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In the oil and gas industry, the need of Multiphase Flow Meters (MPFM) continues slowly to grow. The individual oil, gas and water flows rates measurements are important to monitor the reservoir, to improve the well performances and to optimize the well production. Traditionally the composition of the flow has been performed separating physically the phases with large, cumbersome, time consuming and expensive test separator vessels. A MPFM is, on the other hand, a compact multi-sensors system that provides real-time and continuous measurements of the individual oil, gas and water flows rates of a well without the need to separate the phases. Therefore, procedures for measure quality assessment are of crucial importance. In this work it is proposed an Anomaly Detection approach for MPFM based on unsupervised Machine Learning algorithms. It is effectively able to handle the complexity and variability associated with MPFM data and it has the capability both to detect outliers and to pinpoint the faulty sensor. The proposed approach is designed for embedded implementation.

Background Aim of the present study is to describe characteristics of COVID-19-related deaths and to compare the clinical phenotype and course of COVID-19-related deaths occurring in adults ( Method Medical charts of 3,032 patients dying with COVID-19 in Italy (368 aged < 65 years and 2,664 aged ≥65 years) were revised to extract information on demographics, preexisting comorbidities, and in-hospital complications leading to death. Results Older adults (≥65 years) presented with a higher number of comorbidities compared to those aged Conclusions Individuals dying with COVID-19 present with high levels of comorbidities, irrespective of age group, but a small proportion of deaths occur in healthy adults with no preexisting conditions. Non-respiratory complications are common, suggesting that the treatment of respiratory conditions needs to be combined with strategies to prevent and mitigate the effects of non-respiratory complications.

Supplemental material, sj-docx-1-tmj-10.1177_0300891620979358 for Postoperative complications after minimally invasive esophagectomy in the prone position: any anesthesia-related factor? by Cristian Deana, Luigi Vetrugno, Francesca Stefani, Andrea Basso, Carola Matellon, Federico Barbariol, Massimo Vecchiato, Antonio Ziccarelli, Francesca Valent, Tiziana Bove, Flavio Bassi, Roberto Petri and Amato De Monte in Tumori Journal

Background Among the unknowns posed by the coronavirus disease 2019 (COVID-19) outbreak, the role of biological sex to explain disease susceptibility and progression is still a matter of debate, with limited sex-disaggregated data available. Methods A retrospective analysis was performed to assess if sex differences exist in the clinical manifestations and transitions of care among hospitalized individuals dying with laboratory-confirmed SARS-CoV-2 infection in Italy (February 27–June 11, 2020). Clinical characteristics and the times from symptoms’ onset to admission, nasopharyngeal swab, and death were compared between sexes. Adjusted multivariate analysis was performed to identify the clinical features associated with male sex. Results Of the 32,938 COVID-19-related deaths that occurred in Italy, 3517 hospitalized and deceased individuals with COVID-19 (mean 78 ± 12 years, 33% women) were analyzed. At admission, men had a higher prevalence of ischemic heart disease (adj-OR = 1.76, 95% CI 1.39–2.23), chronic obstructive pulmonary disease (adj-OR = 1.7, 95% CI 1.29–2.27), and chronic kidney disease (adj-OR = 1.48, 95% CI 1.13–1.96), while women were older and more likely to have dementia (adj-OR = 0.73, 95% CI 0.55–0.95) and autoimmune diseases (adj-OR = 0.40, 95% CI 0.25–0.63), yet both sexes had a high level of multimorbidity. The times from symptoms’ onset to admission and nasopharyngeal swab were slightly longer in men despite a typical acute respiratory illness with more frequent fever at the onset. Men received more often experimental therapy (adj-OR = 2.89, 95% CI 1.45–5.74) and experienced more likely acute kidney injury (adj-OR = 1.47, 95% CI 1.13–1.90). Conclusions Men and women dying with COVID-19 had different clinical manifestations and transitions of care. Identifying sex-specific features in individuals with COVID-19 and fatal outcome might inform preventive strategies.

