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Extracorporeal membrane oxygenation (ECMO) is a high-risk and low-volume life support with increasing clinical study. However, heterogenous outcome definitions impede data assimilation into evidence to guide practice. The Academic Research Consortium (ARC), an international collaborative forum committed to facilitating the creation of stakeholder-driven consensus nomenclature and outcomes for clinical trials of medical devices, supported the ECMO Core Elements Needed for Trials Regulation And quality of Life (ECMO-CENTRAL) ARC. The ECMO-CENTRAL ARC was assembled to develop definitions of paediatric ECMO adverse events for use in clinical trials and regulatory device evaluation. An initial candidate list of ECMO adverse events derived from the mechanical circulatory support ARC was supplemented with a review of ECMO-relevant adverse event definitions collated from literature published between Jan 1, 1988, and Feb 20, 2023. Distinct teams of international topic experts drafted separate adverse event definitions that were harmonised to existing literature when appropriate. Draft definitions were revised for paediatric ECMO relevance with input from patients, families, and an international expert panel of trialists, clinicians, statisticians, biomedical engineers, device developers, and regulatory agencies. ECMO-CENTRAL ARC was revised and disseminated across research societies and professional organisations. Up to three rounds of internet-based anonymous surveys were planned as a modified Delphi process. The expert panel defined 13 adverse event definitions: neurological, bleeding, device malfunction, acute kidney injury, haemolysis, infection, vascular access-associated injury, non-CNS thrombosis, hepatic dysfunction, right heart failure, left ventricular overload, lactic acidaemia, and hypoxaemia. Definitional structure varied. Among 165 expert panel members, 114 were eligible to vote and 111 voted. Consensus was achieved for all proposed definitions. Agreement ranged from 82% to 95%. ECMO-CENTRAL ARC paired rigorous development with methodical stakeholder involvement and dissemination to define paediatric ECMO adverse events. These definitions will facilitate new research and the assimilation of data across clinical trials and ECMO device evaluation in children.

(INTEGRAL) has been surveying the sky above 20 keV since its launch in 2002 providing new insights into the nature of the sources that populate our Universe at soft γ-ray energies. The latest IBIS/ISGRI survey lists 929 hard X-ray sources, of which 113 are reported as unidentified, i.e. lacking a lower energy counterpart or simply not studied in other wavebands. To overcome this lack of information, we either browsed the X-ray archives, or, if no data in the X-ray band were available, we requested Target of Opportunity (ToO) observations with the X-ray Telescope (XRT) on-board the Neil Gehrels SwiftObservatory. Following this approach, we selected a sample of 10 objects for which X-ray data were key to investigate their nature. We found a single X-ray association for all of the sources, except for IGR J16267−3303, for which two X-ray detections were spotted within the IBIS positional uncertainty. We then browsed multi-waveband archives to search for counterparts to these X-ray detections at other wavelengths and analysed X-ray spectral properties to determine their nature and association with the high-energy emitter. As a result of our analysis, we identified the most likely counterpart for 7 sources, although in some cases its nature/class could not be definitely assessed on the basis of the information collected. Interestingly, SWIFT J2221.6+5952, first reported in the 105-month Swift/Burst Alert Telescope (BAT) survey, is the only source of the sample for which we did not find any counterpart at radio/optical/IR wavebands. Finally, we found that two IBIS source, IGR J17449−3037 and IGR J17596−2315 are positionally associated with a FermiLarge Area Telescope (LAT) object.

This work describes the possibility to combine multicomponent chemistry and multienzymes cascade transformations in a unique reactive framework to yield highly functionalized 1,4-benzoxazines under favorable heterogeneous conditions. The synthetic scheme involved the generation in situ of electrophilic reactive quinone intermediates of tyrosol esters catalyzed by lipase M and tyrosinase followed by nucleophilic 1,6-Michael addition of selected α-amino acid methyl esters, and successive intramolecular lactonization and aromatization processes. The immobilization of the multienzymes cascade on electroactive lignin nanoparticles improved the sustainability and recyclability of the overall system.

