Explore the vast range of titles available.

ObjectiveThe original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were ‘expert opinion’.MethodsA multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.Results2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only ‘strong for’ therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as ‘weak for’ based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).ConclusionsThese recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.

Objective:To develop evidence-based recommendations for the management of fibromyalgia syndrome.Methods:A multidisciplinary task force was formed representing 11 European countries. The design of the study, including search strategy, participants, interventions, outcome measures, data collection and analytical method, was defined at the outset. A systematic review was undertaken with the keywords “fibromyalgia”, “treatment or management” and “trial”. Studies were excluded if they did not utilise the American College of Rheumatology classification criteria, were not clinical trials, or included patients with chronic fatigue syndrome or myalgic encephalomyelitis. Primary outcome measures were change in pain assessed by visual analogue scale and fibromyalgia impact questionnaire. The quality of the studies was categorised based on randomisation, blinding and allocation concealment. Only the highest quality studies were used to base recommendations on. When there was insufficient evidence from the literature, a Delphi process was used to provide basis for recommendation.Results:146 studies were eligible for the review. 39 pharmacological intervention studies and 59 non-pharmacological were included in the final recommendation summary tables once those of a lower quality or with insufficient data were separated. The categories of treatment identified were antidepressants, analgesics, and “other pharmacological” and exercise, cognitive behavioural therapy, education, dietary interventions and “other non-pharmacological”. In many studies sample size was small and the quality of the study was insufficient for strong recommendations to be made.Conclusions:Nine recommendations for the management of fibromyalgia syndrome were developed using a systematic review and expert consensus.

Osteoarthritis (OA) is the most common joint condition and, with a burgeoning ageing population, is due to increase in prevalence. Beyond conventional medical and surgical interventions, there are an increasing number of ‘alternative’ therapies. These alternative therapies may have a limited evidence base and, for this reason, are often only afforded brief reference (or completely excluded) from current OA guidelines. Thus, the aim of this review was to synthesize the current evidence regarding autologous chondrocyte implantation (ACI), mesenchymal stem cell (MSC) therapy, platelet-rich plasma (PRP), vitamin D and other alternative therapies. The majority of studies were in knee OA or chondral defects. Matrix-assisted ACI has demonstrated exceedingly limited, symptomatic improvements in the treatment of cartilage defects of the knee and is not supported for the treatment of knee OA. There is some evidence to suggest symptomatic improvement with MSC injection in knee OA, with the suggestion of minimal structural improvement demonstrated on MRI and there are positive signals that PRP may also lead to symptomatic improvement, though variation in preparation makes inter-study comparison difficult. There is variability in findings with vitamin D supplementation in OA, and the only recommendation which can be made, at this time, is for replacement when vitamin D is deplete. Other alternative therapies reviewed have some evidence (though from small, poor-quality studies) to support improvement in symptoms and again there is often a wide variation in dosage and regimens. For all these therapeutic modalities, although controlled studies have been undertaken to evaluate effectiveness in OA, these have often been of small size, limited statistical power, uncertain blindness and using various methodologies. These deficiencies must leave the question as to whether they have been validated as effective therapies in OA (or chondral defects). The conclusions of this review are that all alternative interventions definitely require clinical trials with robust methodology, to assess their efficacy and safety in the treatment of OA beyond contextual and placebo effects.

Existing megawatt-scale photovoltaic (PV) power plant producers must understand that simple and low-cost Operation and Maintenance (O&M) practices, even executed by their own personal and supported by a comparison of field data with simulated ones, play a key role in improving the energy outputs of the plant. Based on a currently operating 18 MW PV plant located in an under-developing South-Asia country, we show in this paper that comparing real field data collected with simulated results allows a central vision concerning plant underperformance and valuable indications about the most important predictive maintenances actions for the plant in analysis. Simulations using the globally recognized software PVSyst were first performed to attest to the overall power plant performance. Then, its energy output was predicted using existing ground weather data located at the power plant. Compared with the actual plant’s annual energy output, it was found that it was underperforming by −4.13%, leading to a potential monetary loss of almost 175,000 (EUR)/year. Besides, an analysis of the O&M power plant reports was performed and compared to the best global practices. It was assessed that the tracker systems’ major issues are the forerunner of the most significant PV power plant underperformance. In addition, issues in inverters and combiner boxes were also reported, leading to internal shutdowns. In this case, predictive maintenance and automated plant diagnosis with a bottom-up approach using low-cost data acquisition and processing systems, starting from the strings level, were recommended.

This work proposes a methodology to extend the range of marine unmanned surface vehicles (USV) for border surveillance missions. The typical small scale of USVs and their lack of in-board pilots make USVs an important tool for remote applications, such as border surveillance missions and for dangerous areas operations. However, also due to their small scale, their mission range is typically limited. In this paper, it is proposed a combination of a smart energy management system (SEMS) with electric propulsion and photovoltaic panels to find the optimal path and speed capable of extending the mission range. The developed SEMS is capable of planning a mission profile based on the predicted environmental conditions. To achieve this, one presents a new A-star algorithm with probabilistic behaviour to avoid local minimums and find alternative paths that would reduce the energy consumption in later hours of the mission. The developed system was included in a USV prototype and tested under real environmental conditions at the interface between the Tejo River and the Atlantic Sea, in Lisbon, Portugal. Experimental results showed that the inclusion of photovoltaic panels and the SEMS allowed for planning the mission including the time-variable environmental conditions, leading to an extension of up to 50% of the mission range.