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Background: Rapid neuromuscular block reversal at the end of major abdominal surgery is recommended to avoid postoperative residual. To date, no study has evaluated sugammadex use and performance after rocuronium administration in patients undergoing liver transplantation. This is a randomized controlled trial with the primary objective of assessing the recovery time of neuromuscular transmission with sugammadex versus neostigmine after rocuronium administration in patients undergoing LTx. Methods The TOF-Watch SX® with calibration and linked to a portable computer with TOF-Watch SX Monitor Software® was used to monitor and record intraoperative neuromuscular block, maintained with a continuous infusion of rocuronium. Anaesthetic management was standardized as per our institution's internal protocol. At the end of surgery, neuromuscular moderate block reversal was obtained after administration of 2 mg/kg of sugammadex or 50 mcg/kg of neostigmine (plus 10 mcg/kg of atropine). Results: Data from 41 patients undergoing liver transplantation were analysed. In this population, neuromuscular block recovery time was faster after administration of sugammadex than neostigmine, with a mean value±SD of 9.4±4.6 min vs. 34.6±24.9 min respectively (p

In July 2017 a wave measuring buoy located south of New Zealand broke its mooring and started drifting, still transmitting the essential information. During its short mooring period it also measured a particularly high wave. We make a detailed analysis of the storm, the measured and model spectra allowing also a keen search of the suitability of the conditions for single large waves. The availability of the data in both moored and drifting conditions offers the possibility of a quantified discussion on the accuracy of the measurements in the two different situations.

Small-bore pleural drainage device insertion has become a first-line therapy for the treatment of pleural effusions (PLEFF) in the intensive care unit; however, no data are available regarding the performance of resident doctors in the execution of this procedure. Our aim was to assess the prevalence of complications related to ultrasound-guided percutaneous small-bore pleural drain insertion by resident doctors. In this single-center observational study, the primary outcome was the occurrence of complications. Secondary outcomes studied were as follows: estimation of PLEFF size by ultrasound and postprocedure changes in PaO2/FiO2 ratio. In all, 87 pleural drains were inserted in 88 attempts. Of these, 16 were positioned by the senior intensivist following a failed attempt by the resident, giving a total of 71 successful placements performed by residents. In 13 cases (14.8%), difficulties were encountered in advancing the catheter over the guidewire. In 16 cases (18.4%), the drain was positioned by a senior intensivist after a failed attempt by a resident. In 8 cases (9.2%), the final chest X-ray revealed a kink in the catheter. A pneumothorax was identified in 21.8% of cases with a mean size (±SD) of just 10 mm (±6; maximum size: 20 mm). The mean size of PLEFF was 57.4 mm (±19.9), corresponding to 1148 mL (±430) according to Balik’s formula. Ultrasound-guided placement of a small-bore pleural drain by resident doctors is a safe procedure, although it is associated with a rather high incidence of irrelevant pneumothoraces.

Supplemental material, 2706#Supplemental_material_1 for Assessment of Pleural Effusion and Small Pleural Drain Insertion by Resident Doctors in an Intensive Care Unit: An Observational Study by Luigi Vetrugno, Giovanni M Guadagnin, Federico Barbariol, Stefano D’Incà, Silvia Delrio, Daniele Orso, Rossano Girometti, Giovanni Volpicelli and Tiziana Bove in Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine

Previous epidemiological studies reported a significantly higher risk of Amyotrophic Lateral Sclerosis (ALS) in Italian male soccer players. As a consequence, sports newspapers and news agencies focused on this issue and spread the news of 51 male soccer players with a reported diagnosis of ALS.We searched news on male Italian national soccer players with a reported diagnosis of ALS quoted from January 1, 1950 to July 31, 2016 in at least two Internet web sites or in books by journalists.A total of 39 male soccer players with a reported diagnosis of ALS were identified. Subjects were born from 1905 to 1973, 32 were currently deceased, 6 were still living, while the status of 1 player was unknown. All gathered information was available for 29 soccer players. The group had a mean age at diagnosis of 45.3 ± 12.2 years, a mean age at onset of symptoms of 46.4 ± 12.1 years, and a mean age at death of 50.9 ± 12.3 years. A significant inverse correlation between year of birth and age at onset of symptoms was observed, with a younger age at onset of symptoms in soccer players born in more recent years (r = -0.65, p0.01).Italian male soccer players with a reported diagnosis of ALS have a significantly younger age at diagnosis when compared to other European patients with ALS. Results support a possible relationship between soccer and the risk of ALS. We believe that further research is urgently needed in this field.

Wave observations and modeling have recently demonstrated that wave extremes of short-crested seas are poorly predicted by statistics of time records. Indeed, the highest waves pertain to wave groups at focusing that have space–time dynamics. Therefore, the statistical prediction of extremes of short-crested sea states should rely on the multidimensional random wave fields’ assumption. To adapt wave extreme statistics to the space–time domain, theoretical models using parameters of the directional wave spectrum have been recently developed. In this paper, the influence of metocean forcings (wind conditions, ambient current, and bottom depth) on these parameters and hence on wave extremes is studied with a twofold strategy. First, parametric spectral formulations [Pierson–Moskowitz and Joint North Sea Wave Project (JONSWAP) frequency spectra with cos2 directional distribution function] are considered to represent the dependence of wave extremes upon wind speed, fetch, and space domain size. Afterward, arbitrary conditions are simulated by using the SWAN numerical model adapted to store the spectral parameters, and the effects on extremes of current- and depth-induced shoaling are investigated. Preliminarily, the space–time extremes prediction model adopted is assessed by means of numerical simulations of Gaussian random seas. Compared to the significant wave height of the sea state and for a given space domain size, results show that space–time extremes are enhanced by opposite currents, whereas they are weakened by increasing wind conditions (wind speed and fetch) and by depth-induced shoaling. In this respect, the remarkable contribution to wave extremes of the size of the space domain is substantiated.

Latex allergy is common in the hospital setting.To describe the clinical situation of three pediatric interns with latex allergy and the prevention strategies implemented during clinical clerkships in pediatric and neonatal intensive care units.The three interns referred symptom exacerbation during their internship program. Diagnosis was confirmed based on a compatible history and positive specific immunoglobulin E. A semi-structured interview was done to describe perceptions about prevention strategies, the personnel were trained, and nitrile gloves were provided for carrying out procedures. Interns completed their clinical clerkships without having allergic reactions. Positive aspects referred by interns were that they felt cared for and experienced an improved quality of life; negative aspects were a bad predisposition and resistance against change among some other interns. Strategies designed to this end permitted interns to continue their internship program.La alergia al látex es frecuente en ámbitos hospitalarios.Describir la situación clínica de tres residentes de Pediatría con alergia al látex y las estrategias de prevención en las rotaciones de Terapia Intensiva Pediátrica y Neonatal.Las tres profesionales manifestaron exacerbación de síntomas durante la residencia. Se confirmó el diagnóstico con historia compatible e inmunoglobulina E específica positiva. Se realizó una entrevista semiestructurada para describir sus percepciones en relación con las estrategias de prevención, se capacitó al personal y se incorporaron guantes de nitrilo para los procedimientos. Las residentes realizaron las rotaciones sin presentar manifestaciones alérgicas. Refirieron como aspectos positivos sentirse cuidadas y mejor calidad de vida; como aspectos negativos, mala predisposición y resistencia al cambio en algunos compañeros. Las estrategias diseñadas permitieron que las residentes pudieran continuar su programa de formación.

During liver transplantation surgery, the pulmonary artery catheter—despite its invasiveness—remains the gold standard for measuring cardiac output. However, the new EV1000 transpulmonary thermodilution calibration technique was recently introduced into the market by Edwards LifeSciences. We designed a single-center prospective observational study to determine if these two techniques for measuring cardiac output are interchangeable in this group of patients. Patients were monitored with both pulmonary artery catheter and the EV1000 system. Simultaneous intermittent cardiac output measurements were collected at predefined steps: after induction of anesthesia (T1), during the anhepatic phase (T2), after liver reperfusion (T3), and at the end of the surgery (T4). The 4-quadrant and polar plot techniques were used to assess trending ability between the two methods. We enrolled 49 patients who underwent orthotopic liver transplantation surgery. We analyzed a total of 588 paired measurements. The mean bias between pulmonary artery catheter and the EV1000 system was 0.35 L/min with 95% limits of agreement of − 2.30 to 3.01 L/min, and an overall percentage error of 35%. The concordance rate between the two techniques in 4-quadrant plot analysis was 65% overall. The concordance rate of the polar plot showed an overall value of 83% for all pairs. In the present study, in liver transplantation patients we found that intermittent cardiac output monitoring with EV1000 system showed a percentage error compared with pulmonary artery catheter in the acceptable threshold of 45%. On the others hand, our results showed a questionable trending ability between the two techniques.

A novel implementation of parameters estimating the space-time wave extremes within the spectral wave modelWAVEWATCH III (WW3) is presented. The new output parameters, available in WW3 version 5.16, rely on the theoretical model of Fedele (J Phys Oceanogr 42( 9): 1601-1615, 2012) extended by Benetazzo et al. (J Phys Oceanogr 45( 9): 2261-2275, 2015) to estimate the maximum secondorder nonlinear crest height over a given space-time region. In order to assess the wave height associated to the maximum crest height and the maximum wave height (generally different in a broad-band stormy sea state), the linear quasi-determinism theory of Boccotti (2000) is considered. The new WW3 implementation is tested by simulating sea states and space-time extremes over the Mediterranean Sea ( forced by the wind fields produced by the COSMO-ME atmospheric model). Model simulations are compared to space-time wave maxima observed on March 10th, 2014, in the northern Adriatic Sea (Italy), by a stereo camera system installed on-board the "Acqua Alta" oceanographic tower. Results show that modeled space-time extremes are in general agreement with observations. Differences are mostly ascribed to the accuracy of the wind forcing and, to a lesser extent, to the approximations introduced in the space-time extremes parameterizations. Model estimates are expected to be even more accurate over areas larger than the mean wavelength (for instance, the model grid size).

In this study, we present the analysis of the temporal profile and height of space-time (ST) extreme wind waves. Wave data were gathered from an observational ST sample of sea surface elevations collected during an active sea state, and they were examined to detect the highest waves (exceeding the rogue wave threshold) of specific 3D wave groups close to the apex of their development. Two different investigations are conducted. Firstly, local maximum elevations of the groups are examined within the framework of statistical models for ST extreme waves, and compared with observations and predictions of maxima derived by one-point time series of sea surface elevations. Secondly, the temporal profile near the maximum wave crests is analyzed and compared with the expectations of the linear and second-order nonlinear extension of the Quasi-Determinism (QD) theory. Our goal is to verify, with real sea data, to what extent, one can estimate the shape and the crest-to-trough height of near-focusing large 3D wave groups using the QD and ST extreme model results. From this study, it emerges that the elevations close to the crest apex are narrowly distributed around a mean profile, whilst a larger dispersion is observed away from the maximum elevation. Yet the QD model furnishes, on average, a fair prediction of the maximum wave heights, especially when nonlinearities are taken into account. Moreover, we discuss how the combination of ST extreme and QD model predictions allows establishing, for a given sea condition, the portrait of waves with very large crest height. Our results show that these theories have the potential to be implemented in a numerical spectral model for wave extreme prediction. (C) 2017 Elsevier Ltd. All rights reserved.

