Search

This paper considers the tasks of detecting and recognizing bearing faults in electric motors from the signals collected from supply currents, using machine learning techniques. In particular, following recent trends in AI, the main point of interest was focused towards interpretable solutions that provide explanations on the decisions taken by the classifiers. For this reason, decision trees were chosen, since they represent a classic machine learning approach which inductively learns tree structures from a collection of observations. Paths along the learnt trees can be easily interpreted as plain classification rules. An extensive experimental comparison shows the strong generalization capabilities of such a classifier. In particular, the present work reports results obtained in a highly challenging scenario, usually overlooked in the literature, where the system is tested on configurations of radial and torsional loads that have not been observed during training. The approach achieves over 90% of accuracy even on this cross-load generalization setting.

Background/Objectives: Alexithymia is characterized by a deficit in identifying and communicating feelings. Emerging evidence suggests that alexithymia is highly prevalent in migraine, in a complex interplay with psychiatric comorbidity. Pericranial/cervical muscle tenderness is a remarkable clinical feature in a large proportion of migraine patients. This pilot study aimed at investigating the relationship between alexithymia and pericranial/cervical muscle tenderness in female migraineurs. Methods: A total of 42 female patients fulfilling the diagnostic criteria for migraine were enrolled into this pilot, observational, cross-sectional study after informed consent was obtained. Each patient underwent a psychological assessment to identify any alexithymia by means of TAS-20, anxiety/mood comorbidity (by means of STAI-Y1 STAI-Y2, BDI-II), and migraine-related disability (by means of HIT-6), and a physical cranial/cervical musculoskeletal examination. Palpation of pericranial and cervical muscles was carried out in the standardized manner. A Cumulative Muscle Tenderness (CUM) score (0–6) was calculated for each patient. A multivariate analysis was performed to investigate any association amongst the TAS-20 score, the CUM score, and the following covariates: BDI-II, STAI-Y1, STAI-Y2, and HIT-6 scores, age, disease duration, monthly migraine days, and average head pain intensity in the previous three months. Results: Overall, 35.6% of the sample had alexithymia. The multivariate analysis detected a linear and independent relationship between the TAS-20 and CUM scores, with a statistically significant (p = 0.017) association. Conclusions: This pilot study suggests that alexithymia plays a role in increasing pericranial/cervical muscle tenderness in migraine, independently from psychiatric comorbidity. A novel therapeutical approach, targeting alexithymia, may well reduce muscular tenderness in female migraineurs.

The use of immune checkpoint inhibitors (ICIs) in cancer is increasing. Their side effects are mainly due to the triggering of autoimmunity, which are mild or moderate and include skin rash, colitis, hepatitis, endocrine disorders, myositis, interstitial lung disorder, etc., in most cases during the course of therapy. Autoimmune encephalitis (AE) is rare in cancer patients treated with ICIs. Fifty patients with ICI-related encephalitis were identified in a recent review. Herein, we report a case of pembrolizumab associated with AE with a favorable short-term prognosis. A 68-year-old man with malignant metastatic melanoma achieved complete remission after pembrolizumab treatment. However, 10 months after pembrolizumab cessation due to grade 3 diarrhea, he developed confusion, an altered mental status, progressive memory loss, and gait disturbance. He was admitted to the neurologic department, and a comprehensive neurological workup, brain magnetic resonance imaging, cerebral fluid analysis, EEG, and blood test allowed the diagnosis of autoimmune encephalitis. The patient was treated with plasmapheresis, a high dose of intravenous steroids, and intravenous immunoglobulins. The patient improved, and he is now well with a performance status of 1. This case is interesting since the AE developed approximately 10 months after the cessation of immunotherapy, the underlying cancer was in complete remission, and the AE showed a good response after the treatment was performed.

Rights of Nature (RoN) approaches as a tool to protect ecosystems and nature is gaining growing attention in academic and societal debates. Despite this new momentum, theoretical work is increasingly pointing out major problems and uncertainties related to such approaches. Inspired by this critical work, the paper considers RoN as a type of intervention that competes with those of other actors for the control of, and decision-making power over, natural resources. To understand the implications of such interventions, it is necessary to investigate how they shape, and are shaped by, local context. To that end, we look at Rights of Rivers (RoR) cases in New Zealand, Colombia and India. Investigating these well-researched cases, we aim to tease out the material and discursive contestations that emerge from the establishment and implementation of RoR interventions. We then propose an analytical approach that has emerged from our fieldwork and which can be useful in identifying the conflicts and contestations underpinning RoR.

