Cognitive Assessment and Rehabilitation of subjects with Traumatic Brain Injury

This thesis regards the study and the development of new cognitive assessment and rehabilitation techniques of subjects with traumatic brain injury (TBI). In particular, this thesis i) provides an overview about the state of art of this new assessment and rehabilitation technologies, ii) suggests new methods for the assessment and rehabilitation and iii) contributes to the explanation of the neurophysiological mechanism that is involved in a rehabilitation treatment. Some chapters provide useful information to contextualize TBI and its outcome; they describe the methods used for its assessment/rehabilitation. The other chapters illustrate a series of experimental studies conducted in healthy subjects and TBI patients that suggest new approaches to assessment and rehabilitation. The new proposed approaches have in common the use of electroencefalografy (EEG). EEG was used in all the experimental studies with a different purpose, such as diagnostic tool, signal to command a BCI-system, outcome measure to evaluate the effects of a treatment, etc. The main achieved results are about: i) the study and the development of a system for the communication with patients with disorders of consciousness. It was possible to identify a paradigm of reliable activation during two imagery task using EEG signal or EEG and NIRS signal; ii) the study of the effects of a neuromodulation technique (tDCS) on EEG pattern. This topic is of great importance and interest. The emerged founding showed that the tDCS can manipulate the cortical network activity and through the research of optimal stimulation parameters, it is possible move the working point of a neural network and bring it in a condition of maximum learning. In this way could be possible improved the performance of a BCI system or to improve the efficacy of a rehabilitation treatment, like neurofeedback.

Surface-enhanced vibrational techniques for the detection of synthetic organic colorants

The research project object of this thesis is focused on the development of an advanced analytical system based on the combination of an improved thin layer chromatography (TLC) plate coupled with infrared (FTIR) and Raman microscopies for the detection of synthetic dyes. Indeed, the characterization of organic colorants, which are commonly present in mixtures with other components and in a very limited amount, still represents a challenging task in scientific analyses of cultural heritage materials. The approach provides selective spectral fingerprints for each compound, foreseeing the complementary information obtained by micro ATR-RAIRS-FTIR and SERS-Raman analyses, which can be performed on the same separated spot. In particular, silver iodide (AgI) applied on a gold coated slide is proposed as an efficient stationary phase for the discrimination of complex analyte mixtures, such as dyes present in samples of art-historical interest. The gold-AgI-TLC plate shows high performances related both to the chromatographic separation of analytes and to the spectroscopic detection of components. The use of a mid-IR transparent inorganic salt as the stationary phase avoids interferences of the background absorption in FTIR investigations. Moreover, by ATR microscopy measurements performed on the gold-AgI surface, a considerable enhancement in the intensity of spectra is observed. Complementary information can be obtained by Raman analyses, foreseeing a SERS activity of the AgI substrate. The method has been tested for the characterization of a mixture of three synthetic organic colorants widely used in dyeing processes: Brilliant Green (BG1), Rhodamine B (BV10) and Methylene Blue (BB9).

Design and implementation of an anonymous peer-to-peer iaas cloud

Cloud services are becoming ever more important for everyone's life. Cloud storage? Web mails? Yes, we don't need to be working in big IT companies to be surrounded by cloud services. Another thing that's growing in importance, or at least that should be considered ever more important, is the concept of privacy. The more we rely on services of which we know close to nothing about, the more we should be worried about our privacy. In this work, I will analyze a prototype software based on a peer to peer architecture for the offering of cloud services, to see if it's possible to make it completely anonymous, meaning that not only the users using it will be anonymous, but also the Peers composing it will not know the real identity of each others. To make it possible, I will make use of anonymizing networks like Tor. I will start by studying the state of art of Cloud Computing, by looking at some real example, followed by analyzing the architecture of the prototype, trying to expose the differences between its distributed nature and the somehow centralized solutions offered by the famous vendors. After that, I will get as deep as possible into the working principle of the anonymizing networks, because they are not something that can just be 'applied' mindlessly. Some de-anonymizing techniques are very subtle so things must be studied carefully. I will then implement the required changes, and test the new anonymized prototype to see how its performances differ from those of the standard one. The prototype will be run on many machines, orchestrated by a tester script that will automatically start, stop and do all the required API calls. As to where to find all these machines, I will make use of Amazon EC2 cloud services and their on-demand instances.