Magnetar giant flares are rare explosive events releasing up to 1047erg in gamma rays in less than 1 second from young neutron stars with magnetic fields up to 1015−16G (refs. 1,2). Only three such flares have been seen from magnetars in our Galaxy3,4and in the Large Magellanic Cloud5in roughly 50 years. This small sample can be enlarged by the discovery of extragalactic events, as for a fraction of a second giant flares reach luminosities above 1046erg s−1, which makes them visible up to a few tens of megaparsecs. However, at these distances they are difficult to distinguish from short gamma-ray bursts (GRBs); much more distant and energetic (1050−53erg) events, originating in compact binary mergers6. A few short GRBs have been proposed7–11, with different amounts of confidence, as candidate giant magnetar flares in nearby galaxies. Here we report observations of GRB 231115A, positionally coincident with the starburst galaxy M82 (ref. 12). Its spectral properties, along with the length of the burst, the limits on its X-ray and optical counterparts obtained within a few hours, and the lack of a gravitational wave signal, unambiguously qualify this burst as a giant flare from a magnetar in M82.

Purpose: In light of the growing concern over the possible link between SARS-CoV2 infection and autoimmune diseases, we conducted a review to investigate the impact of the pandemic outbreak on thyroid diseases. Methods: We carried out a narrative review of all pediatric cases described in the literature, mainly focusing on the possible association of COVID-19 with the incidence of autoimmune and post-infective thyroid diseases (namely Hashimoto’s Thyroiditis (HT), Grave’s Disease (GD) and Sub-Acute Thyroiditis (SAT)). We also felt it was necessary to provide a brief review of Non-thyroidal Illness Syndrome (NTIS) and Multisystem Inflammatory Syndrome in Children (MIS-C) because of their overlap with thyroiditis. Results: There is currently no conclusive evidence linking SARS-CoV-2 infection with an increased incidence of autoimmune thyroiditis (AT) in pediatric age. However, SAT may be a mild complication of SARS-CoV-2 infection, as is the case with other viral infections. SAT typically resolves on its own and does not require treatment. NTIS may be associated with inflammatory complications, such as MIS-C, and admission to intensive care. It may also be considered a prognostic risk factor for severe disease. The hypothesized pathogenetic mechanisms of thyroid damage in COVID-19 include direct damage due to the significant expression of angiotensin-converting enzyme 2 (ACE2) in the thyroid gland, which is a ligand for the virus, and indirect damage due to immune dysregulation, such as the overproduction of IL-6, which is thought to be part of the pathogenesis of thyroiditis. Conclusion: However, due to the limited evidence available, further prospective longitudinal studies are required to clarify the relationship between COVID-19 and thyroid disease in children and adolescents, as well as to investigate any potential long-term consequences.

Objectives: To develop an objective, structured observational tool to enable identification and measurement of hazards in the built environment when applied to audiovisual recordings of simulations by trained raters.Background: Simulation-based facility design testing is increasingly used to optimize safety of healthcare environments, often relying on participant debriefing or direct observation by human factors experts.Methods: Hazard categories were defined through participant debriefing and detailed review of pediatric intensive care unit in situ simulation videos. Categories were refined and operational definitions developed through iterative coding and review. Hazard detection was optimized through the use of structured coding protocols and optimized camera angles.Results: Six hazard categories were defined: (1) slip/trip/fall/injury risk, impaired access to (2) patient or (3) equipment, (4) obstructed path, (5) poor visibility, and (6) infection risk. Analysis of paired and individual coding demonstrated strong overall reliability (0.89 and 0.85, Gwet’s AC1). Reliability coefficients for each hazard category were >0.8 for all except obstructed path (0.76) for paired raters. Among individual raters, reliability coefficients were >0.8, except for slip/trip/fall/injury risk (0.68) and impaired access to equipment (0.77).Conclusions: Hazard Assessment and Remediation Tool (HART) provides a framework to identify and quantify hazards in the built environment. The tool is highly reliable when applied to direct video review of simulations by either paired raters or trained single clinical raters. Subsequent work will (1) assess the tool’s ability to discriminate between rooms with different physical attributes, (2) develop strategies to apply HART to improve facility design, and (3) assess transferability to non-ICU acute care environments.

