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Cognitive impairment is a condition that results in a person's inability to remember, learn, concentrate or make decisions that affect his/her everyday life. The assessment of these deficits is usually performed using standardized paper and pencil or computerized tests within a controlled clinical setting. Many traditionally designed tools show only low to moderate levels of ecological validity, limiting the reliability of the collected measures. The proposed system adapts existing screening tests within an immersive virtual reality environment with 360° video, recreating a familiar setting for the patient. This faithful reproduction of everyday environments and situations can enhance the ecological validity of the assessment procedure while maintaining a standardized stimuli delivery, all in a controlled and safe setting. As a computerized system, virtual reality technology allows an error-free computation of the test scores, here collected by means of accuracy for each task. The system involves many technologies aimed at capturing any kind of user input provided by the patient. Additionally, using a visor with integrated eye-tracker sensor, the system can register the visual exploration pattern adopted by the patient during the task execution, providing information concerning the attentional and visuo-spatial functioning which are not obtainable using traditional assessment procedures. Finally, the results of an exploratory study that was conducted with 11 users on the reliability and usability of the system are presented.

Background The previously published “Dose Response Multicentre International Collaborative Initiative (DoReMi)” study concluded that the high mortality of critically ill patients with acute kidney injury (AKI) was unlikely to be related to an inadequate dose of renal replacement therapy (RRT) and other factors were contributing. This follow-up study aimed to investigate the impact of daily fluid balance and fluid accumulation on mortality of critically ill patients without AKI (N-AKI), with AKI (AKI) and with AKI on RRT (AKI-RRT) receiving an adequate dose of RRT. Methods We prospectively enrolled all consecutive patients admitted to 21 intensive care units (ICUs) from nine countries and collected baseline characteristics, comorbidities, severity of illness, presence of sepsis, daily physiologic parameters and fluid intake-output, AKI stage, need for RRT and survival status. Daily fluid balance was computed and fluid overload (FO) was defined as percentage of admission body weight (BW). Maximum fluid overload (MFO) was the peak value of FO. Results We analysed 1734 patients. A total of 991 (57 %) had N-AKI, 560 (32 %) had AKI but did not have RRT and 183 (11 %) had AKI-RRT. ICU mortality was 22.3 % in AKI patients and 5.6 % in those without AKI (p

Latent, systemic, organizational and clinical errors may impend on a single clinical reality that is considered safe. These errors may lead to the occurrence of a critical event with possible damage to the patient. The patients' greater clinical complexity, in the field of AKI or CKD, requires a multidisciplinary approach that involves nephrologists and other specialists in the diagnostic-therapeutic-rehabilitative path requiring the administration of personalized extracorporeal blood purification treatments. In consideration of the comorbidities of these patients, and their increasing management complexity, the Patient Safety becomes a priority objective in these therapeutic pathways. For all caregivers, it is therefore necessary to be able to acquire a series of tools suitable for the analysis of the clinical risk present in each individual nephrological realities in order to introduce a series of measures and tools for the analysis and prevention of possible errors that can determine an event. The aim of this paper is to introduce the problem of patient safety in the extracorporeal blood purification treatments for the initial analysis of local clinical risks, and the prevention of errors in the clinical practice in nephrology by introducing specific procedures and check lists. This work is addressed to all the caregivers involved in the Nephrology care.

This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients. In addition, the article describes recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. This is a consensus report on nomenclature harmonization in extracorporeal blood purification therapies, such as hemofiltration, plasma exchange, multiple organ support therapies, and blood purification in sepsis., 0, SCOPUS: re.j, info:eu-repo/semantics/published

BACKGROUND AND OBJECTIVES: Disease biomarkers require appropriate clinical context to be used effectively. Combining clinical risk factors, in addition to small changes in serum creatinine, has been proposed to improve the assessment of AKI. This notion was developed in order to identify the risk of AKI early in a patient's clinical course. We set out to assess the performance of this combination approach. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A secondary analysis of data from a prospective multicenter intensive care unit cohort study (September 2009 to April 2010) was performed. Patients at high risk using this combination approach were defined as an early increase in serum creatinine of 0.1-0.4 mg/dl, depending on number of clinical factors predisposing to AKI. AKI was defined and staged using the Acute Kidney Injury Network criteria. The primary outcome was evolution to severe AKI (Acute Kidney Injury Network stages 2 and 3) within 7 days in the intensive care unit. RESULTS: Of 506 patients, 214 (42.2%) patients had early creatinine elevation and were deemed at high risk for AKI. This group was more likely to subsequently develop the primary endpoint (16.4% versus 1.0% [not at high risk], P

