is recommended, the positive predictive value of radiology is modest. Recent technological advances in medical imaging, especially in the field of artificial intelligence applied to image analysis, hold promise in addressing clinical challenges in cancer detection, assessment of treatment response, and monitoring disease progression. Radiomics include feature extraction from clinical images; these features are related to tumor size, shape, intensity, and texture, collectively providing comprehensive tumor characterization, the so-called radiomics signature of the tumor. Radiomics is based on the hypothesis that extracted quantitative data derives from mechanisms occurring at genetic and molecular levels. In this article we focus on the role and potential of radiomics in breast cancer diagnosis and prognostication., Highlights • In the screening setting, radiology sensitivity is suboptimal. • Artificial intelligence hold promise in cancer diagnosis and prognostication. • Radiomics include feature extraction from clinical images.

Lichen planus (LP) is a chronic inflammatory and immune-mediated disease that affects the skin, hair, nails and mucous membranes. Although there is a broad clinical spectrum of lichen planus manifestations, the skin and oral cavity remain the major sites of involvement. A group of European dermatologists with a long- standing interest and expertise in lichen planus has sought to define therapeutic guidelines for the management of patients with LP. The clinical features, diagnosis and possible medications that clinicians can use, in order to control the disease, will be reviewed in this manuscript. The revised final version of the lichen planus guideline was passed on to the European Dermatology Forum (EDF) for a final consensus with the European Academy of Dermatology and Venereology (EADV).

Mycosis fungoides (MF) is a rare neoplasm representing the most frequent form of primary cutaneous T-cell lymphoma (CTCL). Diagnosis of MF is generally complex, often requiring integration of clinical, histological, immunophenotypic and molecular data. Currently, there are no epidemiological data supported by registries or local studies on MF in Italy. Moreover, the clinical management of MF in Italy is heterogeneous, and differs according to the geographical area and experience of the physician who manages the disease. Considering the uncertainties in the current scenario for MF in Italy, a consensus project involving experts on CTCL was initiated to define the epidemiological impact of MF and obtain information about the current diagnostic and therapeutic pathway of this disease in Italy. The prevalence of MF in Italy was estimated to be 6,800 patients, 4,900 of whom with early stage of disease; the estimated incidence ranged between 270 and 330 new cases per year. Among the clinical figures involved in the multidisciplinary management of MF, dermatologists were recognised as a reference point for both diagnosis and therapeutic decisions. These findings suggest the importance of monitoring both the disease and its management; it is, therefore, interesting to set up regional registries for monitoring and recognition of rare tumor status for MF. The results further indicate the need to train physicians to favour more rapid diagnosis and simplify the pathway for referring patients to reference centres with adequate diagnostic and treatment standards. In light of the forthcoming introduction of new therapies, the development of a nationwide PDTA (Path of Diagnostic Therapeutic Care, in Italian defined as Percorso Diagnostico-Terapeutico Assistenziale) is also of substantial importance.

After spinal cord injury (SCI), patients face many physical and psychological issues including intestinal dysfunction and comorbidities, strongly affecting quality of life. The gut microbiota has recently been suggested to influence the course of the disease in these patients. However, to date only two studies have profiled the gut microbiota in SCI patients, months after a traumatic injury. Here we characterized the gut microbiota in a large Italian SCI population, within a short time from a not only traumatic injury. Feces were collected within the first week at the rehabilitation center (no later than 60 days after SCI), and profiled by 16S rRNA gene-based next-generation sequencing. Microbial profiles were compared to those publicly available of healthy age- and gender-matched Italians, and correlated to patient metadata, including type of SCI, spinal unit location, nutrition and concomitant antibiotic therapies. The gut microbiota of SCI patients shows distinct dysbiotic signatures, i.e. increase in potentially pathogenic, pro-inflammatory and mucus-degrading bacteria, and depletion of short-chain fatty acid producers. While robust to most host variables, such dysbiosis varies by lesion level and completeness, with the most neurologically impaired patients showing an even more unbalanced microbial profile. The SCI-related gut microbiome dysbiosis is very likely secondary to injury and closely related to the degree of completeness and severity of the lesion, regardless of etiology and time interval. This microbial layout could variously contribute to increased gut permeability and inflammation, potentially predisposing patients to the onset of severe comorbidities.

Syphilis is one of the greatest masqueraders in dermatology, like mycosis fungoides or sarcoidosis. In fact, secondary syphilis can simulate different dermatological conditions, not only clinically but also histopathologically. A 34-year old Brazilian man from Manaus (Amazonas) attended our Department complaining for 2 weeks of asthenia, weight loss and multiple asymptomatic disseminated erythematous papules and scaly plaques with well-defined borders and a tendency to confluence were observed on the trunk, neck and extremities, clinically similar to psoriasis guttata. The skin biopsy and laboratory tests disclosed secondary syphilis and the patient was treated with intramuscular benzathine penicillin with prednisolone, with a complete resolution. Psoriasiform syphilis, which imitates psoriasis, was well known by old dermatologists and was called syphilide psoriasiforme or psoriasis syphilitique. Psoriasiform syphilis is one of the atypical presentations of secondary syphilis and dermatologists should be aware of psoriasiform syphilis in order not to improperly treat syphilis patients with immunosuppressive drugs; also, pathologists should be aware of secondary syphilis histopathological features.

