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Moon Unit Zappa, in her memoir, reflects on her experience growing up as the daughter of rock icon Frank Zappa. She describes her family dynamic as similar to a cult, with her father as the larger-than-life leader. Moon Unit recounts her admiration for her father's creativity and humor, as well as the unique aspects of her upbringing, such as her father's eccentricities and their unconventional celebrations. She also discusses her relationship with her father, including the challenges of his absence and his diagnosis with prostate cancer. Despite the difficulties, Moon Unit cherishes the moments of connection and humor she shared with her father. [Extracted from the article]

Obesity is a chronic disease associated with increased morbidity and mortality and reduced quality of life. Pharmacotherapy can be associated with life style changes in increasing and maintaining weight loss and ameliorating obesity-related complications and comorbidities. In patients affected by obesity and uncontrolled obesity-associated complications or high degrees of BMI (> 40 Kg/m2), metabolic bariatric surgery can be a valid therapeutic option. Many different types of surgical procedures have been developed in last decades, mainly performed via laparoscopic approaches. However, clinical indications for metabolic and bariatric surgery (MBS) and the choice of the most appropriate type of procedure have not been clarified so far.

In the Industry 4.0 environment, the maintenance of industrial assets is of increasing importance, and, in this domain, the recently emerged technology of Cognitive Digital Twin (CDT) is particularly suitable for the satisfaction of today’s manufacturers’ needs for flexibility, dynamism, broad vision of the systems, and responsiveness to stimuli. Although this technology shows considerable potential in supporting the execution of maintenance applications with minimum human intervention, in most cases the to-date technological level is not capable of achieving full automation, making the human role still fundamental in relation to the existing Digital Twin (DT) technologies. In this context, this paper proposes the development of an ontology-based DT aiming at supporting the maintenance fault diagnosis decision-making process in manufacturing systems through the synergistic exploitation of the maintenance ontology KARMA supported by algorithms and database technologies integrated with human knowledge. The solution is meant to enable the cognitive capabilities leading toward the CDT concept. The ontology-based Digital Twin has been applied and assessed in the reality-like facility TELMA, at the Research Center for Automatic Control (CRAN) in Nancy, through the implementation of a fault scenario.

Obesity/overweight and its complications are a growing problem in many countries. Italian Society of Bariatric and Metabolic Surgery for Obesity (Società Italiana di Chirurgia dell'Obesità e delle Malattie Metaboliche-SICOB) decided to develop the first Italian guidelines for the endoscopic bariatric treatment of obesity. The creation of SICOB Guidelines is based on an extended work made by a panel of 44 members and a coordinator. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology has been used to decide the aims, reference population, and target health professionals. Clinical questions have been created using the PICO (patient, intervention, comparison, outcome) conceptual framework. We will perform systematic reviews, formal meta-analyses, and network meta-analyses for each PICO and critical outcomes aimed at assessing and rating the efficacy and safety of endoscopic bariatric procedures in comparison with either no interventions, lifestyle interventions, or approved anti-obesity treatments in trials with a follow-up of at least 52 weeks. For PICO on temporary endoscopic bariatric treatments, we will also consider RCT with a minimum duration of 6 months. The panel proposed 8 questions, organized into four domains: A. Indication for endoscopic bariatric surgery; B. Revisional surgery; C. Temporary gastric and duodenal–jejunal procedures; D. Endoscopic diagnosis/treatment of bariatric and metabolic surgery complications. These guidelines will apply to patients aged ≥ 14 years) with body mass index (BMI) ≥ 27 kg/m2and requiring endoscopic bariatric surgery or endoscopic diagnostic and/or therapeutic procedures. The areas covered by the clinical questions included indications of endoscopic bariatric surgery, types of surgery, revisional surgery, and management of bariatric and metabolic surgery complications.

Recognizing loose condition of rail fastener is a challenging task. To this end, we propose a novel solution integrating deep learning and 3-D vision techniques. The segmentation network is first proposed to locate the spike and nut, and then, fringe projection profilometry (FPP) is used to recover the corresponding depth map. Finally, the looseness condition of rail fastener can be identified by the distance between spike and nut. Semantic segmentation and phase calculation of spike and nut are critical to the reconstruction accuracy of depth map. Aiming at segmentation problem, we propose a U-shaped network based on triplet attention (TAU-Net $4+\text {)}$ to improve segmentation accuracy. On the one hand, we redesign a skip connection layer to better enhance the interaction ability between deep and shallow features. On the other hand, a triple attention module is added to make the network more attentive to spike and nut during the learning process. For the phase calculation problem, we propose a phase correction and verification method based on dual-slope guidance and contextual information to improve the reconstruction accuracy of FPP. The experimental results first show that TAU-Net 4+ can excellently segment the boundaries of spike and nut, and the Dice coefficient reaches 99.27%, which lays the foundation for depth map acquisition. In addition, the experiments also verify that the proposed phase correction method can recover a more accurate depth map. Finally, the experiments validate that the proposed strategy can recognize the loosening status of rail fastener and the minimum looseness recognition distance is about 0.1 mm.

