Design methodology of an active back-support exoskeleton with adaptable backbone-based kinematics

Abstract Manual labor is still strongly present in many industrial contexts (such as aerospace industry). Such operations commonly involve onerous tasks requiring to work in non-ergonomic conditions and to manipulate heavy parts. As a result, work-related musculoskeletal disorders are a major problem to tackle in workplace. In particular, back is one of the most affected regions. To solve such issue, many efforts have been made in the design and control of exoskeleton devices, relieving the human from the task load. Besides upper limbs and lower limbs exoskeletons, back-support exoskeletons have been also investigated, proposing both passive and active solutions. While passive solutions cannot empower the human's capabilities, common active devices are rigid, without the possibility to track the human's spine kinematics while executing the task. The here proposed paper describes a methodology to design an active back-support exoskeleton with backbone-based kinematics. On the basis of the (easily implementable) scissor hinge mechanism, a one-degree of freedom device has been designed. In particular, the resulting device allows tracking the motion of a reference vertebra, i.e., the vertebrae in the correspondence of the connection between the scissor hinge mechanism and the back of the operator. Therefore, the proposed device is capable to adapt to the human posture, guaranteeing the support while relieving the person from the task load. In addition, the proposed mechanism can be easily optimized and realized for different subjects, involving a subject-based design procedure, making possible to adapt its kinematics to track the spine motion of the specific user. A prototype of the proposed device has been 3D-printed to show the achieved kinematics. Preliminary tests for discomfort evaluation show the potential of the proposed methodology, foreseeing extensive subjects-based optimization, realization and testing of the device

Identification of Altered miRNAs in Cerumen of Dogs Affected by Otitis Externa

Otitis externa is one of the most common diseases in dogs. It is associated with bacteria and yeast, which are regarded as secondary causes. Cerumen is a biological substance playing an important role in the protection of ear skin. The involvement of cerumen in immune defense is poorly understood. MicroRNAs can modulate the host immune response and can provide promising biomarkers for several inflammatory and infectious disorder diagnosis. The aims of this study were to profile the cerumen miRNA signature associated with otitis externa in dogs, integrate miRNAs to their target genes related to immune functions, and investigate their potential use as biomarkers. Cerumen was collected from healthy and otitis affected dogs and the expression of miRNAs was profiled by Next Generation Sequencing; the validation of the altered miRNAs was performed using RT-qPCR. The potential ability of miRNAs to modulate immune-related genes was investigated using bioinformatics tools. The results pointed out that 32 miRNAs, of which 14 were up- and 18 down-regulated, were differentially expressed in healthy vs. otitis-affected dogs. These results were verified by RT-qPCR. To assess the diagnostic value of miRNAs, ROC analysis was carried out, highlighting that 4 miRNAs are potential biomarkers to discriminate otitis-affected dogs. Bioinformatics showed that cerumen miRNAs may be involved in the modulation of host immune response. In conclusion, we have demonstrated for the first time that miRNAs can be efficiently extracted and quantified from cerumen, that their profile changes between healthy and otitis affected dogs, and that they may serve as potential biomarkers. Further studies are necessary to confirm their diagnostic value and to investigate their interaction with immune-related genes

Europeïtzació i governança interna del MRR: el cas d'Itàlia i d'Espanya

This article analyzes the governance mechanisms chosen by Italy and Spain to implement their National Recovery and Resilience Plan. The focus is on two factors that are crucial when it comes to down loading and implementing EU policies, which are the political and administrative systems. Thus, it isassumed that any divergence in the structure of governance can be attributed to political structures and the territorial political and administrative structures. To conduct the analysis, both rational choice and historical institutionalism are used as complementary perspectives, to explain which factors led to specifics type of governance

Generalised pustular onychopathy of unknown aetiology in a domestic cat.