Talking through walls: a history of the murals in Northern Ireland

This dissertation examines how some fundamental events of the history of Ireland emerge through the art of the mural. It is divided into three chapters. The first chapter opens with a brief presentation of the mural as a form of art with a semiotic and sociological function, with a particular focus on the socio-political importance it has had and still has today in Ireland, where murals are a significant means of expressing ideals, protest and commemoration. A part of this chapter also provides data about the number of murals and their location, with a particular focus on the two cities of Belfast and Derry. This first chapter ends with the presentation of an initiative put forth by the Arts Council of Northern Ireland, called "Building Peace through the Arts: Re-Imaging Communities", and questions its implementation on the Irish soil. The second chapter provides a history of the murals in Northern Ireland, from the Unionist's early depictions of King Billy in occasion of the 12 July annual celebrations to the Republican response. This will be supported by an explanation of the two events that triggered the start of the mural painting for both factions: the Battle of the Boyne for the Loyalists and the 1981 hunger strike for the Republicans. In the third and last chapter of this dissertation, a key of the main themes, symbols, acronyms and dominant colours which can be found in Loyalist and Republican murals is provided. Furthermore, one mural for each faction is looked at more closely, with an analysis of the symbols which are present in it.

User centered retrofit: The case of kadk campus, Copenhagen, (dk)

The following research thesis is about a retrofit project made in Denmark, Copenhagen, and carried out on one of the buildings belonging to the Royal Danish Academy. The key assumption and base of the entire research process is that, up to now, the standard procedure in retrofit cases like this provides as comparative method between de facto and design, the use of Energy Simulation software. These programs generally divide the space into different thermal zones, assigning to each of them different levels of employment, activities, set-point temperatures set for cooling and heating analysis and so on, but always providing average and constant values, usually taken in the middle point of the single thermal zone. Therefore, the project and its research path stems from the attempt to investigate the potentialities of this kind of designing for retrofit process, as previously anticipated not antithetical but complementary to that classic energy-based retrofit, thus passing from the building scale, and all its thermal zones, to the users' scale, related to humans and microclimates. The main software used in this process is Autodesk Simulation CFD. The idea behind the project is that in certain situations, for example, it will not be necessary to add throughout insulation layers (previously parameterized and optimized with Design Builder), and that even in Winter conditions, due maybe to the users' activities, the increased level of clothing (clo) and the heat produced by equipments, thermal comfort could be achieved also in areas characterized by considerably lower MRT. After the analysis of the State of Art and its simulations, the project has still been supported by the tool itself, the CFD Software, in an iterative process aimed at achieving visible improvements in terms of MRT, on spaces with different needs and characteristics, both in Winter and Summer regimes.

Antiretroviral therapy during pregnancy and premature birth: analysis of Swiss data

Background There is an ongoing debate as to whether combined antiretroviral treatment (cART) during pregnancy is an independent risk factor for prematurity in HIV-1-infected women. Objective The aim of the study was to examine (1) crude effects of different ART regimens on prematurity, (2) the association between duration of cART and duration of pregnancy, and (3) the role of possibly confounding risk factors for prematurity. Method We analysed data from 1180 pregnancies prospectively collected by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and the Swiss HIV Cohort Study (SHCS). Results Odds ratios for prematurity in women receiving mono/dual therapy and cART were 1.8 [95% confidence interval (CI) 0.85–3.6] and 2.5 (95% CI 1.4–4.3) compared with women not receiving ART during pregnancy (P=0.004). In a subgroup of 365 pregnancies with comprehensive information on maternal clinical, demographic and lifestyle characteristics, there was no indication that maternal viral load, age, ethnicity or history of injecting drug use affected prematurity rates associated with the use of cART. Duration of cART before delivery was also not associated with duration of pregnancy. Conclusion Our study indicates that confounding by maternal risk factors or duration of cART exposure is not a likely explanation for the effects of ART on prematurity in HIV-1-infected women.

Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes

Background Prognostic models have been developed for patients infected with HIV-1 who start combination antiretroviral therapy (ART) in high-income countries, but not for patients in sub-Saharan Africa. We developed two prognostic models to estimate the probability of death in patients starting ART in sub-Saharan Africa. Methods We analysed data for adult patients who started ART in four scale-up programmes in Côte d'Ivoire, South Africa, and Malawi from 2004 to 2007. Patients lost to follow-up in the first year were excluded. We used Weibull survival models to construct two prognostic models: one with CD4 cell count, clinical stage, bodyweight, age, and sex (CD4 count model); and one that replaced CD4 cell count with total lymphocyte count and severity of anaemia (total lymphocyte and haemoglobin model), because CD4 cell count is not routinely measured in many African ART programmes. Death from all causes in the first year of ART was the primary outcome. Findings 912 (8·2%) of 11 153 patients died in the first year of ART. 822 patients were lost to follow-up and not included in the main analysis; 10 331 patients were analysed. Mortality was strongly associated with high baseline CD4 cell count (≥200 cells per μL vs <25; adjusted hazard ratio 0·21, 95% CI 0·17–0·27), WHO clinical stage (stages III–IV vs I–II; 3·45, 2·43–4·90), bodyweight (≥60 kg vs <45 kg; 0·23, 0·18–0·30), and anaemia status (none vs severe: 0·27, 0·20–0·36). Other independent risk factors for mortality were low total lymphocyte count, advanced age, and male sex. Probability of death at 1 year ranged from 0·9% (95% CI 0·6–1·4) to 52·5% (43·8–61·7) with the CD4 model, and from 0·9% (0·5–1·4) to 59·6% (48·2–71·4) with the total lymphocyte and haemoglobin model. Both models accurately predict early mortality in patients starting ART in sub-Saharan Africa compared with observed data. Interpretation Prognostic models should be used to counsel patients, plan health services, and predict outcomes for patients with HIV-1 infection in sub-Saharan Africa.

Association of pharmacogenetic markers with premature discontinuation of first-line anti-HIV therapy: an observational cohort study

Poor tolerance and adverse drug reactions are main reasons for discontinuation of antiretroviral therapy (ART). Identifying predictors of ART discontinuation is a priority in HIV care.

Trends over time of virological and immunological characteristics in the Swiss HIV Cohort Study

The long-term outcome of antiretroviral therapy (ART) is not assessed in controlled trials. We aimed to analyse trends in the population effectiveness of ART in the Swiss HIV Cohort Study over the last decade.

I know what I like: Stability of aesthetic preference in Alzheimer's disease

Two studies explored the stability of art preference in patients with Alzheimer’s disease and age-matched control participants. Preferences for three different styles of paintings, displayed on art postcards, were examined over two sessions. Preference for specific paintings differed among individuals but AD and non-AD groups maintained about the same stability in terms of preference judgments across two weeks, even though the AD patients did not have explicit memory for the paintings. We conclude that aesthetic responses can be preserved in the face of cognitive decline. This should encourage caregivers and family to engage in arts appreciation activities with patients, and reinforces the validity of a preference response as a dependent measure in testing paradigms.

The Operatics of Cabiria (1914): Intermediality in Early Italian Cinema

This article presents an intermedial analysis of the Italian silent film Cabiria by Giovanni Pastrone within the cultural context of its time. Employing theories developed by Werner Wolf and Irina Rajewsky, the article lays out the intermedial and transmedial relationships of Cabiria with other media, in particular opera, literature, and painting, and illustrates that operatic references are incorporated recognizably during key moments of the film. By contrasting these references with specific cinematic techniques, Pastrone demonstrates that film is able to elicit an operatic sensation and that film is a distinct and valuable form of art.

