Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil)

Background Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. Methods/design Multicentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis. Discussion This study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions. Trial registration ClinicalTrials.gov (NCT01698580)

Oral cleft prevention program (OCPP)

Background Oral clefts are one of the most common birth defects with significant medical, psychosocial, and economic ramifications. Oral clefts have a complex etiology with genetic and environmental risk factors. There are suggestive results for decreased risks of cleft occurrence and recurrence with folic acid supplements taken at preconception and during pregnancy with a stronger evidence for higher than lower doses in preventing recurrence. Yet previous studies have suffered from considerable design limitations particularly non-randomization into treatment. There is also well-documented effectiveness for folic acid in preventing neural tube defect occurrence at 0.4 mg and recurrence with 4 mg. Given the substantial burden of clefting on the individual and the family and the supportive data for the effectiveness of folic acid supplementation as well as its low cost, a randomized clinical trial of the effectiveness of high versus low dose folic acid for prevention of cleft recurrence is warranted. Methods/design This study will assess the effect of 4 mg and 0.4 mg doses of folic acid, taken on a daily basis during preconception and up to 3 months of pregnancy by women who are at risk of having a child with nonsyndromic cleft lip with/without palate (NSCL/P), on the recurrence of NSCL/P. The total sample will include about 6,000 women (that either have NSCL/P or that have at least one child with NSCL/P) randomly assigned to the 4 mg and the 0.4 mg folic acid study groups. The study will also compare the recurrence rates of NSCL/P in the total sample of subjects, as well as the two study groups (4mg, 0.4 mg) to that of a historical control group. The study has been approved by IRBs (ethics committees) of all involved sites. Results will be disseminated through publications and presentations at scientific meetings. Discussion The costs related to oral clefts are high, including long term psychological and socio-economic effects. This study provides an opportunity for huge savings in not only money but the overall quality of life. This may help establish more specific clinical guidelines for oral cleft prevention so that the intervention can be better tailored for at-risk women. ClinicalTrials.gov Identifier NCT00397917

A resource management scenario for traditional and scientific management of pink shrimp (Farfantepenaeus paulensis) in the Patos Lagoon estuary (RS), Brazil

Abstract Background This article aims to discuss the incorporation of traditional time in the construction of a management scenario for pink shrimp in the Patos Lagoon estuary (RS), Brazil. To meet this objective, two procedures have been adopted; one at a conceptual level and another at a methodological level. At the conceptual level, the concept of traditional time as a form of traditional ecological knowledge (TEK) was adopted. Method At the methodological level, we conduct a wide literature review of the scientific knowledge (SK) that guides recommendations for pink shrimp management by restricting the fishing season in the Patos Lagoon estuary; in addition, we review the ethno-scientific literature which describes traditional calendars as a management base for artisanal fishers in the Patos Lagoon estuary. Results Results demonstrate that TEK and SK describe similar estuarine biological processes, but are incommensurable at a resource management level. On the other hand, the construction of a “management scenario” for pink shrimp is possible through the development of “criteria for hierarchies of validity” which arise from a productive dialog between SK and TEK. Conclusions The commensurable and the incommensurable levels reveal different basis of time-space perceptions between traditional ecological knowledge and scientific knowledge. Despite incommensurability at the management level, it is possible to establish guidelines for the construction of “management scenarios” and to support a co-management process.

Development of an integrative cessation program for co-smokers of cigarettes and cannabis: demand analysis, program description, and acceptability

Abstract Background Tobacco and cannabis use are strongly interrelated, but current national and international cessation programs typically focus on one substance, and address the other substance either only marginally or not at all. This study aimed to identify the demand for, and describe the development and content of, the first integrative group cessation program for co-smokers of cigarettes and cannabis. Methods First, a preliminary study using expert interviews, user focus groups with (ex-)smokers, and an online survey was conducted to investigate the demand for, and potential content of, an integrative smoking cessation program (ISCP) for tobacco and cannabis co-smokers. This study revealed that both experts and co-smokers considered an ISCP to be useful but expected only modest levels of readiness for participation.Based on the findings of the preliminary study, an interdisciplinary expert team developed a course concept and a recruitment strategy. The developed group cessation program is based on current treatment techniques (such as motivational interviewing, cognitive behavioural therapy, and self-control training) and structured into six course sessions.The program was evaluated regarding its acceptability among participants and course instructors. Results Both the participants and course instructors evaluated the course positively. Participants and instructors especially appreciated the group discussions and the modules that were aimed at developing personal strategies that could be applied during simultaneous cessation of tobacco and cannabis, such as dealing with craving, withdrawal, and high-risk situations. Conclusions There is a clear demand for a double cessation program for co-users of cigarettes and cannabis, and the first group cessation program tailored for these users has been developed and evaluated for acceptability. In the near future, the feasibility of the program will be evaluated. Trial registration Current Controlled Trials ISRCTN15248397

Spontaneous combined rupture of a pelvicalyceal cyst into the collector system and retroperitoneal space during the acquisition of computed tomography scan images: a case report

Abstract Introduction Pelvicalyceal cysts are common findings in autopsies and can manifest with a variety of patterns. These cystic lesions are usually a benign entity with no clinical significance unless they enlarge enough to cause compression of the adjacent collecting system and consequently obstructive uropathy. Few cases of the spontaneous rupture of pelvicalyceal renal cysts have been published and to the best of our knowledge there is no report of a combined rupture to collector system and retroperitoneal space documented during a multiphase computed tomography. Case presentation We report a case of a ‘real-time’ spontaneous rupture of a pelvicalyceal cyst into the collecting system with fistulization into the retroperitoneum. The patient was a 78-year-old Caucasian man with a previous history of renal stones and a large pelvicalyceal renal cyst who was admitted to our Emergency department with acute right flank pain. A multiphase computed tomography was performed and the pre-contrast images demonstrated a right pelvicalyceal renal cyst measuring 12.0 × 6.1cm in the lower pole causing moderate dilation of the upper right renal collection system. In addition, a partially obstructive stone on the left distal ureter with mild left hydronephrosis was noted. The nephrographic phase did not add any new information. The excretory phase (10-minute delay) demonstrated a spontaneous rupture of the cyst into the pelvicalyceal system with posterior fistulization into the retroperitoneal space. Conclusion In this case study we present time-related changes of a rare pelvicalyceal cyst complication, which to the best of our knowledge has fortunately not been previously documented. Analysis of the sequential images and comparison with an earlier scan allowed us to better understand the physiopathological process of the rupture, the clinical presentation and to elaborate hypotheses for its etiopathogenesis.

Experimental model identification of open-frame underwater vehicles

Most of the works published on hydrodynamic parameter identification of open-frame underwater vehicles focus their attention almost exclusively on good coherence between simulated and measured responses, giving less importance to the determination of “actual values” for hydrodynamic parameters. To gain insight into hydrodynamic parameter experimental identification of open-frame underwater vehicles, an experimental identification procedure is proposed here to determine parameters of uncoupled and coupled models. The identification procedure includes: (i) a prior estimation of actual values of the forces/torques applied to the vehicle, (ii) identification of drag parameters from constant velocity tests and (iii) identification of inertia and coupling parameters from oscillatory tests; at this stage, the estimated values of drag parameter obtained in item (ii) are used. The procedure proposed here was used to identify the hydrodynamic parameters of LAURS—an unmanned underwater vehicle developed at the University of São Paulo. The thruster–thruster and thruster–hull interactions and the advance velocity of the vehicle are shown to have a strong impact on the efficiency of thrusters appended to open-frame underwater vehicles, especially for high advance velocities. Results of tests with excitation in 1-DOF and 3-DOF are reported and discussed, showing the feasibility of the developed procedure.

A tuple space implementation for large-scale infrastructures

Coordinating activities in a distributed system is an open research topic. Several models have been proposed to achieve this purpose such as message passing, publish/subscribe, workflows or tuple spaces. We have focused on the latter model, trying to overcome some of its disadvantages. In particular we have applied spatial database techniques to tuple spaces in order to increase their performance when handling a large number of tuples. Moreover, we have studied how structured peer to peer approaches can be applied to better distribute tuples on large networks. Using some of these result, we have developed a tuple space implementation for the Globus Toolkit that can be used by Grid applications as a coordination service. The development of such a service has been quite challenging due to the limitations imposed by XML serialization that have heavily influenced its design. Nevertheless, we were able to complete its implementation and use it to implement two different types of test applications: a completely parallelizable one and a plasma simulation that is not completely parallelizable. Using this last application we have compared the performance of our service against MPI. Finally, we have developed and tested a simple workflow in order to show the versatility of our service.