Percutaneous thermo-ablation (TA) may be unfeasible for the tumor location: laparoscopic ablation therapies (LATs) are an alternative option. The aim of this study is to assess the efficacy of LATs in the treatment of HCC not eligible for percutaneous TA or surgical resection. LAT was offered to 503 patients fulfilling at least one of the following criteria: (a) patients with a single nodule or up to three nodules smaller than 3 cm not suitable for surgery; (b) patients not suitable for percutaneous TA; (c) short-term recurrence of HCC (< 3 months). Technical success was achieved with one session in 467 patients (93%). One-month mortality and severe morbidity rates were 0.4% and 2.19%, respectively. During a median follow-up of 38.4 months in the remaining 501 patients, 361 (67%) developed intrahepatic recurrence: it appeared as a local tumor progression (LTP) in 74 cases (15%). Subcapsular lesions showed lower LTP rates (p= 0.008), as well as HCC nodules contiguous to viscera (p= 0.012). In the treatment of HCC, LAT has proved to be a safe and effective technique that enables to treat lesions not eligible for percutaneous approach, with a low morbidity rate.

Background: Hyperglycemia can promote the development of prostate cancer (PCa). Differential expression levels of miRNAs between PCa patients and controls were also reported. Therefore, we examined the relationship between hyperglycemia and miRNA levels in PCa. Methods: Relative expression of urinary miR-574-3p, miR-375, miR-205-5p, miR-200b-3p, miR-187-3p, miR-182-5p, and miR-100-5p were investigated in 105 PCa patients and 138 noncancer controls by Real-Time quantitative PCR. Fasting plasma glucose measurements were retrieved from clinical records. The differential miRNA expressions among groups were compared using non-parametric tests. Correlations with glucose and prostate-specific antigen (PSA) were tested using Pearson correlation coefficient. Results: When we analyzed miRNA expression according to glycemic state, significant down-regulations were found for miR-200b-3p, miR-187-3p, miR-182-5p, and miR-100-5p in noncancer controls with high glucose. The lowest down-regulations were observed for miR-187-3p, miR-182-5p, and miR-100-5p. Subsequently, when hyperglycemia was considered in PCa, significant dysregulations of selected miRNAs were found in hyperglycemic PCa patients than in controls with high glucose. In particular, miR-375 and miR-182-5p showed a 3-FC in hyperglycemic PCa patients than controls who left hyperglycemia untreated. Conversely, only a down-regulation of miR-574-3p was observed in PCa patients regardless of glycemic status and only modest down-regulation of miR-574-3p, miR-200b-3p, miR-187-3p and miR-182-5p were found in normoglycemic PCa patients. Next, significant correlations between miRNAs and glucose (miR-200b-3p, miR-100-5p) and PSA (miR-205-5p and miR-187-3p) were detected in controls. Similarly, miR-205-5p and miR-187-3p were correlated with glucose in PCa patients, while miR-574-3p and miR-375 showed inverse relationships. Conclusions: miRNA dysregulations can occur in hyperglycemic PCa patients as compared to noncancer controls who left hyperglycemia untreated. Hyperglycemia can consistently promote the expression of miR-375 and miR-182-5p. Uncontrolled hyperglycemic state could contribute to the creation of a suitable microenvironment for later PCa development by promoting gene expression.

The long known problem of rail corrugation has a strong impact on the maintenance costs of train lines and underground lines. In fact, the interaction between the train and the corrugated rail generates noise that produces discomfort for the passengers, as well as vibrations. Assessing the state of rail surfaces is a fundamental step for correctly planning the maintenance activities. Measurements are performed with specialized equipment, dedicated for the purpose, and often require a stop of the line. Hence, the possibility to mount a measurement device on board a line train is appealing. In this article, a novel approach for the measurement of rail corrugation is described focusing on short pitch corrugation. The proposed method relies on the analysis of the light polarization state using a division of focal plane (DoFP) polarimeter camera. In particular, the angle of polarization (AoP) change due to the interaction between light coming from an illuminator and the corrugated rail surface is used to retrieve the original rail shape by numerical integration. Unlike other measurement systems, the use of a camera allows for the estimation of several profiles along the whole rail width. The performance of the experimental system in laboratory conditions on a real underground line rail is analyzed. Results show a good correspondence between the test results and the ground truth, measured with a more corroborated measurement technique (i.e., a laser displacement sensor).

Temperature sensors have been widely developed to control the course of diseases, improve haptic feelings, and in multisensing systems to compensate for the output of other temperature-sensitive sensors. The use of additive manufacturing to produce resistive temperature detectors (RTDs) with reduced dimensions and bulkiness is attracting great interest. Among the relevant process parameters and design choices, the curing process must be considered. In this work, two different commercial metallic-based materials are cured at various temperatures to evaluate the differences in their microscopic and macroscopic behavior. The sensors were designed, developed, and evaluated for their temperature coefficient of resistance (TCR) at different curing temperatures using a programmable climatic chamber. A scanning electron microscope (SEM) has been used to microscopically inspect the sensing structures with respect to the different curing temperatures. The results show insightful correlations between the macroscopic and microscopic behavior of the used inks as well as the performance of the sensors. In particular, increasing the curing temperature decreased the room temperature resistance in all the samples by up to 70% and increased the sensitivity by up to 95%. These findings will help propose better processes as well as design choices for the development of printed resistive temperature sensors.

Obsessive‐compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long‐sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans‐ancestry INitiative for OCD genomics (LATINO, https://www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5000 richly phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans‐ancestry genomic analyses to accelerate the identification of OCD risk loci, fine‐map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.