Claw diseases are rare in cats and often associated with cutaneous lesions in other regions of the body. This case report describes an atypical manifestation of a generalised onychopathy of unknown origin in a domestic short hair cat

Infectious diseases team for the early management of severe sepsis and septic shock in the emergency department

Background: The impact on patient survival of an infectious disease (ID) team dedicated to the early management of severe sepsis/septic shock (SS/SS) in Emergency Department (ED) has yet to be assessed. Methods: A quasiexperimental pre-post study was performed at the general ED of our hospital. During the pre phase (June 2013-July 2014), all consecutive adult patients with SS/SS were managed according to the standard of care, data were prospectively collected. During the post phase (August 2014-October 2015), patients were managed in collaboration with a dedicated ID team performing a bedside patient evaluation within 1 hour of ED arrival. Results: Overall, 382 patients were included, 195 in the pre phase and 187 in the post phase. Median age was 82 years (interquartile range, 70-88). The most common infection sources were lung (43%) and urinary tract (17%); in 22% of cases, infection source remained unknown. During the post phase, overall compliance with the Surviving Sepsis Campaign (SSC) bundle and appropriateness of initial antibiotic therapy improved from 4.6% to 32% (P < .001) and from 30% to 79% (P < .001), respectively. Multivariate analysis showed that predictors of all-cause 14-day mortality were quick sepsis-related organ failure assessment \ue2\u89\ua52 (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.15-2.45; P = .007), serum lactate \ue2\u89\ua52 mmol/L (HR, 2.13; 95% CI, 1.39-3.25; P < .001), and unknown infection source (HR, 2.07; 95% CI, 1.42-3.02; P < .001); being attended during the post phase was a protective factor (HR, 0.64; 95% CI, 0.43-0.94; P = .026). Conclusion: Implementation of an ID team for the early management of SS/SS in the ED improved the adherence to SSC recommendations and patient survival

Development and validation of a prediction model for severe respiratory failure in hospitalized patients with SARS-CoV-2 infection: a multicentre cohort study (PREDI-CO study)

Objectives: We aimed to develop and validate a risk score to predict severe respiratory failure (SRF) among patients hospitalized with coronavirus disease-2019 (COVID-19).Methods: We performed a multicentre cohort study among hospitalized (&gt;24 hours) patients diagnosed with COVID-19 from 22 February to 3 April 2020, at 11 Italian hospitals. Patients were divided into derivation and validation cohorts according to random sorting of hospitals. SRF was assessed from admission to hospital discharge and was defined as: SpO(2) &lt;93% with 100% FiO(2), respiratory rate &gt;30 breaths/min or respiratory distress. Multivariable logistic regression models were built to identify predictors of SRF, beta-coefficients were used to develop a risk score. Trial Registration NCT04316949.Results: We analysed 1113 patients (644 derivation, 469 validation cohort). Mean (+/- SD) age was 65.7 (+/- 15) years, 704 (63.3%) were male. SRF occurred in 189/644 (29%) and 187/469 (40%) patients in the derivation and validation cohorts, respectively. At multivariate analysis, risk factors for SRF in the derivation cohort assessed at hospitalization were age &gt;= 70 years (OR 2.74; 95% CI 1.66-4.50), obesity (OR 4.62; 95% CI 2.78-7.70), body temperature &gt;= 38 degrees C (OR 1.73; 95% CI 1.30-2.29), respiratory rate &gt;= 22 breaths/min (OR 3.75; 95% CI 2.01-7.01), lymphocytes &lt;= 900 cells/mm(3) (OR 2.69; 95% CI 1.60-4.51), creatinine &gt;= 1 mg/dL (OR 2.38; 95% CI 1.59-3.56), C-reactive protein &gt;= 10 mg/dL (OR 5.91; 95% CI 4.88 -7.17) and lactate dehydrogenase &gt;= 350 IU/L (OR 2.39; 95% CI 1.11-5.11). Assigning points to each variable, an individual risk score (PREDI-CO score) was obtained. Area under the receiver-operator curve was 0.89 (0.86-0.92). At a score of &gt;3, sensitivity, specificity, and positive and negative predictive values were 71.6% (65%-79%), 89.1% (86%-92%), 74% (67%-80%) and 89% (85%-91%), respectively. PREDI-CO score showed similar prognostic ability in the validation cohort: area under the receiver-operator curve 0.85 (0.81e0.88). At a score of &gt;3, sensitivity, specificity, and positive and negative predictive values were 80% (73%-85%), 76% (70%-81%), 69% (60%-74%) and 85% (80%-89%), respectively.Conclusion: PREDI-CO score can be useful to allocate resources and prioritize treatments during the COVID-19 pandemic. (c) 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved