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HES-SO University of Applied Sciences and Arts Western Switzerland

UniversityDelémont, Jura, Switzerland

Research output, citation impact, and the most-cited recent papers from HES-SO University of Applied Sciences and Arts Western Switzerland (Switzerland). Aggregated across the NobleBlocks index of 300M+ scholarly works.

Total works
10.8K
Citations
269.4K
h-index
171
i10-index
5.9K
Also known as
Fachhochschule WestschweizHES-SO Haute école spécialisée de Suisse occidentaleHES-SO University of Applied Sciences and Arts Western SwitzerlandHaute École Spécialisée de Suisse OccidentaleUniversity of Applied Sciences and Arts Western Switzerland

Top-cited papers from HES-SO University of Applied Sciences and Arts Western Switzerland

Primary microplastics in the oceans: A global evaluation of sources
J.-M. Boucher, D. Friot
20171.7Kdoi:10.2305/iucn.ch.2017.01.en

Plastic has penetrated everyday life, and the disadvantages of plastics are becoming more and more visible: large quantities of plastics leak into rivers and oceans, with adverse effects to marine ecosystems and related economic activities. This report is one of the first of its kind to quantify primary microplastics leakage and to demonstrate that these primary microplastics are globally responsible for a major source of plastics in the oceans.

Evaluating scenarios toward zero plastic pollution
Winnie W. Y. Lau, Yonathan Shiran, Richard M. Bailey, Ed Cook +4 more
2020· Science1.7Kdoi:10.1126/science.aba9475

Plastic pollution is a pervasive and growing problem. To estimate the effectiveness of interventions to reduce plastic pollution, we modeled stocks and flows of municipal solid waste and four sources of microplastics through the global plastic system for five scenarios between 2016 and 2040. Implementing all feasible interventions reduced plastic pollution by 40% from 2016 rates and 78% relative to "business as usual" in 2040. Even with immediate and concerted action, 710 million metric tons of plastic waste cumulatively entered aquatic and terrestrial ecosystems. To avoid a massive build-up of plastic in the environment, coordinated global action is urgently needed to reduce plastic consumption; increase rates of reuse, waste collection, and recycling; expand safe disposal systems; and accelerate innovation in the plastic value chain.

Electromyography data for non-invasive naturally-controlled robotic hand prostheses
Manfredo Atzori, Arjan Gijsberts, Claudio Castellini, Barbara Caputo +4 more
2014· Scientific Data929doi:10.1038/sdata.2014.53

Recent advances in rehabilitation robotics suggest that it may be possible for hand-amputated subjects to recover at least a significant part of the lost hand functionality. The control of robotic prosthetic hands using non-invasive techniques is still a challenge in real life: myoelectric prostheses give limited control capabilities, the control is often unnatural and must be learned through long training times. Meanwhile, scientific literature results are promising but they are still far from fulfilling real-life needs. This work aims to close this gap by allowing worldwide research groups to develop and test movement recognition and force control algorithms on a benchmark scientific database. The database is targeted at studying the relationship between surface electromyography, hand kinematics and hand forces, with the final goal of developing non-invasive, naturally controlled, robotic hand prostheses. The validation section verifies that the data are similar to data acquired in real-life conditions, and that recognition of different hand tasks by applying state-of-the-art signal features and machine-learning algorithms is possible.

Internet of Things and Big Data Analytics for Smart and Connected Communities
Yunchuan Sun, Houbing Song, Antonio J. Jara, Rongfang Bie
2016· IEEE Access889doi:10.1109/access.2016.2529723

This paper promotes the concept of smart and connected communities SCC, which is evolving from the concept of smart cities. SCC are envisioned to address synergistically the needs of remembering the past (preservation and revitalization), the needs of living in the present (livability), and the needs of planning for the future (attainability). Therefore, the vision of SCC is to improve livability, preservation, revitalization, and attainability of a community. The goal of building SCC for a community is to live in the present, plan for the future, and remember the past. We argue that Internet of Things (IoT) has the potential to provide a ubiquitous network of connected devices and smart sensors for SCC, and big data analytics has the potential to enable the move from IoT to real-time control desired for SCC. We highlight mobile crowdsensing and cyber-physical cloud computing as two most important IoT technologies in promoting SCC. As a case study, we present TreSight, which integrates IoT and big data analytics for smart tourism and sustainable cultural heritage in the city of Trento, Italy.

Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review
Coraline Stormacq, Stephan Van den Broucke, Jacqueline Wosinski
2018· Health Promotion International867doi:10.1093/heapro/day062

While socioeconomic disparities are among the most fundamental causes of health disparities, socioeconomic status (SES) does not impact health directly. One of the potential mediating factors that link SES and health is health literacy (HL). Yet although HL can be considered a modifiable risk factor of socioeconomic disparities in health, the relationship between SES, HL and health disparities is not well understood. This study reviewed the evidence regarding the mediating role of HL in the relationship between socioeconomic and health disparities. Medline, Cinahl, Embase, PsychInfo, Eric, Web of Science, Google, Google Scholar, Mednar, Doaj and Worldcat were used to retrieve studies that specifically addressed socioeconomic and socio-demographic factors related to low HL levels, as well as the mediating role of HL in the relationship between SES and disparities in health outcomes. Selected studies were assessed for methodological quality. Sixteen published studies were retained for inclusion and content analyzed using the constant comparison method. The review indicates that disadvantaged social and socioeconomic conditions contribute to low HL levels, whereby low SES, and particularly educational attainment, is the most important determinant of HL, and that HL mediates the relationship between SES and health status, quality of life, specific health-related outcomes, health behaviors and use of preventive services. HL can be considered as a modifiable risk factor of socioeconomic disparities in health. Enhancing the level of HL in the population or making health services more accessible to people with low HL may be a means to reach a greater equity in health.

Deep Learning with Convolutional Neural Networks Applied to Electromyography Data: A Resource for the Classification of Movements for Prosthetic Hands
Manfredo Atzori, Matteo Cognolato, Henning Müller
2016· Frontiers in Neurorobotics659doi:10.3389/fnbot.2016.00009

Natural control methods based on surface electromyography (sEMG) and pattern recognition are promising for hand prosthetics. However, the control robustness offered by scientific research is still not sufficient for many real life applications, and commercial prostheses are capable of offering natural control for only a few movements. In recent years deep learning revolutionized several fields of machine learning, including computer vision and speech recognition. Our objective is to test its methods for natural control of robotic hands via sEMG using a large number of intact subjects and amputees. We tested convolutional networks for the classification of an average of 50 hand movements in 67 intact subjects and 11 transradial amputees. The simple architecture of the neural network allowed to make several tests in order to evaluate the effect of pre-processing, layer architecture, data augmentation and optimization. The classification results are compared with a set of classical classification methods applied on the same datasets. The classification accuracy obtained with convolutional neural networks using the proposed architecture is higher than the average results obtained with the classical classification methods, but lower than the results obtained with the best reference methods in our tests. The results show that convolutional neural networks with a very simple architecture can produce accurate results comparable to the average classical classification methods. They show that several factors (including pre-processing, the architecture of the net and the optimization parameters) can be fundamental for the analysis of sEMG data. Larger networks can achieve higher accuracy on computer vision and object recognition tasks. This fact suggests that it may be interesting to evaluate if larger networks can increase sEMG classification accuracy too.

A survey of Internet-of-Things: Future vision, architecture, challenges and services
Dhananjay Singh, Gaurav Tripathi, Antonio J. Jara
2014513doi:10.1109/wf-iot.2014.6803174

Internet-of-Things (IoT) is the convergence of Internet with RFID, Sensor and smart objects. IoT can be defined as “things belonging to the Internet” to supply and access all of real-world information. Billions of devices are expected to be associated into the system and that shall require huge distribution of networks as well as the process of transforming raw data into meaningful inferences. IoT is the biggest promise of the technology today, but still lacking a novel mechanism, which can be perceived through the lenses of Internet, things and semantic vision. This paper presents a novel architecture model for IoT with the help of Semantic Fusion Model (SFM). This architecture introduces the use of Smart Semantic framework to encapsulate the processed information from sensor networks. The smart embedded system is having semantic logic and semantic value based Information to make the system an intelligent system. This paper presents a discussion on Internet oriented applications, services, visual aspect and challenges for Internet of things using RFID, 6lowpan and sensor networks.