The COVID-19 pandemic poses an ongoing global challenge, and several risk factors make people with multiple sclerosis (pwMS) particularly susceptible to running a severe disease course. Although the literature does report numerous articles on the risk factors for severe COVID-19 and vaccination response in pwMS, there is a scarcity of reviews integrating both these aspects into strategies aimed at minimizing risks. The aim of this review is to describe the risk of vulnerable pwMS exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the issues related to the SARS-CoV-2 vaccine and to evidence possible future strategies in the clinical management of pwMS. The authors searched for papers on severe COVID-19 risk factors, SARS-CoV-2 vaccination and people with multiple sclerosis in support of this narrative literature review. We propose a multilevel strategy aimed at: the evaluation of risk factors for severe COVID-19 in people with multiple sclerosis, identifying the most appropriate vaccination schedule that is safe for people on disease-modifying drugs (DMDs) and a strict follow-up of high-risk people with multiple sclerosis to allow for the prompt administration of monoclonal antibodies to manage COVID-19 risks in this patient population.

Hay is one of the primary constituents of ruminant feed, and rapid classification systems of nutritional value are essential. A reliable approach to evaluating hay quality is a combination of visual combined inspection by NIRS analysis. The analysis was carried out on 1,639 samples of hay collected from 2016 to 2021 in northern Italy. Discriminant analysis (DAPC) on five hay types (FOM, forage mixtures; APG, first alfalfa cutting with prevalence of graminaceous >50%; PRA, prevailing alfalfa >50%; PUA, purity alfalfa >95%; and PEM, permanent meadows) was performed by ex-ante visual inspection categorization and NIRS analysis. This study aimed to provide a complementary method to differentiate hay types and classify unknown samples. Two scenarios were used: i) all data were used for model training, and the discriminant functions were extracted based on all samples; ii) the assignment of each group was assessed without samples belonging to the training set group. DAPC model resulted in an overall assignment success rate of 66%; precisely, the success was 84, 79, 69, 37, and 27% for PUA, FOM, PRA, APG, and PEM, respectively. In the second scenario, three groups showed percentages of posterior assignment probability higher than 70% to only one group: PUA with PRA (~ 99%), PRA with PUA (~71%), and PEM with FOM (~75%). Discriminant analysis can be successfully used to differentiate hay types and could also be used to assess factors related to hay quality in addition to NIRS analysis.

Hybrid stepper motors are widespread in industrial automation due to their robustness and high torque performance in low speed range, e.g. 3D printers, pick and place, and generally in many low power positioning applications. In order to increase the efficiency and dynamic performance, current/speed/position closed loop controls are implemented for high performance sensored stepper drives. The main challenge comes from the high number of magnetic poles which these motors feature, increasing the ratio between the fundamental and switching frequency. This paper critically evaluates four current control structures based field oriented control: classic PI regulators, sliding mode control, deadbeat predictive current control and model predictive current control. Simulations and experimental results aim to evaluate the dynamic performance, phase current amplitude and distortion in order to support the critical comparison.

When compared to the much more common voltage-source inverter (VSI), the current-source inverter (CSI) is rarely used for variable speed drive applications, due to its disadvantages: the need of a constant DC-link current, typically realized with a front-end converter, and the need for reverse-voltage blocking (RVB) devices, typically implemented with in-series diodes. This limits the overall efficiency of the architecture. This paper investigates latest progress of the CSI research, with the aim of demonstrating why CSI could come back in the near future. Different architectures based on modern wide-bandgap (WBG) switches are analyzed, with an emphasis on why CSI can be advantageous compared to VSI.

Abstract We evaluated the effect of DMTs on Covid‐19 severity in patients with MS, with a pooled‐analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid‐19 severity was assessed by multivariate ordinal‐logistic models and pooled by a fixed‐effect meta‐analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti‐CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p

The arrival on the market of new power devices based on wide bandgap semiconductors has raised a relevant interest due to their superior properties compared to conventional technologies. On the other hand, these devices are inherently characterized by high rates of voltage changes over time, which may result in reliability challenges in electric drives adopting them. In fact, dangerous voltage overshoots at the motor terminals and uneven voltage distributions within the machine windings may occur. These phenomena can trigger a high insulation stress and partial discharges and, as a consequence, they may concur to the premature failure of the dielectric materials. This paper proposes a flexible and comprehensive modelling approach for the accurate analysis and estimation of both voltage overshoots and voltage distributions in a typical converter-cable-motor system intended for more electric aircraft applications. The modelling results are validated against experimental measurements carried out on a physical prototype comprising a wide bandgap-based converter, a connecting cable and an electrical machine stator. The findings are then used in the companion papers (part II and part III) to investigate the dependence of partial discharge phenomena on these voltage waveforms, highlight reliability challenges in modern ±270 V DC bus voltage drives for the more electric aircraft and discuss solutions.