This article reports the conclusions of a consensus expert conference on the basic principles and nomenclature of renal replacement therapy (RRT) currently utilized to manage acute kidney injury (AKI). This multidisciplinary consensus conference discusses common definitions, components, techniques, and operations of the machines and platforms used to deliver extracorporeal therapies, utilizing a "machine-centric" rather than a "patient-centric" approach. We provide a detailed description of the performance characteristics of membranes, filters, transmembrane transport of solutes and fluid, flows, and methods of measurement of delivered treatment, focusing on continuous renal replacement therapies (CRRT) which are utilized in the management of critically ill patients with AKI. This is a consensus report on nomenclature harmonization for principles of extracorporeal renal replacement therapies. Devices and operations are classified and defined in detail to serve as guidelines for future use of terminology in papers and research., 0, SCOPUS: re.j, info:eu-repo/semantics/published

The epidemiology of acute kidney injury (AKI) has been difficult to explore in the past, due to different definitions across various studies. Nevertheless, this is a very important topic today in light of the high morbidity and mortality of critically ill patients presenting renal dysfunction during their stay in the intensive care unit (ICU). The case mix has changed over the years, and AKI is a common problem in critically ill patients often requiring renal replacement therapy (RRT). The RIFLE and AKIN initiatives have provided a unifying definition for AKI, making possible large retrospective studies in different countries. The present study aims at validating a unified web-based data collection and data management tool based on the most recent AKI definition/classification system. The interactive database is designed to elucidate the epidemiology of AKI in a critically ill population. As a test, we performed a prospective observational multicenter study designed to prospectively evaluate all incident admissions in ten ICUs in Italy and the relevant epidemiology of AKI. Thus, a simple user-friendly web-based data collection tool was created with the scope to serve for this study and to facilitate future multicenter collaborative efforts. We enrolled 601 consecutive incident patients into the study; 25 patients with end-stage renal disease were excluded, leaving 576 patients for analysis. The median age was 66 (IQR 53–76) years, 59.4% were male, while median Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II scores were 43 (IQR 35–54) and 18 (IQR 13–24), respectively. The most common diagnostic categories for ICU admission were: respiratory (27.4%), followed by neurologic (17%), trauma (14.4%), and cardiovascular (12.1%). Crude ICU and hospital mortality were 21.7% and median ICU length of stay was 5 (IQR 3–14) days. Of 576 patients, 246 patients (42.7%) had AKI within 24 h of ICU admission, while 133 developed new AKI later during their ICU stay. RIFLE-initial class was Risk in 205 patients (54.1%), Injury in 99 (26.1%) and Failure in 75 (19.8%). Progression of AKI to a worse RIFLE class was seen in 114 patients (30.8% of AKI patients). AKI patients were older, with higher frequency of common risk factors. 116 AKI patients (30.6%) fulfilled criteria for sepsis during their ICU stay, compared to 33 (16.7%) of non-AKI patients (p < 0.001). 48 patients (8.3%) were treated with RRT in the ICU. Patients were started on RRT a median of 2 (IQR 0–6) days after ICU admission. AKI patients were started on RRT a median of 1 (IQR 0–4) day after fulfilling criteria for AKI. Median duration of RRT was 5 (IQR 2–10) days. AKI patients had a higher crude ICU mortality (28.8 vs. 8.1%, non-AKI; p < 0.001) and longer ICU length of stay (median 7 vs. 3 days, non-AKI; p < 0.001). Crude ICU mortality and ICU length of stay increased with greater severity of AKI. 225 (59.4% of AKI patients) had complete recovery of renal function, with a serum creatinine at time of ICU discharge which was ≤120% of baseline; an additional 51 AKI patients (13.5%) had partial renal recovery, while 103 (27.2%) had not recovered renal function at the time of death or ICU discharge. The study supports the use of RIFLE as an optimal classification system to stage AKI severity. AKI is indeed a deadly complication for ICU patients, where the level of severity is correlated with mortality and length of stay. The tool developed for data collection was user-friendly and easy to implement. Some of its features, including a RIFLE class alert system, may help the treating physician to systematically collect AKI data in the ICU and possibly may guide specific decisions on the institution of RRT.