Low cycle fatigue life of high-strength reinforcing steel bars (ASTM A706 Grade 80), using photogrammetry by RGB methodology is evaluated. Fatigue tests are performed on specimens under constant axial displacement with total strain amplitudes ranging from 0.01 to 0.05. The experimental observations indicate that buckling of high-strength reinforcing bars results in a damaging degradation of their fatigue life performance as the slenderness ratio increases, including an early rebar failure as the total strain amplitude increases since it achieves the plastic range faster. In addition to this, the results show that the ratio of the ultimate tensile strength to yield strength satisfies the minimum of 1.25 specified in ASTM A706 for reinforcement. On the other hand, the RGB methodology indicates that the axial strains measured by photogrammetry provide more accurate data since the registered results by the traditional experimental setup do not detect second-order effects, such as slippage or lengthening of the specimens within the clamps. Moreover, the RGB filter is faster than digital image correlation (DIC) because the RGB methodology requires a fewer computational cost than DIC algorithms. The RGB methodology allows to reduce the total strain amplitude up to 45% compared to the results obtained by the traditional setup. Finally, models relating total strain amplitude with half-cycles to failure and total strain amplitude with total energy dissipated for multiple slenderness ratios (L/d of 5, 10, and 15) are obtained.

This paper presents a new structured light approach dedicated to 3D mapping of underwater galleries in karst aquifers. This kind of method is based on the projection of a light pattern onto the scene captured by a camera. Our originality comes from the projected pattern used, since unlike literature methods, our light projector is a simple conical diving light. With a light cone, the recovered pattern in the image is a closed 2D curve we extract with a light contour detection method we have developed. A specific calibration method has also been created to estimate the cone geometry with respect to the camera. Therefore, we get a calibrated projector-camera pair, we can use to find matches between projected and recovered patterns. Our last contribution is the recovery of 3D data by triangulation using the camera cone relationship and the extracted closed 2D curve. The experimental results that will be presented in this article show the feasibility of the method.

The term non-melanoma skin cancer (NMSC) refers to skin cancer different from melanoma, and it is usually restricted to basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and their pre-cancerous lesions, e.g., actinic keratosis. These conditions represent the most frequent tumors in Caucasians and are characterized by an increasing incidence worldwide and a high socio-economic impact. The term Integrated Care Pathway (ICP) refers to “a complex intervention for the mutual decision making and organization of care processes for a well-defined group of patients during a well-defined period”. The purpose of this paper is to present a proposal from the Italian Association of Hospital Dermatologists (ADOI) for an ICP organization of care of NMSC, considering the hub-and-spoke model in the different geographical areas.This proposal is based on the most recent literature and on documents from the Italian Association of Medical Oncology (AIOM), the European consensus-based interdisciplinary guidelines from the European Association of Dermato- Oncology (EADO), and the National Comprehensive Cancer Network (NCCN). We initially discuss the NMSC outpatient clinic, the role of the multidisciplinary working groups, and the hub-and-spoke model regarding this topic. Then, we define the ICP processes specific for BCC and SCC. The ICP for NMSC is an innovative strategy to guarantee the highest possible quality of health care while the hub-andspoke model is crucial for the organization of different health care structures. Considering the importance on this topic, it is essential to create a valid ICP together with an efficient organization within the different geographical areas.

Background The p.E318K variant of the Melanocyte Inducing Transcription Factor (MITF) has been implicated in genetic predisposition to melanoma as an intermediate penetrance allele. However, the impact of this variant on clinico-phenotypic, as well as on dermoscopic patterns features of affected patients is not entirely defined. The purpose of our study was to assess the association between the p.E318K germline variant and clinic-phenotypical features of MITF+ compared to non-carriers (MITF−), including dermoscopic findings of melanomas and dysplastic nevi. Methods we retrospectively analyzed a consecutive series of 1386 patients recruited between 2000 and 2017 who underwent genetic testing for CDKN2A, CDK4, MC1R and MITF germline variants in our laboratory for diagnostic/research purposes. The patients were probands of melanoma-prone families and apparently sporadic single or multiple primary melanoma patients. For all, we collected clinical, pathological information and dermoscopic images of the histopathologically diagnosed melanomas and dysplastic nevi, when available. Results After excluding patients positive for CDKN2A/CDK4 pathogenic variants and those affected by non-cutaneous melanomas, our study cohort comprised 984 cutaneous melanoma patients, 22 MITF+ and 962 MITF−. MITF+ were more likely to develop dysplastic nevi and multiple primary melanomas. Nodular melanoma was more common in MITF+ patients (32% compared to 19% in MITF−). MITF+ patients showed more frequently dysplastic nevi and melanomas with uncommon dermoscopic patterns (unspecific), as opposed to MITF− patients, whose most prevalent pattern was the multicomponent. Conclusions MITF+ patients tend to develop melanomas and dysplastic nevi with histopathological features, frequency and dermoscopic patterns often different from those prevalent in MITF− patients. Our results emphasize the importance of melanoma prevention programs for MITF+ patients, including dermatologic surveillance with digital follow-up.

