OBJECTIVE

The aim of this study was to evaluate the efficacy and safety of three anti-malarial combinations--artemether-lumefantrine (A-L), amodiaquine-sulfadoxine-pyrimethamine (AQ-SP), and artesunate-amodiaquine (AQ-AS)--in the treatment of uncomplicated malaria in children younger than 5 years in Bangui, Central African Republic.

METHODS

This study included 186 children aged 6-59 months with uncomplicated falciparum malaria who were treated at the Bédé Combattant Hospital from July through October 2010: 63 randomized to receive A-L, 63 AQ-SP, and 60 AQ-AS. Clinical outcome was classified according to WHO criteria as early treatment failure (ETF), late clinical failure (LCF), late parasitological failure (LPF), or adequate clinical and parasitological response (ACPR). The occurrence of mutations in the pfcrt, pfmdr-1, dhfr and dhps genes was studied by PCR-RFLP.

RESULTS

After PCR correction, ACPR at D28 was 100% for A-L, 96.55% for AQ-SP, and 100% for AQ-AS, with no significant difference between the three combinations (p = 0.36). The 2 cases of treatment failure for AQ-SP were associated with mutations at the following resistance markers: Pfcrt 76T, PfmdrI 86Y, Dhfr 108N, and Dhps A437. There was no significant difference in the reduction of anemia, fever (p = 0.87), or parasitemia (p = 0.63) between the three combinations.

CONCLUSIONS

This study demonstrates that artemisinin-based combinations are still effective and tolerated in the treatment of uncomplicated malaria in children younger than 5 years in Bangui. Treatment failures were due to new infections and mutations in resistance markers.

Sequential extraction has been widely used to classify metal species in soils and sediments; however, the lack of selectivity in extraction reagents may lead to the misinterpretation of metal speciation. In this study, we used X-ray absorption near edge structure (XANES) spectroscopy to classify Cr species based on its molecular form. These results complement the conventional Cr fractionation derived from the Tessier extraction method. The linear combination fitting (LCF) for the Cr-XANES spectra indicated that the Cr species in the soils could generally be described as Cr(III) sorbed on ferrihydrite (Cr-FH), Cr(III) complexed with humic acid (Cr-HA), and precipitated Cr. While the sum of the adsorbed Cr(III) and Cr(III)/Fe coprecipitates showed a nearly 1:1 relationship with reducible Cr, the total of Cr precipitates and organic Cr also followed the same trend with oxidizable Cr. This result indicated that there might be a underestimation in the reducible fraction as pure Cr(III) precipitates associated with surfaces of Fe minerals would not be extracted in the reducible process. Instead, such pure Cr(III) precipitates were dissolved during the oxidizable process, resulting in a overestimation in the fractionation of organic-related Cr.

A life cycle assessment (LCA) focused on greenhouse gas (GHG) emissions from the production of microalgal biodiesel was carried out based on a detailed engineering and economic analysis. This LCA applies the methodology of the California Low Carbon Fuel Standard (CA LCFS) and uses life cycle inventory (LCI) data for process inputs, based on the California-Modified Greenhouse Gases, Regulated Emissions, and Energy use in Transportation (CA GREET) model. Based on detailed mass and energy balances, calculated GHG emissions from this algal biodiesel system are 70% lower than those of conventional diesel fuel, meeting the minimum 50% GHG reduction requirements under the EPA RFS2 and 60% for the European Union Renewable Energy Directive. This LCA study provides a guide to the research and development objectives that must be achieved to meet both economic and environmental goals for microalgae biodiesel production.

Purpose: To report long-term surgical outcomes of autologous and allogenic lens capsular flap transplantation (LCFT) in refractory macular hole (MH) treatment.

Methods: Fifty consecutive eyes with refractory MH who received LCFT were reviewed retrospectively. Twelve eyes underwent autologous LCFT (LCF obtained from the same eye in 7 eyes and the fellow eye in 5 eyes) and 38 eyes with allogenic LCFT. All eyes underwent complete vitrectomy, internal limiting membrane peeling if not peeled, LCF transplantation, and 15% perfluoropropane tamponade. Simultaneous autologus whole blood application was applied in 31 eyes to reduce LCF dislocation. The patients maintained a face-down position for two weeks postoperatively. Demographic information, functional results and structural changes were evaluated.