Permanent grasslands represent the main terrestrial ecosystem and serve as an important global reservoir of biodiversity, providing a wide range of benefits to humans and ecosystems. The effects of environment on permanent meadows (in our survey, they were centuries-old meadows that had not been plowed, mowed, or fertilized with manure) production have been adequately investigated in literature. However, plant species composition impact on potential feed value of first cut has still to be understood, in particular regarding different agronomic management. Our field trial was carried out in five farms, in a territory involved in the value chain of the Parmigiano Reggiano PDO (Val d’Enza, Northern Italy), over a two-year period (2017–2018). Differences in botanical composition, biomass, and Pastoral Value index (PV), which synthesizes grassland yield and nutritional parameters, were investigated in depth. The herbage dry matter (DM) yield was affected by year, farm, and their interaction factors. Its highest value across the two years was recorded in farm 5 (11.7 tons of DM ha−1), which applied the highest rate of nitrogen fertilization. The botanical composition of the first cut has favored the presence of both Poaceae and ‘other species’ (each one around 40 plants per transect) compared to Fabaceae (seven plants per transect). However, higher numbers of Fabaceae plants (13 and 10) plausibly determined increases in PV in farms 3 and 5 (56.4 and 58.7, respectively). Although differences were observed among the most important nutritional parameters of grassland (crude protein, digestible and undigested neutral detergent fiber contents), suitable net energy for lactation (NEL) values for feeding lactating cows were always recorded during the two years of survey. The present study provides a contribution of knowledge on how the botanical composition of permanent meadows may affect their potential nutritive value as fresh herbage for feeding dairy cows. Considering these results, the agronomic management should seek a level of plant biodiversity that at the same time might guarantee satisfactory yield and feed value, also in a context of climate change.

Introduction: Pediatric-onset multiple sclerosis (POMS) is characterized by high inflammatory disease activity. Our aim was to describe the treatment sequencing and report the impact highly effective disease-modifying treatment (HET) had on disease activity. Materials and Methods: Five consecutive patients with POMS were administered HET following lower efficacy drug or as initial therapy. Data on treatment sequencing, relapses and MRIs were collected during the follow-up. Results: Our patients had an average age of 13.8 years (range 9–17) at diagnosis and 13.4 years (range 9–16) at disease onset, and 2/5 (40%) POMS were female. The pre-treatment average annualized relapse rate was 1.6 (range 0.8–2.8), and the average follow-up length was 5 years (range 3–7). A total of 2/5 (40%) patients were stable on HET at initial therapy, and 3/5 (60%) required an escalation to more aggressive treatment, even if two of them had been put on HET as initial treatment. Four out of five patients (80%) had No Evidence of Disease Activity-3 status (NEDA-3) at an average follow-up of 3 years (range 2–5). Conclusion: It has been observed that in a recent time period all the cases had prompt diagnosis, early HET or escalation to HET with a good outcome in 80% of the cases.

This paper analyzes in detail the effect of a simple solution for ground leakage current mitigation applicable to transformerless three-phase current source inverter (CSI). The circuit modification solution is assessed for both traditional CSI topology and for CSI with an additional seventh switch, in literature named CSI7 (or H7), in particular with the splitting of the dc input inductance. In the present work, the solution is applied to grid-connected converters for string photovoltaic applications: scope of the circuit modification is to provide an internal return path from the wye connected capacitors of the output CL filter. This additional return path is able to significantly reduce the ground leakage current without adversely affecting THD. The performance of the proposed solution is assessed by the numerical simulations in case of a string of photovoltaic (PV) modules and the different behavior of CSI and CSI7 topologies is thoroughly investigated. Furthermore, the definition of VcmZC is assessed by applying it to the common mode equivalent circuits for CSI7 with additional return path and their validation by means of a two-step simulation. The simulation results and experimental validation shows good agreement and confirm that the proposed solution is able to strongly reduce the ground leakage current.

This paper investigates the influence of power semiconductor parasitic components on the ground leakage current in the three-phase Current Source Inverter topology, in the literature called H7 or CSI7. This topology allows reducing converter conduction losses with respect to the classic CSI, but at the same time makes the topology more susceptible to the parasitic capacitances of the semiconductors devices. In the present work, a grid-connected converter for photovoltaic power systems is considered as a case study, to investigate the equivalent circuit for ground leakage current. The same analysis can be extended to applications regarding electric drives, since the HF model of electric machines is characterized by stray capacitance between windings and the stator slots/motor frame. Simulation results proved the correctness of the proposed simplified common-mode circuit and highlighted the need of an additional common-mode inductor filter in case of resonance frequencies of the common-mode circuit close to harmonics of the power converter switching frequency. Experimental results are in agreement with the theoretical analysis.

