Excitatory and Inhibitory Descending Commissural Interneurons Differentially Integrate Supraspinal and Segmental Sensory Signals.

The limited information about how descending inputs from the brain and sensory inputs from the periphery use spinal cord interneurons (INs) is a major barrier to understanding how these inputs may contribute to motor functions under normal and pathologic conditions. Commissural interneurons (CINs) are a heterogeneous population of spinal INs that has been implicated in crossed motor responses and bilateral motor coordination (ability to use the right and left side of the body in a coordinated manner) and, therefore, are likely involved in many types of movement (e.g., dynamic posture stabilization, jumping, kicking, walking). In this study, we incorporate mouse genetics, anatomy, electrophysiology, and single-cell calcium imaging to investigate how a subset of CINs, those with descending axons called dCINs, are recruited by descending reticulospinal and segmental sensory signals independently and in combination. We focus on two groups of dCINs set apart by their principal neurotransmitter (glutamate and GABA) and identified as VGluT2+ dCINs and GAD2+ dCINs. We show that VGluT2+ and GAD2+ dCINs are both extensively recruited by reticulospinal and sensory input alone but that VGluT2+ and GAD2+ dCINs integrate these inputs differently. Critically, we find that when recruitment depends on the combined action of reticulospinal and sensory inputs (subthreshold inputs), VGluT2+ dCINs, but not GAD2+ dCINs, are recruited. This difference in the integrative capacity of VGluT2+ and GAD2+ dCINs represents a circuit mechanism that the reticulospinal and segmental sensory systems may avail themselves of to regulate motor behaviors both normally and after injury.SIGNIFICANCE STATEMENT The way supraspinal and peripheral sensory inputs use spinal cord interneurons is fundamental to defining how motor functions are supported both in health and disease. This study, which focuses on dCINs, a heterogeneous population of spinal interneurons critical for crossed motor responses and bilateral motor coordination, shows that both glutamatergic (excitatory) and GABAergic (inhibitory) dCINs can be recruited by supraspinal (reticulospinal) or peripheral sensory inputs. Additionally, the study demonstrates that in conditions where the recruitment of dCINs depends on the combined action of reticulospinal and sensory inputs, only excitatory dCINs are recruited. The study uncovers a circuit mechanism that the reticulospinal and segmental sensory systems may avail themselves of to regulate motor behaviors both normally and after injury.

Balneotherapy using thermal mineral water baths and dermatological diseases: a systematic review.

Balneotherapy includes practices and methods using medically and legally recognized mineral-medicinal waters, muds and natural gases from natural springs for therapeutic purposes. One of the most widely used method in balneotherapy is bathing with thermal mineral water. In the course of the years, scientific community has produced an increasing number of evidences that this practice is an effective method for treating signs and symptoms of several pathologies such as rheumatic, cardiovascular and dermatological diseases. This systematic review is aimed at evaluating the effect of balneotherapy with thermal water baths as a treatment to manage signs and symptoms of patients affected by all types of dermatological diseases. The systematic review was conducted according to the PRISMA Statement, and its protocol was registered on PROSPERO platform (CRD42022295913). The research was performed on the databases Pubmed, Scopus, Web of Science and Cochrane. We included clinical trials evaluating the effects of balneotherapy using thermal mineral water baths for managing dermatological diseases in humans, published in English and Italian language. Eight studies were included, seven of them enrolled adults affected by psoriasis and one studied atopic dermatitis patients. The common result of all the articles included was a clear improvement of signs and symptoms of psoriasis and eczematous diseases after use of thermal mineral water baths. These effects seem to be strictly related to physical and chemical properties of thermal water used for balneotherapy. However, studies in this field are still limited to support robust evidence of the effectiveness of balneotherapy using thermal mineral water baths and often their quality is low. Thus, new clinical studies need to be carried out, using more correct methods for conducting the studies and for processing statistical data.

Consumption of Energy Drinks among Italian University students: a cross-sectional multicenter study.

