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This paper is inspired by a manual picking retail company where shape and weight constraints affect the order-picking process. We proposed an alternative clustering similarity index that considers the similarity, the weight and the shape of products. This similarity index was further incorporated in a storage allocation heuristic procedure to set the location of the products. We test the procedure in a retail company that supplies over 191 stores, in Northern Portugal. When comparing the strategy currently used in the company with this procedure, we found out that our approach enabled a reduction of up to 40% on the picking distance; a percentage of improvement that is 32% higher than the one achieved by applying the Jaccard index, a similarity index commonly used in the literature. This allows warehouses to save time and work faster.

Up to this moment, there is no guideline regarding the materials to produce mouthguards. The most used is Ethylene-Vinyl Acetate (EVA). Studies indicate that laminating EVA sheets with rigid components could increase the protection capacities of the mouthguards whereas other studies suggest that only replacement of the material within it structure can increase energy absorption. The aim of this work is to evaluate the impact response of four different foils when compared to a 4 mm thickness EVA sheet. Five groups of different materials were subjected to impact tests with energies of 1.72 J, 2.85 J and 4.40 J. In this context was considered the following materials: EVA foils (G1), EVA foils with an EVA foam core (G2), EVA foils with an acetate core (G3), Foils of Erkoloc-pro (G4) and Foils of Ortho IBT resin (G5). Comparisons between the materials were made by qualitative analysis of the average energy-time and load-displacement curves, as well as by comparison of the peak load, maximum displacement, contact time and absorbed energy using the Kruskal-Wallis test. It was possible to conclude that statistically significant differences were found in the energy absorbed (p=0.001). Laminated foils with a soft core (G2) are a good option to produce mouthguards, while EVA foils with an acetate core (G3) and foils of Ortho IBT resin (G5) were declared unsuitable.

The majority of pediatric visits occur in general emergency departments. Caring for critically ill neonates is a low-frequency but high-stakes event for emergency physicians, which requires specialized knowledge and hands-on training. We describe a novel clinical rotation for emergency medicine (EM) residents that specifically augments skills in neonatal resuscitation through direct participation as a member of the neonatal resuscitation team. The neonatal resuscitation rotation evaluation median score of 4 (interquartile range [IQR] 3,4) was higher compared to all other off-service senior resident rotations combined (median 3, IQR 3,4) for the academic year 2018–2019. Ninety-two percent of residents evaluated the curriculum change as beneficial (median 4, IQR 4,4). The neonatal resuscitation rotation was rated more favorably than the pediatric intensive care rotation (median 4 IQR 3,4 vs median 3, IQR 2, 3) at a tertiary care children’s hospital during the third year. Residency programs may want to consider implementing a directed neonatal resuscitation experience as part of a comprehensive pediatric curriculum for EM residents.

Abstract In-person home-based rehabilitation and telerehabilitation can be as effective as clinic-based rehabilitation after total knee arthroplasty (TKA), but require heavy logistics and are highly dependent on human supervision. New technologies that allow independent home-based rehabilitation without constant human supervision may help solve this problem. This was a single-center, feasibility study comparing a digital biofeedback system that meets these needs against conventional in-person home-based rehabilitation after TKA over an 8-week program. Primary outcome was the change in the Timed Up and Go score between the end of the program and baseline. Fifty-nine patients completed the study (30 experimental group; 29 conventional rehabilitation). The study demonstrated a superiority of the experimental group for all outcomes. Adverse events were similar in both groups. This is the first study to demonstrate that a digital rehabilitation solution can achieve better outcomes than conventional in-person rehabilitation, while less demanding in terms of human resources.

Individuals with autism spectrum disorder (ASD) present difficulties in developing social behaviours, in communicating gestural or verbally, and they may present some repetitive motor activities. The objective of this study was to improve social competences and to enable the transfer of acquired skills of five children with ASD and intellectual disabilities using a low-cost Lego robot as a mediator. The proposed methodology was divided in five phases: Familiarization, Pre-test, Practice, Post-Test and Transfer of Skills. The study ran in two sequential periods at different places. Each of these periods tackled different individual research questions and goals (taking into account the target group). During each period, the proposed methodology had to be adjusted according to the current context. Therefore, different experimental scenarios and corresponding specific goals had to be delineated. Results show that joint attention of the children increased over the sessions; and interaction with the researcher was verified. Furthermore, results show that there was an effective transfer of skills in the addressed case studies. This reinforces conclusions that robots seem, in fact, powerful tools that should be explored concerning this target population. But a more detailed study is required. The proposed methodology can be used by professionals and parents as a complement to common interventions.