Failure modes, effects, and criticality analysis (FMECA) is a qualitative risk analysis method widely used in various industrial and service applications. Despite its popularity, the method suffers from several shortcomings analyzed in the literature over the years. The classical approach to obtain the failure modes’ risk level does not consider any relative importance between the risk factors and may not necessarily represent the real risk perception of the FMECA team members, usually expressed by natural language. This paper introduces the application of Type-I fuzzy inference systems (FIS) as an alternative to improve the failure modes’ risk level computation in the classic FMECA analysis and its use in cyber-power grids. Our fuzzy-based FMECA considers first a set of fuzzy variables defined by FMECA experts to embody the uncertainty associated with the human language. Second, the “seven plus or minus two” criterion is used to set the number of fuzzy sets to each variable, forming a rule base consisting of 125 fuzzy rules to represent the risk perception of the experts. In the electrical power systems framework, the new fuzzy-based FMECA is utilized for reliability analysis of cyber-power grid systems, assessing its benefits relative to a classic FMECA. The paper provides the following three key contributions: (1) representing the uncertainty associated with the FMECA experts using fuzzy sets, (2) representing the FMECA experts’ reasoning and risk perception through fuzzy-rule-based reasoning, and (3) applying the proposed fuzzy approach, which is a promissory method to accurately define the prioritization of failure modes in the context of reliability analysis of cyber-power grid systems.

IoT encompasses various objects, technologies, communication standards, sensors, actuators in powered environments, and networked communication. The concept adopted here, IoT off-grid, considers an environment without commercial electricity and commercial internet. Managing various utilities with IoT and collecting the relevant information from this environment is the purpose of this project. It uses machine learning to select relevant data. These data are collected safely using a drone that travels through the off-grid stations. A systematic literature mapping is presented, identifying the state of the art. The result is a software architecture proposal with configurations in the drone and off-grid stations that contemplate data collection from the IoT off-grid environment. The results are also presented with different selection algorithms used in machine learning and final execution in the prototype.

The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction have been suggested in recent years. In this report, the product of an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF), we review the evidence for the value of calcium supplementation, with or without vitamin D supplementation, for healthy musculoskeletal ageing. We conclude that (1) calcium and vitamin D supplementation leads to a modest reduction in fracture risk, although population-level intervention has not been shown to be an effective public health strategy; (2) supplementation with calcium alone for fracture reduction is not supported by the literature; (3) side effects of calcium supplementation include renal stones and gastrointestinal symptoms; (4) vitamin D supplementation, rather than calcium supplementation, may reduce falls risk; and (5) assertions of increased cardiovascular risk consequent to calcium supplementation are not convincingly supported by current evidence. In conclusion, we recommend, on the basis of the current evidence, that calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those who are receiving treatment for osteoporosis.

Summary Despite the proven predictive ability of bone mineral density, Fracture Risk Assessment Tool (FRAX®), bone turnover markers, and fracture for osteoporotic fracture, their use as targets for treatment of osteoporosis is limited. Introduction Treat-to-target is a strategy applied in several fields of medicine and has recently become an area of interest in the management of osteoporosis. Its role in this setting remains controversial. This article was prepared following a European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group meeting convened under the auspices of the International Osteoporosis Foundation (IOF) to discuss the feasibility of applying such a strategy in osteoporosis in Europe. Methods Potential targets range from the absence of an incident fracture to fixed levels of bone mineral density (BMD), a desired FRAX® score, a specified level of bone turnover markers or indeed changes in any one or a combination of these parameters. Results Despite the proven predictive ability of all of these variables for fracture (particularly BMD and FRAX), their use as targets remains limited due to low sensitivity, the influence of confounders and current lack of evidence that targets can be consistently reached. Conclusion ESCEO considers that it is not currently feasible to apply a treat-to-target strategy in osteoporosis, though it did identify a need to continue to improve the targeting of treatment to those at higher risk (target-to-treat strategy) and a number of issues for the research agenda. These include international consensus on intervention thresholds and definition of treatment failure, further exploration of the relationship between fracture and BMD, and FRAX and treatment efficacy and investigation of the potential of short-term targets to improve adherence.

The use of a cobalt-iron (VaCoFe) core is investigated as an alternative to silicon-iron (FeSi) in the design of interior permanent magnet synchronous motors (IPMSM). Considering VaCoFe and FeSi cores, a spoke-type IPMSM geometry is optimized for a torque range up to 40 N·m, providing a general comparative analysis between materials. This is done considering the application of a four-motor competition vehicle’s powertrain. A genetic optimization algorithm is coupled to the motor’s electromagnetic and thermal hybrid analytical/finite-element model to provide sufficiently accurate results within a feasible time. VaCoFe allows an estimated increase of up to 64% in torque for the same efficiency level, or up to 5% in efficiency for the same torque. After optimization and using a detailed time-dependent model, a potential 3.2% increase in efficiency, a core weight reduction of 4.1%, and a decrease of 9.6% in the motor’s core volume were found for the VaCoFe at 20 N·m. In addition, for the same motor volume, the VaCoFe allows an increase of 51.9% in torque with an increase of 1.1% in efficiency when compared with FeSi.