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Atrial fibrillation (AF) is a frequent pathology in Internal Medicine departments. The aim of our study was to identify the risk factors associated with the development of new-onset AF during hospitalization and to evaluate its outcome as in-hospital mortality. We conducted a retrospective case–control study on a cohort of 14,179 patients admitted to an internal medicine department. We included in the study the patients who did not have an anamnestic history of AF, who presented a sinus rhythm at the time of admission and who developed a new-onset AF during hospitalization. For each of these cases, two controls were enrolled who were not affected by AF. The patients included in the study were 588, including 196 cases and 392 controls. Patients who developed AF during hospitalization had significantly more comorbidity than controls. The most frequent causes for hospitalization were sepsis, significantly higher in the case group. From the results of the multivariate analysis, the factors related independently to the development of AF were the presence of a number of comorbidities ≥ 3 (OR = 1.52; p = 0.017), sepsis as a reason of hospitalization (OR = 2, 16; p = 0.001) and glycemic value at the admission ≥ 130 mg/dL (OR = 1.44; p = 0.047). Both the length of hospital stay and in-hospital mortality were higher in the group of patients who developed AF, with a statistically significant difference compared to controls (p

In our research, we tested for the existence of cross-modal visual and tactile associations in the experience of abstract art. Specifically, we measured the association of 60 abstract paintings with four couples of antonyms related to texture, such as warm or cold, smooth or rough, lightweight or heavy, soft or hard, investigating if the different modality of presentation on a computer screen (color versions: natural colors, inverted colors, black and white) gave rise to different associations relative to the four couples of opponent qualities. Second, we tested whether there might be differences between the ratings of the paintings when they were presented as images on a computer screen versus in real life at the museum. The results confirmed that associations between visual and tactile experience with such complex stimuli exist. In the case of the couple warm or cold, a significant inversion of associated qualities occurs when the images are presented in inverted colors as opposed to natural colors; furthermore, when presented in black and white, warm evaluations are “cooled down,” but cold evaluations remain the same. The degree of smoothness could be considered not associated with the color versions. When seen in black and white, both the mean softness and the mean lightweight-ness of the paintings were reduced; however, in the last case, this effect was more evident for the most lightweight pictures. There is only a slight difference between the two presentations of the paintings as images presented on a computer screen and seen in real life, relative to the warm or cold and soft or hard dimensions. Of the four opponent qualities, the three pairs warm or cold, lightweight or heavy, and soft or hard showed the most interesting results in relation to the cross-modal associations.

To evaluate the role of performance status evaluated by the Eastern Cooperative Oncology Group (ECOG) score in predicting 30-day mortality in subjects hospitalized for community acquired pneumonia (CAP), this was a prospective study of patients consecutively hospitalized for CAP at a large University Hospital in Italy. Performance status was evaluated using the ECOG score that in a 0–5 point scale indicates progressive functional deterioration. The end-point of the study is the 30-day mortality. Two-hundred-sixteen patients were enrolled, 75.9% were aged > 70 years, 31.5% had severe pneumonia at CURB-65 score (3–4), and 27.5% of patients had severe disability (ECOG 3–4). Thirty-day mortality is 15.3%. Progression in ECOG score independently increases the probability of 30-day mortality at multivariable logistic regression analysis (HR 2.19, 95% CI 1.60–3.01, p