Palmoplantar pustulosis (PPP) is a chronic inflammatory condition where crops of sterile pustules with erythematous keratotic lesions causing bleeding and pain appear on the palms and soles. Recently, the European Rare and Severe Expert Network considered PPP as a variant of pustular psoriasis with or without psoriasis vulgaris. The prevalence of PPP varies from 0.050 to 0.12%. PPP occurs more frequently in women and the highest prevalence occurred between the ages of 50 and 69 years. Nail psoriasis seems to be frequent in PPP, ranging from 30 to 76%, and psoriatic arthritis in 8.6 to 26% of PPP patients. Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome and pustulotic arthro-osteitis are considered PPP-associated disorders. PPP has been reported with other co-morbidities such as psychiatric disorders, thyroid-associated disease, altered calcium homeostasis, gluten sensitivity diabetes, obesity, and dyslipidemia, but larger studies are required to prove such associations. Environmental exacerbating factors might contribute to the onset or worsening of PPP such as cigarette smoking, stress, focal infections, metal allergies, and drug intake. Genetic predisposition plays an important role in PPP. In PPP, both the innate and the adaptive immune systems are activated. The acrosyringeal expression of IL-17 has been demonstrated, indicating that the eccrine sweat gland is an active component of the skin barrier and an immune-competent structure. Increased levels of several inflammatory molecules, including IL-8, IL-1α, IL-1β, IL-17A, IL-17C, IL-17D, IL-17F, IL-22, IL-23A, and IL-23 receptor, have been detected in PPP biopsies. Increased serum levels of TNF-α, IL-17, IL-22, and IFN-γ have been detected in patients with PPP in comparison to healthy subjects, suggesting a similar inflammatory pattern to psoriasis vulgaris. Oral and tonsillar infections serve as trigger factors for PPP. Long-term therapy is required for many patients, but high-quality data are limited, contributing to uncertainty about the ideal approach to treatment.

Patient under anti-TNF-alpha treatment have an increased risk of mycobacterial infections, particularly tuberculosis. Only four case reports of Mycobacterium kansasii infection under anti-TNF-α treatment (two with etanercept, two with infliximab) have been reported, but none under adalimumab. A 72-year-old man treated with adalimumab for psoriasis vulgaris and arthropathic psoriasis, complained on nocturnal cough, occasional hemoptysis and the new onset of ill-defined, reddish, asymptomatic persistent plaquesnodules covered by serum crusts on his back, on the dorsum of the right hand and right middle finger. Routine laboratory investigations, HIV and TB screening (QuantiFERONTB- Gold test) were all within normal limits. A skin biopsy was inconclusive and special stainings resulted negative for microorganisms. Only PCR identified M. kansasii. The patient stopped adalimumab and started anti-TB treatment with gradual improvement of the skin lesions. At 26 months follow-up visit no signs or symptoms of relapse of M. kansasii disease occurred.

Several experiments need to acquire images with different linear polarisation. Acquisition of successive images through a rotating polarising elements give the possibility to achieve this goal. However, the subsequent acquisition of these images implies a temporal modulation and a rotation mechanism (with a consequent consumption of space, power, etc. . . ). The PolarCam©, a camera where an array of linear micropolarizers with orientation are matching the sensor’s pixels, tries to solve these problems. In the present manuscript the features of this camera and the main aspects of its calibration are shown. Finally, an example of its application is presented. In particular, our application of this camera is for the Antarctica solar Coronagraph -AntarctiCor- for the “Extreme Solar Coronagraphy Antarctic Program Experiment” -ESCAPE- that used this technology for a ground-based polarimetric study of the solar K-corona from the Italian-French Concordia Base (Dome C - Antarctica).

Prof. Raffaele Gianotti (“Raf” for friends) was born on July 7th,1959 in Milan (Italy). His father, Prof. Ferdinando Gianotti (1920-1984), was a famous pediatric dermatologist that gave his name to the “papular acrodermatitis of childhood” (Gianotti-Crosti Syndrome) [...].

Papular mycosis fungoides (PMF) is a rare variant of mycosis fungoides (MF). The exact nosology and prognosis of PMF are still unclear. We retrospectively identified cases of PMF from the files of the Department of Dermatology of the Medical University of Graz, Austria, and checked the follow-up data. The patients comprised 13 men and 5 women (median age: 57.5 y; range 13 to 77 y). In 4 patients, an initial clinicopathologic diagnosis of atypical pityriasis lichenoides was made; these cases were subsequently reclassified as PMF due to the onset of conventional patches of MF during follow-up. Follow-up data of our cases showed that 2 patients died of disease progression 50 and 199 months after the first presentation, respectively. Two patients are alive with progressive disease after 215 and 300 months, respectively. Ten patients are alive with stable disease (median: 70 mo). Four patients were in complete remission at last follow-up visit (median: 215 mo; 2 of them died of unrelated causes). Our data confirm that PMF represents a clinicopathologic variant of early MF with prognosis similar to conventional presentations of the disease. Familiarity with PMF and distinction from other cutaneous papular lymphoid proliferations is necessary for a precise diagnosis and management of these patients.