A novel implemtation of parameters estimating the space-time extremes within the spectral wave model WAVEWATCH III (WW3) is presented. The new output parameters, available in WW3 version 5.16, rely on the theoretical model of Fedele (J Phys Oceanogr 42(9): 1601-1615, 2012) extended by Benetazzo et al (J Phys Oceanogr 45(9):2261-2275, 2015) to estimate the maximum second-order nonlinear crest height over a given space-time region. In order to assess the wave height associated to the maximum crest height and the maximum wave height (generally different in a broad-band storrmy sea state), the linear quasi-deterministic theory of Boccotti (2000) is considered. The new WW3 implementation is tested in simulating sea states and space-time extremes over the Mediterranean Sea (forced by the wind fields produced by the COSMO-ME atmospheric model). Model simulations are compared to space-time wave maxima observed on March 10th, 2014, in the northern Adriatic Sea (Italy), by the stereo camera system installed on board of the "Acqua Alta" oceanographic tower. Results show that modeled space-time extremes are in general agreement with observations. Differences are mostly ascribed to the accuracy of the wind forcing and, to a lesser extent, to the approximations introduced in the space-time extremes parameterizations. Model estimates are expected to be even more accurate over areas larger than the mean wavelength (for instance, the model grid size)

Large scale particle image velocimetry (LSPIV) has become a reliable and accurate technique to measure water surface velocity field in open channels and rivers. The LSPIV technique is based on a camera view framing the water surface, complemented with image-processing methods to compute water surface displacements between consecutive frames. Using LSPIV, high flow velocities, such as flood conditions, are accurately measured, whereas determinations of low flow regimes is more challenging, especially in the absence of floating material carried by the stream. In fact, in unseeded conditions, typical surface feature dynamics must be taken into account. Indeed, besides surface structures advected by the current, capillary-gravity waves propagate on the surface, with their own speed and direction. In this study, the discrimination between these phenomena is discussed, providing a new method to distinguish and to correct unseeded LSPIV measurements with capillary-gravity wave dynamics. Current velocity obtained with such a correction at low flow speed in an artificial channel and in a natural river is in fair agreement with reference observations indicating the need of accounting for the speed and direction of capillary-gravity waves on the surface to obtain reliable measurements of the current vector field, and, as a further result, of the flow discharge over a river cross-section.

Between 19-22 January 2014 a baroclinic wave from the Atlantic region goes in cutoff over the Strait of Gibraltar. The resulting depression remains active for approximately 80 hours, passing off shore of the north African coast, crossing the Tyrrhenian Sea and the Adriatic Sea, before turning south. During the first phase (close to the Balearic islands) and when passing over the Adriatic, the depression assumes the characteristics of a TLC (Tropical Like Cyclones). Sea Surface Temperature (SST) is a very important factor for a proper numerical simulation of these events hence we chose to model this TLC event using the COAWST suite (Coupled Ocean Atmosphere Wave Sediment Transport Modelling System). In the first phase of our work we identified the best model configuration to reproduce the phenomenon, extensively testing different microphysics and PBL (Planetary Boundary Layer) schemes available in the numerical model WRF (Weather Research for Forecasting). In the second phase, in order to evaluate the impact of SST, we used the best physical set-up that reproduces the phenomenon in terms of intensity, trajectory and timing, using four different methods of implementation of the SST in the model: i)from a spectrum-radiometer at 8.3 km resolution and updated every six hours; ii) from a dataset provided by "MyOcean" at 1 km resolution and updated every 6 hours; iii) from COAWST suite run in coupled atmosphere-ocean configuration; iv) from COAWST suite in fully coupled atmosphere-ocean- wave configuration). Results show the importance of the selected microphysics scheme in order to correctly reproduce the TLC trajectory, and of the use of high-resolution and high-frequency SST fields, updated every hour in order to reproduce the diurnal cycles. Coupled numerical runs produce less intense heat fluxes which on turn result in better TLC trajectories, more realistic timing and intensity when compared with standalone simulations, even if the latter use a high resolution SST. Last, a temporary increase of the mixed layer depth along the trajectory of the TLC was exhibited by the fully coupled run during the two phases of maximum intensity of the phenomenon, when the wave field is more developed and acts more intensely on the vertical mixing. We will discuss how these results can be improved or further validated in proximity of land by using satellite information that will be available within the framework of H2020 CEASELESS project.