Analysis and Implementation of Multiphase-Multilevel Inverter for Open-Winding Loads

Research work carried out in focusing a novel multiphase-multilevel ac motor drive system much suitable for low-voltage high-current power applications. In specific, six-phase asymmetrical induction motor with open-end stator winding configuration, fed from four standard two-level three-phase voltage source inverters (VSIs). Proposed synchronous reference frame control algorithm shares the total dc source power among the 4 VSIs in each switching cycle with three degree of freedom. Precisely, first degree of freedom concerns with the current sharing between two three-phase stator windings. Based on modified multilevel space vector pulse width modulation shares the voltage between each single VSIs of two three-phase stator windings with second and third degree of freedom, having proper multilevel output waveforms. Complete model of whole ac motor drive based on three-phase space vector decomposition approach was developed in PLECS - numerical simulation software working in MATLAB environment. Proposed synchronous reference control algorithm was framed in MATLAB with modified multilevel space vector pulse width modulator. The effectiveness of the entire ac motor drives system was tested. Simulation results are given in detail to show symmetrical and asymmetrical, power sharing conditions. Furthermore, the three degree of freedom are exploited to investigate fault tolerant capabilities in post-fault conditions. Complete set of simulation results are provided when one, two and three VSIs are faulty. Hardware prototype model of quad-inverter was implemented with two passive three-phase open-winding loads using two TMS320F2812 DSP controllers. Developed McBSP (multi-channel buffered serial port) communication algorithm able to control the four VSIs for PWM communication and synchronization. Open-loop control scheme based on inverse three-phase decomposition approach was developed to control entire quad-inverter configuration and tested with balanced and unbalanced operating conditions with simplified PWM techniques. Both simulation and experimental results are always in good agreement with theoretical developments.

Space charge and dielectric response measurements to assess insulation aging of low-voltage cables used in nuclear power plants

The current design life of nuclear power plant (NPP) could potentially be extended to 80 years. During this extended plant life, all safety and operationally relevant Instrumentation & Control (I&C) systems are required to meet their designed performance requirements to ensure safe and reliable operation of the NPP, both during normal operation and subsequent to design base events. This in turn requires an adequate and documented qualification and aging management program. It is known that electrical insulation of I&C cables used in safety related circuits can degrade during their life, due to the aging effect of environmental stresses, such as temperature, radiation, vibration, etc., particularly if located in the containment area of the NPP. Thus several condition monitoring techniques are required to assess the state of the insulation. Such techniques can be used to establish a residual lifetime, based on the relationship between condition indicators and ageing stresses, hence, to support a preventive and effective maintenance program. The object of this thesis is to investigate potential electrical aging indicators (diagnostic markers) testing various I&C cable insulations subjected to an accelerated multi-stress (thermal and radiation) aging.

Tracking, photometry and spectroscopy of space debris: the Malindi, Loiano, Las Campanas and Cerro Tololo observation campaign results

The main purpose of my thesis has been the analysis of the space debris environment and their characterization through optical measurements. In particular I had the opportunity to contribute to the Italian Space Agency activities in space debris optical observation campaign and I cooperated directly with NASA Orbital Debris Program Office by working at the Astronomy Department of the University of Michigan for six months.

Development of an X-ray spectrometric system and feasibility tests of Silicon Drift Detector for medical and space applications

The thesis work concerns X-ray spectrometry for both medical and space applications and is divided into two sections. The first section addresses an X-ray spectrometric system designed to study radiological beams and is devoted to the optimization of diagnostic procedures in medicine. A parametric semi-empirical model capable of efficiently reconstructing diagnostic X-ray spectra in 'middle power' computers was developed and tested. In addition, different silicon diode detectors were tested as real-time detectors in order to provide a real-time evaluation of the spectrum during diagnostic procedures. This project contributes to the field by presenting an improved simulation of a realistic X-ray beam emerging from a common X-ray tube with a complete and detailed spectrum that lends itself to further studies of added filtration, thus providing an optimized beam for different diagnostic applications in medicine. The second section describes the preliminary tests that have been carried out on the first version of an Application Specific Integrated Circuit (ASIC), integrated with large area position-sensitive Silicon Drift Detector (SDD) to be used on board future space missions. This technology has been developed for the ESA project: LOFT (Large Observatory for X-ray Timing), a new medium-class space mission that the European Space Agency has been assessing since February of 2011. The LOFT project was proposed as part of the Cosmic Vision Program (2015-2025).

Space-based optical observation system suitable for micro satellite

The PhD research activity has taken place in the space debris field. In detail, it is focused on the possibility of detecting space debris from the space based platform. The research is focused at the same time on the software and the hardware of this detection system. For the software, a program has been developed for being able to detect an object in space and locate it in the sky solving the star field. For the hardware, the possibility of adapting a ground telescope for space activity has been considered and it has been tested on a possible electronic board.