PURPOSE: The aim of the study was to evaluate the caffeinated Energy Drinks (EDs) consumption among a large sample of Italian undergraduates and its association with some of the major lifestyle risk factors. METHODS: Students attending twelve public Italian universities were involved between October 2021 and May 2022. Information on socio-demographic characteristics, ED consumption, and on health-related behaviors of participants was collected by the use of a web-based questionnaire. RESULTS: A total of 2165 students participated in the study and 15.2% of them reported having used caffeinated EDs in the last six months, mainly once a month (41.5%). In comparison with non-users, ED users showed a higher proportion of males (p < 0.001) and a higher father's educational level (p = 0.003), came mainly from Northern universities (p = 0.004) and life sciences degree courses (p < 0.001). Besides, ED users reported higher BMI values (p = 0.003), more particular dietary regimens (p < 0.001), higher levels of weekly moderate-vigorous physical activity (p < 0.001) and participation in sports (p < 0.001) and in team sports (p = 0.003), and higher proportion of smokers (p < 0.001) and alcohol drinkers (p = 0.005). ED use was negatively related with female gender (OR 0.546; 95% CI 0.374-0.798), the Mediterranean diet (OR 0.587; 95% CI 0.362-0.951) and coming from the center of Italy (OR 0.500; 95% CI 0.275-0.909) and positively associated with tobacco smoke (OR 1.712; 95% CI 1.176-2.492) and participation in a team sport (OR 1.686; 95% CI 1.051-2.707). CONCLUSION: These findings could encourage figures engaged in education to increase the students' awareness on this issue in order to prevent the excessive use of EDs and associated unhealthy behaviors, especially in the most interested subgroups.

Balneotherapy for osteoarthritis: a systematic review.

This systematic review is aimed to evaluate the effects of balneotherapy with thermal mineral water for managing the symptoms and signs of osteoarthritis located at any anatomical site. The systematic review was conducted according to the PRISMA Statement. The following databases were consulted: PubMed, Scopus, Web of Science, Cochrane Library, DOAJ and PEDro. We included clinical trials evaluating the effects of balneotherapy as a treatment for patients with osteoarthritis, published in English and Italian language, led on human subjects. The protocol was registered in PROSPERO. Overall, 17 studies have been included in the review. All of these studies were performed on adults or elderly patients suffering from osteoarthritis localized to knees, hips, hands or lumbar spine. The treatment assessed was always the balneotherapy with thermal mineral water. The outcomes evaluated were pain, palpation/pressure sensibility, articular tenderness, functional ability, quality of life, mobility, deambulation, ability to climb stairs, medical objective and patients' subjective evaluation, superoxide dismutase enzyme activity, serum levels of interleukin-2 receptors. The results of all the included studies agree and demonstrated an improvement of all the symptoms and signs investigated. In particular, pain and quality of life were the main symptoms evaluated and both improved after the treatment with thermal water in all the studies included in the review. These effects can be attributed to physical and chemical-physical properties of thermal mineral water used. However, the quality of many studies resulted not so high due and, consequently, it is necessary to perform new clinical trial in this field using more correct methods for conducting the study and for processing statistical data.

Wearable Technologies for Electrodermal and Cardiac Activity Measurements: A Comparison between Fitbit Sense, Empatica E4 and Shimmer GSR3.

The capability of measuring specific neurophysiological and autonomic parameters plays a crucial role in the objective evaluation of a human's mental and emotional states. These human aspects are commonly known in the scientific literature to be involved in a wide range of processes, such as stress and arousal. These aspects represent a relevant factor especially in real and operational environments. Neurophysiological autonomic parameters, such as Electrodermal Activity (EDA) and Photoplethysmographic data (PPG), have been usually investigated through research-graded devices, therefore resulting in a high degree of invasiveness, which could negatively interfere with the monitored user's activity. For such a reason, in the last decade, recent consumer-grade wearable devices, usually designed for fitness-tracking purposes, are receiving increasing attention from the scientific community, and are characterized by a higher comfort, ease of use and, therefore, by a higher compatibility with daily-life environments. The present preliminary study was aimed at assessing the reliability of a consumer wearable device, i.e., the Fitbit Sense, with respect to a research-graded wearable, i.e., the Empatica E4 wristband, and a laboratory device, i.e., the Shimmer GSR3+. EDA and PPG data were collected among 12 participants while they performed multiple resting conditions. The results demonstrated that the EDA- and PPG-derived features computed through the wearable and research devices were positively and significantly correlated, while the reliability of the consumer device was significantly lower.