This paper presents information on development, calibration, and validation of three companion macroscopic modeling approaches for nonlinear analysis of reinforced concrete (RC) structural walls, including: (1) the baseline two-dimensional two-node formulation of the Shear–Flexure-Interaction Multiple-Vertical-Line-Element-Model (SFI-MVLEM), (2) extension of the baseline SFI-MVLEM for modeling of squat walls (SFI-MVLEM-SQ), and (3) extension of the baseline SFI-MVLEM to a three-dimensional four-node element for simulation of non-planar RC walls under multi-directional loading (SFI-MVLEM-3D). The models are implemented in the computational platform OpenSees. Models presented are calibrated and validated against experimental results obtained from tests on RC wall specimens that cover a wide range of physical and behavioral characteristics, including: (1) one slender, two moderately-slender and one medium-rise planar RC walls tested under in-plane loading used for validation of the baseline SFI-MVLEM, (2) three squat planar RC wall specimens tested under in-plane loading used for validation of the SFI-MVLEM-SQ, and (3) one T-shaped and one U-shaped RC wall specimen tested under unidirectional and multi-directional loading, respectively, used for validation of SFI-MVLEM-3D. The comprehensive comparisons between analytically-obtained and experimentally-measured wall responses suggest that the analytical models proposed can accurately simulate both global and local wall responses, within their range of applicability. The models capture load–displacement response features of the walls, including lateral load capacity, lateral stiffness, cyclic stiffness degradation, and pinching characteristics, as well as nonlinear shear deformations and their coupling with flexural deformations during cyclic loading. Comparisons between experimental and analytical results at local response levels suggest that the models can also replicate distributions and magnitudes of wall vertical strains and curvatures at various locations. Overall, the analytical models presented provide robust and reliable tools for nonlinear analysis of RC walls, with a wide range of applicability.

Investigation were carried out targeting distribution and source apportioning of hydrocarbons in surface sediments from shallow to deep waters in the Campos Basin, one of the most important oil-producing provinces in Brazil. The observed levels of aliphatic (≤ 124 μg g−1) and polycyclic aromatic hydrocarbons (PAHs ≤ 599 ng g−1) are lower than those considered relevant for environmental risk to the benthic habitats. Higher median concentrations of aliphatic hydrocarbons (8.49 μg g−1) and PAHs (84.8 ng g−1) in the middle slope sediments (700–1000-m water depths) showed the influence of hydrodynamics upon hydrocarbon accumulation in the sediments. Diagnostic ratios and conventional statistical analysis applied to hydrocarbon data produced insufficient information on the contribution of different sources. These traditional approaches do not consider the potential changes affecting source assignment and therefore cannot deal with the uncertainties. The fuzzy logic applied as an alternative method for data treatment successfully incorporated the uncertainties in the differentiation between petrogenic and pyrolytic sources, including those due to degradation. Moreover, by using fuzzy logic, it was possible to identify that water circulation patterns, mass transport, deposition, and degradation processes are more relevant factors in determining hydrocarbon composition than source proximity.

A number of finite element modeling approaches for reinforced concrete (RC) structural walls have recently become available for both research purposes and design applications. Five conceptually-different state-of-the-art finite element models for RC walls are described and evaluated in this paper, including models based on either a fixed-crack or a rotating-crack approach for simulating the biaxial behavior of concrete under plane-stress state, models characterized with either a single- or a multi-layered representation of the wall cross-section, and models with or without consideration of various individual failure mechanisms (e.g., buckling of reinforcement, out-of-plane instability). Modeling approaches were validated against experimental data obtained for five benchmark RC wall specimens, all with rectangular cross-sections, yet are differentiated by a range of salient response characteristics (e.g., aspect ratio, axial load, failure mechanism), in order to assess the capabilities of the models in representing the response of isolated planar walls under uni-directional lateral loading, as well as to identify future research directions. Results presented suggest that the models considered in this study can all capture the lateral load at yield and the peak lateral load capacity of the wall specimens with ±10% accuracy, while the initial stiffness and yield stiffness can be overestimated as much as 3.0 and 1.8 times, respectively. All models can capture nonlinear shear deformations and interaction between flexural and shear responses under cyclic loading, where the analytically-predicted flexural and shear deformations are within ±30% of the experimentally-measured values. Moderate differences between the predicted crack orientations and distributions are noted between the models, and the model results for the magnitudes of principal compressive stresses in concrete and the extent of stress localization are comparable. All models can capture the nonlinear distribution of vertical strains measured along the base of the walls, where the magnitudes of the predicted tensile and compressive strains are within ±50% of experimentally-measured strains for most models. Although some of the model formulations proved to be successful in capturing the experimentally-observed strength loss mechanisms for individual wall specimens, none of the models were capable of comprehensively simulating all of the strength degradation mechanisms observed during the tests.

Slender RC walls are often used in Chile and commonly, due to architectural constraint, the length of walls increases (setback) between floors designated for parking space and upper floors. These types of elements are commonly called flag walls. In this research, the behavior of slender reinforced concrete walls with a constant axial load and a cyclic lateral displacement is numerically studied, in order to compare the results obtained with previous tests. Two different model alternatives are considered: a finite element model and a strut-and-tie model. The selected models allow understanding local response, as well as, distribution of internal forces, which is also relevant information for wall design and detailing. The studied finite element model, based on quadrilateral elements with 3 degrees of freedom per node (2 translational and 1 rotation) and a model of smeared reinforced concrete material based on a rotating angle approach, is able to correctly capture the global response, showing the capacity, degradation and failure mode obtained in the tests. On the other hand, a parametric analysis is performed for models of walls with higher aspect ratio (tall buildings) with small discontinuities, showing a larger impact in deformation capacity due to the high concentration of damage at the discontinuity. These results indicate that in 25-floor high walls (or taller) a reduction of displacement capacity of 40% for discontinuities located at the first floor could be observed. In addition, by incorporating the effect of the slabs into the model, the results indicate that a pure flexure model is an adequate and sufficient tool for analysis. Finally, a strut-and-tie model is also proposed for each direction of the lateral load, whose results are compared with the estimated load calculated with the strains measured by photogrammetry. The considered strut-and-tie model for the case of lateral load with tension in the continuous wall boundary is similar to the wall without discontinuity, which is consistent with the measured strains. For both lateral loading directions, the estimated forces of the horizontally distributed bars and boundary reinforcements are consistent with photogrammetry in the lower zone of the wall, where cracking is relevant. The strut-and-tie model also adequately interprets the effect of the discontinuous bar on the discontinuous boundary of the wall. All these results can help designing and detailing flag walls.

