Design and acceptability assessment of a new reversible orthosis

International audience— We present a new device aimed at being used for upper limb rehabilitation. Our main focus was to design a robot capable of working in both the passive mode (i.e. the robot shall be strong enough to generate human-like movements while guiding the weak arm of a patient) and the active mode (i.e. the robot shall be able of following the arm without disturbing human natural motion). This greatly challenges the design, since the system shall be reversible and lightweight while providing human compatible strength, workspace and speed. The solution takes the form of an orthotic structure, which allows control of human arm redundancy contrarily to clinically available upper limb rehabilitation robots. It is equipped with an innovative transmission technology, which provides both high gear ratio and fine reversibility. In order to evaluate the device and its therapeutic efficacy, we compared several series of pointing movements in healthy subjects wearing and not wearing the orthotic device. In this way, we could assess any disturbing effect on normal movements. Results show that the main movement characteristics (direction, duration, bell shape profile) are preserved

Spatial and Temporal Dust Source Variability in Northern China Identified Using Advanced Remote Sensing Analysis

The aim of this research is to provide a detailed characterization of spatial patterns and temporal trends in the regional and local dust source areas within the desert of the Alashan Prefecture (Inner Mongolia, China). This problem was approached through multi-scale remote sensing analysis of vegetation changes. The primary requirements for this regional analysis are high spatial and spectral resolution data, accurate spectral calibration and good temporal resolution with a suitable temporal baseline. Landsat analysis and field validation along with the low spatial resolution classifications from MODIS and AVHRR are combined to provide a reliable characterization of the different potential dust-producing sources. The representation of intra-annual and inter-annual Normalized Difference Vegetation Index (NDVI) trend to assess land cover discrimination for mapping potential dust source using MODIS and AVHRR at larger scale is enhanced by Landsat Spectral Mixing Analysis (SMA). The combined methodology is to determine the extent to which Landsat can distinguish important soils types in order to better understand how soil reflectance behaves at seasonal and inter-annual timescales. As a final result mapping soil surface properties using SMA is representative of responses of different land and soil cover previously identified by NDVI trend. The results could be used in dust emission models even if they are not reflecting aggregate formation, soil stability or particle coatings showing to be critical for accurately represent dust source over different regional and local emitting areas

The nature of dark energy

According to a variety of cosmological observations at small and large redshifts, the universe is composed by a large fraction of a weakly clustered component with negative pressure, called dark energy. The nature of the dark energy, i.e. its interaction and self-interaction properties, is still largely unknown. In this contribution we review the properties of dark energy as inferred from observations, with particular emphasis on the cosmic microwave background. We argue that the current dataset imposes strong constraints on the coupling of dark energy to dark matter, while it is still insufficient to constrain the equation of state or potential. Future data will dramatically improve the prospects

Factors affecting adherence to guidelines for antithrombotic therapy in elderly patients with atrial fibrillation admitted to internal medicine wards

Current guidelines for ischemic stroke prevention in atrial fibrillation or flutter (AFF) recommend Vitamin K antagonists (VKAs) for patients at high-intermediate risk and aspirin for those at intermediate-low risk. The cost-effectiveness of these treatments was demonstrated also in elderly patients. However, there are several reports that emphasize the underuse of pharmacological prophylaxis of cardio-embolism in patients with AFF in different health care settings. AIMS: To evaluate the adherence to current guidelines on cardio-embolic prophylaxis in elderly (> 65 years old) patients admitted with an established diagnosis of AFF to the Italian internal medicine wards participating in REPOSI registry, a project on polypathologies/polytherapies stemming from the collaboration between the Italian Society of Internal Medicine and the Mario Negri Institute of Pharmacological Research; to investigate whether or not hospitalization had an impact on guidelines adherence; to test the role of possible modifiers of VKAs prescription. METHODS: We retrospectively analyzed registry data collected from January to December 2008 and assessed the prevalence of patients with AFF at admission and the prevalence of risk factors for cardio-embolism. After stratifying the patients according to their CHADS(2) score the percentage of appropriateness of antithrombotic therapy prescription was evaluated both at admission and at discharge. Univariable and multivariable logistic regression models were employed to verify whether or not socio-demographic (age >80years, living alone) and clinical features (previous or recent bleeding, cranio-facial trauma, cancer, dementia) modified the frequency and modalities of antithrombotic drugs prescription at admission and discharge. RESULTS: Among the 1332 REPOSI patients, 247 were admitted with AFF. At admission, CHADS(2) score was ≥ 2 in 68.4% of patients, at discharge in 75.9%. Among patients with AFF 26.5% at admission and 32.8% at discharge were not on any antithrombotic therapy, and 43.7% at admission and 40.9% at discharge were not taking an appropriate therapy according to the CHADS(2) score. The higher the level of cardio-embolic risk the higher was the percentage of antiplatelet- but not of VKAs-treated patients. At admission or at discharge, both at univariable and at multivariable logistic regression, only an age >80 years and a diagnosis of cancer, previous or active, had a statistically significant negative effect on VKAs prescription. Moreover, only a positive history of bleeding events (past or present) was independently associated to no VKA prescription at discharge in patients who were on VKA therapy at admission. If heparin was considered as an appropriate therapy for patients with indication for VKAs, the percentage of patients admitted or discharged on appropriate therapy became respectively 43.7% and 53.4%. CONCLUSION: Among elderly patients admitted with a diagnosis of AFF to internal medicine wards, an appropriate antithrombotic prophylaxis was taken by less than 50%, with an underuse of VKAs prescription independently of the level of cardio-embolic risk. Hospitalization did not improve the adherence to guideline