Results: The mean preoperative MH diameter was 1102.00±561.63 μm. The mean follow-up duration was 18.50±6.05 months (range: 12.0 months ∼38.9months). The MH was completely closed in 48 eyes (96.00%) (18 eyes receiving autologous LCFT and 30 receiving allogenic LCFT). There are no differences of age, previous MH surgery times, MH diameter, preoperative and postoperative best-corrected visual acuity (BCVA) and closure rate between the subgroups. The median visual acuity improved from 1.78(interquartile range, 1.28,1.85) logarithm of the minimum angle of resolution (LogMar) (median Snellen acuity: 20/1200) preoperatively to 1.00(interquartile range, 0.90,1.70) logMAR(median Snellen acuity: 20/200)(P<0.01) in all patients.

Conclusions: Both autologous and allogenic LCFT application may provide anatomical and visual improvements in refractory MH cases. Blood application can be applied in selected cases to reduce LCF dislocation. LCFT can be performed as primary treatment for refractory MHs.

Freeze-dried cell-free extracts (CFE) from Lactobacillus casei LC01, Weissella cibaria 1XF5, Hafnia alvei Moller ATCC 51815, and Debaryomyces hansenii LCF-558 were used as sources of enzyme activities for conditioning the ripening of ewe milk cheese. Compared with control cheese (CC), CFE did not affect the gross composition and the growth of the main microbial groups of the cheeses. As shown through urea-PAGE electrophoresis of the pH 4.6-soluble nitrogen fraction and the analysis of free AA, the secondary proteolysis of the cheeses with CFE added was markedly differed from that of the CC. Compared with CC, several enzyme activities were higher in the water-soluble extracts from cheeses made with CFE. In agreement, the levels of 49 volatile compounds significantly differentiated CC from the cheeses made with CFE. The level of some alcohols, ketones, sulfur compounds, and furans were the lowest in the CC, whereas most aldehydes were the highest. Each CFE seemed to affect a specific class of chemical compounds (e.g., the CFE from H. alvei ATCC 51815 mainly influenced the synthesis of sulfur compounds). Apart from the microbial source used, the cheeses with the addition of CFE showed higher score for acceptability than the control cheese. Cheese ripening was accelerated or conditioned using CFE as sources of tailored enzyme activities.

Light chain-associated Fanconi syndrome (LCFS) is a disorder of renal proximal tubule due to immunoglobulin light chains. Cases of LCFS are rare and mostly sporadically reported, and treatment of this entity is still controversial. This single-center retrospective study included 22 patients diagnosed with LCFS in Peking Union Medical College Hospital. Monoclonal gammopathy of undetermined significance was diagnosed in 13 patients, and overt multiple myeloma in six patients, with two smoldering myeloma and one Waldenstrom macroglobulinemia. Light chain was mostly kappa type (90.9%). Baseline median estimated glomerular filtration rate was 66 (13-126) ml/min/1.73 m², with one patient presented as end-stage renal disease. After a median follow-up of 37 months, three patients died. Twelve patients were treated with chemotherapy, including 7 with bortezomib-based regimens. Renal function was significantly improved in the group of patients who received chemotherapy (p = 0.026). Compared with other chemotherapy regimens, patients with bortezomib-based treatment had a better hematological response (p = 0.027) as well as a better proximal tubule outcome (p = 0.015). Chemotherapy likely outweighs supportive treatment in patients with LCFS. Bortezomib-based regimen seems to be a safe first-line therapy for management of those patients.