Bringing results to fruition through publication: An analysis of a peer-reviewed, open access and context-focused journal's editorial practice

When it comes to helping to shape sustainable development, research is most useful when it bridges the science–implementation/management gap and when it brings development specialists and researchers into a dialogue (Hurni et al. 2004); can a peer-reviewed journal contribute to this aim? In the classical system for validation and dissemination of scientific knowledge, journals focus on knowledge exchange within the academic community and do not specifically address a ‘life-world audience’. Within a North-South context, another knowledge divide is added: the peer review process excludes a large proportion of scientists from the South from participating in the production of scientific knowledge (Karlsson et al. 2007). Mountain Research and Development (MRD) is a journal whose mission is based on an editorial strategy to build the bridge between research and development and ensure that authors from the global South have access to knowledge production, ultimately with a view to supporting sustainable development in mountains. In doing so, MRD faces a number of challenges that we would like to discuss with the td-net community, after having presented our experience and strategy as editors of this journal. MRD was launched in 1981 by mountain researchers who wanted mountains to be included in the 1992 Rio process. In the late 1990s, MRD realized that the journal needed to go beyond addressing only the scientific community. It therefore launched a new section addressing a broader audience in 2000, with the aim of disseminating insights into, and recommendations for, the implementation of sustainable development in mountains. In 2006, we conducted a survey among MRD’s authors, reviewers, and readers (Wymann et al. 2007): respondents confirmed that MRD had succeeded in bridging the gap between research and development. But we realized that MRD could become an even more efficient tool for sustainability if development knowledge were validated: in 2009, we began submitting ‘development’ papers (‘transformation knowledge’) to external peer review of a kind different from the scientific-only peer review (for ‘systems knowledge’). At the same time, the journal became open access in order to increase the permeability between science and society, and ensure greater access for readers and authors in the South. We are currently rethinking our review process for development papers, with a view to creating more space for communication between science and society, and enhancing the co-production of knowledge (Roux 2008). Hopefully, these efforts will also contribute to the urgent debate on the ‘publication culture’ needed in transdisciplinary research (Kueffer et al. 2007).

'Security Here is Not Safe': Violence, Punishment, & Space in the Contemporary U.S. Penitentiary

The US penitentiary at Lewisburg, Pennsylvania, was retrofitted in 2008 to offer the country’s first federal Special Management Unit (SMU) program of its kind. This model SMU is designed for federal inmates from around the country identified as the most intractably troublesome, and features double-celling of inmates in tiny spaces, in 23-hour or 24-hour a day lockdown, requiring them to pass through a two-year program of readjustment. These spatial tactics, and the philosophy of punishment underlying them, contrast with the modern reform ideals upon which the prison was designed and built in 1932. The SMU represents the latest punitive phase in American penology, one that neither simply eliminates men as in the premodern spectacle, nor creates the docile, rehabilitated bodies of the modern panopticon; rather, it is a late-modern structure that produces only fear, terror, violence, and death. This SMU represents the latest of the late-modern prisons, similar to other supermax facilities in the US but offering its own unique system of punishment as well. While the prison exists within the system of American law and jurisprudence, it also manifests features of Agamben’s lawless, camp-like space that emerges during a state of exception, exempt from outside scrutiny with inmate treatment typically beyond the scope of the law.

"Security Here is Not Safe": Violence, Punishment, and Space in the Contemporary US Penitentiary

The US penitentiary at Lewisburg, Pennsylvania, was retrofitted in 2008 to offer the country's first federal Special Management Unit (SMU) program of its kind. This model SMU is designed for federal inmates from around the country identified as the most intractably troublesome, and features double-celling of inmates in tiny spaces, in 23-hour or 24-hour a day lockdown, requiring them to pass through a two-year program of readjustment. These spatial tactics, and the philosophy of punishment underlying them, contrast with the modern reform ideals upon which the prison was designed and built in 1932. The SMU represents the latest punitive phase in American penology, one that neither simply eliminates men as in the premodern spectacle, nor creates the docile, rehabilitated bodies of the modern panopticon; rather, it is a late-modern structure that produces only fear, terror, violence, and death. This SMU represents the latest of the late-modern prisons, similar to other supermax facilities in the US but offering its own unique system of punishment as well. While the prison exists within the system of American law and jurisprudence, it also manifests features of Agamben's lawless, camp-like space that emerges during a state of exception, exempt from outside scrutiny with inmate treatment typically beyond the scope of the law