A Neuroergonomic Approach Fostered by Wearable EEG for the Multimodal Assessment of Drivers Trainees.

When assessing trainees' progresses during a driving training program, instructors can only rely on the evaluation of a trainee's explicit behavior and their performance, without having any insight about the training effects at a cognitive level. However, being able to drive does not imply knowing how to drive safely in a complex scenario such as the road traffic. Indeed, the latter point involves mental aspects, such as the ability to manage and allocate one's mental effort appropriately, which are difficult to assess objectively. In this scenario, this study investigates the validity of deploying an electroencephalographic neurometric of mental effort, obtained through a wearable electroencephalographic device, to improve the assessment of the trainee. The study engaged 22 young people, without or with limited driving experience. They were asked to drive along five different but similar urban routes, while their brain activity was recorded through electroencephalography. Moreover, driving performance, subjective and reaction times measures were collected for a multimodal analysis. In terms of subjective and performance measures, no driving improvement could be detected either through the driver's subjective measures or through their driving performance. On the other side, through the electroencephalographic neurometric of mental effort, it was possible to catch their improvement in terms of mental performance, with a decrease in experienced mental demand after three repetitions of the driving training tasks. These results were confirmed by the analysis of reaction times, that significantly improved from the third repetition as well. Therefore, being able to measure when a task is less mentally demanding, and so more automatic, allows to deduce the degree of users training, becoming capable of handling additional tasks and reacting to unexpected events.

Differences in Training Characteristics Between Junior, Under 23 and Professional Cyclists.

The aim was to compare the training characteristics of junior, under 23 and professional road cyclists. Training data collected during the 2019 competitive season of thirty male cyclists, divided into three age-related categories (JUN; U23; PRO), were retrospectively analyzed for training characteristics, external and internal training load. Higher duration per training session were observed in PRO (2.6±0.3 h) compared to both U23 (2.2±0.3 h; P<0.001) and JUN (2.0±0.2 h; P<0.001). Elevation gain per distance was higher in PRO (13.8±1.9 m·km-1) compared to U23 (10.6±0.9 m·km-1; P=0.001) and JUN (6.7±0.3 m·km-1; P<0.001), and in U23 compared to JUN (P<0.001). Annual total work was lower in JUN (3694±467 kJ·kg-1) compared to U23 (5268±746 kJ·kg-1; P=0.001) and PRO (5759±1103 kJ·kg-1; P<0.001). eTRIMP per hour was higher in JUN (151±40) compared to both U23 (115±23; P=0.003) and PRO (112±22; P=0.013). JUN spent more training time at medium and high heart rate intensity zones compared to U23 and PRO (P<0.05).

Thyroid parameters variations in healthcare workers and students exposed to low-dose ionizing radiations.

