Search

The advent of computerized medical recording systems in healthcare facilities has made data retrieval tasks easier, compared to manual recording. Nevertheless, the potential of the information contained within medical records remains largely untapped, mostly due to the time and effort required to extract data from unstructured documents. Natural Language Processing (NLP) represents a promising solution to this challenge, as it enables the use of automated text-mining tools for clinical practitioners. In this work, we present the architecture of the Virtual Dementia Institute (IVD), a consortium of sixteen Italian hospitals, using the NLP Extraction and Management Tool (NEMT), a (semi-) automated end-to-end pipeline that extracts relevant information from clinical documents and stores it in a centralized REDCap database. After defining a common Case Report Form (CRF) across the IVD hospitals, we implemented NEMT, the core of which is a Question Answering Bot (QABot) based on a modern NLP model. This QABot is fine-tuned on thousands of examples from IVD centers. Detailed descriptions of the process to define a common minimum dataset, Inter-Annotator Agreement calculated on clinical documents, and NEMT results are provided. The best QABot performance show an Exact Match score (EM) of 78.1%, a F1-score of 84.7%, a Lenient Accuracy (LAcc) of 0.834, and a Mean Reciprocal Rank (MRR) of 0.810. EM and F1 scores outperform the same metrics obtained with ChatGPTv3.5 (68.9% and 52.5%, respectively). With NEMT the IVD has been able to populate a database that will contain data from thousands of Italian patients, all screened with the same procedure. NEMT represents an efficient tool that paves the way for medical information extraction and exploitation for new research studies.

The knowledge of the associations between the variables and the cause–effect discrimination allows the breeders to make efficient of new cultivars development with traits that meet the demands of producers and consumers. Therefore, the present work aimed to study the associations among the quality variables of papaya (Carica papayaL.) fruits and the effects on selection process. Eight variables related to fruit quality were evaluated in 62 topcross hybrids. The phenotypic and genotypic correlations and path analyses were performed to verify the associations between the variables and the effects on pulp volume. Canonical correlation analysis between primary and secondary quality variables was also carried out. Fruit firmness and soluble solids content showed a positive and significant genotypic correlation, providing evidence for selecting fruits with high averages for both variables. Fruit weight and pulp thickness (PT) were the variables that most contributed to the reduction and increased pulp volume percentage (PV%), respectively. The canonical correlation analysis showed an increase in PT associated with an increase in the fruit length and PV%variables. The physical–chemical variables showed a low association with others, which will make the selection process more laborious to obtain satisfactory gains between the groups of variables. Estimates of correlation coefficients change between different populations.Pulp thickness has a great direct influence on pulp volume percentage.Hybrids with increased weight tend to have reduced pulp volume percentage.

A complex problem when outsourcing data to the cloud is access control management. Encryption, by wrapping data with a self-enforcing protection layer, provides access control enforcement by making resources intelligible only to users holding the necessary key. The real challenge becomes then the efficient revocation of access. We address this challenge and present an approach to effectively and efficiently enforce access revocation on resources stored at external cloud providers. The approach relies on a resource transformation that provides strong mutual inter-dependency in its encrypted representation. To revoke access on a resource, it is then sufficient to update a small portion of it, with the guarantee that the resource as a whole (and any portion of it) will become unintelligible to those from whom access is revoked. Our experimental results show the effectiveness of our approach, and confirm its efficiency, especially when managing large resources with dynamic access policy.

Background: SARS-CoV-2 breakthrough infections (BI) after vaccine booster dose are a relevant public health issue. Methods: Multicentric longitudinal cohort study within the ORCHESTRA project, involving 63,516 health workers (HW) from 14 European settings. The study investigated the cumulative incidence of SARS-CoV-2 BI after booster dose and its correlation with age, sex, job title, previous infection, and time since third dose. Results: 13,093 (20.6%) BI were observed. The cumulative incidence of BI was higher in women and in HW aged < 50 years, but nearly halved after 60 years. Nurses experienced the highest BI incidence, and administrative staff experienced the lowest. The BI incidence was higher in immunosuppressed HW (28.6%) vs others (24.9%). When controlling for gender, age, job title and infection before booster, heterologous vaccination reduced BI incidence with respect to the BNT162b2 mRNA vaccine [Odds Ratio (OR) 0.69, 95% CI 0.63–0.76]. Previous infection protected against asymptomatic infection [Relative Risk Ratio (RRR) of recent infection vs no infection 0.53, 95% CI 0.23–1.20] and even more against symptomatic infections [RRR 0.11, 95% CI 0.05–0.25]. Symptomatic infections increased from 70.5% in HW receiving the booster dose since < 64 days to 86.2% when time elapsed was > 130 days. Conclusions: The risk of BI after booster is significantly reduced by previous infection, heterologous vaccination, and older ages. Immunosuppression is relevant for increased BI incidence. Time elapsed from booster affects BI severity, confirming the public health usefulness of booster. Further research should focus on BI trend after 4th dose and its relationship with time variables across the epidemics.

ABSTRACTNeutralizing monoclonal antibodies (mAbs) have been shown to reduce disease progression in patients with underlying predisposing conditions. Unfortunately, there is no evidence on the use of Sotrovimab in pregnant women. Herein we present a case series of pregnant women who received mAbs with Sotrovimab following the Italian Drug Agency (AIFA) indications. Since February 1, 2022 all pregnant women – regardless of gestational age – admitted to Obstetrics & Gynaecology of Policlinico University of Bari, with positive nasopharyngeal NAAT for SARS-CoV-2 were screened according to the AIFA indications for Sotrovimab and, if eligible, were proposed for treatment. Data on COVID-19, pregnancy, delivery, newborn outcomes, and adverse events were collected. From February 1 to May 15, 2022, 58 pregnant women were screened. Fifty (86%) patients were eligible, 19 of them (32.7%) denied their consent, in 18 cases (31%), the drug was temporarily unavailable, and the remaining 13 (22%) were treated with Sotrovimab. Out of these 13 patients, 6 (46%) were in the 3rd and 7 (54%) in the 2nd trimester of pregnancy. None of the 13 patients experienced adverse reactions due to Sotrovimab and all had a good clinical outcome. Furthermore, evaluating pre- and post-infusion clinical status and hematochemical profile, a reduction in D-dimers and an increase in SARS-CoV-2 antibodies (p < 0.01) during the 72 h following the infusion were observed. Our data, the first on the use of Sotrovimab in pregnant women, showed the safety and efficacy drug profile and its potential crucial role in preventing COVID-19 disease progression.

IntroductionThe epidemiological surveillance of mesothelioma incidence is a crucial key for investigating the occupational and environmental sources of asbestos exposure. The median age at diagnosis is generally high, according to the long latency of the disease. The purposes of this study are to analyse the incidence of mesothelioma in young people and to evaluate the modalities of asbestos exposure.MethodsIncident malignant mesothelioma (MM) cases in the period 1993–2018 were retrieved from Italian national mesothelioma registry and analysed for gender, incidence period, morphology and exposure. Age-standardised rates have been calculated and the multiple correspondence analysis has been performed. The association between age and asbestos exposure has been tested by χ2test.ResultsFrom 1993 to 2018, 30 828 incident MM cases have been collected and 1278 (4.1%) presented diagnosis at early age (≤50 years). There is a substantial association between age at diagnosis and the type of asbestos exposure and a significantly lower frequency of cases with occupational exposure to asbestos (497 cases vs 701 expected) in young people has been documented. Paraoccupational and environmental exposure to asbestos have been found more frequent in young MM cases (85 and 93 observed cases vs 52 and 44 expected cases, respectively).ConclusionsMesothelioma incidence surveillance at population level and the anamnestic individual research of asbestos exposure is a fundamental tool for monitoring asbestos exposure health effects, supporting the exposure risks prevention policies. Clusters of mesothelioma incident cases in young people are a significant signal of a potential non-occupational exposure to asbestos.

Background: Arteriovenous malformation of umbilical cord is an extremely rare congenital malformation. Causes of this condition are unknown. AVM of umbilical cord can cause significant complications in the developing fetus. Methods: We report our management of the case with accurate ultrasound study that could improve and facilitate the approach to this pathology due to the lack of literature and with an overview of the available literature. Results: There are only two cases of umbilical AVM diagnosed in the prenatal period with associated pathology. The mainstay of prenatal detection is the accurate study of umbilical cord also even if it is not requested from the actual guide lines in a way to improve the perinatal morbidity and mortality.

Biologists have long pondered the extreme limits of life on Earth, including the maximum elevation at which species can live and reproduce. Here we review evidence of a self-sustaining population of mice at an elevation that exceeds that of all previously reported for mammals. Five expeditions over 10 years to Volcán Llullaillaco on the Argentina/Chile border observed and collected mice at elevations ranging from 5,070 m at the mountain’s base to the summit at 6,739 m (22,110 feet). Previously unreported evidence includes observations and photographs of live animals and mummified remains, environmental DNA, and a soil microbial community reflecting animal activity that are evaluated in combination with previously reported video recordings and capture of live mice. All of the evidence identifies the mouse as the leaf-eared mouse Phyllotis vaccarum, and it robustly places the population within a haplotype group containing individuals from the Chilean Atacama Desert and nearby regions of Argentina. A critical review of the literature affirms that this population is not only an elevational record for mammals but for all terrestrial vertebrates to date, and we further find that many extreme elevations previously reported for mammals are based on scant or dubious evidence.

Supplemental Digital Content is Available in the Text.

The aim of this study was to evaluate the effect of blanching and spinach drying methods on the physicochemical and cooking properties of enriched pasta. Blanched and unblanched spinach were subjected to fixed bed drying and foam mat drying and used to enrich the pasta. The pasta enriched with blanched spinach showed more desirable physicochemical properties, for both drying methods. The blanching associated with fixed bed drying resulted in a greener enriched pasta with a higher total chlorophyll content (9.66 mg/100 g d.b.). On the other hand, foam mat drying contributed to less degradation of total carotenoids and antioxidant activity (ABTS and DPPH methods), with values of 798.01 µg of lutein/100 g d.b., 7.14 µM Trolox/g d.b. and 84.81% RSC, respectively. The spinach flours used for enrichment did not significantly affect the technological properties of the pasta. Spinach blanched and dried in a foam mat to obtain flour represents a potential alternative for enriching the pasta, since this processing contributed to the greater preservation of the product's compounds.

BackgroundNight shift work can disrupt circadian rhythm and cause chronic sleep deprivation, which might increase the risk of lymphoma through immunosuppression and oxidative stress.Material and methodsWe investigated the association between night shift work and risk of lymphoma subtypes in 867 incident cases and 774 controls, who participated in a multicentre Italian study between 2011 and 2017. Based on questionnaire information, occupational experts assessed the lifetime probability of night shift work, the total number of night shifts and years of night shift work among study participants. OR and 95% CI for lymphoma and its major subtypes associated with night shift work was calculated with logistic regression, adjusting by age, gender, education, study area, marital status and family history of haemolymphatic cancer.ResultsEver working night shifts was associated with an increase in the risk of chronic lymphocytic leukaemia (CLL) (OR 1.9, 95% CI 1.14 to 3.32), which was highest after a 15–34 years latency. However, there was not a linear increase in risk by probability of exposure, years of night shift work, nor lifetime number of night shifts whether under rotating or permanent work schedules. Risk of lymphoma overall, B cell lymphoma (BCL), its major subtypes other than CLL, and other less prevalent BCL subtypes combined did not show an association.ConclusionsWe found conflicting evidence of an association between night shift work and the risk of CLL. We did not observe an association with other lymphoma subtypes.

Selection indexes represent the real efforts of a breeding program to obtain genetic gains for various significant traits simultaneously. As such, this study selected superior F5 lines by combined selection for fruit quality using an index based on predicted genotypic values via residual or restricted maximum likelihood/best linear unbiased prediction (REML/BLUP) methodology weighted by agronomic weights. To do so, 97 F5 papaya lines obtained by the single seed descent method, resulting from the biparental cross between the genotypes JS-12 and Sekati, were evaluated for the main traits related to fruit quality. Results of the analysis of deviance and the genetic parameters indicated that there was genetic variability, indicating possible success in the selection process. Based on the selection index, 29 lines were selected as superior for fruit quality with 'Formosa' pattern. The strategy of the selection index combining BLUPs of multiple traits of interest associated with agronomic weights allows maximizing genetic progress while discarding less-promising genotypes. [ABSTRACT FROM AUTHOR]

When moving large and heterogeneous data collections to the cloud, a key requirement concerns the selection of the most suitable (set of) cloud service(s) for outsourcing. Not only can different resources have different characteristics and requirements, but different cloud providers can also offer different services and security guarantees, and can have different costs. Selecting a single service for outsourcing an entire data collection can result in a non-optimal solution, as a single service satisfying, at reasonable costs, all the requirements specified by the data owner might not exist. Selecting a set of services could instead ensure the satisfaction of the requirements, possibly with economic advantages. In this article, we address this problem and present a flexible and expressive, yet simple model for supporting data owners in identifying a proper allocation of their resources to a set of cloud services. Our model allows data owners to specify in an easy and intuitive way protection requirements operating at the granularity level of single resource (or class thereof), and representing the minimum security guarantees that a cloud service must offer to store resources. Resources can be outsourced in plaintext or encrypted form, depending on their requirements and on what is the most convenient allocation. Data owners can then also specify global allocation requirements that apply to the overall allocation, to reduce the burden on their side and to avoid excessive fragmentation of the resource collection. We solve the problem of finding an allocation that satisfies both the protection and the global allocation requirements, while minimizing economic costs, by formulating it as a binary programming problem, thus allowing the use of existing techniques for its efficient solution.

Introduction: Peripherally inserted central catheters are very common devices for short, medium and long-term therapies. Their performance is strictly dependent on the correct tip location, at the junction between the upper caval vein and the right atrium. It is very important to obtain an estimated measure of the catheter, in order to reach the cavo-atrial junction and optimize the catheter length. Estimated measures are often obtained using cutaneous landmarks.Objective: Evaluate the reliability of cutaneous landmark-based length estimation during catheter insertion. Identify any patient’s related factors that may affect cutaneous landmarks reliability.Methods: We used two distinct techniques and collected data about cutaneous landmark-based length estimation, electrocardiographic guided intravascular length, age, weight and height. We studied the reliability of possible correcting factors, balancing the error average by regression models, and we found and tested two different models of prediction.Results: A total number of 519 patients were studied. The average bias, between the two studied length assessment by cutaneous landmarks and electrocardiographic guided catheter length, were 3.77 ± 2.44 cm and 3.28 ± 2.57 cm, respectively. The analysed prediction models (deviance explained 43.5%, Akaike information criterion = 1313.67% and 43.4%, Akaike information criterion = 1313.92), fitted on the validation set, showed a root mean square error of 3.07 and 3.06.Conclusion: Landmark-based length estimation for preventive catheter length assessment seems to be unreliable, when associated with post-procedural tip location. They are useful for distal trimming catheters to optimize the ‘out of skin’ portion when associated with electrocardiographic tip location. Models identified for balancing bias are probably not useful.

Background No published studies have evaluated in pregnant women with HIV weight gain with different antiretroviral drug classes.Methods Data from a national cohort study were used. We compared absolute weight gain and occurrence of excessive weight gain in women with HIV who received during pregnancy integrase inhibitors (INSTI), protease inhibitors (PI), or non-nucleoside reverse transcriptase inhibitors (NNRTI). Excessive weight gain was defined according to the Institute of Medicine recommendations. Possible predictors of weight gain were assessed using univariate and multivariate analyses.Results Among 273 cases (PI: 191, NNRTI: 43, INSTI: 39), the mean weight increase was 11.3 kg, and 25.4% of the mothers had an excessive weight increase. No significant differences were found among the three treatment groups for absolute weight increase, occurrence of excessive weight gain, infant birthweight, and other pregnancy and laboratory outcomes. The comparisons of individual drugs, although based on a limited number of cases, suggested no major differences. A significant positive correlation was found between weight gain and CD4+T-cell increase during pregnancy. In multivariate analyses, drug class and nucleoside backbone were not associated with absolute or excessive weight increase. Excessive weight increase was significantly associated with week of delivery (adjusted odds ratio: 1.74, 95% CI 1.15, 2.63), obesity (5.21, 95% CI 1.85, 14.64), overweight (7.95, 95% CI 3.26, 19.39), recent substance use (5.96, 95% CI 1.13, 31.40) and fasting 2nd trimester hyperglycaemia (3.94, 95% CI 1.14, 13.65).Conclusions No significant differences in absolute weight change or occurrence of excessive weight gain were found among women with HIV who received during pregnancy different classes of antiretroviral drugs.

The current cloud market features a multitude of cloud services that differ from one another in terms of functionality or of security/performance guarantees. Users wishing to use a cloud service for storing, processing, or sharing their data must be able to select the service that best matches their desiderata. In this paper, we propose a novel, user centric, brokering service for supporting users in the specification of requirements and enabling their evaluation against available cloud plans, assessing how much the different plans can satisfy the user's desiderata. Our brokering service allows users to specify their desiderata in an easy and intuitive way by using natural language expressions and high-level concepts. Fuzzy logic and fuzzy inference systems are adopted to quantitatively assess the compliance of cloud services with the users' desiderata, and hence to help users in the cloud service selection process.

ABSTRACTDespite the international recommendation and specific programs, and although the vaccination of health-care workers (HCWs) is considered the main measure to prevent nosocomial influenza, vaccination coverage (VC) among HCWs remains low. One of the most important barriers to vaccination uptake is the time required to attend a vaccination clinic. Centers for Disease Control and Prevention (CDC) recommends on-site influenza vaccination as a proven and cost-effective strategy that increases productivity, reduces overall absenteeism and prevents direct health-care costs. In order to increase vaccine compliance in the HCWs, the Hygiene and the Occupational Medicine departments of Bari Policlinico General University-Hospital, in the 2017/18 influenza season, promoted an on-site vaccination program in eight Operative Units (OUs). We investigated the influenza VC among HCWs of Bari Policlinico (n = 3,397), comparing VC after implementation of the on-site strategy by the Hygiene department during the 2017/18 influenza season to VC in 2016/17 season. For 2017/18 season, we also compared VC in OUs target of on-site strategy with data from in eight “control” Units (choose by simple random sampling) not included in the on-site offer. In the 2016/17 influenza season, 295/3,397 HCWs were vaccinated (VC: 8.7%) while in the 2017/18 season 482 HCWs (VC: 14.2%) received the vaccination. In OUs target of on-site vaccination, 71 HCWs (VC: 10.0%) were vaccinated in the 2016/17 season and 126 (18.0%) in the 2017/18 season, of which 101/126 (80.2%) were vaccinated in an on-site clinic. VC in OUs target of on-site vaccination increased between 2016/17 and 2017/18 seasons of 16.8 ± 10.4% (range: 5.5–37.1), while the coverage in OUs of the control group increased of 1.6 ± 2.2% (range: −1.7–4.5), with a significant difference (p< .05). Our study suggests that the offer of on-site vaccination during the 2017/18 season led to an increase of VC in HCWs compared to the classical vaccination clinic approach. The determinants of adhesion and not-adhesion must be analyzed in dept, to experiment, in the future, new good clinical practices to increase the vaccination coverage in HCWs.