Background: Cerebrospinal fluid (CSF) kappa free light chains (KFLC) are gaining increasing interest as markers of intrathecal immunoglobulin synthesis. The main aim of this study was to assess the diagnostic accuracy (AUC) of the kappa index (CSF/serum KFLC divided by the CSF/serum albumin ratio) compared to CSF oligoclonal IgG bands (OCB) in predicting Multiple Sclerosis (MS) or a central nervous system infectious/inflammatory disorder (CNSID). Methods: We enrolled patients who underwent a diagnostic spinal tap throughout two years. KFLC levels were determined using a Freelite assay (Binding Site) and the turbidimetric Optilite analyzer. Results: Of 540 included patients, 223 had a CNSID, and 84 had MS. The kappa index was more sensitive (0.89 versus 0.85) and less specific (0.84 versus 0.89), with the same AUC (0.87) as OCB for MS diagnosis (optimal cut-off: 6.2). Adding patients with a single CSF IgG band to the OCB-positive group slightly increased the AUC (0.88). Likewise, the kappa index (cut-off: 3.9) was more sensitive (0.67 versus 0.50) and less specific (0.81 versus 0.97), with the same AUC (0.74) as OCB, for a CNSID diagnosis. Conclusion: The kappa index and CSF OCB have comparable diagnostic accuracies for a MS or CNSID diagnosis and supply the clinician with useful, complementary information.

The aim of this work was to study the yield and nutritional characteristics of winter wheat hay. A selection of cultivars recommended for three main purposes: grain, whole plant (biomass) and dual purpose (grain and biomass) production were cultivated and harvested from heading to grain dough stages. Yield dry weight (YDW), dry matter (DM) and undigested neutral detergent fiber (uNDF) increased with advancing maturity, ranging from 9 t ha−1, 20 and 11% of DM to 16 t ha−1, 43 and 17% of DM, respectively; while crude protein (CP) and neutral detergent fiber (NDF) decreased from 11 and 59% of DM to 6 and 54% of DM, respectively. Our study showed that dual purpose winter wheat cultivars displayed similar performance of CP, NDF and net energy for lactation, when harvested at heading or grain milk stages. In addition, winter wheat recommended to be harvested as whole plant showed similar values of YDW, sugar and starch contents, when harvested at grain dough and milk stages. These characteristics are strategic in hay production, allowing a more flexible harvesting strategy. These results might be useful to improve the hay production, given useful information on harvest time and improving agricultural sustainability covering the soil in autumn and winter.

Background: Thrombolysis in the elderly is still a matter of debate. Recently, the Third International Stroke Trial (IST-3) suggested that recombinant tissue plasminogen activator (rt-PA) improves functional outcome, without a substantial absolute increase in symptomatic intracranial hemorrhage, even in older patients. The aim of the current prospective study is to describe safety and functional outcome in a cohort of patients treated by intravenous rt-PA in an Italian stroke unit “real world setting”. Methods: All the consecutive patients treated with rt-PA between 2006 and 2010 in an Italian province with 290,000 inhabitants were enrolled. Total and symptomatic (associated with a 4-point worsening on the National Institutes of Health Stroke Scale [NIHSS] score) hemorrhages were evaluated, as safety measures, along with disability (at 3-month modified Rankin scale) as effectiveness measure. Results: One hundred and eighty-seven patients were treated with rt-PA; 90 males (48.1%); average age 75.1 (±11.9) years; 79 (42.2%) patients aged ≥80 years. Patients aged ≥80 years had a higher NIHSS score at stroke onset (13.5 vs. 10.9). No significant difference was found between patients aged

Acute confusional migraine (ACM) is recognized as a rare, but highly disabling migraine equivalent, mostly reported in children and adolescents. Herein we describe the case of a 12-year-old girl admitted to hospital for an acute confusional state and severe psychomotor agitation, associated with a pulsating headache and nausea, which turned out to be a manifestation of ACM. The girl was discharged on topiramate prophylaxis, titrated up to 75 mg/die; no recurrence of confusional and/or headache episodes has been reported over the last 14 months to date. Due to the rarity of this clinical entity, only anecdotal reports about acute and prophylactic treatment of ACM are available in the literature. The case reported herein suggests that topiramate seems to be effective in ACM prophylaxis, although a longer observation period in our patient and more cases are needed to confirm any long-term clinical benefit.