Layer by layer (LbL) assembly can be regarded as an emerging technology for the separation of organic micro-pollutants from water. Direct assembly of polyelectrolytes (PEs) under LbL mode on natural support material is rare. Here we report the integration of LbL to one of the most resourceful support materials that might have an enduring impact on water treatment in color industry. A low-cost adsorbent is developed from chitosan (CHI) and polyacrylic acid (PAA) through LbL deposition on coir fiber (CF) by alternate exposure to their aqueous solutions. Their layer dependent formation is characterized by spectroscopic and microscopic techniques. CHI/PAA multilayer coated coir fiber or simply, layered coir fiber (LCF) showed high loading of cationic and anionic dyes both at acidic and alkaline loading pH. The loading was between 70% and 99% at the acidic pH 3 which is attributed to the binding between LCF and dye molecules by electrostatic and hydrophobic forces. The performance of LCF in presence of NaCl, Na2SO4 and sodium dodecyl sulfate (SDS) in dye solution is discussed. Textile industrial waste water showed significant reduction in dye (81%) content along with COD (84%) and TDS.

Heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) provide important information on cardiovascular autonomic control. However, little is known about the reorganization of HRV, BPV, and BRS after aerobic exercise. While there is a positive relationship between heart rate (HR) recovery rate and cardiorespiratory fitness, it is unclear whether there is a relationship between cardiorespiratory fitness and reorganization of cardiovascular autonomic modulation during recovery. Thus, this study aimed to investigate whether cardiorespiratory fitness influences the cardiovascular autonomic modulation recovery, after a cardiopulmonary exercise test. Sixty men were assigned into groups according to their cardiorespiratory fitness: low cardiorespiratory fitness (LCF = VO2: 22-38 mL kg^-1 min^-1), moderate (MCF = VO2: 38-48 mL kg^-1 min^-1), and high (HCF = VO2 > 48 mL kg^-1 min^-1). HRV (linear and non-linear analysis) and BPV (spectral analysis), and BRS (sequence method) were performed before and after a cardiopulmonary exercise test. The groups with higher cardiorespiratory fitness had lower baseline HR values and HR recovery time after the cardiopulmonary exercise test. On comparing rest and recovery periods, the spectral analysis of HRV showed a decrease in low-frequency (LF) oscillations in absolute units and high frequency (HF) in absolute and normalized units. It also showed increases in LF oscillations of blood pressure. Nonlinear analysis showed a reduction in approximate entropy (ApEn) and in Poincare Plot parameters (SD1 and SD2), accompanied by increases in detrended fluctuation analysis (DFA) parameters α1 and α2. However, we did not find differences in cardiovascular autonomic modulation parameters and BRS in relation to cardiorespiratory fitness neither before nor after the cardiopulmonary test. We concluded that cardiorespiratory fitness does not affect cardiovascular autonomic modulations after cardiopulmonary exercise test, unlike HR recovery.

The second-generation aluminum-magnesium-scandium (Al-Mg-Sc) alloy, which is often referred to as Scalmalloy®, has been developed as a high-strength aluminum alloy for selective laser melting (SLM). The high-cooling rates of melt pools during SLM establishes the thermodynamic conditions for a fine-grained crack-free aluminum structure saturated with fine precipitates of the ceramic phase Al₃-Sc. The precipitation allows tensile and fatigue strength of Scalmalloy® to exceed those of AlSi10Mg by ~70%. Knowledge about properties of other additive manufacturing processes with slower cooling rates is currently not available. In this study, two batches of Scalmalloy® processed by SLM and laser metal deposition (LMD) are compared regarding microstructure-induced properties. Microstructural strengthening mechanisms behind enhanced strength and ductility are investigated by scanning electron microscopy (SEM). Fatigue damage mechanisms in low-cycle (LCF) to high-cycle fatigue (HCF) are a subject of study in a combined strategy of experimental and statistical modeling for calculation of Woehler curves in the respective regimes. Modeling efforts are supported by non-destructive defect characterization in an X-ray computed tomography (µ-CT) platform. The investigations show that Scalmalloy® specimens produced by LMD are prone to extensive porosity, contrary to SLM specimens, which is translated to ~30% lower fatigue strength.