The application of modal analysis is a well-established procedure for detecting damage in civil structures. However, implementing monitoring systems on civil structures could involve a large number of sensors leading to expensive and cumbersome setups. On the other hand, unmanned aerial vehicles (UAVs) are already employed for monitoring purposes. Moreover, using UAVs inspections can be executed close to structures and using a single measurement node that can be moved from one measurement point to another. In this article, a vision-based measurement procedure composed of a system mounted on a prototype drone is presented in order to perform modal analysis of a structure. This measuring system is equipped with a grayscale camera, a time-of-flight (ToF) sensor, and a trajectory tracking camera. This composition is necessary to measure vibrations by tracking features on the structure (grayscale camera) to convert vibrations from pixels to millimeters (ToF sensor) and to track the trajectory of the drone (trajectory tracking camera). This latter sensor is used to reduce the effect of the movement of the drone in relation to the vibrations of the structure and to reconstruct the 3-D geometry of the structure. The grayscale camera on the drone is synchronized with another fixed grayscale camera, that frames a point on the structure, used as the reference point for modal analysis. This measurement procedure was tested on a mock-up of a structure a few meters in size, and the results are compared with those obtained using accelerometers. The outcome of these tests proves that it is possible to correctly measure resonance frequencies (with errors lower than 0.3%) and to reconstruct mode shapes with cameras assembled on a drone, as well as to reconstruct the 3-D geometry of the points measured.

To overcome the limitation caused by the production of surface speckles, digital image correlation (DIC) with speckles generated by the light interference of lasers reflected from rough surfaces has been developed by researchers. However, such speckle patterns are highly dependent on the light path that is determined by the locations of the laser, the target surface, and the cameras, which leads to two problems: 1) the speckle distributions of the same subset are different for cameras of different locations, and thus, 3-D measurements based on stereo cameras are unavailable and 2) the speckle distributions are changing when the target is going through large displacements, and thus, measurements of large displacement are not available. In this article, a method to align the laser speckle subsets in the left and right cameras using printed or projected speckles is proposed to solve the first aforementioned problem, and a speckle updating method is proposed to solve the second problem. An experiment is performed to evaluate the feasibility and the accuracy of the proposed methods with standard DIC measurement results as benchmarks. The result suggests that both the methods provide accurate measurement result. The extra error caused by the method proposed for left–right alignment is minor and that by the speckle updating method is much better than the other existing solution.

The prediction of the dynamic loads produced by groups of people is a crucial aspect of the design of stadiums or entertainment venues. This is because the coordinated motion of lively crowds may induce severe vibration levels in the structure, which can become critical for both human comfort and structural safety. However, the available information on this topic is very limited. Human loads often rely on deterministic models that do not consider the interaction and the coordination achieved by the participants or try to account for them through empirical assumptions. Therefore, they could find very little correspondence in realistic scenarios. This article aims to close this gap by introducing a vision-based technique able to directly measure crowd loading and quantify the synchronization level between individuals. Starting from a sequence of images of a jumping crowd, digital image correlation (DIC) is used to extract the vertical velocity of different regions occupied by the participants; then, the vertical force time record is estimated. Finally, the comparison between the actual force signals and their envelopes allows for estimating the crowd synchronization over time. The method has been successfully validated with two field tests on the grandstands of the Giuseppe Meazza stadium in Milan, demonstrating its ability to reliably estimate the synchronization level reached by the participants.

Introduction: Vaccination strongly reduces the risk of hospitalization and death due to coronavirus disease 2019 (COVID-19). However, the severity of the acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and the degree of protection exerted over time by vaccination remains to be fully elucidated among hospitalized comorbid and vulnerable patients with SARS-CoV-2 infection. Methods: We report a case series of nine hospitalized vulnerable patients who developed a SARS-CoV-2 infection during a cardiac rehabilitation inpatient program. Results: Age ranged from 50 to 81 years. All but one patient had received at least three doses of anti-COVID-19 vaccine more than 4 months before the cardiac event. Indications for cardiac rehabilitation included acute coronary syndromes, congestive heart failure, heart valve surgery, and coronary artery bypass graft. After the confirmed diagnosis of SARS-CoV-2 infection, all patients developed symptoms. Eight patients developed at least one SARS-CoV-2-related complication, including a significant increase in high-sensitivity troponin I levels, new-onset hypoxemia, persistent atrial fibrillation, non-sustained ventricular tachycardia and recurrent sinus arrest, pericardial effusion, and a persistent increase in blood pressure. Conclusion: Almost all patients developed complications which, however, did not evolve towards more severe expressions of the disease. These data suggest that even in this new phase of the pandemic, vaccination may exert a potential role to reduce the risk of progression towards more severe disease of SARS-CoV-2 infection in vulnerable patients with cardiovascular comorbidities.

We present here results of the Quantum Technology Flagship project UNIQORN in the area of integrated photonics for quantum communication applications. Three distinct integration platforms, namely indium phosphide based monolithic integration, polymer-based hybrid integration and the CMOS-compatible silicon platform, have been employed to manufacture components and sub-systems on chip for quantum communication devices. The choice of different platforms was made to exploit the best characteristics of each platform for the intended quantum communication device. The indium phosphide platform was employed to manufacture a transmitter chip for quantum key distribution featuring laser, modulators, and attenuators. The transmitter chip was evaluated in a QKD experiment achieving a secure rate of 1 kbit/s. The polymer platform was investigated for engineering non-classical light sources. Entangled and heralded single-photon sources, based on non-linear optics, were assembled on the polymer in a hybrid fashion together with waveguides and other passive micro-optical elements. A quantum random number generator, featuring a 70% randomness extraction efficiency, was also fabricated using the polymer integration technique. An array of 32 individual single-photon avalanche diodes, operating at room temperature and featuring an onboard coincidence logic, was coupled to the chip to demonstrate direct detection of photons on the polymer. Finally, a transimpedance amplifier based on gallium arsenide high electron mobility transistors was produced with an exceptional large electrical noise clearance of 28 dB at 100 MHz.