Rights of Nature (RoN) approaches as a tool to protect ecosystems and nature is gaining growing attention in academic and societal debates. Despite this new momentum, theoretical work is increasingly pointing out major problems and uncertainties related to such approaches. Inspired by this critical work, the paper considers RoN as a type of intervention that competes with those of other actors for the control of, and decision-making power over, natural resources. To understand the implications of such interventions, it is necessary to investigate how they shape, and are shaped by, local context. To that end, we look at Rights of Rivers (RoR) cases in New Zealand, Colombia and India. Investigating these well-researched cases, we aim to tease out the material and discursive contestations that emerge from the establishment and implementation of RoR interventions. We then propose an analytical approach that has emerged from our fieldwork and which can be useful in identifying the conflicts and contestations underpinning RoR. [ABSTRACT FROM AUTHOR]

The objective of the present work was to develop calibration equations for the prediction of chemical composition and forage digestibility from different populations of alfalfa hay harvested in Parmigiano- Reggiano cheese production area of Northern Italy. Due to annual climatic variations that affect soil and growing conditions and consequently cause high variability in chemical and physical composition, 319 hay samples from four years were used to build robust calibration. NIRS calibration equations were developed for the prediction of in vitro NDF digestibility (IVNDFd) and 20 chemical parameters (dry matter, starch, fat, sugar, fiber fractions, crude protein, nitrogen fractions and some minerals) of Italian hay. The results obtained show that NIRS equations greatly explain the variation in the composition existing in alfalfa hays grown in Northern Italy, except for a few parameters characterized by low variability range value. The equations obtained for the prediction of biological and chemical parameters explain the major part of the variation existing in the reference data, which open great prospects for the use of NIRS in planning feeding strategies of livestock, based on alfalfa forage.

• B-cell suppressor treatments are associated with the risk of breakthrough COVID-19 in our cohort. • We did not observe any case of severe COVID-19: vaccination fully protected our cohort of people with multiple sclerosis against severe breakthrough disease. • B-cell suppressor treatments and EDSS were factors associated with low antibody titers after vaccination. Disease modifying treatments (DMTs) for multiple sclerosis (MS) are effective in preventing both relapses and disability progression. Highly effective treatments (HETs) are more effective than platform therapy in preventing confirmed disability progression (CDP), when used early. Infections may complicate HETs administration, and their prevention through vaccination is crucial in order to assure the safety of people with MS (pwMS). The aim of the present study is to describe the effect of MS DMTs on COVID-19 vaccination and the risk of breakthrough infection in a cohort of pwMS. This is a monocentric retrospective observational study conducted at the MS center of the Guglielmo da Saliceto Hospital in Piacenza, Italy. One hundred and fifty-seven (157) pwMS who received two doses of the SARS-CoV-2 vaccine (with 80.3 % receiving a booster dose) were included in the study. fifty-six pwMS (35.7 %) were females, the mean age was 48.6 (SD: 12.87) years, and 59 (37.6 %) had at least one comorbidity. Twenty-five (15.9 %) breakthrough infections were observed, with 17 (68.0 %) classified as mild and 8 (32.0 %) as moderate. A multivariable linear regression model confirmed that B-cell suppressor DMTs and EDSS were factors associated with the latest antibody titre. Patients treated with B-cell suppressors exhibited a risk almost four times higher for breakthrough infections compared to other patients, with a hazard ratio (HR) of 3.72 (95 % CI: 1.50 – 9.27) (p = 0.005). B-cell suppressor DMTs are associated with the risk of breakthrough COVID-19 in our cohort, but vaccination fully protected pwMS against severe breakthrough disease. [ABSTRACT FROM AUTHOR]