HEMERA is a large research community which operates in the field of tropospheric and stratospheric balloon-borne research. The Hemera project is aimed to improve the technologies related to the balloons and to favour the research on balloons by offering the opportunity to fly scientific experiment to the international community. The project, described in this paper together with its major outcomes, involves major space agencies dealing with balloon infrastructures, companies operating the balloons, companies providing the necessary technologies and scientific experts.

We present Monte Carlo computer simulations for melts of semiflexible randomly knotted and randomly concatenated ring polymers on the fcc lattice and in slit confinement. Through systematic variation of the slit width at fixed melt density, we explore the influence of confinement on single-chain conformations and interchain interactions. We demonstrate that confinement makes chains globally larger and more elongated while enhancing both contacts and knottedness propensities. As for multichain properties, we show that ring–ring contacts decrease with the confinement, yet neighboring rings overlap more as confinement grows. These aspects are accompanied by a marked decrease in the links formed between pairs of neighboring rings. In connection with the quantitative relation between links and entanglements in polymer melts recently established by us [Ubertini, M. A.; Rosa, A.Macromolecules2023, 56, 3354–3362], we propose that confinement can be used to set polymer networks that act softer under mechanical stress and suggest a viable experimental setup to validate our results.

Current theories on the conformation and dynamics of unknotted and non-concatenated ring polymers in melt conditions describe each ring as a tree-like double-folded object. While evidence from simulations supports this picture on a single ring level, other works show pairs of rings also thread each other, a feature overlooked in the tree theories. Here we reconcile this dichotomy using Monte Carlo simulations of the ring melts with different bending rigidities. We find that rings are double-folded (more strongly for stiffer rings) on and abovethe entanglement length scale, while the threadings are localized on smaller scales. The different theories disagree on the details of the tree structure, i.e., the fractal dimension of the backbone of the tree. In the stiffer melts we find an indication of a self-avoiding scaling of the backbone, while more flexible chains do not exhibit such a regime. Moreover, the theories commonly neglect threadings and assign different importance to the impact of the progressive constraint release (tube dilation) on single ring relaxation due to the motion of other rings. Despite that each threading creates only a small opening in the double-folded structure, the threading loops can be numerous and their length can exceed substantially the entanglement scale. We link the threading constraints to the divergence of the relaxation time of a ring, if the tube dilation is hindered by pinning a fraction of other rings in space. Current theories do not predict such divergence and predict faster than measured diffusion of rings, pointing at the relevance of the threading constraints in unpinned systems as well. Revision of the theories with explicit threading constraints might elucidate the validity of the conjectured existence of topological glass.

In this contribution, the modelling of salt crystallization-induced damage in layered porous materials (such as masonry strengthened with composites, glazed earthenware, etc.) is addressed through a staggered multiphysics method. A staggered interchange of data is pursued between a multiphase model (crystallization pressure) and a macro-scale nonlinear mechanical model (material damage). Such method is preliminary applied to layered porous materials through a simple benchmark. Accordingly, the effects of layers with different properties on the crystallized salt distribution and damage pattern are highlighted.

Purpose: Denosumab is a fully human monoclonal anti-RANK-L antibody that is clinically used to counteract the bone loss induced by exacerbated osteoclast activity. Indeed, its binding to RANK-L prevents the interaction RANK-L/receptor RANK that is essential for osteoclastogenesis and bone resorbing activity. Although there are many medications available to treat bone loss diseases, including bisphosphonates, Denosumab is highly effective since it reduces the bone erosion. The use in pediatric patients is safe. However, some concerns are related to the interruption of the treatment. Indeed, in this study, we reported hypercalcemia in two pediatric patients and alterations of circulating osteoclast precursors. Methods: Peripheral Blood Mononuclear Cells (PBMC) were isolated from two pediatric patients with hypercalcemia after Denosumab interruption and from 10 controls. Cytofluorimetric analysis and in vitro osteoclastogenesis experiments were performed. Results: Increase of CD16−CD14+CD11b+cells was revealed in PBMC from patients reflecting the enhanced in vitro osteoclastogenesis. Conclusion: Our data suggest that precautions must be taken when Denosumab therapy is interrupted and gradual decrease of dose and/or timing of treatment should be performed. To prevent the onset of hypercalcemia that could be in the discontinuation phase, cytofluorimetric analysis of PBMC should be performed to evaluate osteoclast precursors.