Background: Severe sepsis and septic shock are leading causes of morbidity and mortality among critically ill patients, thus the identification of prognostic factors is crucial to determine their outcome. In this study, we explored the value of procalcitonin (PCT) variation in predicting 30-day mortality in patients with sepsis admitted to an intermediate care unit. Methods: This prospective observational study enrolled 789 consecutive patients with severe sepsis and septic shock admitted to a medical intermediate care unit between November 2012 and February 2014. Kinetics of PCT expressed as percentage were defined by the variation between admission and 72 hours, and 24 and 72 hours; they were defined as Δ-PCT0-72h and Δ-PCT24-72h, respectively. Results: The final study group of 144 patients featured a mean age of 73 ± 14 years, with a high prevalence of comorbidities (Charlson index greater than 6 in 39%). Overall, 30-day mortality was 28.5% (41/144 patients). A receiver-operating-characteristic (ROC) analysis identified a decrease of Δ-PCT0-72h less than 15% (area under the curve: 0.75; 95% confidence interval (CI): 0.67 - 0.82) and a decrease of Δ-PCT24-72h less than 20% (area under the curve: 0.83; 95% CI: 0.74 - 0.92) as the most accurate cut-offs in predicting mortality. Decreases of Δ-PCT0-72h less than 15% (HR: 3.9, 95% CI: 1.6 - 9.5; P < 0.0001) and Δ-PCT24-72h less than 20% (HR: 3.1, 95% CI: 1.2 - 7.9; P < 0.001) were independent predictors of 30-day mortality. Conclusions: Evaluation of PCT kinetics over the first 72 hours is a useful tool for predicting 30-day mortality in patients with severe sepsis and septic shock admitted to an intermediate care unit. J Clin Med Res. 2015;7(9):706-713 doi: http://dx.doi.org/10.14740/jocmr2251w

It is often assumed that works of art have the ability to elicit emotion in their observers. An emotional response to a visual stimulus can occur as early as 120 ms after stimulus onset, before object categorisation can take place. This implies that emotions elicited by an artwork may depend in part on bottom-up processing of its visual features (e.g., shape, colour, composition) and not just on object recognition or understanding of artistic style. We predicted that participants are able to judge the emotion conveyed by an artwork in a manner that is consistent across observers. We tested this hypothesis using abstract paintings; these do not provide any reference to objects or narrative contexts, so that any perceived emotion must stem from basic visual characteristics. Nineteen participants with no background in art rated 340 abstract artworks from different artistic movements on valence and arousal on a Likert scale. An intra-class correlation model showed a high consistency in ratings across observers. Importantly, observers used the whole range of the rating scale. Artworks with a high number of edges (complex) and dark colours were rated as more arousing and more negative compared to paintings containing clear lines, bright colours and geometric shapes. These findings provide evidence that emotions can be captured in a meaningful way by the artist in a set of low-level visual characteristics, and that observers interpret this emotional message in a consistent, uniform manner.

Throughout recorded history, and across cultures, humans have made visual art. In recent years, the neural bases of creativity, including artistic creativity, have become a topic of interest. In this study we investigated the neural bases of the visual creative process with both professional artists and a group of control participants. We tested the idea that creativity (planning an artwork) would influence the functional connectivity between regions involved in the default mode network (DMN), implicated in divergent thinking and generating novel ideas, and the executive control network (EN), implicated in evaluating and selecting ideas. We measured functional connectivity with functional Magnetic Resonance Imaging (fMRI) during three different conditions: rest, visual imagery of the alphabet and planning an artwork to be executed immediately after the scanning session. Consistent with our hypothesis, we found stronger connectivity between areas of the DMN and EN during the creative task, and this difference was enhanced in professional artists. These findings suggest that creativity involves an expert balance of two brain networks typically viewed as being in opposition.

Although Renaissance artworks provide valuable information about the development of artistic depth cues, eye-movement studies of these works are rather scarce. This study examines how naïve viewers explore and perceive space and perspective in the Perugia Annunciation by Piero della Francesca (1467–1469). Seven participants viewed a high-quality image of the painting on a computer screen, while their eye movements were recorded with a video-oculographic device. Following recording, five subjects verbally described the painting, and all seven drew the painting from memory. Based on the sequence of ocular fixations, the authors conclude that the painting stimulates inquisitive spatial eye exploration, resulting in assimilation of complex spatial architectural details, even by naïve observers.