Background and purpose: Dimethyl fumarate (DMF) causes a mean lymphocyte count drop of approximately 30% in relapsing–remitting multiple sclerosis (RRMS) patients. The relationship between this reduction and DMF effectiveness is controversial. The objective was to investigate if the decrease in absolute lymphocyte count (ALC) from baseline during DMF treatment is associated with clinical and magnetic resonance imaging (MRI) disease activity. A secondary aim was to evaluate ALC variations over time in a real‐life cohort of DMF‐treated patients. Methods: Demographic, laboratory, clinical and MRI data were collected in this observational multicentre study, conducted on RRMS patients treated with DMF for at least 6 months. Multivariate Cox models were performed to evaluate the impact of 6‐month ALC drop on time to no evidence of disease activity (NEDA‐3) status loss. NEDA‐3 is defined as absence of clinical relapses, MRI disease activity and confirmed disability progression. Results: In all, 476 patients (312 females, age at DMF start 38.4 ± 9.97 years) were analysed up to 5‐year follow‐up. A greater lymphocyte decrease was associated with a lower risk of NEDA‐3 status loss (hazard ratio 0.87, P = 0.01). A worse outcome in patients with lower ALC drop (<11.5%), compared with higher tertiles (11.5%–40.5% and >40.5%), was observed (P = 0.008). The nadir of ALC drop (−33.6%) and 35% of grade III lymphopaenia cases occurred after 12 months of treatment. Conclusion: A higher lymphocyte count drop at 6 months is related to better outcomes in DMF‐treated patients. A careful ALC monitoring should be pursued up to 24 months of treatment. [ABSTRACT FROM AUTHOR]

• Cognitive profile and physician-based and patients-reported outcomes could have a considerable impact on the disease management and on treatment decision making. • According to the Control Preference Scale, more than 50% of patients who needed to change therapy chose a "collaborative" role in making treatment decision. • Cognitive profile with SDMT seems to influence patients' preference on treatment decision. Clinicians are increasingly recognizing the importance of shared decision-making in complex treatment choices, highlighting the importance of the patient's rationale and motivation for switching therapies. This study aimed to evaluate the association between different modalities of changing multiple sclerosis (MS) treatments, cognitive profile and attitude and preferences of patients concerning treatment choice. This multicenter cross-sectional study was conducted at 28 Italian MS centers in the period between June 2016 and June 2017. We screened all MS patients treated with any DMT, with a treatment compliance of at least 80% of therapy administered during the 3 last months who needed to modify MS therapy because of efficacy, safety or other reasons during a follow-up visit. At the time of switching the symbol digit modalities test (SDMT) and the Control Preference Scale (CPS) were evaluated. According to the CPS, patients were classified as "active" (i.e. who prefer making the medical decision themselves), "collaborative" (i.e. who prefer decisions be made jointly with the physician), or "passive" (i.e. who prefer the physician make the decision). Out of 13,657 patients recorded in the log, 409 (3%) changed therapy. Of these, 336 (2.5%) patients, 69.6% were female and with mean age 40.6 ± 10.5 years, were enrolled. According to the CPS score evaluation, a significant high percentage of patients (51.1%) were considered collaborative, 74 patients (22.5%) were passive, and 60 (18.2%) patients were active. Stratifying according to CPS results, we found a higher SDMT score among collaborative patients compared to active and passive ones (45.8 ± 12.3 versus 41.0 ± 13.2 versus 41.7 ± 12.8, p < 0.05). In this study, the CPS evaluation showed that more than 50% of patients who needed to change therapy chose a "collaborative" role in making treatment decision. Cognitive profile with SDMT seems to correlate with patients' preference on treatment decision, showing better scores in collaborative patients. [ABSTRACT FROM AUTHOR]