Starting from the results of a high-resolution forecast, nonlinear analysisof cross-sea conditions at the Draupner location reveals a situation strongly favorable to the appearance of particularly large waves

Large Scale Particle Image Velocimetry (LSPIV) is widely recognized as a reliable method to measure water surface velocity field in open channels and rivers. LSPIV technique is based on a camera view that frames the water surface in a sequence, and image-processing methods to compute water surface displacements between consecutive frames. Using LSPIV, high flow velocities, as for example flood conditions, were accurately measured, whereas determinations of low flow velocities is more challenging, especially in absence of floating seeding transported by the flow velocity. In fact, in unseeded conditions, typical surface features dynamics must be taken into account: besides surface structures convected by the current, capillary-gravity waves travel in all directions, with their own dynamics. Discrimination between all these phenomena is here discussed, providing a new method to distinguish and to correct unseeded LSPIV measurements associated with wavy structures, accounting for their phase speed magnitude and direction. This has been done measuring wavenumber vectors by using the same images exploited for PIV analysis. All measurements are performed without any flow seeding and in total absence of suspended materials, using the specular reflection of the water surface as a key marker. Results obtained at low-flow regimes in a straight concrete-made rectangular-section channel and in a river are satisfying, especially if compared to those obtained from classic LSPIV application without discrimination and correction. Moreover, a novel simple and safe procedure to orthorectify images is here presented.

Between the 4th and 10th of November 2011 a cut-off low developed in the western Mediterranean, parted from the Atlantic flow and evolved into a Tropical-Like Cyclone (TLC) around the Balearic Islands, where it persisted for three days. Between 12:00 UTC on 06 Nov and 12:00 UTC on 09 Nov, the TLC generated intense winds, heavy rainfall and waves up to 8 meters. To investigate the drivers of this event we ran a set of numerical simulations over the entire Mediterranean basin and extending to the "European" Atlantic ocean in order to account for the effects of the Atlantic circulation on the Mediterranean region. Different initial conditions, nesting and model coupling strategies have been tested with the COAWST system, which includes an atmospheric (WRF), an ocean circulation (ROMS), and a wave (SWAN) model, and pushing the horizontal grid spacing down to 5x5 km. Since the cyclone developed southern of the Iberian Peninsula and the Pyrenees, the sensitivity to topography was also explored. The results of the numerical experiments demonstrate how this event is strongly influenced by the initialization strategy and the balance of the initial fields with respect to the marine conditions and topography. In particular, two-way coupling the atmospheric model with ocean and wave models showed that the interaction with waves in the presence of a detailed SST fields can modify the distribution of heat fluxes, rainfall and horizontal pressure gradient. Also the 10 meters wind is conditioned by the coupling and by the wave-induced roughness patterns, especially in the southern part of the basin where the larger fetch produces more developed sea for the study of the case. The effect of atmosphere-ocean-waves interactions associated to the TLC is also pronounced in the marine variables, resulting in a decrease of SST and Mixed Layer thickness along the trajectory of the cyclone.

Using the new high-resolution operational model of ECMWF, we revisit the storm during which the Draupner freak wave of 1 January 1995 was recorded. The modeling system gives a realistic evolution of the storm highlighting the crucial role played by the southward propagating polar low in creating the extreme wave conditions present at the time the freak wave was recorded. We also discuss the predictability of the meteorological event. The hindcast wave spectra allow a new analysis of the probability of occurrence of the Draupner wave that we analyze not only in time at a specific position, but also in space. This leads us to discuss how exceptional the so-called freak waves really are. For a given sea state, as characterized by the significant wave height, they are namely part of the reality of the ocean, the key point being the probability of encountering them. In this respect, the often considered record at a specific location can be misleading because the probability of detecting a freak wave must be considered both in space and time.