A Multi-Method Analysis of the Cultural, Sociodemographic and Economic Elements in Osteoarthritis Care

Background: Osteoarthritis (OA) quality of care is influenced by various cultural, sociodemographic, and economic elements that shape the context in which first-line interventions are implemented. This thesis aims at providing insights to improve OA care quality by analysing the role of healthcare professionals' knowledge and adherence to clinical practice guidelines and patients' sociodemographic (e.g., sex and age) and economic factors (e.g., income), and their experience and beliefs of OA care, through four studies. Methods: The four studies analysed: 1) physiotherapists’ knowledge of and adherence to OA clinical practice guidelines (survey-based study in Italy); 2) patients’ experience of the OA care process (qualitative study in Italy); 3) association between demographic, socioeconomic and disease-related factors and exercise adherence in OA (register-based study in Sweden); 4) income inequalities in people attending an OA first-line intervention and whether these inequalities changed after attending it (cohort study in Sweden). Results: Study 1 revealed that Italian physiotherapists knew but did not always apply first-line interventions. Study 2 suggested that people with OA experience an uncertain care process due to the lack of clear explanations, resulting in a negative attitude towards first‐line interventions. Study 3 found associations between exercise adherence and age, sex, socioeconomic status, disease severity and self-efficacy. All the investigated factors explained 1% of the exercise adherence variability. Study 4 indicated income inequalities among participants to an OA first-line intervention that widened after it. Conclusion: Several areas in the OA care process require attention. Physiotherapists must bridge the gap between their knowledge of and adherence to OA clinical practice guidelines. Patients need to be guided throughout their care process to be more empowered. Further studies on the factors associated with OA exercise adherence are necessary. Finally, we need to address inequalities in OA care, prioritising upstream interventions

Methodology for Modeling and Comparing Video Codecs: HEVC, EVC, and VVC

Online videos are the major source of internet traffic, and are about to become the largest majority. Increasing effort is aimed to developing more efficient video codecs. In order to compare existing and novel video codecs, this paper presents a simple but effective methodology to model their performance in terms of Rate Distortion (RD). A linear RD model in the dB variables, Peak Signal-to-Noise Ratio (PSNR) and Bitrate (BR), easily allows us to estimate the difference in PSNR or BR between two sets of encoding conditions. Six sequences from the MPEG test set with the same resolution, encoded at different BR and different Quantization Parameters, were used to create the data set to estimate each RD model. Three codecs (HEVC, EVC, and VVC) were compared with this methodology, after estimating their models. Fitting properties of each model and a performance comparison between the models are finally shown and discussed

Comparison of measurement methods of the front velocity of small-scale debris flows

Debris flow is a gravity-driven process, which is characterized by a travelling dense surge including large boulders, and it is followed by a more fluid tail. These characteristics make difficult the measurement of the mean flow velocity by means of common hydraulic techniques. Different methods can be used at real scale and small-scale to measure the front velocity but a dedicate comparison between available methods is still lacking. This research aims to compare the front velocity measurements in the transport zone of a miniature debris flow using three devices: i) a common digital video camera (29 frames per second); ii) a high speed thermo camera (60 fps); and iii) a laser photoelectric sensors system. The statistical analysis of data has highlighted no significant differences exist between front velocities obtained by means of the video camera and the thermo camera, whereas photocells data statistically differ from those achieved via the other systems. Some lack of data recorded by photocell was documented, while the thermo camera technique did not show significant loss of information being also helpful to detect the kinematic behaviour of single particles. Finally, the tests confirmed the influence of the solid volumetric concentration in the debris-flow mechanics, which promotes, ceteris paribus, the debris-flow slowing down

Prevalence, Characteristics, Association Factors of and Management Strategies for Low Back Pain Among Italian Amateur Cyclists: an Observational Cross-Sectional Study

Background Low back pain (LBP) is a burdensome problem affecting amateur cyclists. This cross-sectional study analysed Italian amateur cycling cohort's demographic and sport-specific characteristics, the prevalence and characteristics of LBP among this population, its possible association factors, the management strategies adopted to deal with LBP and the sample's beliefs among possible LBP triggers. A web-based cross-sectional survey was created. The questionnaire included 56 questions divided into six sections, querying the sample's demographic, clinical, and cycling characteristics. Binomial logistic regression with a Wald backward method was performed to ascertain the effects of some covariates ("Sex", "Age", "Body Mass Index", "Sleep hours", "Work type", "Cycling year", "Number of training sessions per week", "Stretching sessions", "Being supervised by a coach or following a scheduled training", "Other sports practised regularly", "Number of cycling competitions per year", "Past biomechanic visits", "Specific pedal training", "LBP before cycling") on the likelihood of developing LBP in the last 12 months. Results A total of 1274 amateur cyclists answered the survey. The prevalence of LBP appeared to be 55.1%, 26.5% and 10.8% in life, in the last 12 months and the last 4 weeks, respectively. The final model of the logistic regression included the covariates "Sex", "Work type", "Cycling year", "Being supervised by a coach or following a scheduled training", "Other sports practised regularly", "Specific pedal training", "LBP before cycling", among which "Cycling year" (variable "Between 2 and 5 years" vs. "Less than 2 years", OR 0.48, 95% CI [0.26-0.89]), "Being supervised by a coach or following a scheduled training" (OR 0.53, 95% CI [0.37-0.74]), "Specific pedal training" (OR 0.69, 95% CI [0.51-0.94]), and "LBP before cycling" (OR 4.2, 95% CI [3.21-5.40]) were found to be significant. Conclusions The prevalence of LBP among Italian amateur cyclists seems to be less frequent compared to the general population. Moreover, undergoing previous specific pedal training and being supervised by a coach or following scheduled training drew a negative association with LBP development. This evidence highlights the importance of being overseen by specific sport figures that could offer a tailored evidence-based training to reach good physical level and to practise sports safely