Conscious awareness plays a major role in human cognition and adaptive behavior, though its function in multisensory integration is not yet fully understood, hence, questions remain: How does the brain integrate the incoming multisensory signals with respect to different external environments? How are the roles of these multisensory signals defined to adhere to the anticipated behavioral-constraint of the environment? This work seeks to articulate a novel theory on conscious multisensory integration (CMI) that addresses the aforementioned research challenges. Specifically, the well-established contextual field (CF) in pyramidal cells and coherent infomax theory (Kay et al., 1998; Kay and Phillips, 2011) is split into two functionally distinctive integrated input fields: local contextual field (LCF) and universal contextual field (UCF). LCF defines the modulatory sensory signal coming from some other parts of the brain (in principle from anywhere in space-time) and UCF defines the outside environment and anticipated behavior (based on past learning and reasoning). Both LCF and UCF are integrated with the receptive field (RF) to develop a new class of contextually-adaptive neuron (CAN), which adapts to changing environments. The proposed theory is evaluated using human contextual audio-visual (AV) speech modeling. Simulation results provide new insights into contextual modulation and selective multisensory information amplification/suppression. The central hypothesis reviewed here suggests that the pyramidal cell, in addition to the classical excitatory and inhibitory signals, receives LCF and UCF inputs. The UCF (as a steering force or tuner) plays a decisive role in precisely selecting whether to amplify/suppress the transmission of relevant/irrelevant feedforward signals, without changing the content e.g., which information is worth paying more attention to? This, as opposed to, unconditional excitatory and inhibitory activity in existing deep neural networks (DNNs), is called conditional amplification/suppression.

Keywords: audio-visual speech processing; coherent infomax neuron; contextually-adaptive neuron; deep neural network; multisensory integration; pyramidal cell; universal contextual field.

The International Agency for Research on Cancer has classified the consumption of "very hot" beverages (temperature >65 °C) as "probably carcinogenic to humans", but there is no information regarding the serving temperature of Brazil's most consumed hot beverage-coffee. The serving temperatures of best-selling coffee beverages in 50 low-cost food service establishments (LCFS) and 50 coffee shops (CS) were studied. The bestsellers in the LCFS were dominated by 50 mL shots of sweetened black coffee served in disposable polystyrene (PS) cups from thermos flasks. In the CS, 50 mL shots of freshly brewed espresso served in porcelain cups were the dominant beverage. The serving temperatures of all beverages were on average 90% and 68% above 65 °C in the LCFS and CS, respectively (P95 and median value of measurements: 77 and 70 °C, LCFS; 75 and 69 °C, CS). Furthermore, the cooling periods of hot water systems (50 mL at 75 °C and 69 °C in porcelain cups; 50 mL at 77 °C and 70 °C in PS cups) to 65 °C were investigated. When median temperatures of the best-selling coffees are considered, consumers should allow a minimum cooling time before drinking of about 2 min at both LCFS and CS.

Keywords: Brazil; coffee; food service industry; risk; temperature.

Similar to chromium contamination, the environmental contamination caused by uranium in radioactive coal bottom ash (CBA) is primarily dependent on the chemical speciation of uranium. However, the relationship between uranium speciation and environmental contamination has not been adequately studied. To determine the relationship between uranium speciation and environmental contamination, X-ray absorption fine structure (XAFS) and X-ray photoelectron spectra (XPS) analyses were performed to determine the uranium speciation in CBA exposed to different chemical environments and simulated natural environments. The leachability of the different forms of uranium in the CBA was studied via a simulated acid rain leaching experiment, and the results showed that 57.0% of the total uranium was leached out as U(VI). The results of a linear combination fit (LCF) of the X-ray absorption near edge structure (XANES) spectrum revealed that in the raw CBA, the uranium mainly occurred as U3O8 (71.8%). However, in the iron-rich particles, the uranium mainly occurred as UO2 (91.9%) after magnetic separation. Magnetite is a ubiquitous ferrous-bearing oxide, and it was effective for the sorption of U(IV). The result of FeSO4 leaching experiment indicated that 96.57% of total uranium was reduced from U(VI) to U(IV) when infiltrated with the FeSO4 solution for 6months. This result clearly demonstrated the changes in chemical valence of uranium in the coal ash and provided a conceptual principle for preventing uranium migration from ash to the surrounding soil and plants.