Purpose: Constitutional delay of growth and puberty (CDGP) represents the most frequent cause of delayed puberty in males, sharing some clinical features with growth hormone deficiency (GHD) and isolated hypogonadotropic hypogonadism (IHH). Short-term induction therapy (SIT) has been approved for the induction of puberty in CDGP. We aim to investigate the efficacy of SIT with transcutaneous testosterone gel (TTG) or intramuscular testosterone therapy (IMTT) in a cohort of CDGP subjects, compared to clinical observation. Furthermore, we aim to evaluate the role of SIT as a diagnostic tool to differentiate CDGP from GHD and IHH subjects. Methods: The retrospective study included 246 male subjects with delayed puberty. The study population was divided into three groups: TTG, IMTT, and control group (CNT). Results: At 6 months observation, height velocity (HV) was significantly increased in both treated groups compared to CNT group, particularly higher in TTG than IMTT group. A significant testicular enlargement was revealed in both CNT and TTG group compared to IMTT group. Furthermore, LH value was significantly greater in TTG compared to IMTT group. IGF-1 values after SIT rose significantly in both treated groups compared to CNT group. Moreover, almost all GH provocative tests performed after SIT showed a normal GH response. Conclusion: SIT with TTG appears to be more effective to induce growth spurt, better tolerated and with a more physiological effect on pubertal induction compared to IMTT in CDGP population. Finally, TTG might be a useful tool in the diagnostic work up to discriminate CDGP from GHD or IHH.

Efficient storage solutions that decouple energy use and production are pivotal for the green energy transition, due to the non-controllable operation of solar and wind power. In this scenario, hydrogen, and in particular metal hydride storage, has shown excellent potential.

The INTernational Gamma-ray Astrophysics Laboratory(INTEGRAL) has detected the Short Gamma-Ray Burst (SGRB), GRB170817A with a signal-to-noise ratio of 4.6 and demonstrated its association with the binary neutron star merging event GW170817 detected by the LIGO and Virgo gravitational wave observatories. The association was immediately evident due to the timing and positional coincidence of this event with the initial error box, derived from gravitational wave (GW) measurements and the contemporaneous detection of a similar gamma-ray signal by Fermi/GBM. This SGRB was detected by the INTEGRAL SPI ACS about 1.7 s after the end of the GW emission, with a fluence of (1.4±0.4) ×10-7ergcm-2in the 75–2000 keV energy range. After the serendipitous detection of the short prompt GRB, INTEGRALcontinued the planned observation for about 20 h, and then performed a targeted follow-up ToO observation lasting several days. This ToO observation provided a stringent upper limit on any electromagnetic signal in a very broad energy range, from 3 keV to 8 MeV, in particular constraining the soft gamma-ray afterglow flux to <7.1×-11ergcm-2s-1in the range 80–300 keV. Exploiting the unique capabilities of INTEGRAL, we constrained the gamma-ray line emission intensity from radioactive decays expected to be the principal source of the energy behind a kilonova event following a NS–NS coalescence. Finally, we put a stringent upper limit on any delayed bursting activity, for example, from a newly formed magnetar. The INTEGRAL prompt detection and the subsequent continuous observations at all wavelengths have provided important constraints on the high energy emission of the resulting kilonova and the post inspiral object: NS, BH, or a new exotic object.

Soft ?-ray repeaters exhibit bursting emission in hard X-rays and soft ?-rays. During the active phase, they emit random short (milliseconds to several seconds long), hard-X-ray bursts, with peak luminosities1of 1036to 1043erg per second. Occasionally, a giant flare with an energy of around 1044to 1046erg is emitted2. These phenomena are thought to arise from neutron stars with extremely high magnetic fields (1014to 1015gauss), called magnetars1,3,4. A portion of the second-long initial pulse of a giant flare in some respects mimics short ?-ray bursts5,6, which have recently been identified as resulting from the merger of two neutron stars accompanied by gravitational-wave emission7. Two ?-ray bursts, GRB 051103 and GRB 070201, have been associated with giant flares2,8–11. Here we report observations of the ?-ray burst GRB 200415A, which we localized to a 20-square-arcmin region of the starburst galaxy NGC 253, located about 3.5 million parsecs away. The burst had a sharp, millisecond-scale hard spectrum in the initial pulse, which was followed by steady fading and softening over 0.2 seconds. The energy released (roughly 1.3 × 1046erg) is similar to that of the superflare5,12,13from the Galactic soft ?-ray repeater SGR 1806-20 (roughly 2.3 × 1046erg). We argue that GRB 200415A is a giant flare from a magnetar in NGC 253.