Quantitative Comparison of Human and Software Reliability in the Categorisation of Sit-to-stand Motion Pattern

The Sit-to-Stand (STS) test is used in clinical practice as an indicator of lower-limb functionality decline, especially for older adults. Due to its high variability, there is no standard approach for categorising the STS movement and recognising its motion pattern. This paper presents a comparative analysis between visual assessments and an automated-software for the categorisation of STS, relying on registrations from a force plate. 5 participants (30 +/- 6 years) took part in 2 different sessions of visual inspections on 200 STS movements under self-paced and controlled speed conditions. Assessors were asked to identify three specific STS events from the Ground Reaction Force, simultaneously with the software analysis: the start of the trunk movement (Initiation), the beginning of the stable upright stance (Standing) and the sitting movement (Sitting). The absolute agreement between the repeated raters' assessments as well as between the raters' and software's assessment in the first trial, were considered as indexes of human and software performance, respectively. No statistical differences between methods were found for the identification of the Initiation and the Sitting events at self-paced speed and for only the Sitting event at controlled speed. The estimated significant values of maximum discrepancy between visual and automated assessments were 0.200 [0.039; 0.361] s in unconstrained conditions and 0.340 [0.014; 0.666] s for standardised movements. The software assessments displayed an overall good agreement against visual evaluations of the Ground Reaction Force, relying, at the same time, on objective measures

Looking for a new test of general relativity in the solar system

This paper discusses three matter-of-principle methods for measuring the general relativity correction to the Newtonian values of the position of collinear Lagrangian points L1 and L2 of the Sun-Earth-satellite system. All approaches are based on time measurements. The first approach exploits a pulsar emitting signals and two receiving antennas located at L1 and L2, respectively. The second method is based on a relativistic positioning system based on the Lagrangian points themselves. These first two methods depend crucially on the synchronization of clocks at L1 and L2. The third method combines a pulsar and an artificial emitter at the stable points L4 or L5 forming a basis for the positioning of the collinear points L1 and L2. Further possibilities are mentioned and the feasibility of the measurements is considered.Comment: 8 pages, 2 figure

Prognostic factors influencing infectious complications after cytoreductive surgery and HIPEC. Results from a tertiary referral center

Background. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) showed promising results in selected patients. High morbidity restrains its wide application. The aim of this study was to report postoperative infectious complications and investigate possible correlations with preoperative nutritional status and other prognostic factors in patients with peritoneal metastases treated with CRS and HIPEC. Methods. For the study we reviewed the clinical records of all patients with peritoneal metastases from different primary cancers and treated by CRS and HIPEC in our Institution from November 2000 to December 2017. Patients were divided according to their nutritional status (SGA) in group A (well-nourished), B/C (mild or severely malnourished). Possible statistical correlations between risk factors and postoperative complications rates have been investigated by univariate and multivariate analysis. Results. Two hundred patients were selected and underwent CRS and HIPEC during the study period. Postoperative complications occurred in 44% of the patients, 35.3% in SGA-A patients and 53% in SGA-B /C patients. Cause of complications was infective in 42, non-infective in 37 and HIPEC related in 9 patients. Infectious complications occurred more frequently in SGA-B /C patients (32.6% vs. 9.8% of SGA-A patients). The most frequent sites of infection were Surgical Site Infections (SSI, 35.7%) and Central Line Associated BloodStream Infections (CLABSI, 26.2%). The most frequent isolated species was Candida (22.8%). ASA score, blood loss, performance status, PCI, large bowel resection, postoperative serum albumin levels and nutritional status correlated with higher risk for postoperative infectious complications. Conclusions. Malnourished patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are more prone to post-operative infectious complications and adequate perioperative nutritional support should be considered, including immune-enhancing nutrition. Sequential monitoring of common sites of infection, antifungal prevention of candidiasis, and careful patient selection should be implemented to reduce complications rate