Ocean waves are significantly damped by biogenic surfactants, which accumulate at the sea surface in every ocean basin. The growth, development, and breaking of short wind-driven surface waves are key mediators of the air–sea exchange of momentum, heat and trace gases. The mechanisms through which surfactants suppress waves have been studied in great detail through careful laboratory experimentation in quasi-one-dimensional wave tanks. However, the spatial scales over which this damping occurs in structurally complex surfactant slicks on the real ocean have not been resolved. Here, we present the results of field observations of the spatial response of decimetre- to millimetre-scale waves to biogenic surfactant slicks. We found that wave damping in organic material-rich coastal waters resulted in a net (spatio-temporally averaged) reduction of approximately 50% in wave slope variance relative to the open ocean for low to moderate wind speeds. This reduction of wave slope variance is understood to result in a corresponding reduction in momentum input to the wave field. This significant effect had thus far evaded quantification due in large part to the enormous range of scales required for its description—spanning the sea surface microlayer to the ocean submesoscale.

Monitoring general practitioner prescribing costs is an important topic in order to efficiently allocate National Health Insurance resources. Using generalized additive models for location, scale, and shape with random effects, we investigate how second-order variables, related to patients, contribute to estimating the frequency, severity, and hence the total amount of costs. The total cost of prescriptions associated with a general practitioner is then derived following a collective risk theory approach by aggregating cumulants of patient cost distributions. By means of the fourth-order Cornish-Fisher expansion series of quantiles of the aggregate cost distribution of general practitioners, we construct a confidence interval for each doctor, which is used to select a subset of doctors that should be monitored to identify potential inefficiencies. A case study is developed by using structured data regarding the number and cost of prescriptions of about 900,000 patients linked to corresponding general practitioners. The prescription costs considered are only those paid fully by the national health coverage.

Colorectal cancer screening is recommended for people aged 50–75 years, but the optimal screening test and strategy are not established. We aimed to compare single CT colonography versus three faecal immunochemical test (FIT) rounds for population-based screening of colorectal cancer.

This work serves as an observation‐based exploration into the role of wave‐driven turbulence at the air‐sea interface by measuring Turbulent Kinetic Energy (TKE) dissipation rates above and below the sea surface. Subsurface ocean measurements confirm a TKE dissipation rate enhancement relative to the predicted law‐of‐the‐wall (εobs> εp), which appears to be fully supported by wave breaking highlighting the role of the transport terms in balancing the subsurface TKE budget. Simultaneous measurements of TKE dissipation rates on the atmospheric side capture a deficit relative to the law‐of‐the‐wall (εobs< εp). This deficit is explained in terms of wave‐induced perturbations, with observed convergence to the law‐of‐the‐wall at 14 m above mean sea level. The deficit on the atmospheric side provides an estimate of the energy flux divergence in the wave boundary layer. An exponential function is used to integrate in the vertical and provide novel estimates of the amount of energy going into the wave field. These estimates correlate well with classic spectral input parameterizations and can be used to derive an effective wave‐scale, capturing wind‐wave coupling purely from atmospheric observations intimately tied to wave‐induced perturbations of the air‐flow. These atmospheric and oceanic observations corroborate the commonly assumed input‐dissipation balance for waves at wind speeds in the 8‐14 ms−1range in the presence of developed to young seas. At wind speeds above 14 ms−1under young seas (U10cp>1.2$\sfrac{{U}_{10}}{{c}_{p}} > 1.2$)observations suggest a deviation from the TKE input‐dissipation balance in the wave field. A long‐term field campaign on the Western North Atlantic shelf provided observations of Turbulent Kinetic Energy (TKE) dissipation rates on both sides of the sea surface. These observations were used to track the energy exchange between the atmosphere and ocean that is mediated by surface waves. Deviations from the expected law‐of‐the‐wall scaling in our TKE dissipation rate estimates were linked to wind energy input leading to wave growth, wave breaking and the subsequent TKE injection into the water column. Observations confirm the subsurface enhancement of TKE relative to the classic law‐of‐the‐wall and showcase a TKE deficit on the atmospheric side. Atmospheric and oceanic TKE dissipation rates converge to the expected law‐of‐the‐wall profiles away from the surface but clearly show the importance of waves in atmosphere‐ocean interaction closer to the sea surface. Deviations from the law‐of‐the‐wall are presented as signature of wave‐induced turbulence close to the ocean surface. Turbulent Kinetic Energy (TKE) dissipation rates across the interface show a deficit and enhancement supported by the wave fieldA depth integrated subsurface TKE budget highlights the relevance of the transport terms and their connection to wave breakingThe atmospheric TKE dissipation rate deficit can be explained in terms of wave‐induced perturbations mediating energy input to the waves Turbulent Kinetic Energy (TKE) dissipation rates across the interface show a deficit and enhancement supported by the wave field A depth integrated subsurface TKE budget highlights the relevance of the transport terms and their connection to wave breaking The atmospheric TKE dissipation rate deficit can be explained in terms of wave‐induced perturbations mediating energy input to the waves

Prone positioning is a therapeutic intervention to improve oxygenation in patients with severe acute respiratory distress syndrome (ARDS). [1] Several clinical studies evaluated the safety and efficacy of prone positioning in mechanically ventilated patients; however, a higher frequency of thrombotic and hemorrhagic events has been reported (especially in critically ill patients with severe COVID-19). [2] This study described the prevalence and the characteristics of each hemorrhagic event occurred during prone positioning in critically ill patients with severe ARDS.

The endoplasmic reticulum (ER) is a single-copy organelle that cannot be generated de novo, suggesting coordination between the mechanisms overseeing ER integrity and those controlling the cell cycle to maintain organelle inheritance. The Unfolded Protein Response (UPR) is a conserved signaling network that regulates ER homeostasis. Here, we show that pharmacological and genetic inhibition of the UPR sensors IRE1, ATF6, and PERK in unstressed cells delays the cell cycle, with PERK inhibition showing the most penetrant effect, which was associated with a slowdown of the G1-to-S/G2transition. Treatment with the small molecule ISRIB to bypass the effects of PERK-dependent phosphorylation of the translation initiation factor eIF2α had no such effect, suggesting that cell cycle timing depends on PERK’s kinase activity but is independent of eIF2α phosphorylation. Using complementary light and electron microscopy and flow cytometry-based analyses, we also demonstrate that the ER enlarges before mitosis. Together, our results suggest coordination between UPR signaling and the cell cycle to maintain ER physiology during cell division.

Compound hot–dry events—co-occurring hot and dry extremes—frequently cause damages to human and natural systems, often exceeding separate impacts from heatwaves and droughts. Strong increases in the occurrence of these events are projected with warming, but associated uncertainties remain large and poorly understood. Here, using climate model large ensembles, we show that mean precipitation trends exclusively modulate the future occurrence of compound hot–dry events over land. This occurs because local warming will be large enough that future droughts will always coincide with at least moderately hot extremes, even in a 2 °C warmer world. By contrast, precipitation trends are often weak and equivocal in sign, depending on the model, region and internal climate variability. Therefore, constraining regional precipitation trends will also constrain future compound hot–dry events. These results help to assess future frequencies of other compound extremes characterized by strongly different trends in the drivers.

Obesity negatively affects physical and psychological health and increases health care costs. Although there is increasing interest in early diagnosis and timely intervention, there are several principles of care included in the current guidelines for clinical management of obesity that can potentially be updated and improved to address the “clinical inertia” and, consequently, to optimize the management of adult obesity. Using an online Delphi-based process, an Italian board of experts involved in the management of obesity discussed the usefulness of a pro-active approach to the care of patients with obesity, providing a consensus document with practical indications to identify risk factors for morbidity and death and raise awareness throughout the treatment continuum, including the early stages of the disease. In clinical practice, it seems inappropriate to delay an intervention that could avoid progression to a more severe level of obesity and/or prevent the onset of obesity-related comorbidities.

Background: Microinvasion (MI), defined as infiltration of the portal or hepatic vein or bile duct and intrahepatic metastasis are accurate indicators of a poor prognosis for mall hepatocellular carcinomas (HCC). A previous study showed that intraoperative ultrasound (IOUS) definition of MI-HCC had a high concordance with histological findings. Aim of this study is to evaluate overall survival and recurrence patterns of patients with MI-HCC submitted to hepatic resection (HR) or laparoscopic ablation therapies (LAT). Methods: A total of 171 consecutive patients (78 h; 93 LAT) with single, small HCC (&lt; 3 cm) with a MI pattern at IOUS examination were compared analyzing overall survival and recurrence patterns using univariate and multivariate analysis and weighting by propensity score. Results: Overall recurrences were similar in the 2 groups (HR: 51 patients (65%); LAT: 66 patients (71%)). The rate of local tumor progression in the HR group was very low (5 pts; 6%) in comparison to LAT group (22 pts; 24%; p= 0.002). The overall survival curves of HR are significantly better than that of the LAT group (p= 0.0039). On the propensity score Cox model, overall mortality was predicted by the surgical treatment with a Hazard ratio 1.68 (1.08–2.623) (p= 0.022). Conclusions: If technically feasible and in patients fit for surgery, HR with an adequate tumor margin should be preferred to LAT in patients with MI-HCC at IOUS evaluation, to eradicate MI features near the main nodule, which are relatively frequent even in small HCC (&lt; 3 cm).

We report a facile and robust room-temperature NO2sensor fabricated using bi- and multi-layered 2H variant of tungsten di-selenide (2H-WSe2) nanosheets, exhibiting high sensing characteristics. A simple liquid-assisted exfoliation of 2H-WSe2, prepared using ambient pressure chemical vapor deposition, allows smooth integration of these nanosheets on transducers. Three sensor batches are fabricated by modulating the total number of layers (L) obtained from the total number of droplets from a homogeneous 2H-WSe2dispersion, such as ∼2L, ∼5–6L, and ∼13–17L, respectively. The gas-sensing attributes of 2H-WSe2nanosheets are investigated thoroughly. Room temperature (RT) experiments show that these devices are specifically tailored for NO2detection. 2L WSe2nanosheets deliver the best rapid response compared to ∼5–6L or ∼13–17L. The response of 2L WSe2at RT is 250, 328, and 361% to 2, 4, and 6 ppm NO2, respectively. The sensor showed nearly the same response toward low NO2concentration even after 9 months of testing, confirming its remarkable long-term stability. A selectivity study, performed at three working temperatures (RT, 100, and 150 °C), shows high selectivity at 150 and 100 °C. Full selectivity toward NO2at RT confirms that 2H-WSe2nanosheet-based sensors are ideal candidates for NO2gas detection.

Supplemental Digital Content is available in the text.