Three different design research topics are presented in this article: how to design social and active play for teenagers, how to design for openended and emergent play, and how to evaluate interactive playful installations in situ. The Wiggle the Eye installation, five interactive wiggle benches and a central lamp, was iteratively developed and evaluated with more than 1000 users, at two high schools, one university and a design festival. The installation succeeded in inviting teenagers to play in a social way, yet the interaction design proved challenging: uncoordinated mass usage and a variety of external factors influenced the exploration and discovery process for the users. The presented insights serve as advice for everyone designing for teenagers, public spaces or playful interactions.

L'articolo descrive il progetto di una mostra interattiva basata sul paradigma del touch based interaction e la sperimentazione sui processi di interazione basati su nuove tecnologie nei bambini

Introduction In ICUs, both fluid overload and oliguria are common complications associated with increased mortality among critically ill patients, particularly in acute kidney injury (AKI). Although fluid overload is an expected complication of oliguria, it remains unclear whether their effects on mortality are independent of each other. The aim of this study is to evaluate the impact of both fluid balance and urine volume on outcomes and determine whether they behave as independent predictors of mortality in adult ICU patients with AKI. Methods We performed a secondary analysis of data from a multicenter, prospective cohort study in 10 Italian ICUs. AKI was defined by renal sequential organ failure assessment (SOFA) score (creatinine >3.5 mg/dL or urine output (UO)

This paper will analyse a variety of interaction styles that can be designed in hypermedia applications, will point out the need of using them consistently, and will analyze the possible design trade-offs between richness of interaction and easiness of use. Examples will be taken from a museum hypermedia we are currently developing in co-operation with the Poldi Pezzoli Museum in Milano.

This paper reports about the recent advances towards establishing a common platform for adaptive educational hypermedia (AEH) authoring. We present the conversion from MOT, a dedicated authoring system, to AHA! used in this context as delivery system for AEH. Moreover, we describe two new representation languages that emerged in the process: a common format for defining the static material, CAF, and an extended adaptation language for the description of the dynamic behaviour, LAG. Finally, some evaluations are shown and conclusions are drawn.

This paper focuses on a vital aspect for educational adaptive hypermedia (AEH): the design. The proper design is the first step towards common design patterns, leading to better, semantically enhanced authoring systems for AEH. This can mean easier access to these special tools for personalization for the domain expert without computer knowledge. A high-level taxonomy is proposed here, as a result of many brainstorming sessions within the European Community project, ADAPT. This taxonomy is justified with the help of both AEH implementations and theoretical frameworks

In this paper we report about our attempts to rebuild a historical building, ‘Huys Hengelo’, its interior, a farm built next to it and other parts of its environment (including a draw-bridge and a gate) using the Virtual Reality Modeling Language (VRML). This castle building played an important role in the history of its region. The main issues we deal with in this paper are: the unreliability of available sources − forcing us to show alternatives rather than ‘the building as it was’, the possibility to allow users to make changes and to experiment with different geographies, animations showing how parts of the wooden buildings were constructed during that time, the interface with the user and, as the project started as a student project on the request of some local historians and architects, some of our experiences with the co-operation between them and computer science students and researchers.

The quality of content is a key attribute for assessing the global quality of a museum application. Unfortunately, producing good content, especially in multimedia digital form, is expensive and time-consuming. One way to reduce the costs without sacrificing quality is to exploit the concept of information reuse. The idea is to use (portions of) the same multimedia material in different applications, possibly adapting it for different contexts, for different categories of users, and for different delivery channels (e.g., on-line and off-line). Information reuse does not come free. To be effective, it requires a well-organized environment in which information can be easily stored, inspected, retrieved, and adapted for different purposes. This paper describes the approach adopted in the project "The Virtual Museum of Italian Computer Science History", funded by the Italian National Council of Research (CNR). In this project, all the digital material (documents, images, video interviews, etc.) is stored in a digital archive based on a multimedia database with a WWW front-end. The archive is designed for specialists only: members of the editorial board of the project; researchers in the history of science; application developers (who are looking for interesting content to include in their CD-ROMs or Web sites). Each research group involved in the project extracted and adapted from the digital archive the multimedia material needed to build a different hypermedia application in two "versions" - WWW and CD-ROM. These applications, both on-line and off-line, strongly reuse (portions of) the digital archive content, but organize and present it with a totally different style, to address the needs of non-specialists (e.g, people who have some interest, or curiosity, on the history of Italian computer science).