Cyber-physical systems (CPSs) are nowadays an important component of most industrial infrastructures and materialize the integration of control systems with advanced information technologies. Commonly, they aggregate distinct communication platforms and networked devices or nodes with different capabilities and goals. The resulting increase in complexity has inevitably brought into playing new challenges, namely, on the physical world and cyber space. In these systems, the development and gaining of state awareness and how to deal with the inherent vulnerabilities of the overall system are essential and also challenging. In this paper, the problem of resilience enhancement in CPSs is addressed based on a hierarchical multi-agent framework that is implemented over a distributed middleware, in which each agent carries out specific tasks. Physical and cyber vulnerabilities are taken into account, and state and context awarenesses of the whole system are targeted. The proposed framework ensures a minimum level of acceptable performance in case of physical disturbances and malicious attacks, as demonstrated by experiments on an IPv6-based test-bed.

Purpose: This study assesses the postural stability and the effect of balance training using a force platform visual biofeedback among outpatients with postural disturbances following stroke. Method: A tilting multiaxial force platform was used to assess bilateral postural stability in 38 outpatients (mean age 69.50 ± 8.57 years) with hemiplegia and/or ataxia after stroke. Stability indexes were obtained. Afterwards, a subgroup of 12 patients with the poorest overall stability index (OASI) started a balance training programme in the force platform.Postural control training consisted of a 30 minute training session once a week for a 15 week period. The test was then repeated. Results: In the 38 outpatients sample the mean OASI was 4.7 ± 2.0 and 42.1% of the patients used their hands for support. In the 12 outpatients group, the initial OASI was 5.8 ± 2.3 and half of the patients used their hands for support. The final OASI was 3.3 ± 1.0 (p=0.005) and only 2 of the patients used their hands for support (p=0.046). Conclusion: Our results suggest that a training program using force platform visual biofeedback improves objective measures of bilateral postural stability in patients with hemiplegia and/or ataxia after stroke.

Introduction Low physical activity (PA) levels are associated with poor health‐related outcomes in Chronic Obstructive Pulmonary Disease (COPD). Thus, PA should be routinely assessed in clinical practice. Objectives This study assessed the construct validity of the Brief Physical Activity Assessment Tool (BPAAT) for clinical use in COPD and explored differences in age, sex and COPD grades. Methods After linguistic adaptation of the tool to Portuguese, 110 patients (66.4 ± 9.6yrs, 72.7% male, FEV1 = 59.3 ± 25.5%predicted) completed the BPAAT and received an accelerometer. The BPAAT includes two questions assessing the weekly frequency and duration of vigorous‐ and moderate‐intensity PA/walking, classifying individuals as insufficiently or sufficiently active. The BPAAT was correlated with accelerometry (moderate PA, MPA = 1952‐5724 counts‐per‐min [CPM]); vigorous PA, VPA = 5725‐∞CPM; moderate‐to‐vigorous PA, MVPA = 1952‐∞CPM; daily steps), through: Spearman’s correlations (ρ) for continuous data; %agreement, Kappa, sensitivity and specificity, positive and negative predictive values (PPV, NPV) for categorical data. Results The BPAAT identified 73.6% patients as “insufficiently active” and 26.4% as “sufficiently active”. The BPAAT was weakly to moderately correlated with accelerometry (0.394 ≤ ρ ≤ 0.435, P < 0.05), except for VPA (P = 0.440). This was also observed in age (<65/≥65yrs), COPD grades (GOLD 1–2/3–4) and in male patients (0.363 ≤ ρ ≤ 0.518, P < 0.05 except for VPA). No significant correlations were found in female patients (P > 0.05). Agreement was fair to moderate (0.36 ≤ κ ≤ 0.43; 73.6% ≤ %agreement ≤ 74.5%; 0.50 ≤ sensitivity ≤ 0.52; 0.84 ≤ specificity ≤ 0.91, 0.55 ≤ PPV ≤ 0.79, 0.72 ≤ NPV ≤ 0.82). Conclusion The BPAAT may be useful to screen patients’ PA, independently of age and COPD grade, and identify male patients who are insufficiently active. Care should be taken when using this tool to assess vigorous PA or female patients.

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Introduction: Chronic obstructive pulmonary disease (COPD) often leads to an increased dependence on the informal carer, which can result in higher levels of distress, anxiety or depression associated with the burden of caregiving and, consequently, reduced quality of life [1]. Several instruments have been used to assess carer burden in COPD; however, their measurement properties have been poorly assessed in this population [2]. The Question ario de Avaliação de Sobrecarga do Cuidador Informal (QASCI) is a Portuguese questionnaire, originally created for carers of patients with stroke [3] and later validated in a sample with various chronic diseases, including respiratory diseases [4]. However, its S85 ANNALS OF MEDICINE

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