Impacts of Climate Change on SOC Dynamic and Crop Yield of Italian Rainfed Wheat-Maize Cropping Systems Managed with Conventional or Conservation Tillage Practices

There is still uncertainty on the ability of conservation tillage (i.e., reduced- RT and no till - NT) in contributing to the resilience of cropping systems to climate change pressures (Powlson et al 2016). RT or NT can improve soil physical and biological proprieties thus increasing water holding capacity and fertility, stabilizing soil structure and enhancing soil biodiversity and functions. They are also frequently proposed as mitigation practices as they can contribute to increase soil organic carbon (SOC) compared to conventional moldboard ploughing practices (Gonzalez-Sanchezet al., 2012). However, SOC increase occurs mostly in the upper soil layer but not always in the deeper profile (Haddaway et al., 2016) where SOC measurements are less frequently measured. In this study, we used data obtained from long term field experiments(LTE) coupled with three crop simulation models in order to assess the long-term effects of different tillage management practices on crop yield and on changes in SOC stocks in both superficial (0-20cm) and deeper layers (20-50cm) in Mediterranean rainfed cereal cropping systems at current and future climate scenarios

Penumbra indigo percutaneous aspiration thrombectomy system in the treatment of aortic endograft iliac limb occlusion: results from an Italian Multicentre Registry

Objective: This study aimed to evaluate the safety and effectiveness of the Penumbra Indigo percutaneous aspiration thrombectomy (PAT) system in the clinical presentation of iliac limb occlusion (ILO) after endovascular aortic repair (EVAR).Methods: A retrospective, observational, multicentre study conducted in eight Italian vascular centres. Consecutive patients presenting with ILO after EVAR were eligible. To assess vessel revascularisation, Thrombo-aspiration In Peripheral Ischaemia (TIPI) classification (score 0-3) was used at presentation (t1), after PAT (t2), and after adjunctive procedures (t3). Successful revascularisation was considered TIPI 2-3 (near complete or complete). Primary intra-operative outcomes were technical success (TS) of Indigo PAT and combined TS of PAT associated with adjunctive procedures when needed. Primary follow up outcomes were safety and effectiveness at one, six, and 12 months.Results: From September 2019 to December 2021, there were 48 ILO and 17 patients (35%) [median age 75 years, IQR 71, 83 years; male, 14 (82%); urgent, 8 (47%)] were treated and enrolled. The median time after primary EVAR was 24 months (IQR 0, 42 months). The median clot age from ILO diagnosis to PAT was three days (IQR 1, 12 days). Ten patients (59%) presented with limb threatening ischaemia. At t1, TIPI 0 and 1 was present in 13 (76%) and four (24%) cases, respectively. At t2, primary TS (TIPI 2-3) was achieved in 14 cases (82%) after Indigo PAT (p < .001). Fifteen patients (88%) required adjunctive procedures (14 re-linings, one surgical patch angioplasty). At t3, combined TS was achieved in 16 cases (94%). Intra-operative complication included one (6%) distal embolisation, treated successfully. The 30 day mortality was one case (6%) due to pneumonia. At one, six, and 12 months, clinical success was 100% without ILO recurrence. The median follow up was 23 months (IQR 11, 41 months): at 18 months, survival and freedom from re-intervention were 91 + 8% and 90 + 9%, respectively.Conclusion: This study reports for the first time the efficacy and safety of Penumbra Indigo PAT for ILO after EVAR, with promising technical and clinical success up to one year

Design and acceptability assessment of a new reversible orthosis

We present a new device aimed at being used for upper limb rehabilitation. Our main focus was to design a robot capable of working in both the passive mode (i.e. the robot shall be strong enough to generate human-like movements while guiding the weak arm of a patient) and the active mode (i.e. the robot shall be able of following the arm without disturbing human natural motion). This greatly challenges the design, since the system shall be reversible and lightweight while providing human compatible strength, workspace and speed. The solution takes the form of an orthotic structure, which allows control of human arm redundancy contrarily to clinically available upper limb rehabilitation robots. It is equipped with an innovative transmission technology, which provides both high gear ratio and fine reversibility. In order to evaluate the device and its therapeutic efficacy, we compared several series of pointing movements in healthy subjects wearing and not wearing the orthotic device . In this way, we could assess any disturbing effect on normal movements. Results show that the main movement characteristics (direction, duration, bell shape profile) are preserved. ©2008 IEEE