We present a wearable time-domain near infrared spectroscopy (TD-NIRS) system (two wavelengths, one detection channel), which fits in a backpack and performs real-time hemodynamic measurements on the brain and muscle tissues of freely moving subjects. It can provide concentration values of oxygenated hemoglobin (O_2Hb), deoxygenated hemoglobin (HHb), total hemoglobin (tHb = O_2Hb + HHb) and tissue oxygen saturation (StO_2). The system is battery-operated and can be wirelessly controlled. By following established characterization protocols for performance assessment of diffuse optics instruments, we achieved results comparable with state-of-the-art research-grade TD-NIRS systems. We also performed in-vivo measurements such as finger tapping (motor cortex monitoring), breath holding (prefrontal cortex monitoring and forearm muscle monitoring), and outdoor bike riding (vastus lateralis muscle monitoring), in order to test the system capabilities in evaluating both muscle and brain hemodynamics.

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection.

The SARS-CoV-2 epidemic is pressuring healthcare systems worldwide. Disease outcomes in certain subgroups of patients are still scarce, and data are needed. Therefore, we describe here the experience of four dialysis centers of the Brescia Renal COVID Task Force. During March 2020, within an overall population of 643 hemodialysis patients, SARS-CoV-2 RNA positivity was detected in 94 (15%). At disease diagnosis, 37 of the 94 (39%) patients (group 1) were managed on an outpatient basis, whereas the remaining 57 (61%) (group 2) required hospitalization. Choices regarding management strategy were made based on disease severity. In group 1, 41% received antivirals and 76% hydroxychloroquine. Eight percent died and 5% developed acute respiratory distress syndrome (ARDS). In group 2, 79% received antivirals and 77% hydroxychloroquine. Forty two percent died and 79% developed ARDS. Overall mortality rate for the entire cohort was 29%. History of ischemic cardiac disease, fever, older age (over age 70), and dyspnea at presentation were associated with the risk of developing ARDS, whereas fever, cough and a C-reactive protein higher than 50 mg/l at disease presentation were associated with the risk of death. Thus, in our population of hemodialysis patients with SARS-CoV-2 infection, we documented a wide range of disease severity. The risk of ARDS and death is significant for patients requiring hospital admission at disease diagnosis.

Large-format single-photon avalanche diode (SPAD) arrays often suffer from low fill-factors—the ratio of the active area to the overall pixel area. The detection efficiency of these detector arrays can be vastly increased with the integration of microlens arrays designed to concentrate incident light onto the active areas and may be refractive or diffractive in nature. The ability of diffractive optical elements (DOEs) to efficiently cover a square or rectangular pixel, combined with their capability of working as fast lenses (i.e., ∼f/3) makes them versatile and practical lens designs for use in sparse photon applications using microscale, large-format detector arrays. Binary-mask-based photolithography was employed to fabricate fast diffractive microlenses for two designs of 32×32 SPAD detector arrays, each design having a different pixel pitch and fill-factor. A spectral characterization of the lenses is performed, as well as analysis of performance under different illumination conditions from wide- to narrow-angle illumination (i.e., f/2 to f/22 optics). The performance of the microlenses presented exceeds previous designs in terms of both concentration factor (i.e., increase in light collection capability) and lens speed. Concentration factors greater than 33× are achieved for focal lengths in the substrate material as short as 190µm, representing a microlens f-number of 3.8 and providing a focal spot diameter of <4µm. These results were achieved while retaining an extremely high degree of performance uniformity across the 1024 devices in each case, which demonstrates the significant benefits to be gained by the implementation of DOEs as part of an integrated detector system using SPAD arrays with very small active areas.

ObjectiveTo estimate the predictive role of faecal haemoglobin (f-Hb) concentration among subjects with faecal immunochemical test (FIT) results below the positivity cut-off for the subsequent risk of advanced neoplasia (AN: colorectal cancer—CRC—or advanced adenoma).DesignProspective cohort of subjects aged 50–69 years, undergoing their first FIT between 1 January 2004 and 31 December 2010 in four population-based programmes in Italy.MethodsAll programmes adopted the same analytical procedure (OC Sensor, Eiken Japan), performed every 2 years, on a single sample, with the same positivity cut-off (20 µg Hb/g faeces). We assessed the AN risk at subsequent exams, the cumulative AN detection rate (DR) over the 4-year period following the second FIT and the interval CRC (IC) risk following two negative FITs by cumulative amount of f-Hb concentration over two consecutive negative FITs, using multivariable logistic regression models and the Kaplan-Meier method.ResultsThe cumulative probability of a positive FIT result over the subsequent two rounds ranged between 7.8% (95% CI 7.5 to 8.2) for subjects with undetectable f-Hb at the initial two tests (50% of the screenees) and 48.4% (95% CI 44.0 to 53.0) among those (0.7% of the screenees) with a cumulative f-Hb concentration ≥20 µg/g faeces. The corresponding figures for cumulative DR were: 1.4% (95% CI 1.3 to 1.6) and 25.5% (95% CI 21.4 to 30.2) for AN; 0.17% (95% CI 0.12 to 0.23) and 4.5% (95% CI 2.8 to 7.1) for CRC. IC risk was also associated with cumulative f-Hb levels.ConclusionThe association of cumulative f-Hb concentration with subsequent AN and IC risk may allow to design tailored strategies to optimise the utilisation of endoscopy resources: subjects with cumulative f-Hb concentration ≥20 µg/g faeces over two negative tests could be referred immediately for total colonoscopy (TC), while screening interval might be extended for those with undetectable f-Hb.

Electrospinning is a well know technology for the production of nano and micro fibers. Graphene has been used in different fields due to its unique stability. Reduced graphene oxide (rGO) is prepared from the reduction of graphene oxide. In this work, we electrospun of Polyvinyl Alcohol (PVA) solutions with rGO to combine the different physical properties of the materials, on a rotating collector to verify the influence of the solutions and rotation on the morphology of the fibers. The optimization of the process highlighted the influence of the flow rate and tip-collector distance in relation to the rotation speed used.