This study determined, by means of X-ray absorption near-edge structure (XANES) spectroscopy, the speciation of mercury (Hg) in black pine (Pinus nigra) barks from Monte Amiata, that were previously shown to contain exceptionally high (up to some mg kg-1) Hg contents because of the proximity to the former Hg mines and roasting plants. Linear fit combination (LCF) analysis of the experimental spectra compared to a large set of reference compounds showed that all spectra can be fitted by only four species: β-HgS (metacinnabar), Hg-cysteine, Hg bound to tannic acid, and Hg0. The first two are more widespread, whereas the last two occur in one sample only; the contribution of organic species is higher in deeper layers of barks than in the outermost ones. We interpret these results to suggest that, during interaction of barks with airborne Hg, the metal is initially mechanically captured at the bark surface as particulate, or physically adsorbed as gaseous species, but eventually a stable chemical bond is established with organic ligands of the substrate. As a consequence, we suggest that deep bark Hg may be a good proxy for long term time-integrated exposure, while surface bark Hg is more important for recording short term events near Hg point sources.

The diagnostic and research aspects of compressor blade fatigue detection have been elaborated in the paper. The real maintenance and overhaul problems and characteristic of different modes of metal blade fatigue (LCF, HCF, and VHCF) have been presented. The polycrystalline defects and impurities influencing the fatigue, along with their related surface finish techniques, are taken into account. The three experimental methods of structural health assessment are considered. The metal magnetic memory (MMM), experimental modal analysis (EMA) and tip timing (TTM) methods provide information on the damage of diagnosed objects, for example, compressor blades. Early damage symptoms, that is, magnetic and modal properties of material strengthening and weakening phases (change of local dislocation density and grain diameter, increase of structural and magnetic anisotropy), have been described. It has been proven that the shape of resonance characteristic gives abilities to determine if fatigue or a blade crack is concerned. The capabilities of the methods for steel and titanium alloy blades have been illustrated in examples from active and passive experiments. In the conclusion, the MMM, EMA, and TTM have been verified, and the potential for reliable diagnosis of the compressor blades using this method has been confirmed.

Telehealth systems have shown success in the remote management of several neurological disorders, but there is a paucity of evidence in disorders of consciousness (DOC). In this study, we explore the effectiveness of a new telemonitoring system, for monitoring Vegetative State (VS) and Minimally Conscious State (MCS) patients. This was a prospective, mono-center randomized controlled study. We included only traumatic brain injury (TBI) patients who required long-term motor/cognitive assistance having a stable clinical condition. We examined their clinical evolution over ~4 years of the follow-up period. Twenty-two TBI patients were enrolled and equally divided into two groups: one telemonitored at home with our service and the second admitted to a standard long-stay hospitalization (LSH) program. Patients enrolled in the telehealth service (age: 49.9 ± 20.4; 45% female; diagnosis: 36% VS/64% MCS) were demographically and clinically-matched with those admitted to the LSH program (age: 55.1 ± 15; 18% female; diagnosis: 54% VS/46% MCS). Thirty-six percent of patients in the LSH program died before completing follow up evaluation with respect to 18% of death in the group of TBI patients telemonitored at home. At follow-up, patients in LSH and telemonitoring groups showed similar clinical progression, as measured by CRS-r, NCS, WHIM, and LCF scales, as well as by the number of medical complications (i.e., bedsores, infections). Finally, we estimated the total daily cost per patient. Severe TBI patients enrolled in the conventional LSH program cost 262€ every single day, whereas the cost per patient in the telehealth service resulted to be less expensive (93€). Here, we highlight that our telehealth monitoring service is as efficacious as in-person usual care to manage a severe neurological disorder such as TBI in a cost-effective way.

Keywords: coma recovery scale revised; healthcare costs; medical complications; telerehabilitation; traumatic brain injury.

Analysis of time-resolved data typically involves discriminating noise against the signal and extracting time-independent components and their time-dependent contributions. Singular value decomposition (SVD) serves this purpose well, but the extracted time-independent components are not necessarily the physically meaningful spectra directly representing the actual dynamic or kinetic processes but rather a mathematically orthogonal set necessary for constituting the physically meaningful spectra. Converting the orthogonal components into physically meaningful spectra requires subsequent posterior analyses such as linear combination fitting (LCF) and global fitting (GF), which takes advantage of prior knowledge about the data but requires that all components are known or satisfactory components are guessed. Since in general not all components are known, they have to be guessed and tested via trial and error. In this work, we introduce a method, which is termed SVD-aided Non-Orthogonal Decomposition (SANOD), to circumvent trial and error. The key concept of SANOD is to combine the orthogonal components from SVD with the known prior knowledge to fill in the gap of the unknown signal components and to use them for LCF. We demonstrate the usefulness of SANOD via applications to a variety of cases.

The influenza A (H1N1) pdm09 virus emerged in 2009 and has been continuously circulating in humans for over ten years. Here, we analyzed a clinical influenza A (H1N1) pdm09-infected patient case hospitalized for two months in Guangdong (from December 14, 2019 to February 15, 2020). This isolate, named A/Guangdong/LCF/2019 (LCF/19), was genetically sequenced, rescued by reverse genetics, and phylogenetically analyzed in the context of other relevant pdm09 isolates. Compared with earlier isolates, this pdm09 virus's genetic sequence contains four substitutions, S186P, T188I, D190A, and Q192E, of the hemagglutinin (HA) segment at position 186-192 (H3 numbering) in the epitope Sb, and two of which are located at the 190-helix. Phylogenetic analysis indicated that the epitope Sb started undergoing a rapid antigenic change in 2018. To characterize the pathogenicity of this novel substitution motif, a panel of reassortant viruses containing the LCF/2019 HA segment or the chimeric HA segment with the four substitutions were rescued. Kinetic growth data revealed that the reassortant viruses, including the LCF/2019 with the PTIAAQE substitution, propagated faster than those rescued ones having the STTADQQ motif in the epitope Sb in Madin-Darby Canine Kidney (MDCK) cells. The HI test showed that the binding activity of escape mutant to 2018 pdm09 sera was weaker than GLW/2018, suggesting that old vaccines might not effectively protect people from infection. Due to the difference in the selection of vaccine strains, people vaccinated in the southern hemisphere could still suffer a severe infection if infected with this antigenic drift pdm09 virus.

Keywords: HA antigenic drift; HA epitope Sb; Influenza A (H1N1) pdm09 virus.

BACKGROUND

Critical illness polyneuropathy and myopathy (CIPNM) frequently occur in intensive care unit (ICU) critically ill subjects; about 55-70% of subjects achieve full recovery. CIPNM can occur in ICU subjects with severe acquired brain injury (sABI), but no data have been reported regarding their outcome.

OBJECTIVE

The aim of the present study was to investigate the functional recovery in subjects suffering from both CIPNM and sABI and whether they had poorer outcome than those with sABI only.

METHODS

Prospective cohort study.

METHODS

Dedicated rehabilitation setting.

METHODS

Adult ICU subjects with sABI causing a disorder of consciousness graded 3-8 on the Glasgow Coma Scale admitted to a dedicated rehabilitative setting were enrolled from January 2015 to June 2016.

METHODS

The enrolled sample was divided in two groups: patients with CIPNM and coexistent sABI (CIPNM+sABI) and patients with sABI. Electromyography was performed in all subjects to ascertain CIPNM occurrence, at admission. Functional outcome was investigated using the Rancho Los Amigos Levels of Cognitive Functioning (LCF), Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS), at admission and discharge. Mortality and length of stay (LOS) were recorded.