SUMMARY: Background. Ionizing Radiations (IR) are an important occupational risk factor for the potential damage that can cause to workers' health and for their presence in numerous professional settings. Health care workers (HCW) can be exposed to IR from various sources, in particular from x-rays using radiological equipment, and represent the largest group of workers occupationally at risk, despite increased regulation and protection which caused exposure to low dose radiations. The thyroid gland is one of the most sensitive organs to damage and an important target of IR, leading to functional and organic diseases. The aim of this study is to assess the variations in thyroid hormones, in a population of HCW exposed to low-dose IR. Methods. 121 individuals of the Teaching Hospital Policlinico Umberto I in Rome exposed to low-dose of IR (78 HCW, 17 Residents and 26 Radiology Technicians Students) were observed assessing serum levels of different thyroid function parameters as free triiodothyronine, free thyroxine and thyroid stimulating hormone at T1, T2 and DeltaT. Age, gender, history of thyroid diseases, BMI and smoke were analyzed as possible influencing factors using linear and multiple logistic regression analysis. Results. Analyzing TSH, fT3 and fT4 serum levels, in two different measurement (T1 and T2) and considering Delta between them, adjusting for different confounding factors, data showed no variation of TSH levels related to occupational exposure, a decrease of fT3 hormone values in HCW and residents, and an increase of fT4 in HCW. Discussion. The analysis of our results revealed that hospital occupation has an impact on thyroid hormones variations, with an increase of fT4 and a decrease of fT3 and no variations of TSH. These results are in conflict with previous studies evidences, in which both free hormones decreased with a concomitant increase of TSH. Conclusion. Exposure to low dose IR influences levels of free thyroid hormones, with no variation in TSH, which could result in a functional or organic disease. For this reason it is recommended continuous surveillance through a periodic check of all the thyroid hormones for an overall view of each HCW. However, further studies are necessary to confirm hormones trend and assess any related thyroid diseases.

Healthcare Management, avoidable mortality, telemedicine to improve health of the diabetic population.

BACKGROUND: Worldwide the International Diabetes Federation (IDF) estimated that in 2021 9.2% of adults (536.6 million, between 20 and 79 years of age) are diabetic and 32.6% under 60 years (6.7 million) die because of diabetes. This disease is set to become the leading cause of disability and mortality by 2030. In Italy, the prevalence of Diabetes is about 5%; in the pre-pandemic period, from 2010 to 2019, diabetes was responsible for 3% of deaths recorded, while during the pandemic in 2020, these deaths increased to about 4%. The present work aimed to measure the outcomes obtained from the ICPs (integrated care pathways) implemented by a Health Local Authority according to the model of the Lazio region and its impact on avoidable mortality, i.e., those deaths potentially avoidable with primary prevention interventions, early diagnosis and targeted therapies, adequate hygienic conditions and proper health care. MATERIALS AND METHODS: Data from 1675 patients enrolled in the diagnostic treatment pathway were analyzed, 471 with type 1 diabetes and the remainder with type 2 (mean age 17.5 and 69, respectively). 987 patients with type 2 diabetes also had comorbidities: in 43% obesity, 56% dyslipidemia, 61% hypertension, 29% COPD. In 54% they had at least 2 comorbidities. All patients enrolled in the ICPs were equipped with a glucometer and an app capable of recording results on capillary blood, 269 with type 1 diabetes were equipped with continuous and 198 insulin pump measurement devices. All enrolled patients recorded at least one daily blood glucose reading, one weekly weight reading, and recorded steps taken daily. They also underwent glycated hemoglobin monitoring, periodic visits and scheduled instrumental checks. A total of 5500 parameters were measured for patients with type 2 diabetes and 2345 for patients with type 1 diabetes. RESULTS: Analysis of medical records revealed that 93% of patients with type 1 diabetes were found to be adherent to the treatment pathway, adherence of patients with type 2 diabetes was recorded in 87% of enrolled cases. The analysis of accesses to the Emergency Department for decompensated diabetes saw only 21% of patients enrolled in the ICPs, but recording poor compliance. The mortality in enrolled patients was 1.9% compared with 4.3 percent in patients not enrolled in ICPs, and patients amputated for diabetic foot resulted in 82% of patients not enrolled in ICPs. Finally, it is noted that patients also enrolled in the telerehabilitation pathway or home care rehabilitation (28%), with the same conditions of severity of neuropathic and vasculopathic picture presented a reduction of 18% in leg or lower limb amputation compared to patients not enrolled or not adhering to ICPs, a reduction of 27% in metatarsal amputation and 34% in toes amputation. CONCLUSIONS: Telemonitoring of diabetic patients allows for greater patient empowerment with increased adherence, as well as a reduction in Emergency Department and inpatient admissions, thus resulting in ICPs being a tool for both standardization of quality of care and standardization of the average cost of the chronic patient with diabetic disease. Likewise, telerehabilitation can reduce the incidence of amputations from diabetic foot disease if associated with adherence to the proposed pathway with ICPs.