AbstractPurpose:The evaluation of the association between different exposure to pesticides and different types of comet images among a group of 26 recruited subject.Material and methods:We have recruited 26 subjects (farmers and not farmers). They were submitted to a blood drawing of 10 mL and a questionnaire was administered to investigate personal habits and work history. By means of the comet assay it was assessed the oxidative DNA damage of peripheral lymphocytes by pesticides in the exposed and non-exposed workers.Result:The data measured by means of the comet were log transformed and the associations (odds ratios – ORs) with the single pesticides were calculated. The regression analysis shows a significant dose effects relationships between the Intensity Score of pesticides exposures tail moment (TM) and other measured parameters. Insecticides TM OR = 17.00 [1.47 – 196.41]. This relationship is independent from the smoking habits.Conclusions:TM values higher than the 75° percentile were significantly associated with the exposure to particular insecticides such as chlorpyriphos, deltamethrin and with other pesticides (near the statistical significance).

ABSTRACTNieves penitentes are pinnacle-shaped ice structures found at high elevations in the dry Andes. Here we report, using molecular and microscopic approaches, the first description of snow algae communities inhabiting penitente ice at 5,277 m a.s.l., demonstrating a new habitat for snow algae in one of the most extreme environments on Earth. Red ice patches on penitentes contained a microbial community dominated by algae in the genera Chlamydomonasand Chloromonas, both of which were closely related to known snow algae from alpine and polar environments. In contrast, we obtained few snow algae sequences from clear ice, but we did find cyanobacteria sequences and evidence of aeolian-deposited organic matter. Tephra (“soil”) within and just downhill from the penitente field hosted more complex bacterial and eukaryotic communities that were significantly different from ice communities in terms of both alpha and beta diversity. In this environment penitentes provide both water and shelter from harsh winds, high UV radiation, and thermal fluctuations, creating an oasis in an otherwise extreme landscape. Intriguingly, recent planetary investigations have suggested the existence of penitente-like structures on other planetary bodies of our solar system. Therefore, penitentes and the harsh environment that surrounds them provide a new terrestrial analog for astrobiological studies of life beyond Earth.

Background: Thyroid diseases occur more frequently in people exposed to ionizing radiation, but the relationship between occupational exposure to ionizing radiation and thyroid pathologies still remains unclear. Objective: To evaluate the prevalence of thyroid diseases in healthcare workers exposed to low-level ionizing radiation compared with a control group working at the University Hospital of Bari, Southern Italy, and living in the same geographical area, characterized by mild iodine deficiency. Methods: We ran a cross-sectional study to investigate whether healthcare workers exposed to ionizing radiation had a higher prevalence of thyroid diseases. Four hundred and forty-four exposed healthcare workers (241 more exposed, or “A Category”, and 203 less exposed, or “B Category”) and 614 nonexposed healthcare workers were enrolled during a routine examination at the Occupational Health Unit. They were asked to fill in an anamnestic questionnaire and undergo a physical examination, serum determination of fT3, fT4 and TSH, anti-TPO ab and anti-TG ab and ultrasound neck scan. Thyroid nodules were submitted to fine needle aspiration biopsy when indicated. Results: The prevalence of thyroid diseases was statistically higher in the exposed workers compared to controls (40% vs 29%, adPR 1.65; IC95% 1.34-2.07). In particular, the thyroid nodularity prevalence in the exposed group was approximately twice as high as that in the controls (29% vs 13%; adPR 2.83; IC95% 2.12-3.8). No statistically significant association was found between exposure to ionizing radiation and other thyroid diseases. Conclusion: In our study, mild ionizing radiation-exposed healthcare workers had a statistically higher prevalence of thyroid diseases than the control group. The results are likely due to a closer and more meticulous health surveillance programme carried out in the ionising radiation-exposed workers, allowing them to identify thyroid alterations earlier than non-exposed health staff.

The availability of cloud services offered by different providers brings several advantages to users and companies, facilitating the storage, sharing, and processing of data. At the same time, the adoption of cloud services brings new security and privacy risks and challenges. As a matter of fact when leveraging cloud-based services for data storage and processing, data owners loose direct control on their data. Data and queries over them could then be at risk for both potentially improper exposure, compromising their confidentiality, or tampering, compromising their integrity. In this paper, we discuss the main issues to be addressed for guaranteeing data security and privacy in cloud-based storage and processing. We illustrate the different challenges to be considered and the research directions toward their solutions.