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After the collapse of the San Rafael waterfall in Northeast Ecuador on 2 February 2020, a regressive erosion started along the River Coca putting national infrastructure, the environment and indigenous communities at risk. A fast monitoring of areas exposed to landslides on local scales therefore is necessary to provide adequate risk management for the region. The study area, located in the Andean tropics close to the volcano Reventador, is characterized by steep slopes, seismic activity and high rainfall throughout the year. Sentinel-1 SAR data provide a solution for time-series monitoring in the region as imagery is available day and night and not affected by cloud cover. Landslide monitoring with Sentinel-1 SAR data was implemented using a bi-temporal change detection (BCD) with SNAP and a sequential change detection (SCD) with EESA Docker and the Google Earth Engine (GEE) aiming at the identification of a suited approach for fast disaster monitoring and management. The SCD showed an overall accuracy of 0.91 compared to 0.88 using the BCD approach validated with high-resolution imagery. Based on the landslide detection, hazard variables could be further identified to support future hazard and risk assessment. Fast processing of Sentinel-1 time-series data in a cloud-based environment allows for near real-time monitoring of ongoing erosion and provides a potential for pro-active measures to protect the national economy, the environment and the society.

Background: Little is known about vulnerability to severe COVID-19 illness after vaccination completion with three doses of vaccine against COVID-19. Objectives: To identify individual features associated with increased risk of severe clinical manifestation of SARS-CoV-2 infections after receiving the third dose of vaccine against COVID-19. Methods: We performed a nested case-control study based on 3,360,116 citizens from Lombardy, Italy, aged 12 years or older who received the third dose of vaccine against COVID-19 from 20 September through 31 December 2021. Individuals were followed from 14 days after vaccination completion until the occurrence of severe COVID-19 illness, death unrelated to COVID-19, emigration or 15 March 2022. For each case, controls were randomly selected to be 1:10 matched for the date of vaccination completion and municipality of residence. The association between candidate predictors and outcome was assessed through multivariable conditional logistic regression models. Results: During 12,538,330 person-months of follow-up, 5171 cases of severe illness occurred. As age increased, a trend towards increasing odds of severe illness was observed. Male gender was a significant risk factor. As the number of contacts with the Regional Health Service increased, a trend towards increasing odds of severe illness was observed. Having had a previous SARS-CoV-2 infection was a significant protective factor. Having received the Moderna vaccine significantly decreased the odds of severe illness. Significant higher odds were associated with 42 diseases/conditions. Odds ratios ranged from 1.23 (diseases of the musculoskeletal system) to 5.00 (autoimmune disease). Conclusions: This study provides useful insights for establishing priority in fourth-dose vaccination programs.

Background: Scarce information is available on the duration of the protective effect of COVID-19 vaccination against the risk of SARS-CoV-2 infection and its severe clinical consequences. We investigated the effect of time since vaccine completion on the SARS-CoV-2 infection and its severe forms. Methods: In this retrospective observational analysis using the vaccination campaign integrated platform of the Italian region of Lombardy, 5 351 085 individuals aged 12 years or older who received complete vaccination from Jan 17 to July 31, 2021, were followed up from 14 days after vaccine completion until Oct 20, 2021. Changes over time in outcome rates (ie, SARS-CoV-2 infection and severe illness among vaccinated individuals) were analysed with age-period-cohort models. Trends in vaccine effectiveness (ie, outcomes comparison in vaccinated and unvaccinated individuals) were also measured. Findings: Overall, 14 140 infections and 2450 severe illnesses were documented, corresponding to incidence rates of 6·7 (95% CI 6·6–6·8) and 1·2 (1·1–1·2) cases per 10 000 person-months, respectively. From the first to the ninth month since vaccine completion, rates increased from 4·6 to 10·2 infections, and from 1·0 to 1·7 severe illnesses every 10 000 person-months. These figures correspond to relative reduction of vaccine effectiveness of 54·9% (95% CI 48·3–60·6) for infection and of 40·0% (16·2–57·0) for severe illness. The increasing infection rate was greater for individuals aged 60 years or older who received adenovirus-vectored vaccines (from 4·0 to 23·5 cases every 10 000 person-months). The increasing severe illness rates were similar for individuals receiving mRNA-based vaccines (from 1·1 to 1·5 every 10 000 person-months) and adenovirus-vectored vaccines (from 0·5 to 0·9 every 10 000 person-months). Interpretation: Although the risk of infection after vaccination, and even more of severe illness, remains low, the gradual increase in clinical outcomes related to SARS-CoV-2 infection suggests that the booster campaign should be accelerated and that social and individual protection measures against COVID-19 spread should not be abandoned. Funding: None.