In this article, a simple and accurate quadrilateral thin flat layered shell element formulation for the nonlinear analysis of reinforced concrete (RC) wall systems under static and cycling loads is presented. The 4 node shell element, with 6 degree of freedom (DOF) per node (3 displacements and 3 rotations) is created by superposing the quadrilateral layered membrane element with drilling degrees of freedom (12 DOF, 2 displacement and 1 rotation per node) developed by Rojas et al. (Eng Struct 124:521–538, 2016), and the Discrete Kirchhoff Quadrilateral Element (12 DOF, 1 displacement and 2 rotations) formulated by Batoz and Tahar (Int J Numer Methods Eng 18(11):1655–1677, 1982), to model the in-plane and the out of plane bending behavior of the shell element, respectively. In addition, to model the complex behavior and coupling of the axial, flexural and shear behavior, observed in complex RC wall structures, the transversal section of the shell element consists of a layered system of fully bonded, smeared steel reinforcement and smeared orthotropic concrete material with the rotating angle formulation. The formulation used a tangent stiffness matrix approach, which include the coupling of membrane and bending effects. For verification, the shell element formulation is used to model a set of experimental results for T-shaped RC walls that are available in the literature. The proposed element is robust, simple to implement, and it can predict the global results (load vs. displacement and maximum capacity) and also the local behavior (vertical strain at the base level along the web and the flange) observed in RC wall structures.

After the 2010 Maule, Chile, earthquake (Mw 8.8), several reinforced concrete (RC) buildings presented damage in some walls (crushing of concrete, buckling and fracture of steel reinforcement). These buildings had been designed according to the up-to-date seismic standards in the country and were not expected to suffer damage as severe as what was observed. Common features of the damaged walls were: little or no confinement at the wall ends; relatively high axial load; narrow thicknesses (below 200 mm); and discontinuities in height. Slender RC walls are often used in Chile and commonly, due to architectural constraints, the length of the walls changes between floors designated for parking use and the upper floors, creating a setback in the lower levels. These types of walls are commonly called “flag walls”. The problem of discontinuity has not been investigated experimentally and therefore it is necessary to observe its impact in RC walls. Four structural wall specimens were designed, one with no discontinuity and the other three with different sizes of the setback. They were tested under a nominal constant axial load of 0.1f'cAg and cyclic lateral loads increasing at specific drift levels. Conventional instrumentation and photogrammetry were used to monitor the tests. The experimental results show that the impact of the setback, for the sizes tested, is not significant for the strength but it is relevant for the strength degradation and deformation capacity. Strains in the extreme fibers, curvature and principal strains are studied using photogrammetry. It is found that the plastic hinge length increases with drift, but it remains constrained to the setback region. Another discontinuity is found around the reinforcement of the setback where large concentration of strains can cause premature failure of the wall.

According to Chilean design practice, walls usually have complex geometries and discontinuities in height, mainly in the first story. However, the Chilean design code, similar to many design codes, does not provide special provisions for discontinuities. This paper shows the results of an experimental and numerical study of walls with a central opening at the base. Four slender walls are constructed with the same general dimensions, but with different shapes of the opening (15% and 30% of the length, and 11% and 22% of the wall height). The specimens were tested under constant axial load, while cyclic lateral loading is applied at the top. One of the specimens presents slab elements at the base. Results indicate that lateral strength is similar in all cases; however, displacement capacity varies with opening size. All specimens with openings have less ductility, where the specimen with wider and taller opening had a reduced displacement capacity (∼30% reduction). The width of the opening was more influential than the height in the displacement capacity. Numerical analysis was done through a finite element modeling, where one of the models considered all features of the formulation and a second model considered rigid beams placed in all levels forcing the Bernoulli hypothesis (flexural model). Both models can capture strength, stiffness and displacement capacity, and therefore a flexural model can be used for boundary detailing.

Low-cycle fatigue life of Grade 300E and 500E reinforcing bars including the effect of buckling is evaluated. Low-cycle fatigue tests are carried out on un-machined specimens subjected to constant axial strain loading with strain amplitude ranging from 1% to 5%. The experimental test observations suggest that buckling of reinforcing bars has detrimental effect on its fatigue life and increase in slenderness ratio of the reinforcing bars results in substantial reduction of their low-cycle fatigue life. Equations relating the fatigue life (i.e. number of reversals to failure) with total strain amplitude and total energy dissipated as a function of buckling parameter is proposed. Also, experimental tests are carried out to investigate the influence of mean strain ratio on low-cycle fatigue behaviour of reinforcing bars. Comparative evaluation of the fatigue life models with the results of experimental investigation shows that the proposed model can predict the fatigue life of buckled and unbuckled reinforcing bars with reasonable accuracy.