Healthcare Quality Management and Integrated Care Pathways (ICPs).

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is one of the largest causes of morbidity and chronic mortality and a public health problem of high importance. In Italy, COPD afflicts 5.6% of adult (3.5 million people) and is responsible for 55% of all deaths related to respiratory diseases. Smokers have a higher risk, in fact up to 40% develop the disease. From the Covid-19 pandemic, the most affected population is the elderly (mean age 80 years old), with previous chronic diseases, in 18% with chronic respiratory. The aim of the present work was to validate and measure the outcomes produced by the recruitment and care of COPD patients enrolled by an Healthcare Local Authority in the corresponding Integrated Care Pathways (ICPs) in order to measure how a multidisciplinary, systemic and e-health monitored care impacts upon mortality and morbidity. MATERIALS AND METHODS: Enrolled patients were stratified through the GOLD guidelines classification, a unified method to discriminate the various degrees of severity of COPD, using specific spirometric cut-points and providing homogeneous classes of patients. Monitoring examinations include simple spirometry, global spirometry, diffusing capacity measurement, pulse oximetry, EGA, 6-minute walk test. Chest Rx, chest CT, ECG may also be required. The severity of COPD identifies the timing of monitoring, which involves a fixed annual re-assessment for mild offset clinical forms, biannually in case of exacerbation, a quarterly cadence in moderate forms that becomes bimonthly in severe forms. RESULTS: In 2344 enrolled patients (46% women and 54% men, mean age 78 yo) 18% had GOLD severity 1, 35% GOLD 2, 27% GOLD 3 and 20% GOLD 4. In addition, 73% of patients had at least one other chronic comorbidity, mainly diabetes or hypertension, and in 48% both. The data analysis showed that the population followed in e-health presented a 49% reduction in improper hospital admissions and a 68% reduction in clinical exacerbations compared to the population enrolled in the ICPs but not followed also in e-health. Smoking habits present at the time of patient enrollment in the ICPs remained in 49% of the total population enrolled and in 37% of the population enrolled in e-health. The patients enrolled in GOLD 1 and 2 obtained the same benefits both if treated in e- health and if treated in the clinic. However, GOLD 3 and 4 patients instead presented better compliance if treated in e-health and continuous monitoring allowed punctual and early interventions such as to reduce complications and hospitalization. CONCLUSION: The e-health approach made possible to ensure proximity medicine and personalization of care. Indeed, the implemented diagnostic treatment protocols, if properly followed and monitored, are able to control complications and impact the mortality and disability of chronic disease. The advent of e-health and ICT tools are demonstrating a great support capacity for care taking that also allows greater adherence to patient care pathways, even more than the protocols up to now identified, characterized by a monitoring programmed over time, enhancing a patients and their families quality of life improvement.

Management of an Integrated Care Pathways (ICPs): an Italian Study.