Why should vision science turn its gaze towards artworks? One possibility is that understanding visual processing might yield some fundamental insight into the nature of art. However, there are many examples of phenomena that can be seen - such as automobiles, clouds or leaves - but which are not explained in any deep sense by the properties of human visual perception. We examine one art historical question that might benefit from knowledge about the visual system: why do some artworks 'survive' historically while others fade into the dustbin of time? One possible reason, suggested by studies of rapid visual categorization, is that some objects are recognized more quickly and easily than others and thus are less culturally specific in terms of pictorial representation. A second, related, explanation is that many artistic techniques use the eyes as a channel to evoke other senses, cognition, emotions and the motor system. 'Art' is a social and historical construct - after all, the concept of 'fine art' was invented in the 18th century - and thus many aspects of artistic appreciation are specific to particular cultural and historical contexts. Some great works, however, may be adopted by successive generations because of an ability to appeal to a shared perceptual system.

Background B-type natriuretic peptide (BNP) represents a promising predictor of early (30 days) re-admission in patients with heart failure (HF) admitted to cardiology units. Whether BNP retains its predictive value in unselected patients admitted to general medical wards is unknown. Methods We determined BNP levels on admission and pre-discharge in 100 consecutive patients (71 male, mean age 78±10 years) admitted to a general medical unit due to decompensated HF. Follow-up after discharge was 30 days. Results Of the 100 patients, 86 had ≥1 comorbid conditions. Median BNP was 739 pg/ml on admission (25th–75th percentile 355–1333 pg/ml, respectively), and 414 pg/ml pre-discharge (25th–75th percentile 220–696 pg/ml). Seventeen patients were re-admitted or died within 30 days. Patients with pre-discharge BNP values >75th percentile (696 pg/ml) had greater risk of re-hospitalisation, as compared to values ≤696 pg/ml (56% vs. 4%, respectively; p 75th percentile were associated with a 15.0 independent relative hazard (RH) of early re-admission or death (95% CI 4.2–53.8; p

One of the basic limitations on visual perception is that it is impossible, in any given moment, to see the world sharply and full of colors beyond the central area of the visual field. This fact was popularized and brought to the attention of artists in the nineteenth century. To accurately represent the ‘impression’, or vision of a single glance, an artistic work should contain only a central area in focus surrounded by a progressively greater blur. The work of the Italian sculptor Medardo Rosso (1858–1928) may be the first artistic representation of differences in central and peripheral acuity. Despite using the medium of sculpture, typically three-dimensional, Rosso conceived of his art as two-dimensional because in a given moment it is possible to view a scene from only one viewpoint. The analysis of Rosso's photographs of his own sculptures emphasizes the areas of detail and relative blur, allowing a reconstruction of his point de vue unique—where the observer should stand when viewing that specific sculpture. We argue that the role of central and peripheral vision in subjective perception is critical to understanding the work of Rosso, aptly defined by critics as monument d'un instant.

There is a long-standing and fundamental debate regarding how emotion can be expressed by fine art. Some artists and theorists have claimed that certain features of paintings, such as color, line, form, and composition, can consistently express an "objective" emotion, while others have argued that emotion perception is subjective and depends more on expertise of the observer. Here, we discuss two studies in which we have found evidence for consistency in observer ratings of emotion for abstract artworks. We have developed a stimulus set of abstract art images to test emotional priming, both between different painting images and between paintings and faces. The ratings were also used in a computational vision analysis of the visual features underlying emotion expression. Overall, these findings suggest that there is a strong bottom-up and objective aspect to perception of emotion in abstract artworks that may tap into basic visual mechanisms.