Water is a crucial and highly sensitive political issue. The overexploitation of groundwater resources and deterioration of water quality caused by pollution as well as the deficiencies of the existing infrastructure require immediate attention. The main goal of this paper is to carry out a multi-voiced multicriteria analysis that integrates the preferences of local researchers and decision makers in a process aimed at prioritizing watersheds that require the implementation of groundwater management instruments. Using the Criterium Decision Plus system, criteria and subcriteria were integrated into a spatial multi-voiced decision model for the prioritization of watersheds for groundwater resources management. The criteria chosen were Groundwater quality, Groundwater quantity, Land use with potential pollutant load, Equity and Intrinsic aquifer vulnerability. Criteria and subcriteria preferences analysis were derived from workshops with local researchers and decision makers. The spatial multi-voiced decision model identified five of the fourteen watersheds as high to very high priority and requiring groundwater resources management. Based on the local researchers' and decision makers' preferences and hierarchy scheme of the multi-voiced decision model the main criteria and subcriteria that contributed to the final model results were identified. Regarding the criteria, Groundwater quality, Equity and Groundwater quantity contributed extensively to the model. The subcriteria contributions to the groundwater resources management came mainly from High intrinsic aquifer vulnerability, Agrochemicals, Groundwater Storage and Groundwater for domestic supply. This proposed procedure showed that time and effort can be directed to using data and preferences to assist in planning and decision making for groundwater resources management.

The Spectrometer/Telescope for Imaging X-rays (STIX) is the instrument of the Solar Orbiter mission conceived for the observation of the hard X-ray flaring emission, with the objective of providing insights on the diagnosis of thermal and non-thermal accelerated electrons at the Sun. The STIX imaging system is composed of 30 pairs of tungsten grids, each one placed in front of a four-pixel detector, and produces as many Fourier components of the angular distribution of the flaring source, via Moiré pattern modulation. Therefore, the data recorded by STIX, named visibilities, can be interpreted as a sparse sampling of the Fourier transform of the X-ray signal and the corresponding image reconstruction problem requires the inversion of the Fourier transform from limited data, usually addressed with regularization techniques. Since the current calibration status of STIX measurements still prevents the use of visibility phases for imaging purposes, here we propose a parameter identification process based on forward fitting just the amplitude of the experimental visibilities. Specifically, we have parameterized the flaring source by means of pre-assigned source shapes (e.g., circular and elliptical bi-variate Gaussian functions), and we relied on several approaches to non-linear optimization in order to estimating the shape parameters. In particular, we have implemented a forward-fit method based on deterministic chi-squared minimization, a stochastic optimization algorithm and a deep neural approach based on ensemble learning, also equipping them with an ad hoc statistical technique for uncertainty quantification. The performances of the three approaches are compared in the case of both microflares and M class events recorded by STIX during its commissioning phase and the validation of results is realized also exploiting the EUV information provided by the Atmospheric Imaging Assembly within the Solar Dynamics Observatory.

47 year-old man who suffered for plaque psoriasis since 2013 was previously treated with topicals, UVB photherapy, acitretin, methotrexate and adalimumab (Imraldi®) with scarce response. Brodalumab (IL-17 receptor chain A blocking antibody) at 210 mg sc day 0, week-1, week-2 and every 2 weeks was initiated (baseline PASI of 16) with fast improvement of psoriasis (PASI-90 at week 4) and new onset of erythema, pustules and pain in the palmoplantar area after each subcutaneous Brodalumab administration and progressive improvement after 5-8 days.

Melanoma in situ including glans penis and fossa navicularis is unique and represents a challenging dilemma since surgery should not be very aggressive. We present a case of melanoma in situ treated with a two-stage penile and urethral reconstructive surgery, with emphasis on functional and aesthetic results. At the first-stage surgery an anatomic glansectomy was perfomed, and combined preputial and full-thickness skin grafts were used to prepare the urethral plate and restore the aesthetic aspect of the corpora cavernosa. After 6 months, the distal urethra was repaired including the configuration of an orthotopic meatus and a neo-glans.

PROBA-3 is a space mission of the European Space Agency that will test, and validate metrology and control systems for autonomous formation flying of two independent satellites. PROBA-3 will operate in a High Elliptic Orbit and when approaching the apogee at 6·104 Km, the two spacecraft will align to realize a giant externally occulted coronagraph named ASPIICS, with the telescope on one satellite and the external occulter on the other one, at inter-satellite distance of 144.3 m. The formation will be maintained over 6 hrs across the apogee transit and during this time different validation operations will be performed to confirm the effectiveness of the formation flying metrology concept, the metrology control systems and algorithms, and the spacecraft manoeuvring. The observation of the Sun's Corona in the field of view [1.08;3.0]RSun will represent the scientific tool to confirm the formation flying alignment. In this paper, we review the mission concept and we describe the Shadow Position Sensors (SPS), one of the metrological systems designed to provide high accuracy (sub-millimetre level) absolute and relative alignment measurement of the formation flying. The metrology algorithm developed to convert the SPS measurements in lateral and longitudinal movement estimation is also described and the measurement budget summarized.