RESULTS

One-hundred and thirty-one patients (59 F, 72 M; mean age 54.7±15.8) were admitted to the rehabilitation setting, and 111 (47 F, 64 M; mean age: 53.6±18.4 years) were enrolled. Thirty-six (31.8%) had CIPNM+sABI, and 75 patients had isolated sABI. Significant functional outcomes in all assessment measures were observed after rehabilitation in all samples. The estimated mean scores (95% confidence interval) of LCF, DRS, GOS and mRS from a multivariate model adjusted for age, sex and time of ICU stay were: 2.85 (2.53-3.21) and 5.24 (4.81-5.71), 23.94 (22.37-25.62) and 16.04 (14.77-17.41), 2.86 (2.70-3.04) and 3.46 (3.28-3.65), and 4.91 (4.67-5.17) and 3.79 (3.58-4.02), at admission and at discharge, respectively. Despite functional improvement, CIPNM+sABI patients showed lesser improvement than those with sABI only. Furthermore, patients with both disorders had significantly higher median LOS than sABI subjects: 107 (q1-q3: 65-146), and 65 (q1-q3: 38-105) days (P=5.5x10-83), respectively. No statistically significant difference in mortality rates was found between groups.

CONCLUSIONS

Subjects with CIPNM and coexistent sABI improved after rehabilitation, but had poorer recovery than those with solely sABI requiring a longer LOS.

CONCLUSIONS

The rehabilitation process in subjects suffering from CINPM is challenging and no evidence support the use of specific rehabilitative approaches to improve function and activities of daily living.

Background: Despite the high frequency of tracheotomy in severe acquired brain injury (sABI) patients, available literature about the weaning procedure is mainly represented by expert opinions with no standardised and evidence-based criteria.

Aim: The Institute of Physical and Rehabilitation Medicine "Gervasutta" adopted a new decannulation procedure, recommended by the Italian Society of Physical Medicine and Rehabilitation (SIMFER): this study evaluates whether the new procedure helps to improve the decannulation process of sABI patients.

Design: A prospective observational with historical control was performed by dividing sABI patients into two groups depending on whether they were treated with or without the new procedure.

Setting: The Neurorehabilitation Department of the Institute of Physical and Rehabilitation Medicine "Gervasutta" in Udine, Italy.

Population: sABI patients with tracheal cannula admitted to the Institute of Physical and Rehabilitation Medicine "Gervasutta" from January 2015 to March 2019.

Methods: Clinical data were collected as both process and outcome indicators before and after the adoption of the new procedure. Data have been processed with "Simple Interactive Statistical Analysis" (SISA) software.

Results: A sample of 141 patients was analysed. Among the 141 patients, 57 (40.4%) were treated with the new procedure. No differences were found between the two groups in terms of complications, Functional Independence Measure (FIM), or Level of Cognitive Functioning (LCF) at the admission. When the new procedure was applied, the decannulation rate was significantly higher (OR = 1.8; 95% CI = 1.2- 9.8; p= 0.01) and the time (days) between admission and oral feeding resumption was significantly lower (p< 0.001; 95% CI = -10 , -34 days).

Conclusions: The introduction of the new protocol allowed the safe achievement of both oral feeding resumption and decannulation, which are two of the main early rehabilitation goals.

Clinical rehabilitation impact: The standardisation of the decannulation process has determined the achievement of a significantly faster oral feeding resumption and an increase in the decannulation rate during the rehabilitation of sABI patients.