Multiple origins of cultivated grapevine (<i>Vitis vinifera</i> L. ssp. <i>sativa</i>) based on chloroplast DNA polymorphisms
Rosa Arroyo-García, Leonor Ruiz‐García, L. BOLLING, R. OCETE +4 more
2006· Molecular Ecology483doi:10.1111/j.1365-294x.2006.03049.x

Abstract The domestication of the Eurasian grape ( Vitis vinifera ssp. sativa ) from its wild ancestor ( Vitis vinifera ssp. sylvestris ) has long been claimed to have occurred in Transcaucasia where its greatest genetic diversity is found and where very early archaeological evidence, including grape pips and artefacts of a ‘wine culture’, have been excavated. Whether from Transcaucasia or the nearby Taurus or Zagros Mountains, it is hypothesized that this wine culture spread southwards and eventually westwards around the Mediterranean basin, together with the transplantation of cultivated grape cuttings. However, the existence of morphological differentiation between cultivars from eastern and western ends of the modern distribution of the Eurasian grape suggests the existence of different genetic contribution from local sylvestris populations or multilocal selection and domestication of sylvestris genotypes. To tackle this issue, we analysed chlorotype variation and distribution in 1201 samples of sylvestris and sativa genotypes from the whole area of the species’ distribution and studied their genetic relationships. The results suggest the existence of at least two important origins for the cultivated germplasm, one in the Near East and another in the western Mediterranean region, the latter of which gave rise to many of the current Western European cultivars. Indeed, over 70% of the Iberian Peninsula cultivars display chlorotypes that are only compatible with their having derived from western sylvestris populations.

Carbon pricing in climate policy: seven reasons, complementary instruments, and political economy considerations
Andrea Baranzini, Jeroen C.J.M. van den Bergh, Stefano Carattini, Richard B. Howarth +2 more
2017· Wiley Interdisciplinary Reviews Climate Change461doi:10.1002/wcc.462

Carbon pricing is a recurrent theme in debates on climate policy. Discarded at the 2009 COP in Copenhagen, it remained part of deliberations for a climate agreement in subsequent years. As there is still much misunderstanding about the many reasons to implement a global carbon price, ideological resistance against it prospers. Here, we present the main arguments for carbon pricing, to stimulate a fair and well‐informed discussion about it. These include considerations that have received little attention so far. We stress that a main reason to use carbon pricing is environmental effectiveness at a relatively low cost, which in turn contributes to enhance social and political acceptability of climate policy. This includes the property that corrected prices stimulate rapid environmental innovations. These arguments are underappreciated in the public debate, where pricing is frequently downplayed and the erroneous view that innovation policies are sufficient is widespread. Carbon pricing and technology policies are, though, largely complementary and thus are both needed for effective climate policy. We also comment on the complementarity of other instruments to carbon pricing. We further discuss distributional consequences of carbon pricing and present suggestions on how to address these. Other political economy issues that receive attention are lobbying, co‐benefits, international policy coordination, motivational crowding in/out, and long‐term commitment. The overview ends with reflections on implementing a global carbon price, whether through a carbon tax or emissions trading. The discussion goes beyond traditional arguments from environmental economics by including relevant insights from energy research and innovation studies as well. WIREs Clim Change 2017, 8:e462. doi: 10.1002/wcc.462 This article is categorized under: Climate Economics &gt; Economics of Mitigation