BACKGROUND: The World Health Organization defines chronic disease as long duration and generally slow progression disease, with a continuous treatment over decades. The management of such diseases is complex, as the aim of treatment is not cure, but maintenance of a good quality of life and prevention of possible complications. Cardiovascular diseases are the leading cause of death worldwide (18 million deaths per year) and hypertension remains the largest preventable cause of cardiovascular disease globally. In Italy, the prevalence of hypertension was of 31.1%. The goal of antihypertensive therapy should be to reduce blood pressure back to physiological levels or to a range of values identified as targets. The National Chronicity Plan identifies an Integrated Care Pathways (ICPs) for several acute or chronic conditions, at different stages of disease and care levels, in order to optimize the healthcare processes. The aim of the present work was to perform a cost-utility analysis of management models of Hypertension ICPs to assist frail patients with hypertension following the National Health Service (NHS) guidelines in order to reduce morbidity and mortality rates. In addition, the paper emphasizes the importance of e-Health technologies for the implementation of chronic care management models based on the Chronic Care Model (CCM). MATERIALS AND METHODS: The management of the health needs of frail patients in a Healthcare Local Authority finds an effective tool in the Chronic Care Model, involving the analysis of the epidemiological context. Hypertension Integrated Care Pathways (ICPs) includes a series of first-level laboratory and instrumental tests necessary at the beginning of the intake, for accurate pathology assessment, and annually for adequate surveillance of the hypertensive patient. For the cost-utility analysis were investigated the flows of pharmaceutical expenditure for cardiovascular drugs and the measurement of the outcomes of the patients assisted by the Hypertension ICPs. RESULTS: The average cost of a patient included in the ICPs for hypertension is 1636.21 euros/year, reduced to 1345 euros/year using telemedicine follow-up. The data collected by Rome Healthcare Local Authority on 2143 enrolled patients allow us to measure both the effectiveness of prevention and the monitoring of adherence to therapy and thus the maintenance of hematochemical and instrumental tests in a range of compensation such that it is possible to impact on the outcomes, resulting in the 21% reduction in the expected mortality and the 45 % reduction in avoidable mortality due to cerebrovascular accidents, with related impact on potential disability. It was also estimated that patients included in ICPs and followed by telemedicine compared to outpatient care, obtained a 25% reduction in morbidity, with greater adherence to therapy and better empowerment results. The patients enrolled in the ICPs who accessed the Emergency Department (ED) or hospitalization presented adherence to therapy in 85% of cases and a change in lifestyle habits in 68%, compared to the population not enrolled in the ICPs, which presented a 56% adherence to therapy and a change in lifestyle habits of 38%. CONCLUSIONS: The performed data analysis allows to standardize an average cost and to evaluate the impact of primary and secondary prevention on the costs of hospitalizations associated with a lack of effective treatment management, and e-Health tools lead to a positive impact on adherence to therapy.

A Video-Based Technique for Heart Rate and Eye Blinks Rate Estimation: A Potential Solution for Telemonitoring and Remote Healthcare.

Current telemedicine and remote healthcare applications foresee different interactions between the doctor and the patient relying on the use of commercial and medical wearable sensors and internet-based video conferencing platforms. Nevertheless, the existing applications necessarily require a contact between the patient and sensors for an objective evaluation of the patient's state. The proposed study explored an innovative video-based solution for monitoring neurophysiological parameters of potential patients and assessing their mental state. In particular, we investigated the possibility to estimate the heart rate (HR) and eye blinks rate (EBR) of participants while performing laboratory tasks by mean of facial-video analysis. The objectives of the study were focused on: (i) assessing the effectiveness of the proposed technique in estimating the HR and EBR by comparing them with laboratory sensor-based measures and (ii) assessing the capability of the video-based technique in discriminating between the participant's resting state (Nominal condition) and their active state (Non-nominal condition). The results demonstrated that the HR and EBR estimated through the facial-video technique or the laboratory equipment did not statistically differ (p > 0.1), and that these neurophysiological parameters allowed to discriminate between the Nominal and Non-nominal states (p < 0.02).

Wearable Technologies for Mental Workload, Stress, and Emotional State Assessment during Working-Like Tasks: A Comparison with Laboratory Technologies.

The capability of monitoring user's performance represents a crucial aspect to improve safety and efficiency of several human-related activities. Human errors are indeed among the major causes of work-related accidents. Assessing human factors (HFs) could prevent these accidents through specific neurophysiological signals' evaluation but laboratory sensors require highly-specialized operators and imply a certain grade of invasiveness which could negatively interfere with the worker's activity. On the contrary, consumer wearables are characterized by their ease of use and their comfortability, other than being cheaper compared to laboratory technologies. Therefore, wearable sensors could represent an ideal substitute for laboratory technologies for a real-time assessment of human performances in ecological settings. The present study aimed at assessing the reliability and capability of consumer wearable devices (i.e., Empatica E4 and Muse 2) in discriminating specific mental states compared to laboratory equipment. The electrooculographic (EOG), electrodermal activity (EDA) and photoplethysmographic (PPG) signals were acquired from a group of 17 volunteers who took part to the experimental protocol in which different working scenarios were simulated to induce different levels of mental workload, stress, and emotional state. The results demonstrated that the parameters computed by the consumer wearable and laboratory sensors were positively and significantly correlated and exhibited the same evidences in terms of mental states discrimination.