• PM2.5, PM10 and NO2 are risk factors for Covid-19 pneumonia among MS patients. • We studied the joint exposure to the three pollutants as an environmental mixture. • The most dangerous pollutants within the mixture were NO2 and PM2.5. Many studies investigated the association between air pollution and Covid-19 severity but the only study focusing on patients with Multiple Sclerosis (MS) exclusively evaluated exposure to PM2.5. We aim to study, in a sample of MS patients, the impact of long-term exposure to PM2.5, PM10 and NO2 on Covid-19 severity, described as occurrence of pneumonia. A 1:2 ratio case-control study was designed, differentiating cases and controls based on Covid-19 pneumonia. Associations between pollutants and outcome were studied using logistic regression. Weighted quantile sum (WQS) logistic regression was used to identify the individual contribution of each pollutant within the mixture; Least Absolute Shrinkage and Selection Operator (LASSO) penalized regression was performed to confirm the variable selection from WQS. All the analyses were adjusted for confounders selected a priori. Of the 615 eligible patients, 491 patients provided detailed place of exposure and were included in the principal analysis. Higher concentrations of air pollutants were associated with increased odds of developing Covid-19 pneumonia (PM2.5: 3rd vs 1st tercile OR(95% CI)=2.26(1.29;3.96); PM10: 3rd vs 1st tercile OR(95% CI)=2.12(1.22;3.68); NO2: 3rd vs 1st tercile OR(95% CI)=2.12(1.21;3.69)). Pollutants were highly correlated with each other; WQS index was associated to an increased risk of pneumonia (β=0.44; p-value=0.004) and the main contributors to this association were NO2 (41%) and PM2.5 (34%). Consistently, Lasso method selected PM2.5 and NO2. Higher long-term exposure to PM2.5, PM10 and NO2 increased the odds of Covid-19 pneumonia among MS patients and the most dangerous pollutants were NO2 and PM2.5. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether COVID-19 could be a concurrent factor in the genesis and/or worsening of stroke and to provide data on COVID-19 -associated stroke patients during the first pandemic wave and comparative data on COVID-19 negative stroke patients in the same period.Materials and Methods: This is a retrospective, observational, case-control, single centre study, carried out in a General Hospital in northern Italy. Sixty-three consecutive stroke patients were included, COVID-19-associated stroke was classified as cases and non COVID-19-associated stroke as controls.Results: A total of 19/63 (28.8%) had a COVID-19-associated stroke, 11 /63 (17.5%) were haemorrhagic and 52/63 (82.5%) ischaemic. COVID-19-associated strokes were more severe (p-value 0.019) and had a higher risk of severe disability and/or death (OR 3.79, CI 95%: 1.21-11.93, p-value 0.19). The COVID-19-associated stroke patients with onset during hospitalization for COVID-19 had a more severe stroke than patients with COVID-19 onset during hospitalization for stroke (p-value 0.019).Conclusion: Although no relationship was observed between the stroke aetiology and COVID-19, intriguingly, COVID-associated stroke turned out to be more severe and disabling. Hopefully, further studies will provide more data and help in the management of this emerging population. [ABSTRACT FROM AUTHOR]

• The aim of this study was to construct such score and to evaluate its performance. • 3852 patients were included in the study and 17% of the patients required hospitalization. • This score can be used as an additional instrument to identify high-risk patients and persuade them to take important measures to prevent Covid-19 infection. Many risk factors for the development of severe forms of Covid-19 have been identified, some applying to the general population and others specific to Multiple Sclerosis (MS) patients. However, a score for quantifying the individual risk of severe Covid-19 in patients with MS is not available. The aim of this study was to construct such score and to evaluate its performance. Data on patients with MS infected with Covid-19 in Italy, Turkey and South America were extracted from the Musc-19 platform. After imputation of missing values, data were separated into training data set (70%) and validation data set (30%). Univariable logistic regression models were performed in the training dataset to identify the main risk factors to be included in the multivariable logistic regression analyses. To select the most relevant variables we applied three different approaches: (1) multivariable stepwise, (2) Lasso regression, (3) Bayesian model averaging. Three scores were defined as the linear combination of the coefficients estimated in the models multiplied by the corresponding value of the variables and higher scores were associated to higher risk of severe Covid-19 course. The performances of the three scores were compared in the validation dataset based on the area under the ROC curve (AUC) and an optimal cut-off was calculated in the training dataset for the score with the best performance. The probability of showing a severe Covid-19 course was calculated based on the score with the best performance. 3852 patients were included in the study (2696 in the training dataset and 1156 in the validation data set). 17% of the patients required hospitalization and risk factors for severe Covid-19 course were older age, male sex, living in Turkey or South America instead of living in Italy, presence of comorbidities, progressive MS, longer disease duration, higher Expanded Disability Status Scale, Methylprednisolone use and anti-CD20 treatment. The score with the best performance was the one derived using the Lasso selection approach (AUC= 0.72) and it was built with the following variables: age, sex, country, BMI, presence of comorbidities, EDSS, methylprednisolone use, treatment. An excel spreadsheet to calculate the score and the probability of severe Covid-19 is available at the following link: https://osf.io/ac47u/?view%5fonly=691814d57b564a34b3596e4fcdcf8580. The originality of this study consists in building a useful tool to quantify the individual risk for Covid-19 severity based on patient's characteristics. Due to the modest predictive ability and to the need of external validation, this tool is not ready for being fully used in clinical practice to make important decisions or interventions. However, it can be used as an additional instrument to identify high-risk patients and persuade them to take important measures to prevent Covid-19 infection (i.e. getting vaccinated against Covid-19, adhering to social distancing, and using of personal protection equipment). [ABSTRACT FROM AUTHOR]