This study evaluated effect of mental rotation (MR) training on learning outcomes and explored effectiveness of teaching via three-dimensional (3D) software among medical students with diverse spatial intelligence. Data from n = 67 student volunteers were included. A preliminary test was conducted to obtain baseline level of MR competency and was utilized to assign participants to two experimental conditions, i.e., trained group (n = 25) and untrained group (n = 42). Data on the effectiveness of training were collected to measure participants' speed and accuracy in performing various MR activities. Six weeks later, a large class format (LCF) session was conducted for all students using 3D software. The usefulness of technology-assisted learning at the LCF was evaluated via a pre- and post-test. Students' feedback regarding MR training and use of 3D software was acquired through questionnaires. MR scores of the trainees improved from 25.9±4.6 points to 28.1±4.4 (P = 0.011) while time taken to complete the tasks reduced from 20.9±3.9 to 12.2±4.4 minutes. Males scored higher than females in all components (P = 0.016). Further, higher pre- and post-test scores were observed in trained (9.0±1.9 and 12.3±1.6) versus untrained group (7.8±1.8; 10.8±1.8). Although mixed-design analysis of variance suggested significant difference in their test scores (P < 0.001), both groups reported similar trend in improvement by means of 3D software (P = 0.54). Ninety-seven percent of students reported technology-assisted learning as an effective means of instruction and found use of 3D software superior to plastic models. Software based on 3D technologies could be adopted as an effective teaching pedagogy to support learning across students with diverse levels of mental rotation abilities. Anat Sci Educ 0: 1-11. © 2018 American Association of Anatomists.

In countries where integrated coastal zone management (ICZM) is not enshrined in statute, a voluntary approach has often been taken. This review examines issues relating to funding in ICZM partnerships, particularly the local coastal fora (LCF) network in the UK. It highlights the lack of sustainable long-term funding mechanisms for organisations with the core aim of sustainable management of coastal resources. The relative difficulty of raising funds for core costs as opposed to projects is addressed, as is the lack of business/industry involvement. The 'hamster wheel syndrome' of fundraising is noted, where staff spend too much time trying to raise money, as opposed to developing ICZM. The resultant impact on the staff and the operation of the LCF is considered. Examples beyond the UK are considered, as are the problems associated with 'pump-prime' funding and implementation. Is the lack of formality in ICZM the crux of the funding problem?

Static frontal plane tibiofemoral alignment is an important factor in dynamic knee alignment and knee adduction moments. However, little is known about the relationship between alignment and compartment contact forces or muscle control strategies. The purpose of this study was to estimate medial (MCF) and lateral (LCF) compartment knee joint contact forces and muscle forces during stair ascent using a musculoskeletal model implementing subject specific knee alignments. Kinematic and kinetic data from 20 healthy individuals with radiographically confirmed varus or valgus knee alignments were simulated using alignment specific models to predict MCFs and LCFs. Muscle forces were determined using static optimization. Independent samples t-tests compared contact and knee and frontal plane hip muscle forces between groups during weight acceptance and during pushoff. The varus group exhibited increased weight acceptance peak MCFs, while the valgus group exhibited increased pushoff peak LCFs. The varus group utilized increased vasti muscle forces during weight acceptance and hip adductor forces during pushoff. The valgus group utilized increased hip abductor forces during pushoff. The alignment dependent contact forces provide evidence of the significance of frontal plane knee alignment in healthy individuals, which may be important in considering future knee joint health. The differing muscle control strategies between alignments detail specific neuromuscular responses to control frontal plane knee loads.

Diabetic retinopathy (DR) is a diabetes complication, which in extreme situations may lead to blindness. Since the first stages are often asymptomatic, regular eye examinations are required for an early diagnosis. As microaneurysms (MAs) are one of the first signs of DR, several automated methods have been proposed for their detection in order to reduce the ophthalmologists' workload. Although local convergence filters (LCFs) have already been applied for feature extraction, their potential as MA enhancement operators was not explored yet. In this work, we propose a sliding band filter for MA enhancement aiming at obtaining a set of initial MA candidates. Then, a combination of the filter responses with color, contrast and shape information is used by an ensemble of classifiers for final candidate classification. Finally, for each eye fundus image, a score is computed from the confidence values assigned to the MAs detected in the image. The performance of the proposed methodology was evaluated in four datasets. At the lesion level, sensitivities of 64% and 81% were achieved for an average of 8 false positives per image (FPIs) in e-ophtha MA and SCREEN-DR, respectively. In the last dataset, an AUC of 0.83 was also obtained for DR detection.

Keywords: Diabetic retinopathy screening; Fundus image analysis; Microaneurysm detection; Sliding band filter.