Background: The recovery of upper limb mobility and functions is essential for people with cervical spinal cord injuries (cSCI) to maximize independence in daily activities and ensure a successful return to normality. The rehabilitative path should include a thorough neuromotor evaluation and personalized treatments aimed at recovering motor functions. Body-machine interfaces (BoMI) have been proven to be capable of harnessing residual joint motions to control objects like computer cursors and virtual or physical wheelchairs and to promote motor recovery. However, their therapeutic application has still been limited to shoulder movements. Here, we expanded the use of BoMI to promote the whole arm’s mobility, with a special focus on elbow movements. We also developed an instrumented evaluation test and a set of kinematic indicators for assessing residual abilities and recovery. Methods: Five inpatient cSCI subjects (four acute, one chronic) participated in a BoMI treatment complementary to their standard rehabilitative routine. The subjects wore a BoMI with sensors placed on both proximal and distal arm districts and practiced for 5 weeks. The BoMI was programmed to promote symmetry between right and left arms use and the forearms’ mobility while playing games. To evaluate the effectiveness of the treatment, the subjects’ kinematics were recorded while performing an evaluation test that involved functional bilateral arms movements, before, at the end, and three months after training. Results: At the end of the training, all subjects learned to efficiently use the interface despite being compelled by it to engage their most impaired movements. The subjects completed the training with bilateral symmetry in body recruitment, already present at the end of the familiarization, and they increased the forearm activity. The instrumental evaluation confirmed this. The elbow motion’s angular amplitude improved for all subjects, and other kinematic parameters showed a trend towards the normality range. Conclusion: The outcomes are preliminary evidence supporting the efficacy of the proposed BoMI as a rehabilitation tool to be considered for clinical practice. It also suggests an instrumental evaluation protocol and a set of indicators to assess and evaluate motor impairment and recovery in cSCI.

The EU funded the FLARECAST project, that ran from Jan 2015 until Feb 2018. FLARECAST had a R2O focus, and introduced several innovations into the discipline of solar flare forecasting. FLARECAST innovations were: first, the treatment of hundreds of physical properties viewed as promising flare predictors on equal footing, extending multiple previous works; second, the use of fourteen (14) different ML techniques, also on equal footing, to optimize the immense Big Data parameter space created by these many predictors; third, the establishment of a robust, three-pronged communication effort oriented toward policy makers, space-weather stakeholders and the wider public. FLARECAST pledged to make all its data, codes and infrastructure openly available worldwide. The combined use of 170+ properties (a total of 209 predictors are now available) in multiple ML algorithms, some of which were designed exclusively for the project, gave rise to changing sets of best-performing predictors for the forecasting of different flaring levels. At the same time, FLARECAST reaffirmed the importance of rigorous training and testing practices to avoid overly optimistic pre-operational prediction performance. In addition, the project has (a) tested new and revisited physically intuitive flare predictors and (b) provided meaningful clues toward the transition from flares to eruptive flares, namely, events associated with coronal mass ejections (CMEs). These leads, along with the FLARECAST data, algorithms and infrastructure, could help facilitate integrated space-weather forecasting efforts that take steps to avoid effort duplication. In spite of being one of the most intensive and systematic flare forecasting efforts to-date, FLARECAST has not managed to convincingly lift the barrier of stochasticity in solar flare occurrence and forecasting: solar flare prediction thus remains inherently probabilistic., Comment: 67 pages, 14 figures; submitted

El Ordenamiento Territorial (OT) y la Gestión Integrada de Recursos Hídricos (GIRH), conforman instrumentos centrales para alcanzar los Objetivos de Desarrollo Sostenible (ODS) previstos en la Agenda 2030. Aunque existe un reconocimiento de la importancia de articular estas políticas, su vinculación ha sido escasamente estudiada. El presente trabajo analiza la vinculación de los aspectos normativos e institucionales entre las políticas públicas de OT y de gestión del agua en Argentina y en la Provincia de Buenos Aires (PBA) en el período 2003-2019. El procedimiento metodológico incluyó la revisión de aspectos relevantes de dichas políticas a nivel nacional y provincial, con énfasis en las principales normas y planes propuestos. A nivel nacional se destaca la ausencia de leyes en ambas temáticas; así como los escasos puntos en común entre estas políticas, con la única excepción de la gestión del riesgo. En la PBA existen dos normas que condicionan fuertemente el OT y la gestión del agua a nivel local, siendo su relación débil. La investigación realizada permite destacar la importancia de vincular estos procesos desde una perspectiva integral a fin de contribuir a la sostenibilidad en el marco de las metas previstas en los ODS. Spatial Planning (SP) and Integrated Water Resources Management (IWRM) constitute central instruments to achieve the Sustainable Development Goals (SDGs) foreseen in the 2030 Agenda. Although there is a recognition of the importance of linking these policies, their connection has been scarcely studied. This work analyzes the link of normative and institutional aspects between SP and water management public policies in Argentina and the Buenos Aires Province (BAP) in the period 2003-2019. The methodological procedure included the review of relevant aspects of these policies at the national and provincial level, with emphasis on the main laws and proposed plans. At the national level, the absence of laws on both issues stands out; as well as the few points in common between them, with the exception of risk management. In the BAP there are two norms that strongly condition SP and water management at the local level, being their relationship weak. The research carried out makes it possible to highlight the importance of linking these processes from a comprehensive perspective in order to contribute to sustainability within the framework of the SDGs. Fil: Calderon, Gabriela. Universidad Nacional de Mar del Plata. Facultad de Arquitectura, Urbanismo y Diseño. Instituto de Hábitat y Medio Ambiente; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata; Argentina Fil: Zulaica, Maria Laura. Universidad Nacional de Mar del Plata. Facultad de Arquitectura, Urbanismo y Diseño. Instituto de Hábitat y Medio Ambiente; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata; Argentina Fil: Massone, Hector Enrique. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Geología de Costas y del Cuaternario. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto de Geología de Costas y del Cuaternario; Argentina Fil: Dalla Torre, Julieta. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Instituto de Estudios Históricos, Económicos, Sociales e Internacionales. Instituto Multidisciplinario de Estudios Sociales Contemporáneos; Argentina