Introduction The American College of Emergency Physicians (ACEP) and the Council of Emergency Medicine Residency Directors (CORD) were invited to contribute to the 2016 Accreditation Council for Graduate Medical Education’s (ACGME) Second Resident Duty Hours in the Learning and Working Environment Congress. We describe the joint process used by ACEP and CORD to capture the opinions of emergency medicine (EM) educators on the ACGME clinical and educational work hour standards, formulate recommendations, and inform subsequent congressional testimony. Methods In 2016 our joint working group of experts in EM medical education conducted a consensus-based, mixed-methods process using survey data from medical education stakeholders in EM and expert iterative discussions to create organizational position statements and recommendations for revisions of work hour standards. A 19-item survey was administered to a convenience sample of 199 EM residency training programs using a national EM educational listserv. Results A total of 157 educational leaders responded to the survey; 92 of 157 could be linked to specific programs, yielding a targeted response rate of 46.2% (92/199) of programs. Respondents commented on the impact of clinical and educational work-hour standards on patient safety, programmatic and personnel costs, resident caseload, and educational experience. Using survey results, comments, and iterative discussions, organizational recommendations were crafted and submitted to the ACGME. Conclusion EM educators believe that ACGME clinical and educational work hour standards negatively impact the learning environment and are not optimal for promoting patient safety or the development of resident professional citizenship.

Objetivo: conhecer os sentidos atribuídos à solidão por idosos. Método: pesquisa exploratória realizada com 68 idosos com idade mínima de 62 anos e máxima de 94 anos, de ambos os sexos, residentes em instituições de longa permanência no município de João Pessoa – Paraíba, brasil. Os dados foram coletados a partir de entrevista semiestruturada e analisados com o auxilio do software alceste: 2010. Resultados: os dados analisados apontaram cinco classes ou categorias em que os idosos associam solidão às dimensões negativas como: abandono e desprezo. Conclusão: as representações dos idosos são decorrentes das suas vivencias anteriores e do contato existente ou não com seus familiares.

Este trabalho de investigação tem como objetivo averiguar as relações existentes entre a saúde (ocorrências na urgência com AVC, Dispneia & Asma e Dor Torácica) e o contexto socioambiental dos doentes, a partir da análise de múltiplas variáveis, de modo a contribuir para a identificação de fatores que possam ajudar a explicar a distribuição e magnitude do número de ocorrências diárias de urgências e, assim, fornecer informações úteis para a definição de medidas que permitam antecipar e mitigar o problema, minimizando a exposição ao risco de desenvolvimento ou agravamento das doenças mencionadas.

Background and study aims: One of the indications for capsule endoscopy (CE) is the detection of proximal small bowel (SB) involvement in Crohn's disease (CD) patients. Our aim was to assess clinical, laboratory and endoscopic predictors associated with proximal SB involvement in CD patients submitted to CE. Patients and methods: Retrospective multicenter study in which Lewis score (LS) was systematically determined in 190 CE of patients diagnosed with CD between 2003 and 2014. Results: Significant inflammatory activity (LS > 135) was present in 23 % of the patients in the first tertile and in 31 % of the patients in the second tertile. Albumin, haemoglobin, and total proteins were significantly lower in patients with a LS > 790 compared to patients with a LS 0.249 predicts proximal SB involvement with 90 % sensitivity and 40 % specificity (AUROC 0.732). Conclusions: One-third of patients had proximal SB involvement. Predictive factors were significant weight loss, stricturing behaviour, and ileal involvement at ileocolonoscopy. These data help to select CD patients that benefit the most from performing a CE.

Cross-referencing qualitative and quantitative statistics from handwritten Portuguese trade sources shows the Spanish in the first half of the 19th century using Portuguese trade to introduce their wool in English and other markets. High quality Spanish merino wool played a key role in Portuguese trade during this period, particularly in the golden years of 1809-1819 and 1825. Its quality intensified both legal trade and smuggling.

Background/Objectives: Increasing evidence indicates that body composition can significantly influence prognosis in women with breast cancer. However, alterations in body composition, particularly among young women (<40 years), remain largely unknown and underexplored. This study aimed to investigate the relationship of computed tomography (CT)-derived body composition with mortality rates among young women recently diagnosed with breast cancer, identifying the best-correlated cutoff value. Methods: This is a bi-set cohort study with retrospective data collection. Women newly diagnosed with ductal invasive breast cancer, aged 20 to 40 years, treated in reference oncology units were included. Body composition was assessed using CT scans at the third lumbar vertebra (L3) level, including muscle and adipose compartments. The outcome of interest was the incidence of overall mortality. A maximally selected log-rank Cox-derived analysis was employed to assess the cutoffs associated with mortality. Results: A total of 192 women were included before any form of treatment (median age of 35 years, IQ range: 31–37). Overall mortality occurred in 12% of the females. Stages III–IV were the most frequent (69.5%). Patients who died had a significantly lower muscle area index. CT-derived muscle area was inversely associated with mortality. Each 1 cm2/m2 decrease in skeletal muscle index increased the mortality hazard by 9%. Higher values of adiposity compartments were independently associated with higher mortality. Conclusions: Our study highlights the predictive significance of skeletal muscle area and adipose tissue in predicting survival among young women recently diagnosed with breast cancer. [ABSTRACT FROM AUTHOR]