Summary Background Thrombolysis in the elderly is still a matter of debate. Recently, the Third International Stroke Trial (IST-3) suggested that recombinant tissue plasminogen activator (rt-PA) improves functional outcome, without a substantial absolute increase in symptomatic intracranial hemorrhage, even in older patients. The aim of the current prospective study is to describe safety and functional outcome in a cohort of patients treated by intravenous rt-PA in an Italian stroke unit “real world setting”. Methods All the consecutive patients treated with rt-PA between 2006 and 2010 in an Italian province with 290,000 inhabitants were enrolled. Total and symptomatic (associated with a 4-point worsening on the National Institutes of Health Stroke Scale [NIHSS] score) hemorrhages were evaluated, as safety measures, along with disability (at 3-month modified Rankin scale) as effectiveness measure. Results One hundred and eighty-seven patients were treated with rt-PA; 90 males (48.1%); average age 75.1 (±11.9) years; 79 (42.2%) patients aged ≥80 years. Patients aged ≥80 years had a higher NIHSS score at stroke onset (13.5 vs. 10.9). No significant difference was found between patients aged <80 years and ≥80 years in mortality rate ( p = 0.1), total or symptomatic intracranial hemorrhage ( p = 0.52 and p = 0.085, respectively), whereas the 3-month disability was higher in octogenarians ( p = 0.004). Conclusion Thrombolysis in patients aged ≥80 years was not associated with significantly increased intracranial hemorrhage. The higher 3-month disability rate observed in octogenarians may be explained by the more severe stroke and higher poststroke disability. Based on the current, “real world setting” study, we advocate the need for a randomized clinical trial to better clarify the efficacy and safety of intravenous thrombolysis for acute ischemic stroke in the elderly. [ABSTRACT FROM AUTHOR]

Background and Purpose: an estimated 40-80% of acute ischemic stroke patients have dysphagia and about 14% develop stroke-associated pneumonia. However, it may be difficult to detect swallowing problems at admission. Moreover, there might not be an on-duty specialist skilled in the diagnosis of this condition. This study aimed at developing a user-friendly bedside examination to identify the risk of dysphagia in stroke patients at hospital admission.Methods: a diagnostic accuracy study was carried out to assess the concurrent validity of a simple Bedside Screening Tool for Dysphagia (BSTD) in acute stroke. All the consecutive stroke patients admitted between January and April 2018 were enrolled. Sensitivity, specificity, positive (PPV), negative predictive values (NPV) and the Cohen K concordance index scores, reported by nurses and speech-pathologists, were assessed.Results: a total of 67/120 patients (55.8%) were male; overall average age was 67.4 (range 45-91) and 80.8% of the whole population had a history of ischemic stroke. The nursing staff identified 33.3% of dysphagia cases at admission and the speech pathologists 30%. The Cohen K was 0.92 (optimal concordance when K was > 0.8), sensitivity was 100%, specificity 95.2%, PPV 90% and NPV 100%.Conclusions: our BSTD had a 100% negative predictive value, indicating that this screening test is very useful in ruling out/confirming dysphagia in acute stroke patients. [ABSTRACT FROM AUTHOR]

• The introduction of increasingly effective treatments has changed the MS scenario. • This study investigated the reasons that brought about modification of treatment. • In our study, out of 13,657 patients, 336 (3%) modified treatment. • 90.2% switched, 8.9% temporarily discontinued, and 0.9% permanently discontinued. • Efficacy remains the main driving force behind switching in 58.4% of patients. clinical factors and frequency of disease-modifying therapy (DMT) changes/interruptions in relapsing-remitting multiple sclerosis (RRMS) patients have not been well defined. The aim of this study was to describe reasons of MS treatment modifications in a large cohort of Italian MS patients. this multicenter, cross-sectional non interventional study (SWITCH) conducted at 28 Italian MS centers, screened, by visit/telephone contact between June 2016 and June 2017, all RRMS patients receiving stable DMT treatment and enrolled patients with change in DMT treatment. out of 13,657 recorded in the log, 409 (3%) changed therapy. Of these, 336 (2.5%), met the study criteria and were considered eligible. Among 303 (90.2% of 336) patients switching, the most common reason was "lack of efficacy" (58.4% of 303). Among 30 (8.9%) patients who interrupted treatment temporarily, the most common reason was pregnancy (40.0% of 30). Out of 3 (0.9%) patients who discontinued treatment permanently, 2 (66.7%) had as first reason as "patient decision". Multivariate analysis showed that EDSS was the only variable with statistically significant effect on changing treatments (r = 8.33; p -value of Type III Sum of Squares = 0.016). in our study, 303 (90.2% of eligible patients) switched treatment, 30 (8.9%) interrupted treatment temporarily, and 3 (0.9%) discontinued treatment permanently. Efficacy remains the main driving force behind switching behavior, as the primary aim of treatment is to be disease free or reduce disease activity. [ABSTRACT FROM AUTHOR]