Objectives Error simulation models have been used to understand the relationship between analytical performance and clinical outcomes. We developed an error simulation model to understand the effects of method bias and precision on misclassification rate for neonatal hyperbilirubinemia using an age-adjusted risk assessment tool. Methods For each of 176 measured total bilirubin (TSBM) values, 10,000 simulated total bilirubin (TBS) values were generated at each combination of bias and precision conditions for coefficient of variation (CV) between 1 and 15%, and for biases between −51.3 μmol/L and 51.3 μmol/L (−3 and 3 mg/dL) fixed bias. TBS values were analyzed to determine if they were in the same risk zone as the TSBM value. We then calculated sensitivity and specificity for prediction of ≥75th percentile for postnatal age values as a function of assay bias and precision, and determined the rate of critical errors (≥95th percentile for age TSBM with S). Results A sensitivity >95% for predicting ≥75th percentile bilirubin values was observed when there is a positive fixed bias of greater than 17.1 μmol/L (1.0 mg/dL) and CV is maintained ≤10%. A specificity >70% for predicting 0.2% until negative bias was −17.1 μmol/L (−1 mg/dL) or lower. Conclusions A positive systematic bias of 17.1 μmol/L (1 mg/dL) may be optimal for balancing sensitivity and specificity for predicting ≥75th percentile TSB values. Negative systematic bias should be avoided to allow detection of high risk infants and avoid critical classification errors.

Background Total cell counts (TC-BF) and percent polymorphonuclear cells (%PMN) of synovial fluid (SF) aspirates provide important cues for the timely diagnosis and management of septic arthritis. To facilitate faster turnaround time, we compared automated to manual TC-BF and differential counts in order to identify reporting cut-offs for automated TC-BF and %PMN that would allow release of automated results concordant with manual counts and differentials. Methods Automated TC-BF and %PMN counts of a non-validated analyzer (Analyzer-B in STAT laboratory) were compared to a validated analyzer (Analyzer-A) and manual TC-BF counts and cytospin differentials. Concordance and %differences of Analyzer-B versus Analyzer-A and manual counts were assessed by linear regression analysis and Bland-Altman comparison. Results Overall, automated and manual counts displayed good correlation. A majority of samples demonstrated unacceptable (>20%) differences between automated and manual counts at lower TC-BF ( Conclusions Based on good overall correlation and fewer samples with unacceptable (>20%) differences between automated and manual counts, we adopted TC-BF > 10,000 cells/μl and %PMN > 60% as cutoffs for reporting automated counts. These cutoffs minimize differences between automated and manual cell counts and differentials and would allow rapid automated reporting in the vast majority of septic arthritis cases.

The last decade has seen a rising popularity of active learning methodologies in Computer Science, empowering students and developing their soft skills as well as their technical knowledge. In parallel, the speed of technological obsolescence also increased, creating challenges for teachers to keep their course content fresh and up to date. In this paper, we present a constructivist redesign of a Graduate-level laboratory course in Web Service Design and Engineering that leverages latent pockets of student knowledge to tackle these challenges through Learning by Teaching. We illustrate how such redesign was planned, deployed and evaluated, highlighting the guiding role of teachers in the process and discussing how this approach was able to solve the problem of keeping content updated while broadening both content and tools students were exposed to. Furthermore, we will discuss how the additional motivation stemming from their empowerment allowed students not only to perform more work compared to a lecture-based implementation, but also to perceive it in the end as a lesser load.

Indigenous communities in the Amazon suffer from lack of access to basic services, such as electricity. Due to their isolation and difficult access it is challenging to acquire data on their location, numbers and needs, which would enable adequate development plans. Earth observation (EO), in combination with participatory mapping can support the creation of settlement maps as a basis for creating spatially explicit models of needs of basic services. Combining Landsat time series with SkySat and PlanetScope imagery, we have mapped the location and size of these settlements and modelled the number and densities of their houses. Additionally, we have projected settlement growth by 2030 in order to assess a demand of services that will be valid in the near future. We conducted surveys in 49 communities in the Ecuadorian Amazon to acquire information on the peoples&rsquo, living conditions and needs, and validated our model based on the findings. The number of buildings per cleared land had a strong linear relationship with the communities surveyed (adjusted R2 0.8). We used this linear relationship to model the number of buildings for the complete study area as well as for the 2030 settlement projection. Combining this information with data on the living conditions of indigenous communities, we can efficiently estimate the needs of basic services for larger territories and prompt development plans according to indigenous peoples&rsquo, needs and wishes.