Best practice for motor imagery: a systematic literature review on motor imagery training elements in five different disciplines
Corina Schuster‐Amft, Roger Hilfiker, Oliver Amft, Anne Scheidhauer +4 more
2011· BMC Medicine436doi:10.1186/1741-7015-9-75

BACKGROUND: The literature suggests a beneficial effect of motor imagery (MI) if combined with physical practice, but detailed descriptions of MI training session (MITS) elements and temporal parameters are lacking. The aim of this review was to identify the characteristics of a successful MITS and compare these for different disciplines, MI session types, task focus, age, gender and MI modification during intervention. METHODS: An extended systematic literature search using 24 databases was performed for five disciplines: Education, Medicine, Music, Psychology and Sports. References that described an MI intervention that focused on motor skills, performance or strength improvement were included. Information describing 17 MITS elements was extracted based on the PETTLEP (physical, environment, timing, task, learning, emotion, perspective) approach. Seven elements describing the MITS temporal parameters were calculated: study duration, intervention duration, MITS duration, total MITS count, MITS per week, MI trials per MITS and total MI training time. RESULTS: Both independent reviewers found 96% congruity, which was tested on a random sample of 20% of all references. After selection, 133 studies reporting 141 MI interventions were included. The locations of the MITS and position of the participants during MI were task-specific. Participants received acoustic detailed MI instructions, which were mostly standardised and live. During MI practice, participants kept their eyes closed. MI training was performed from an internal perspective with a kinaesthetic mode. Changes in MI content, duration and dosage were reported in 31 MI interventions. Familiarisation sessions before the start of the MI intervention were mentioned in 17 reports. MI interventions focused with decreasing relevance on motor-, cognitive- and strength-focused tasks. Average study intervention lasted 34 days, with participants practicing MI on average three times per week for 17 minutes, with 34 MI trials. Average total MI time was 178 minutes including 13 MITS. Reporting rate varied between 25.5% and 95.5%. CONCLUSIONS: MITS elements of successful interventions were individual, supervised and non-directed sessions, added after physical practice. Successful design characteristics were dominant in the Psychology literature, in interventions focusing on motor and strength-related tasks, in interventions with participants aged 20 to 29 years old, and in MI interventions including participants of both genders. Systematic searching of the MI literature was constrained by the lack of a defined MeSH term.

Comparison of six electromyography acquisition setups on hand movement classification tasks
Stefano F. Pizzolato, Luca Tagliapietra, Matteo Cognolato, Monica Reggiani +2 more
2017· PLoS ONE405doi:10.1371/journal.pone.0186132

Hand prostheses controlled by surface electromyography are promising due to the non-invasive approach and the control capabilities offered by machine learning. Nevertheless, dexterous prostheses are still scarcely spread due to control difficulties, low robustness and often prohibitive costs. Several sEMG acquisition setups are now available, ranging in terms of costs between a few hundred and several thousand dollars. The objective of this paper is the relative comparison of six acquisition setups on an identical hand movement classification task, in order to help the researchers to choose the proper acquisition setup for their requirements. The acquisition setups are based on four different sEMG electrodes (including Otto Bock, Delsys Trigno, Cometa Wave + Dormo ECG and two Thalmic Myo armbands) and they were used to record more than 50 hand movements from intact subjects with a standardized acquisition protocol. The relative performance of the six sEMG acquisition setups is compared on 41 identical hand movements with a standardized feature extraction and data analysis pipeline aimed at performing hand movement classification. Comparable classification results are obtained with three acquisition setups including the Delsys Trigno, the Cometa Wave and the affordable setup composed of two Myo armbands. The results suggest that practical sEMG tests can be performed even when costs are relevant (e.g. in small laboratories, developing countries or use by children). All the presented datasets can be used for offline tests and their quality can easily be compared as the data sets are publicly available.