Legal immigrants: invasion of alien microbial communities during winter occurring desert dust storms

Background A critical aspect regarding the global dispersion of pathogenic microorganisms is associated with atmospheric movement of soil particles. Especially, desert dust storms can transport alien microorganisms over continental scales and can deposit them in sensitive sink habitats. In winter 2014, the largest ever recorded Saharan dust event in Italy was efficiently deposited on the Dolomite Alps and was sealed between dust-free snow. This provided us the unique opportunity to overcome difficulties in separating dust associated from “domestic” microbes and thus, to determine with high precision microorganisms transported exclusively by desert dust. Results Our metagenomic analysis revealed that sandstorms can move not only fractions but rather large parts of entire microbial communities far away from their area of origin and that this microbiota contains several of the most stress-resistant organisms on Earth, including highly destructive fungal and bacterial pathogens. In particular, we provide first evidence that winter-occurring dust depositions can favor a rapid microbial contamination of sensitive sink habitats after snowmelt. Conclusions Airborne microbial depositions accompanying extreme meteorological events represent a realistic threat for ecosystem and public health. Therefore, monitoring the spread and persistence of storm-travelling alien microbes is a priority while considering future trajectories of climatic anomalies as well as anthropogenically driven changes in land use in the source regions

Spatially controlled cell adhesion on three-dimensional substrates

The microenvironment of cells in vivo is defined by spatiotemporal patterns of chemical and biophysical cues. Therefore, one important goal of tissue engineering is the generation of scaffolds with defined biofunctionalization in order to control processes like cell adhesion and differentiation. Mimicking extrinsic factors like integrin ligands presented by the extracellular matrix is one of the key elements to study cellular adhesion on biocompatible scaffolds. By using special thermoformable polymer films with anchored biomolecules micro structured scaffolds, e.g. curved and µ-patterned substrates, can be fabricated. Here, we present a novel strategy for the fabrication of µ-patterned scaffolds based on the “Substrate Modification and Replication by Thermoforming” (SMART) technology: The surface of a poly lactic acid membrane, having a low forming temperature of 60°C and being initially very cell attractive, was coated with a photopatterned layer of poly(L-lysine) (PLL) and hyaluronic acid (VAHyal) to gain spatial control over cell adhesion. Subsequently, this modified polymer membrane was thermoformed to create an array of spherical microcavities with diameters of 300 µm for 3D cell culture. Human hepatoma cells (HepG2) and mouse fibroblasts (L929) were used to demonstrate guided cell adhesion. HepG2 cells adhered and aggregated exclusively within these cavities without attaching to the passivated surfaces between the cavities. Also L929 cells adhering very strongly on the pristine substrate polymer were effectively patterned by the cell repellent properties of the hyaluronic acid based hydrogel. This is the first time cell adhesion was controlled by patterned functionalization of a polymeric substrate with UV curable PLL-VAHyal in thermoformed 3D microstructures

Restructuring surgical training after COVID-19 pandemic: A nationwide survey on the Italian scenario on behalf of the Italian polyspecialistic young surgeons society (SPIGC)

Introduction: The COVID-19 pandemic has led to the disruption of surgical training. Lack of communication, guidelines for managing clinical activity as well as concerns for safety in the workplace appeared to be relevant issues. This study aims to investigate how surgical training has been reorganized in Italy, almost 2 years after the outbreak of COVID-19 pandemic. Materials and methods: A 16-item-electronic anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of different sections concerning demographic characteristics and impacts of the second COVID-19 pandemic wave on surgical and research/didactic activities. Changes applied in the training programme and activities carried out were also investigated. The survey was carried out in the period between June and October 2021. Results: Four hundred and thirty responses were collected, and 399 were considered eligible to be included in the study analysis. Three hundred and thirty-five respondents continued working in Surgical Units, with a significant reduction (less than one surgical session per week) of surgical sessions in 49.6% of them. With concern to didactic and research activities, 140 residents maintained their usual activity, while 116 reported a reduction. A sub-group analysis on resident moved to COVID-19 departments showed a reduction of research activities in 35% of them. During the period considered in this survey, the surgical training program was not substantially modified for most of participants (74.6%). Conclusion: Our survey demonstrated that surgical residency programs haven't improved 2 years after the beginning of the pandemic. Further improvements are needed to guarantee completeness of surgical training, even in emergency conditions