ObjectiveThe impact of a screening programme on colorectal cancer (CRC) incidence in its target population depends on several variables, including coverage with invitations, participation rate, positivity rate of the screening test, compliance with an invitation to second-level assessment and endoscopists’ sensitivity. We propose a synthetic indicator that may account for all the variables influencing the potential impact of a screening programme on CRC incidence.DesignWe defined the ‘rate of advanced adenoma on the target population’ (AA-TAP) as the rate of patients who received a diagnosis of advanced adenoma within a screening programme, divided by the programme target population. We computed the AA-TAP for the CRC Italian screening programmes (biennial faecal immunochemical test, target population 50–69 year olds) using the data of the Italian National Survey from 2003 to 2016, overall and by region, and assessed the association between AA-TAP and CRC incidence fitting a linear regression between the trend of regional CRC incidence rates in 50–74 year old subjects and the cumulative AA-TAP.ResultsIn 2016, the AA-TAP at a national level was 105×100 000, whereas significant differences were observed between the northern and central regions (respectively 126 and 149×100 000) and the South and Islands (36×100 000). The cumulative AA-TAP from 2004 to 2012 was significantly correlated with the difference between CRC incidence rates in 2013–2014 and those in 2003–2004 (p=0.009).ConclusionThe AA-TAP summarises into a single indicator the potential impact of a screening programme in reducing CRC incidence rates.

The quality of the forecasts, that is, the accuracy in predicting the observed streamflow, affects the decisions that can be taken thus determining the success or failure of hydropower operations, that is, the so‐called forecast value. Although preprocessing techniques can be employed to improve forecast quality, the corresponding improvement in forecast value to hydropower is not straightforward to anticipate because of the complex relationship between quality and value, which depends on the hydrometeorological regime and water system features. The objective of this paper is to demonstrate the value to hydropower reservoir operations of preprocessed (i.e., bias corrected and downscaled) subseasonal forecasts and to compare the forecast quality and value across and within seasons. We use the forecast ensembles provided by the European Center for Medium‐Range Weather Forecasts (ECMWF). We assess forecast quality in terms of bias, Continuous Ranked Probability Score (CRPS), and Continuous Ranked Probability Skill Score (CRPSS), and forecast value in terms of mean revenue and avoided unproductive spill. We consider daily subseasonal hydrometeorological forecasts covering lead times up to 1 month and a quantile mapping technique to preprocess the hydrometeorological forecasts. Forecasts are then used in a rolling horizon set up to optimize hydropower operations of the Verzasca hydropower system in the Alps (CH). Results show that preprocessing is essential to improve both forecast quality and value. Although hydropower reservoir operations benefit from considering forecasts all the yearlong, the relationship between forecast quality and value is complex and strongly depends on the metrics used to assess forecast quality and value and on the season. We jointly assess quality and value of subseasonal hydrometeorological forecasts for hydropower operationsUsing a preprocessing technique (in our case quantile mapping) is essential to improve both forecast quality and valueThe relationship between forecast quality and value is complex and strongly depends on the season and the metrics used to assess quality and value

Introduction: Peripherally Inserted Central Catheters and Midline Catheters are particularly attractive because of their favorable risk/benefit ratio. If the ideal venipuncture site is in an area inappropriate for catheter emergence, a valid alternative is the tunneling technique, which allows the exit site to be moved to reach the optimal position. There are two main types of tunneling techniques: standard tunnel, using a tunneling device (metal tunneler or peel-away tunneler), and pseudo-tunnel. As much as both are recognized as appropriate and safe, there are still few literature data indicating the criteria for choosing and using the two techniques and the possible related complications.Methods: This retrospective observational investigation analyzed data regarding intra- and post-procedural complications of tunneled catheters inserted using two different techniques. The sample was stratified into three subgroups: (1) Standard Tunnel (patients with no PLT or INR disorders), (2) Pseudotunnel (patients with no PLT or INR disorders), and (3) Pseudotunnel (patients with any PLT or INR disorder). Data regarding the procedure, at 24 h and 7 days were collected and analyzed.Results: A total of 143 patients who underwent tunneled catheter insertion were included in the study. Among these, 113 patients were divided into subgroups 1 and 2 and 30 were assigned to subgroup 3. No significant differences were found among the three subgroups regarding immediate, short, and medium-term tunnel complications.Conclusions: The findings of this study suggest that both standard and pseudo-tunnels provide comparable levels of safety and comfort for patients. It was noted that Pseudotunnel offers an equivalent level of safety for patients with coagulation disorders related to PLT and INR, rendering it comparable to a “minimally invasive procedure,” which necessitates the same precautions as a non-tunneled PICC.

Informal advice relations across units in an organization are beneficial for knowledge sharing and problem solving. Prior research suggests that despite their benefits, there are costs to informal advice relations across units. However, the mechanisms by which these costs are mitigated remain unclear. We theorize that this lack of clarity is because work factors have not been sufficiently considered. We examine one such work factor, specifically time pressure, and develop a cost-based explanation for how time pressure influences cross-unit advice relationships. We investigate two time-pressure levels. In the first, work is conducted under lower time pressure, and there is less likelihood of a negative outcome. In the second, work is conducted under higher time-pressure conditions, and there is a greater likelihood of a negative outcome. We theorize that under lower time-pressure conditions, the costs of advice relations across units are mitigated by reciprocal advice relationships. However, under higher time pressure, the cost of informal advice relations across units is higher owing to the need for quick coordination of advice, and these costs are mitigated by reciprocal advice relationships in conjunction with cross-unit formal workflow relationships. To test our hypotheses, we examine the informal advice network and formal workflow network in lower and higher time-pressure conditions among 118 members of the Information Technology and Systems division of a Formula One racing team. Our results indicate that under lower time-pressure conditions, reciprocal advice ties are sufficient to overcome costs. However, under higher time-pressure conditions, cross-unit advice ties are facilitated by reciprocal advice ties embedded in the workflow ties between units. Thus, our findings have implications for how knowledge is managed and how problems are solved in organizations.