Crossed activation of thoracic trunk motoneurons by medullary reticulospinal neurons.

Activation of contralateral muscles by supraspinal neurons, or crossed activation, is critical for bilateral coordination. Studies in mammals have focused on the neural circuits that mediate cross activation of limb muscles, but the neural circuits involved in crossed activation of trunk muscles are still poorly understood. In this study, we characterized functional connections between reticulospinal (RS) neurons in the medial and lateral regions of the medullary reticular formation (medMRF and latMRF) and contralateral trunk motoneurons (MNs) in the thoracic cord (T7 and T10 segments). To do this, we combined electrical microstimulation of the medMRF and latMRF and calcium imaging from single cells in an ex vivo brain stem-spinal cord preparation of neonatal mice. Our findings substantiate two spatially distinct RS pathways to contralateral trunk MNs. Both pathways originate in the latMRF and are midline crossing, one at the level of the spinal cord via excitatory descending commissural interneurons (reticulo-commissural pathway) and the other at the level of the brain stem (crossed RS pathway). Activation of these RS pathways may enable different patterns of bilateral trunk coordination. Possible implications for recovery of trunk function after stroke or spinal cord injury are discussed.NEW & NOTEWORTHY We identify two spatially distinct reticulospinal pathways for crossed activation of trunk motoneurons. Both pathways cross the midline, one at the level of the brain stem and the other at the level of the spinal cord via excitatory commissural interneurons. Jointly, these pathways provide new opportunities for repair interventions aimed at recovering trunk functions after stroke or spinal cord injury.

Bioimpedance patterns and bioelectrical impedance vector analysis (BIVA) of road cyclists.

Bioelectrical impedance vector-analysis (BIVA) describes cell-mass, cell function and hydration status of an individual or a group. The goal of the present investigation was to provide bioelectrical impedance data for 525 male road cyclists (155 professionals, 79 elite, 59 elite-youth, and 232 amateurs) at the time of their optimal performance level. Data were plotted on the resistance-reactance (R-Xc) graph to characterize cyclists group vectors using BIVA. Compared to the general male population, the mean vector position of the road cyclists indicates a higher body cell mass (BCM) and phase angle (p<0.001). The vector position of the high-performance, compared to the amateur cyclists showed similar patterns with higher BCM and phase angles and higher reactance values for the high-performance athletes (p<0.001). The bio-impedance data were used to calculate the 50%, 75%, and 95% tolerance ellipses of each group of cyclists. The characteristic vector positions of the road cyclists indicate normal hydration and greater muscle mass and function of the high-performance cyclists compared to amateur cyclists and the normal population. The cyclists specific tolerance ellipses, particularly the high-performance cyclists might be used for classifying a cyclist according to the individual vector position and to define target vector regions for lower level cyclists.

A Behavioural Case Study of Early Social Isolation of a Subadult White-Handed Gibbon (Hylobates lar).

Our aim in this study was to analyse the effects of early social isolation on the behaviour of a white-handed gibbon (Hylobates lar) and at the same time to improve his level of welfare. The subject was a 6-year-old male, isolated from conspecific as well as other non-human primates since he was 3 months old. We presented the gibbon with a series of species-specific vocalisations, and we then introduced a 23-year-old conspecific female into his cage. Our subject did not respond to playbacks, whereas he immediately interacted positively with the conspecific female. After 2 days of presentation, the pair started to spend time in proximity to each other and initiated grooming through the wire-mesh dividing the cages. Four days later we recorded vocal duets. No obvious ste-reotypic behaviours were observed, and the prolonged isolation did not seem to compromise the ability of the young gibbon to socialise with the female conspecific. It appears that prolonged isolation does not always compromise the possibility of recovering socially in a satisfactory manner.

Fault Diagnosis Strategies for SOFC-Based Power Generation Plants.