In this study, the authors investigate the use of conductive concrete to enhance nondestructive evaluation (NDE) capabilities. Preliminary results have shown that a conductive concrete can facilitate the utilization of an eddy current technique, in which damages in a conductive specimen were easier to detect compared with a nonconductive substrate. While such results demonstrated the promise of using conductive concrete to facilitate and potentially accelerate the NDE process, the fabrication of a homogeneous conductive concrete is technically or economically challenging, depending on the conductive filler used in the process. In this paper, the authors propose a new cementitious composite to accelerate NDE. The composite uses inexpensive carbon black particles and a block-copolymer. The purpose of the block copolymer, a styrene-ethylene-butylene-styrene (SEBS), is to facilitate the creation of conductive chains, therefore reducing the necessary concentration of conductive filler required to achieve electrical percolation. Several cementitious composite specimens of various concentrations of carbon black particles were fabricated, and results show that the utilization of SEBS reduced the electrical percolation threshold by approximately 50%, with a gain on electrical conductivity relative to a nonconductive specimen mix of approximately 33%. Strain-sensing tests also demonstrated that SEBSbased specimens have good sensing properties, but lag behind those of conductive concrete specimens fabricated with carbon black only. [ABSTRACT FROM AUTHOR]

The progress of nanotechnology resulted in the development of new instruments in the civil engineering and its applications. In particular, the use of carbon nanofillers into the matrix of construction materials can provide enhanced properties to the material in both of mechanical and electrical performance. In constructions, concrete is among the most used material. Due to the peculiarities of its components and its structure, it is suitable to modifications, at the nanometer level too. Moreover, to guarantee structural safety it is desirable to achieve a diffuse monitoring of structures in order to identify incipient situations of damages and possible risk for people. The ideal solution would be to realize structures able to identify easily and quickly their behavior modifications. This paper presents a research work about the characterization of the self-sensing abilities of novel cementitious composites with conductive carbon nanoinclusions and their application into a structural reinforced concrete beam. The self-sensing evidence is achieved through the correlation between the variation of strains and the variation of electrical resistance or resistivity. Nanomodified cement pastes with different carbon nanofillers has been tested. The experimental campaign shows the potentialities of this new types of sensors made of nanomodified concrete for diffuse Structural Health Monitoring.

Abstract"Hospital of Objects" is a service that provides for the recovery of forgotten, obsolete and accidentally broken objects, it fall within typical chain of personal manufacturing. Through the design input of the designer / maker, the obsolete object reacquires an aesthetic and functional dignity, according to the contemporary hybrid design and hacking design logic. The aim is to give new life to small everyday objects , recomposing, aggregating or replacing some parts with new parts 3d printed, using filament obtained from the recycling plastic of WEEE waste. The service through the exchange of expertise (including Laboratory for the recycling of WEEE and Rapid Manufacturing Laboratory), cooperation (between user and designer / maker), attention to environmental impact, leading to the creation of a particular product: hybrid of languages and technologies, that allows experiments in the field of recycling, technology and creativity, exploiting the 3D Printing aimed at small-scale production or unique pieces.

Civil constructions need to be monitored during their lifespan to assess any changes in structural performance following critical events. Among the various available monitoring solutions, this paper contributes to the literature on multifunctional construction materials that have the ability to provide an electrical output that can be correlated with materials’ damage. The novelty of the work consists of achieving self-sensing properties in a sustainable concrete, where cement is substituted with natural earth in the ratio of 7/2 in volume. Self-sensing properties are provided through the addition of a small amount of carbon microfibers enabling a piezoresistive behavior. Experimental tests were carried out using samples with different shapes to investigate their electrical and sensing properties. The results showed that the best carbon microfiber doping level of 0.05% relative to the binder exhibited clear and repeatable signals, an average gauge factor of 46, and high linearity. Moreover, the smart multifunctional earth-concrete showed good electrical, diagnostic, and sensing properties during failure tests.