We demonstrate that conductometric gas sensing at room temperature with SnO2nanowires (NWs) is enhanced by visible and supraband gap UV irradiation when and only when the metal oxide NWs are decorated with Ag nanoparticles (NPs) (diameter< 20 nm); no enhancement is observed for the bare SnO2case. We combine the spectroscopic techniques with conductometric gas sensing to study the wavelength dependency of the sensors’ response, showing a strict correlation between the Ag-loaded SnO2optical absorption and its gas response as a function of irradiation wavelength. Our results lead to the hypothesis that the enhanced gas response under UV–vis light is the effect of plasmonic hot electrons populating the Ag NPs surface. Finally, we discuss the chemiresistive properties of Ag-loaded SnO2sensor in parallel with the theory of plasmon-driven catalysis, to propose an interpretative framework that is coherent with the established paradigma of these two separated fields of study.

Background: Long peripheral catheters (LPCs) role in Difficult IntraVenous Access (DIVA) patients admitted to the emergency department has already been studied, resulting in a rapid, safe, and cost-effective procedure. Although their use in outpatient settings is established, there is a lack of studies assessing their benefits. In particular, rheumatologic outpatients affected by scleroderma, especially those affected by digital ulcers, are often treated with intravenous infusions of prostaglandin I2(PGI2) analog (IV-PGI2A).Objective and methods: From 1 October 2021 to 31 March 2024, we conducted a prospective study enrolling DIVA outpatients affected by systemic sclerosis or undifferentiated connective tissue disease who needed IV-PGI2A therapy at L. Sacco Hospital in Milan (Italy). Each treatment cycle consisted of four consecutive days of infusion of iloprost or alprostadil. The primary aim was to assess the efficacy and potential complications associated with LPCs for IV-PGI2A.Results: Twenty-six patients were enrolled 23 were females (88.5%), and the median age was 72 years (IQR 56–78.7). In total, 97 LPCs were inserted, with a mean number of insertions per patient/year of 2.3. An increase in LPCs insertion during the 30 months of the enrollment period was observed. Eighteen patients required more than one LPC placement, and in 61% of them, the second venipuncture was executed at a different site. No procedural complications were registered (accidental puncture of the brachial artery, accidental median nerve puncture, bleeding) nor late complications (Catheter-Related Thrombosis, Catheter-Related Bloodstream Infections, Accidental Removal).Conclusions: Our experience shows that LPCs could be valuable and safe for rheumatologic outpatients. The increased number of insertions and new and total patients enrolled each year defines the satisfaction of patients and health care professionals.

While neutral reactions involved in methane oxidation have been intensively studied, much less information is known about the reaction dynamics of the oxygen radical anion with methane. Here, we study the scattering dynamics of this anion–molecule reaction using crossed-beam velocity map imaging with deuterated methane. Differential scattering cross sections for the deuterium abstraction channel have been determined at relative collision energies between 0.2 and 1.5 eV and ab initio calculations of the important stationary points along the reaction pathway have been performed. At lower collision energies, direct backscattering and indirect complex-mediated reaction dynamics are observed, whereas at higher energies, sideways deuterium stripping dominates the reaction. Above 0.7 eV collision energy, a suppressed cross section is observed at low product ion velocities, which is likely caused by the endoergic pathway of combined deuteron/deuterium transfer, forming heavy water. The measured product internal energy is attributed mainly to the low-lying deformation and out-of-plane bending vibrations of the methyl radical product. The results are compared with a previous crossed-beam result for the reaction of oxygen anions with nondeuterated ̧methane and with the related neutral–neutral reactions, showing similar dynamics and qualitative agreement.

Purpose: Overweight and obesity affects 60% of adults causing more than 1.2 million deaths across world every year. Fight against involved different specialist figures and multiple are the approved weapons. Aim of the present survey endorsed by the Italian Society of Bariatric Surgery (SICOB) is to reach a national consensus on obesity treatment optimization through a Delphi process. Methods: Eleven key opinion leaders (KOLs) identified 22 statements with a major need of clarification and debate. The explored pathways were: (1) Management of patient candidate to bariatric/metabolic surgery (BMS); (2) Management of patient not eligible for BMS; (3) Management of patient with short-term (2 years) weight regain (WR) or insufficient weight loss (IWL); (4) Management of the patient with medium-term (5 years) WR; and (5) Association between drugs and BMS as WR prevention. The questionnaire was distributed to 65 national experts via an online platform with anonymized results. Results: 54 out of 65 invited panelists (83%) respond. Positive consensus was reached for 18/22 statements (82%); while, negative consensus (s20.4; s21.5) and no consensus (s11.5, s17) were reached for 2 statements, respectively (9%). Conclusion: The Delphi results underline the importance of first-line interdisciplinary management, with large pre-treatment examination, and establish a common opinion on how to properly manage post-operative IWL/WR. Level of evidence V: Report of expert committees.