The LOTUS initiative for open knowledge management in natural products research
Adriano Rutz, Maria Sorokina, Jakub Galgonek, Daniel Mietchen +4 more
2022· eLife400doi:10.7554/elife.70780

Contemporary bioinformatic and chemoinformatic capabilities hold promise to reshape knowledge management, analysis and interpretation of data in natural products research. Currently, reliance on a disparate set of non-standardized, insular, and specialized databases presents a series of challenges for data access, both within the discipline and for integration and interoperability between related fields. The fundamental elements of exchange are referenced structure-organism pairs that establish relationships between distinct molecular structures and the living organisms from which they were identified. Consolidating and sharing such information via an open platform has strong transformative potential for natural products research and beyond. This is the ultimate goal of the newly established LOTUS initiative, which has now completed the first steps toward the harmonization, curation, validation and open dissemination of 750,000+ referenced structure-organism pairs. LOTUS data is hosted on Wikidata and regularly mirrored on https://lotus.naturalproducts.net. Data sharing within the Wikidata framework broadens data access and interoperability, opening new possibilities for community curation and evolving publication models. Furthermore, embedding LOTUS data into the vast Wikidata knowledge graph will facilitate new biological and chemical insights. The LOTUS initiative represents an important advancement in the design and deployment of a comprehensive and collaborative natural products knowledge base.

Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis
Roger Hilfiker, André Meichtry, Manuela Eicher, Lina Nilsson Balfe +3 more
2017· British Journal of Sports Medicine393doi:10.1136/bjsports-2016-096422

AIM: To assess the relative effects of different types of exercise and other non-pharmaceutical interventions on cancer-related fatigue (CRF) in patients during and after cancer treatment. DESIGN: Systematic review and indirect-comparisons meta-analysis. DATA SOURCES: Articles were searched in PubMed, Cochrane CENTRAL and published meta-analyses. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised studies published up to January 2017 evaluating different types of exercise or other non-pharmaceutical interventions to reduce CRF in any cancer type during or after treatment. STUDY APPRAISAL AND SYNTHESIS: Risk of bias assessment with PEDro criteria and random effects Bayesian network meta-analysis. RESULTS: We included 245 studies. Comparing the treatments with usual care during cancer treatment, relaxation exercise was the highest ranked intervention with a standardisedmean difference (SMD) of -0.77 (95% Credible Interval (CrI) -1.22 to -0.31), while massage (-0.78; -1.55 to -0.01), cognitive-behavioural therapy combined with physical activity (combined CBT, -0.72; -1.34 to -0.09), combined aerobic and resistance training (-0.67; -1.01 to -0.34), resistance training (-0.53; -1.02 to -0.03), aerobic (-0.53; -0.80 to -0.26) and yoga (-0.51; -1.01 to 0.00) all had moderate-to-large SMDs. After cancer treatment, yoga showed the highest effect (-0.68; -0.93 to -0.43). Combined aerobic and resistance training (-0.50; -0.66 to -0.34), combined CBT (-0.45; -0.70 to -0.21), Tai-Chi (-0.45; -0.84 to -0.06), CBT (-0.42; -0.58 to -0.25), resistance training (-0.35; -0.62 to -0.08) and aerobic (-0.33; -0.51 to -0.16) showed all small-to-moderate SMDs. CONCLUSIONS: Patients can choose among different effective types of exercise and non-pharmaceutical interventions to reduce CRF.

Secure and Trustable Electronic Medical Records Sharing using Blockchain
Alevtina Dubovitskaya, Zhigang Xu, Samuel Ryu, Michael Schumacher +1 more
2017· arXiv (Cornell University)390doi:10.48550/arxiv.1709.06528

Electronic medical records (EMRs) are critical, highly sensitive private information in healthcare, and need to be frequently shared among peers. Blockchain provides a shared, immutable and transparent history of all the transactions to build applications with trust, accountability and transparency. This provides a unique opportunity to develop a secure and trustable EMR data management and sharing system using blockchain. In this paper, we present our perspectives on blockchain based healthcare data management, in particular, for EMR data sharing between healthcare providers and for research studies. We propose a framework on managing and sharing EMR data for cancer patient care. In collaboration with Stony Brook University Hospital, we implemented our framework in a prototype that ensures privacy, security, availability, and fine-grained access control over EMR data. The proposed work can significantly reduce the turnaround time for EMR sharing, improve decision making for medical care, and reduce the overall cost