Estimating loss to follow-up in HIV-infected patients on antiretroviral therapy: the effect of the competing risk of death in Zambia and Switzerland

Background Loss to follow-up (LTFU) is common in antiretroviral therapy (ART) programmes. Mortality is a competing risk (CR) for LTFU; however, it is often overlooked in cohort analyses. We examined how the CR of death affected LTFU estimates in Zambia and Switzerland. Methods and Findings HIV-infected patients aged ≥18 years who started ART 2004–2008 in observational cohorts in Zambia and Switzerland were included. We compared standard Kaplan-Meier curves with CR cumulative incidence. We calculated hazard ratios for LTFU across CD4 cell count strata using cause-specific Cox models, or Fine and Gray subdistribution models, adjusting for age, gender, body mass index and clinical stage. 89,339 patients from Zambia and 1,860 patients from Switzerland were included. 12,237 patients (13.7%) in Zambia and 129 patients (6.9%) in Switzerland were LTFU and 8,498 (9.5%) and 29 patients (1.6%), respectively, died. In Zambia, the probability of LTFU was overestimated in Kaplan-Meier curves: estimates at 3.5 years were 29.3% for patients starting ART with CD4 cells <100 cells/µl and 15.4% among patients starting with ≥350 cells/µL. The estimates from CR cumulative incidence were 22.9% and 13.6%, respectively. Little difference was found between naïve and CR analyses in Switzerland since only few patients died. The results from Cox and Fine and Gray models were similar: in Zambia the risk of loss to follow-up and death increased with decreasing CD4 counts at the start of ART, whereas in Switzerland there was a trend in the opposite direction, with patients with higher CD4 cell counts more likely to be lost to follow-up. Conclusions In ART programmes in low-income settings the competing risk of death can substantially bias standard analyses of LTFU. The CD4 cell count and other prognostic factors may be differentially associated with LTFU in low-income and high-income settings.

Outcomes of antiretroviral treatment in programmes with and without routine viral load monitoring in Southern Africa

Objectives: To compare outcomes of antiretroviral therapy (ART) in South Africa, where viral load monitoring is routine, with those in Malawi and Zambia, where monitoring is based on CD4 cell counts. Methods: We included 18 706 adult patients starting ART in South Africa and 80 937 patients in Zambia or Malawi. We examined CD4 responses in models for repeated measures and the probability of switching to second-line regimens, mortality and loss to follow-up in multistate models, measuring time from 6 months. Results: In South Africa, 9.8% [95% confidence interval (CI) 9.1–10.5] had switched at 3 years, 1.3% (95% CI 0.9–1.6) remained on failing first-line regimens, 9.2% (95% CI 8.5–9.8) were lost to follow-up and 4.3% (95% CI 3.9–4.8) had died. In Malawi and Zambia, more patients were on a failing first-line regimen [3.7% (95% CI 3.6–3.9], fewer patients had switched [2.1% (95% CI 2.0–2.3)] and more patients were lost to follow-up [15.3% (95% CI 15.0–15.6)] or had died [6.3% (95% CI 6.0–6.5)]. Median CD4 cell counts were lower in South Africa at the start of ART (93 vs. 132 cells/μl; P < 0.001) but higher after 3 years (425 vs. 383 cells/μl; P < 0.001). The hazard ratio comparing South Africa with Malawi and Zambia after adjusting for age, sex, first-line regimen and CD4 cell count was 0.58 (0.50–0.66) for death and 0.53 (0.48–0.58) for loss to follow-up. Conclusion: Over 3 years of ART mortality was lower in South Africa than in Malawi or Zambia. The more favourable outcome in South Africa might be explained by viral load monitoring leading to earlier detection of treatment failure, adherence counselling and timelier switching to second-line ART.