The aeroelastic wind tunnel testing of flexible roofs made of hyperbolic paraboloid cable nets is a challenging task for designers and researchers, with very limited documented experiences in the literature. The reduced-scale model construction and its dynamic identification are the main issues to address when approaching this problem, mainly because of (i) the very small mass of the roof, (ii) the strict aeroelastic criteria to satisfy and (iii) a large number of very closely spaced significant natural frequencies. To suggest an approach to follow to investigate the wind—structure interaction for this structural typology, this paper discusses the aeroelastic scaling, the aeroelastic model construction, the dynamic modal identification and the FEM predictive numerical modelling of hyperbolic paraboloid roofs (HPRs) with square, rectangular and circular plan shapes and two different curvatures. Modal identification is especially challenging due to the presence of several closely spaced modes and it is here tackled by different methods such as Welch’s method, random decrement technique (RDT), Empirical mode decomposition with a time-varying filter (TVF-EMD) and frequency domain decomposition method (FDD). The satisfying accuracy of the aeroelastic scaling has been verified by comparing the wind-induced vertical displacements of the prototypes against those of the experimental models. Furthermore, an extensive qualitative investigation of the natural mode shapes has been carried out revealing that test models reproduce most of the prototype modes.

Through an optical campaign performed at 5 telescopes located in the northern and the southern hemispheres, plus archival data from two on line sky surveys, we have obtained optical spectroscopy for 17 counterparts of suspected or poorly studied hard X-ray emitting active galactic nuclei (AGNs) detected with Swift/BAT in order to determine or better classify their nature. We find that 7 sources of our sample are type 1 AGNs, 9 are type 2 AGNs, and 1 object is an X-ray bright optically normal galaxy; the redshifts of these objects lie in a range between 0.012 and 0.286. For all these sources, X-ray data analysis was also performed to estimate their absorption column and to search for possible Compton thick candidates. Among our type 2 objects, we did not find any clear Compton thick AGN, but at least 6 out of 9 of them are highly absorbed (NH> 1023cm-2), while one does not require intrinsic absorption; i.e., it appears to be a naked Seyfert 2 galaxy.

Within the framework of our program of assessment of the nature of unidentified or poorly known INTEGRALsources, we present here spectroscopy of optical objects, selected through positional cross-correlation with soft X-ray detections (afforded with satellites such as Swift, ROSAT, Chandraand/or XMM-Newton) as putative counterparts of hard X-ray sources detected with the IBIS instrument onboard INTEGRAL. Using 6 telescopes of various sizes and archival data from two on-line spectroscopic surveys we are able to identify, either for the first time or independent of other groups, the nature of 20 INTEGRALhard X-ray sources. Our results indicate that: 11 of these objects are active galactic nuclei (AGNs) at redshifts between 0.014 and 0.978, 7 of which display broad emission lines, 2 show narrow emission lines only, and 2 have unremarkable or no emission lines (thus are likely Compton thick AGNs); 5 are cataclysmic variables (CVs), 4 of which are (possibly magnetic) dwarf novae and one is a symbiotic star; and 4 are Galactic X-ray binaries (3 with high-mass companions and one with a low-mass secondary). It is thus again found that the majority of these sources are AGNs or magnetic CVs, confirming our previous findings. When possible, the main physical parameters for these hard X-ray sources are also computed using the multiwavelength information available in the literature. These identifications support the importance of INTEGRALin the study of the hard X-ray spectrum of all classes of X-ray emitting objects, and the effectiveness of a strategy of multi-catalogue cross-correlation plus optical spectroscopy to securely pinpoint the actual nature of unidentified hard X-ray sources.

Context. The combination of compact objects, short period variability and peculiar chemical composition of the ultra compact X-ray binaries make up a very interesting laboratory to study accretion processes and thermonuclear burning on the neutron star surface. Improved large optical telescopes and more sensitive X-ray satellites have increased the number of known ultra compact X-ray binaries allowing their study with unprecedented detail.