There is a long-standing and fundamental debate regarding how emotion can be expressed by fine art. Some artists and theorists have claimed that certain features of paintings, such as color, line, form, and composition, can consistently express an “objective” emotion, while others have argued that emotion perception is subjective and depends more on expertise of the observer. Here, we discuss two studies in which we have found evidence for consistency in observer ratings of emotion for abstract artworks. We have developed a stimulus set of abstract art images to test emotional priming, both between different painting images and between paintings and faces. The ratings were also used in a computational vision analysis of the visual features underlying emotion expression. Overall, these findings suggest that there is a strong bottom-up and objective aspect to perception of emotion in abstract artworks that may tap into basic visual mechanisms.

Community-acquired pneumonia (CAP) represents a common cause of hospitalization in Internal Medicine wards and a frequent cause of antibiotic prescription. An approach based on procalcitonin (PCT) algorithm, has shown to reduce the antibiotic exposure without affecting outcome, in patients admitted to hospital for pneumonia We conducted a study to evaluate the role of a PCT algorithm in a real-life perspective, to reduce the length of antibiotic treatment (AT) in patients hospitalized with CAP. We performed a prospective case-control study, enrolling patients with CAP admitted to an Internal Medicine ward of Careggi Hospital, between December 2013 and February 2014. We used a validated algorithm of AT guided by PCT in CAP. Discontinuation of AT was strongly indicated when PCT level was normal or reduced by 80% in patients with PCT values higher than 10 pg/mL on admission. PCT was drawn on admission, 24 h, 4th day and 6th day from admission. The outcomes evaluated were the length of AT, the length of in hospital stay, mortality and serious adverse clinical events. Forty-six patients were consecutively enrolled. On 20 patients, AT was discontinued according to protocol and on 26 patients the AT was continued on clinical judgement. At the baseline, both groups were similar regarding clinical, laboratory, microbiology characteristics, and CURB-65 score. PCT guidance reduced total antibiotic exposure (5.1±1.5 vs 9.1±5.8 days, P=0.005) without any increase of mortality or serious clinical event. In our study, a PCT algorithm was a useful and safe tool to guide the AT in patients with CAP, reducing the antibiotic exposure.

Most artworks are explicitly created to evoke a strong emotional response. During the centuries there were several art movements which employed different techniques to achieve emotional expressions conveyed by artworks. Yet people were always consistently able to read the emotional messages even from the most abstract paintings. Can a machine learn what makes an artwork emotional? In this work, we consider a set of 500 abstract paintings from Museum of Modern and Contemporary Art of Trento and Rovereto (MART), where each painting was scored as carrying a positive or negative response on a Likert scale of 1-7. We employ a state-of-the-art recognition system to learn which statistical patterns are associated with positive and negative emotions. Additionally, we dissect the classification machinery to determine which parts of an image evokes what emotions. This opens new opportunities to research why a specific painting is perceived as emotional. We also demonstrate how quantification of evidence for positive and negative emotions can be used to predict the way in which people observe paintings.

We prospectively evaluated whether the N-terminal brain natriuretic peptide (NT-ProBNP) reduction percentage, during hospitalization for acutely decompensated heart failure (HF), has a prognostic significance in 6-month follow-up. In 120 patients consecutively admitted for acute HF to an internal medicine unit, plasma NT-ProBNP was measured on admission and at discharge. During a 6-month follow-up 52 (43.3%) patients had events: 9 (7.5%) died from cardiovascular causes, and 43 (35.8%) were readmitted for HF. In patients without events, the mean reduction percentage of NT-ProBNP was greater than in patients with events (39.5 +/- 7.4 versus 26.3 +/- 5.9%; P = 0.04). In receiver operating characteristic curve analysis, the mean area under the curve for NT-ProBNP reduction percentage was 0.63 (95% CI, 0.51-0.75; P = 0.04) for the composite end point (death or readmission), and 0.81 (95% CI, 0.65-0.97, P = 0.01) for cardiovascular mortality. NT-ProBNP reduction percentage less than 30% was the best cut-off for the identification of patients at risk of events. We suggest that in clinical practice the evaluation of change of NT-ProBNP levels during admission is probably more helpful than predischarge NT-ProBNP absolute value.