Objective Determine whether introduction of a reformulated bilirubin reagent, the Roche bilirubin Gen.3 assay, changed the relationship between BiliChek transcutaneous bilirubin (TcB) and total serum bilirubin (TSB). Design and methods TcB results from term infants in the level 1 nursery obtained within one hour of a TSB were reviewed over two periods, six months before and after the conversion from the previous generation Roche bilirubin reagent to the new Roche Gen.3 bilirubin assay. TcB measurements were performed using BiliChek transcutaneous devices (Respironics, Marietta GA). Distribution of TSB results, and TcB minus TSB bias, were compared before and after introduction of the reformulated Roche bilirubin Gen.3 assay. Median and interquartile range (IQR) TSB values and bias were calculated. A statistical difference between median TSB values and bias were assessed using Man-Whitney test. Results A total of 301 paired TcB and TSB results were obtained, 172 before and 129 after implementation of the reformulated Roche bilirubin Gen.3 reagent. Median (IQR) TSB was 7.8 (6.8–8.7)mg/dL (133.3 (116.3–148.8) μmol/L) before and 7.6 (6.7–8.4)mg/dL (130 (114.6–143.6)μmol/L) after implementation of the reformulated reagent (p = .1373). Median (IQR) bias between TcB and TSB was 2.9 (2.2–3.7) mg/dL (49.6 (37.6–63.3)μmol/L) before the reformulated reagent was implemented; and did not change at 2.9 (2.1–3.9) mg/dL (49.6 (35.9–66.7)μmol/L) after implementation (p = .8242). Conclusion Implementation of the reformulated Roche bilirubin Gen.3 reagent did not affect the relationship between BiliChek transcutaneous and total serum bilirubin; thus no changes were needed to the neonatal TcB screening protocol as a result of the new bilirubin reagent.

Access to reliable and affordable energy is vital for sustainable development. In the off-grid areas of developing countries, decentralized energy solutions have received increasing attention due to their contributions to reducing poverty. However, most of the rural population in many developing countries still has little or no access to modern energy technologies. This paper assesses the factors that determine the successes and failures of decentralized energy solutions based on local harmonized case studies from heterogeneous contexts from Asia, sub-Saharan Africa, and South America. The case studies were analyzed through the coupled lenses of energy transition and the Water–Energy–Food Security (WEF) Nexus. The findings indicate that access to modern decentralized energy solutions has not resulted in complete energy transitions due to various tradeoffs with the other domains of the WEF Nexus. On the other hand, the case studies point at the potential for improvements in food security, incomes, health, the empowerment of women, and resource conservation when synergies between decentralized energy solutions and other components of the WEF Nexus are present.

Introduction The CLSI EP15-A3 guideline “User Verification of Precision and Estimation of Bias” provides a simple experimental approach to estimate a method’s imprecision and bias. The objective is to determine if the laboratory precision performance of repeatability (SR) and within-laboratory imprecision (SWL) are in accordance to the manufacturer specification claims (MSCs). Objectives Evaluate the utility of the EP15-A3 protocol to verify method precision during a troubleshooting investigation and after major instrument maintenance, using a carcinoembryonic antigen (CEA) immunoassay as an example. Methods CEA was performed on the Beckman Coulter DxI (Beckman Coulter, Brea, CA). Quality control (QC) levels (L1: 2.89; L2: 21.10; L3: 39.10 ng/mL) (Bio-Rad Laboratories, Irvine, CA) were used. Each QC level was measured before and after instrument maintenance as follows: five replicates per run, one run per day, and during 5 days. Imprecision estimates (IEs) for SR (%CVR) and SWL (%CVWL) were calculated by one-way analysis of variance using Microsoft Excel Analyse-it software. Estimated imprecision was compared to MSC and desirable imprecision specifications based on biological variation (BV). Results A change in the analytical performance of CEA was detected by a decreased sigma-metric indicator. After a bias problem was ruled out, the observed %CVR for L1, L2, and L3 were 7.2%, 3.7%, and 4.8%, respectively. The %CVWL were 8.3%, 5.0%, and 5.5%, which exceeded the MSC of %CVWL~4.0% to 4.5%. After a laboratory investigation, major instrument maintenance was performed by the manufacturer. The %CVR and %CVWL estimates for L1, L2, and L3 after maintenance were 3.2%, 3.8%, 3.5% and 3.9%, 4.2%, 4.0%, respectively. After maintenance, the CEA performance was consistent with the MSC for each of the levels analyzed and within the BV impression goal of %CV ≤6.4. Conclusion CLSI EP15-A3 guideline is an alternative troubleshooting tool that can be used to investigate and verify method precision performance before and after significant instrument maintenance.