The success of distributed power generation by plants based on solid oxide fuel cells (SOFCs) is hindered by reliability problems that can be mitigated through an effective fault detection and isolation (FDI) system. However, the numerous operating conditions under which such plants can operate and the random size of the possible faults make identifying damaged plant components starting from the physical variables measured in the plant very difficult. In this context, we assess two classical FDI strategies (model-based with fault signature matrix and data-driven with statistical classification) and the combination of them. For this assessment, a quantitative model of the SOFC-based plant, which is able to simulate regular and faulty conditions, is used. Moreover, a hybrid approach based on the random forest (RF) classification method is introduced to address the discrimination of regular and faulty situations due to its practical advantages. Working with a common dataset, the FDI performances obtained using the aforementioned strategies, with different sets of monitored variables, are observed and compared. We conclude that the hybrid FDI strategy, realized by combining a model-based scheme with a statistical classifier, outperforms the other strategies. In addition, the inclusion of two physical variables that should be measured inside the SOFCs can significantly improve the FDI performance, despite the actual difficulty in performing such measurements.

Viruses associated with acute respiratory infections and influenza-like illness among outpatients from the Influenza Incidence Surveillance Project, 2010-2011.

BACKGROUND: The Influenza Incidence Surveillance Project (IISP) monitored outpatient acute respiratory infection (ARI; defined as the presence of ≥ 2 respiratory symptoms not meeting ILI criteria) and influenza-like illness (ILI) to determine the incidence and contribution of associated viral etiologies. METHODS: From August 2010 through July 2011, 57 outpatient healthcare providers in 12 US sites reported weekly the number of visits for ILI and ARI and collected respiratory specimens on a subset for viral testing. The incidence was estimated using the number of patients in the practice as the denominator, and the virus-specific incidence of clinic visits was extrapolated from the proportion of patients testing positive. RESULTS: The age-adjusted cumulative incidence of outpatient visits for ARI and ILI combined was 95/1000 persons, with a viral etiology identified in 58% of specimens. Most frequently detected were rhinoviruses/enteroviruses (RV/EV) (21%) and influenza viruses (21%); the resulting extrapolated incidence of outpatient visits was 20 and 19/1000 persons respectively. The incidence of influenza virus-associated clinic visits was highest among patients aged 2-17 years, whereas other viruses had varied patterns among age groups. CONCLUSIONS: The IISP provides a unique opportunity to estimate the outpatient respiratory illness burden by etiology. Influenza virus infection and RV/EV infection(s) represent a substantial burden of respiratory disease in the US outpatient setting, particularly among children.

The Influence of High-Intensity Work on the Record Power Profile of Under-23, Pro Team, and World Tour Cyclists.

BACKGROUND: Durability (ie, the ability to attenuate the decline in performance after accumulated work) has been identified as a performance determinant in elite cyclists. The aim of the present study was to compare durability in elite cyclists of various performance levels, particularly after high-intensity work, referred to as "high-intensity durability." METHODS: Forty-nine (N = 49) male road cyclists were categorized as either under 23 years of age (U23) (N = 11), Pro Team (N = 13), or World Tour (N = 24). The participants' critical power (CP) was assessed during the preseason. Thereafter, the participants' maximum mean power (MMP) values were determined for efforts of different durations (from 5 s to 30 min) after different levels of accumulated work above CP (from 0 to 7.5 kJ·kg-1). RESULTS: U23 cyclists showed a significant reduction of all relative MMP values for durations ≥1 minute after ≥5 kJ·kg-1 above CP compared with the "fresh" state (0 kJ·kg-1), whereas in Pro Team and World Tour cyclists, a significant reduction was not observed until 7.5 kJ·kg-1 above CP. In the "fresh" state, both Pro Team and particularly World Tour cyclists attained higher MMP values for efforts ≥10 minutes than U23 riders. However, more differences emerged with greater previous work levels, and indeed after 7.5 kJ·kg-1 above CP World Tour cyclists attained higher MMP values than both U23 and Pro Team cyclists for most efforts (≥30 s). CONCLUSION: Pro Team and particularly World Tour cyclists tolerate greater levels of accumulated work at high intensity, which might support the importance of high-intensity durability for performance.