Long-term performance of the SwissQuantum quantum key distribution network in a field environment
Damien Stucki, Matthieu Legré, François Buntschu, B Clausen +4 more
2011· New Journal of Physics369doi:10.1088/1367-2630/13/12/123001

In this paper, we report on the performance of the SwissQuantum quantum key distribution (QKD) network. The network was installed in the Geneva metropolitan area and ran for more than one-and-a-half years, from the end of March 2009 to the beginning of January 2011. The main goal of this experiment was to test the reliability of the quantum layer over a long period of time in a production environment. A key management layer has been developed to manage the key between the three nodes of the network. This QKD-secure network was utilized by end-users through an application layer.

Why rankings of biomedical image analysis competitions should be interpreted with care
Lena Maier‐Hein, Matthias Eisenmann, Annika Reinke, Sinan Onogur +4 more
2018· Nature Communications361doi:10.1038/s41467-018-07619-7

International challenges have become the standard for validation of biomedical image analysis methods. Given their scientific impact, it is surprising that a critical analysis of common practices related to the organization of challenges has not yet been performed. In this paper, we present a comprehensive analysis of biomedical image analysis challenges conducted up to now. We demonstrate the importance of challenges and show that the lack of quality control has critical consequences. First, reproducibility and interpretation of the results is often hampered as only a fraction of relevant information is typically provided. Second, the rank of an algorithm is generally not robust to a number of variables such as the test data used for validation, the ranking scheme applied and the observers that make the reference annotations. To overcome these problems, we recommend best practice guidelines and define open research questions to be addressed in the future.

Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials
Valérie Santschi, Arnaud Chioléro, April Colosimo, Robert W. Platt +4 more
2014· Journal of the American Heart Association343doi:10.1161/jaha.113.000718

BACKGROUND: Control of blood pressure (BP) remains a major challenge in primary care. Innovative interventions to improve BP control are therefore needed. By updating and combining data from 2 previous systematic reviews, we assess the effect of pharmacist interventions on BP and identify potential determinants of heterogeneity. METHODS AND RESULTS: Randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients with or without diabetes were identified from MEDLINE, EMBASE, CINAHL, and CENTRAL databases. Weighted mean differences in BP were estimated using random effect models. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Thirty-nine RCTs were included with 14 224 patients. Pharmacist interventions mainly included patient education, feedback to physician, and medication management. Compared with usual care, pharmacist interventions showed greater reduction in systolic BP (-7.6 mm Hg, 95% CI: -9.0 to -6.3; I(2)=67%) and diastolic BP (-3.9 mm Hg, 95% CI: -5.1 to -2.8; I(2)=83%). The 95% PI ranged from -13.9 to -1.4 mm Hg for systolic BP and from -9.9 to +2.0 mm Hg for diastolic BP. The effect tended to be larger if the intervention was led by the pharmacist and was done at least monthly. CONCLUSIONS: Pharmacist interventions - alone or in collaboration with other healthcare professionals - improved BP management. Nevertheless, pharmacist interventions had differential effects on BP, from very large to modest or no effect; and determinants of heterogeneity could not be identified. Determining the most efficient, cost-effective, and least time-consuming intervention should be addressed with further research.

Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice
Peter Franks, Judith C. Barker, Mark Collier, Georgina Gethin +4 more
2016· Journal of Wound Care309doi:10.12968/jowc.2016.25.sup6.s1

Introduction It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. (1) Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age (2) in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. (3) Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%. (4) (-6) Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic judgments can assist in policy development, and decision making, improve communication, reduce errors and improve patient outcomes. There is an abundance of studies and guidelines that are available and regularly updated, however, there is still variation in the quality of the services offered to patients with a VLU. There are also variations in the evidence and some recommendations contradict each other, which can cause confusion and be a barrier to implementation. (7) The difference in health-care organisational structures, management support and the responsibility of VLU management can vary in different countries, often causing confusion and a barrier to seeking treatment. These factors further complicate the guideline implementation process, which is generally known to be a challenge with many diseases. (8).

Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs
Ruedi Steuri, Martin Sattelmayer, Simone Elsig, Chloé Kolly +3 more
2017· British Journal of Sports Medicine303doi:10.1136/bjsports-2016-096515

OBJECTIVE: To investigate the effectiveness of conservative interventions for pain, function and range of motion in adults with shoulder impingement. DESIGN: Systematic review and meta-analysis of randomised trials. DATA SOURCES: Medline, CENTRAL, CINAHL, Embase and PEDro were searched from inception to January 2017. STUDY SELECTION CRITERIA: Randomised controlled trials including participants with shoulder impingement and evaluating at least one conservative intervention against sham or other treatments. RESULTS: For pain, exercise was superior to non-exercise control interventions (standardised mean difference (SMD) -0.94, 95% CI -1.69 to -0.19). Specific exercises were superior to generic exercises (SMD -0.65, 95% CI -0.99 to -0.32). Corticosteroid injections were superior to no treatment (SMD -0.65, 95% CI -1.04 to -0.26), and ultrasound guided injections were superior to non-guided injections (SMD -0.51, 95% CI -0.89 to -0.13). Nonsteroidal anti-inflammatory drugs (NSAIDS) had a small to moderate SMD of -0.29 (95% CI -0.53 to -0.05) compared with placebo. Manual therapy was superior to placebo (SMD -0.35, 95% CI -0.69 to -0.01). When combined with exercise, manual therapy was superior to exercise alone, but only at the shortest follow-up (SMD -0.32, 95% CI -0.62 to -0.01). Laser was superior to sham laser (SMD -0.88, 95% CI -1.48 to -0.27). Extracorporeal shockwave therapy (ECSWT) was superior to sham (-0.39, 95% CI -0.78 to -0.01) and tape was superior to sham (-0.64, 95% CI -1.16 to -0.12), with small to moderate SMDs. CONCLUSION: Although there was only very low quality evidence, exercise should be considered for patients with shoulder impingement symptoms and tape, ECSWT, laser or manual therapy might be added. NSAIDS and corticosteroids are superior to placebo, but it is unclear how these treatments compare to exercise.

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations
Lyvonne N. Tume, Frédéric V. Valla, Koen F. M. Joosten, Corinne Jotterand Chaparro +4 more
2020· Intensive Care Medicine292doi:10.1007/s00134-019-05922-5

BACKGROUND: Nutritional support is considered essential for the outcome of paediatric critical illness. There is a lack of methodologically sound trials to provide evidence-based guidelines leading to diverse practices in PICUs worldwide. Acknowledging these limitations, we aimed to summarize the available literature and provide practical guidance for the paediatric critical care clinicians around important clinical questions many of which are not covered by previous guidelines. OBJECTIVE: To provide an ESPNIC position statement and make clinical recommendations for the assessment and nutritional support in critically ill infants and children. DESIGN: The metabolism, endocrine and nutrition (MEN) section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) generated 15 clinical questions regarding different aspects of nutrition in critically ill children. After a systematic literature search, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was applied to assess the quality of the evidence, conducting meta-analyses where possible, to generate statements and clinical recommendations, which were then voted on electronically. Strong consensus (> 95% agreement) and consensus (> 75% agreement) on these statements and recommendations was measured through modified Delphi voting rounds. RESULTS: The final 15 clinical questions generated a total of 7261 abstracts, of which 142 publications were identified relevant to develop 32 recommendations. A strong consensus was reached in 21 (66%) and consensus was reached in 11 (34%) of the recommendations. Only 11 meta-analyses could be performed on 5 questions. CONCLUSIONS: We present a position statement and clinical practice recommendations. The general level of evidence of the available literature was low. We have summarised this and provided a practical guidance for the paediatric critical care clinicians around important clinical questions.