Access to modern energy is vital for sustainable development. In rural areas, decentralized energy solutions may play a significant role in reducing poverty, supporting community institutions and facilitating the generation of basic services such as communication, water access, education and health services. However, the majority of dwellers in off-grid communities in developing countries have little or no access to modern energy technologies, although they are endowed with a vast potential of renewable energy resources. Decentralized energy solutions could serve as an option to solve this energy access problem. However, the previous literature indicates that there are financial, technical, infrastructural, and institutional constraints to scale up decentralized energy options. This paper seeks to study the underlying factors behind the successes and failures of household- and community-based decentralized energy technologies through local case studies from different parts of the world, analyzed through the lenses of the Water-Energy-Food Security (WEF) nexus. First, the paper reviews the literature on the main benchmarks used to evaluate the success and failure of community-based energy. Second, the conceptual framework relating decentralized energy to the WEF nexus elements is briefly described. Thirdly, the methods and data used in the paper are described, followed by the presentation of the case studies. Lastly, the paper is concluded by drawing policy lessons and recommendations. Further empirical studies are recommended to quantitatively evaluate the impacts of decentralized energy solutions on the welfare of households and communities within the framework of the Water-Energy-Food nexus.

In this review we present an update on the anatomy and vascularization of the male urethra. The real objective of this review is to make the following chapters more understandable, both to know the physio-pathological mechanisms of urethral pathology and also to help us in their surgical management.

Currently, there are a lot of people trying to leverage on the success of social networks by implementing social applications. However, implementing social applications is complex, due to the requirements and constraints put by the social networks to protect their data. In this work we present Simple Flow, a tool that simplifies the creation of social applications. Simple Flow proposes a processes-based approach to the design and execution of social applications. Simple Flow targets end-users and programmers with no experience in programming for social networks, giving them the possibility to design processes by concatenating social network actions (like post a message or comment a photo). For the execution of the designed processes Simple Flow interconnects, at runtime, template web pages (one page per action) according to the process design defined previously. These templates abstract the complexities of the interactions with social networks.

Social media data is growing exponentially, to the point where it is already hard to analyze. Consequently, there is a need to increase the number of people analyzing this data, to make sense out of it and, if possible, react to it. However, accessing this data is not simple because it is behind a knowledge barrier, which can only be overcome either with learning or with money. To considerably lower this barrier, we implemented the Social Spreadsheet, which is a spreadsheet template that we extended with functions that make simple the retrieval of social media data. Moreover, the collected data is ready to be analyzed by end-users, who can use formulas, custom functions, charts, and other commonly known spreadsheet features to create visualizations similar to the ones offered by commercial applications. To validate our work, we demonstrate how end-users can easily implement the same dashboards as the ones offered by popular social media analysis tools.

Radical Radiotherapy constitutes a useful therapeutic option for localized prostate cancer. Almost one third of prostate cancer patients choose this alternative to treat the disease. Despite modifications in the technique as intensity modulation, 3D conformational radiotherapy or computer-assisted brachytherapy, a significant percentage of these patients will show an increase in PSA values after radiation. Local relapse without distant disease and PSA less than 10 ng/ml are candidates for salvage therapy. Cryotherapy has already become a curative treatment option in this group of patients. Recent technological as well as surgical advances in salvage-cryotherapy have reduced dramatically complications and progressively increase the interest on this alternative.

Occipital condyle syndrome (OCS) results from a unilateral occipital pain associated with an ipsilateral paresis of the 12th cranial nerve (hypoglossal), and is typically caused by metastasis of the skull base. OCS diagnosis occurred, in all cases described in the published literature, when metastatic prostate cancer (MPC) was previously known. We present a case of a patient whose initial manifestation of MPC was OCS. The patient was treated with complete hormonal blockade and non-steroidal anti-inflammatory drugs as opposed to locoregional radiotherapy applied in other cases. After 18 month follow-up, the patient had a complete neurological and biochemical response.

The distinct abilities of older adults to interact with touchscreen devices have motivated a wide range of contributions in the form of design guidelines, which aim at informing the design for the aging population. However, despite the growing effort by the research community, many challenges still remain in translating these research findings into actionable design guidelines, with reports hinting scant adoption or implementation issues, which ultimately hurt the development of more accessible interactive systems. In this systematic literature review, we look at the research-derived design guidelines that set the foundation for design guideline compilations and standards, analyzing the aforementioned issues from the perspective of experts trying to discover, classify, and evaluate the work on the area of touchscreen design guidelines for older adults. The review analyses 52 research articles resulting in 434 research-derived design guidelines for touchscreen applications. These guidelines are analyzed using a taxonomy that considered the older adults ability evolution and the design aspects that are the target of the recommendations. The results point to the use of different definition of older adults, which go as early as 55+, with the design of displays and interaction styles to accommodate to vision and dexterity declines as the most prominent areas of research. However, proposed guidelines and recommendations were validated in only 15% of articles analyzed. The analysis also revealed that identifying guidelines and characterizing their focus in terms of ability declines and design aspects addressed is a demanding activity and prone to error, given the quality of reporting and details offered in research articles.