Dermatology Reports is an open access journal published online since 2009. It is devoted to any aspects of dermatology and it is indexed in most citation databases, such as Medline and Embase. Recently, the journal changed, in a sense, its life by becoming the Official Journal of the Italian Association of Hospital Dermatologists (ADOI - Associazione Dermatologi-Venereologi Ospedalieri Italiani e della sanità pubblica) and, thanks to an agreement with ADOI, of the Italian Melanoma Intergroup (IMI). (...)

Background: Psoriasis (Ps) is a chronic systemic autoimmune disease associated with pruritus in 64–98% of patients. However, few modestly sized studies assess factors associated with psoriatic pruritus. Objective: To investigate factors associated with Ps pruritus intensity. Methods: Psoriasis patients 18years or older seen in one of 155 centres in Italy between September 2005 and 2009 were identified from the Italian PsoCare registry. Patients without cutaneous psoriasis and those with missed information on pruritus were excluded. Results: We identified 10802 patients, with a mean age 48.8±14.3years. Mild itch was present in 33.2% of patients, moderate in 34.4%, severe in 18.7% and very severe in 13.7%. Higher itch intensity was associated with female gender, lower educational attainment compared to university degree, pustular psoriasis, psoriasis on the head, face, palmoplantar areas, folds and genitalia, more severe disease, disease duration

Within the multiple approaches to the concept of quality of life, access to safe water is, directly or indirectly, part of the variables that define its components. However, this ability to access safe water brings into play the environmental, socio-cultural, political and economic dimensions of sustainability. Thus, this chapter aims to analyze the relationship between sustainability and quality of life from the groundwater pollution risk management perspective, comparing policies (“what it should be”) with practice (“what it really is”) in each stage of the groundwater pollution risk management process (assessment, prediction, prevention and warning system), as well as proposing adjustment actions for the study case of an intermediate city of the Global South. Mar del Plata is a Global South intermediate city, where groundwater is the only water supply source. The city presents a sizeable peri-urban area, where multiple land uses have been developed; this development increases the occurrence of pollution processes because the majority of this area lacks water and sanitation systems. Hence, the policy aspect was reviewed from international and national guidelines and laws, while practice was obtained from semi-structured interviews. The main reasons that explain the gap between policy and practice are related to political, administrative, information, funding and accountability factors. As such, adjustment actions were proposed for the study area to reduce those gaps.

Aims. The Spectrometer Telescope for Imaging X-rays (STIX) on Solar Orbiter is a hard X-ray imaging spectrometer, which covers the energy range from 4 to 150 keV. STIX observes hard X-ray bremsstrahlung emissions from solar flares and therefore provides diagnostics of the hottest (⪆10 MK) flare plasma while quantifying the location, spectrum, and energy content of flare-accelerated nonthermal electrons. Methods. To accomplish this, STIX applies an indirect bigrid Fourier imaging technique using a set of tungsten grids (at pitches from 0.038 to 1 mm) in front of 32 coarsely pixelated CdTe detectors to provide information on angular scales from 7 to 180 arcsec with 1 keV energy resolution (at 6 keV). The imaging concept of STIX has intrinsically low telemetry and it is therefore well-suited to the limited resources available to the Solar Orbiter payload. To further reduce the downlinked data volume, STIX data are binned on board into 32 selectable energy bins and dynamically-adjusted time bins with a typical duration of 1 s during flares. Results. Through hard X-ray diagnostics, STIX provides critical information for understanding the acceleration of electrons at the Sun and their transport into interplanetary space and for determining the magnetic connection of Solar Orbiter back to the Sun. In this way, STIX serves to link Solar Orbiter’s remote and in-situ measurements.

Because of the COVID‐19 emergency, on March 9, 2020 Italy went in lock‐down imposing the closure of non‐urgent outpatient clinics devoted to care of chronic, severe, inflammatory skin diseases that require periodic follow‐up. In this emergency situation, due to the lack of a teledermatology platform and in order not to leave our vulnerable high‐need patients without proper follow‐up, we started a teledermatologic service in smartworking using phone calls and emails. The total number of patients scheduled was 195; in 12 cases we were not able to talk to the patients. Remote monitoring was performed in 183 patients (126 moderate to severe psoriasis, 10 severe acne, 11 severe atopic dermatitis, 11 hidradenitis suppurativa, 9 blistering autoimmune diseases, 16 other autoimmune skin diseases). During remote‐visits several interventions were conducted: triage for COVID‐19 suspected symptoms, email check of clinical pictures and of laboratory examinations, advices for topical and systemic therapy continuation or discontinuation/switch and re‐schedule of next appointment. Only 5 patients required personal office visit (2.6%), reducing consistently the number of face‐to face visits. Our real‐life experience shows that remote monitoring was effective in preventing unnecessary worsening of severe chronic skin diseases and poor outcomes due to withdrawal of current therapy. This article is protected by copyright. All rights reserved.