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Topical chlormethine (CL) gel formulation was approved by the EMA in 2017 for the treatment of adult patients with mycosis fungoides (MF). To expand the knowledge on the management of patients with MF, this paper provides an overview of clinical practice evidence about the MF diagnostic phase and a collection of clinical experiences to better characterize the use of CL gel in daily practice. Collected cases underline the importance of the concomitant biopsy and clinical evaluation in the diagnostic phase, with the contribution of a multidisciplinary team and support the use of CL gel as a first-line or adjuvant treatment in selected patients.

On 1 January 2001, the IEC 61000-3-2 regulation became effective. Since then, mitigating current harmonics has been essential to ensure that electronic equipment connected to single-phase power distribution lines conforms to electromagnetic compatibility directives. Today, high-quality rectification, commonly known as power factor correction (PFC), is a well-established technique widely adopted by the industry for powering various devices from the ac line. The topic has been studied by academia and industry since the mid-1980s; thus, an enormous amount of research has been published and countless solutions have been proposed since then. However, only a few of those solutions have encountered wide industrial usage. So, it is not the authors’ intention to provide a comprehensive review, but to take stock of the most used PFC techniques from an industry perspective. This paper will review the power factor theory with non-sinusoidal currents, the practical and regulatory aspects of using PFC, and the most common industry solutions for power factor correction in equipment operated from the single-phase, public, low-voltage supply system, with a special focus on boost PFC pre-regulators, their control methods, design procedures, and issues.

Abstract Background Effective pain management during labor induction for pregnancy termination is essential. However, to date, no effective treatment has been identified. The primary aim of this study was to measure the analgesic efficacy of a sufentanil sublingual tablet system during pregnancy termination and patient satisfaction by comparing nulliparous and multiparous women. The secondary aims were to characterize the safety profile by reporting any side effects or adverse events and to determine the need for rescue therapy. Methods We conducted an observational, retrospective, single-center study involving 48 women. The data retrieved for analysis included the total and hourly doses of sublingual sufentanil, evaluations of pain management satisfaction using a 5-point rating scale (ranging from 1, indicating “not satisfied” to 5, denoting “completely satisfied”), occurrence of side effects and adverse events, and the rate of rescue analgesic use. Categorical and numerical variables were compared between the two groups, and a correlation analysis was performed. Results The median total dose of sufentanil required was 60 mcg. Nulliparous women required a higher dose of sufentanil compared with multiparous women (105 mcg vs. 45 mcg; P = 0.01). Additionally, they underwent a longer labor, indirectly measured by the time of device usage (625 min vs. 165 min; P = 0.05). Regarding satisfaction, 40 patients (83.4%) were satisfied or completely satisfied, whereas only 8 patients (16.6%) reported dissatisfaction. Multiparous women exhibited higher satisfaction levels than did nulliparous women (P = 0.03). No adverse events were reported, and the most common side effects were nausea and vomiting (31.2%). Four patients (12%) required acetaminophen due to insufficient analgesia, with only one patient necessitating a switch to intravenous morphine. Conclusions Sublingual sufentanil was effective in both nulliparous and multiparous women with minimal side effects. Therefore, sublingual sufentanil can be considered a valid strategy for analgesia during labor induction for pregnancy termination.

Hydrogen, as a versatile and sustainable energy carrier, plays a pivotal role in the global transition towards a low-carbon economy. However, the safe and efficient operation of hydrogen production plants is paramount to exploiting the full potential of this clean energy source. This scientific article investigates typical HILP (High Intensity Low Probability) scenarios that can occur in hydrogen production plants and storage. The assessment is based on a HazOp (Hazard and Operability) study on a representative electrolysis unit. The study has been conducted through a multidisciplinary approach, integrating knowledge from chemical engineering, process safety and risk analysis, focusing on consequence modelling, to understand root causes, potential impacts and mitigation strategies. Through the analysis of plant design and operation parameters, the article identifies common vulnerabilities in hydrogen production processes. The main accident scenarios explored include equipment failures and leaks, each with the potential to compromise plant safety and disrupt production. Furthermore, the article analyses the dynamic interaction between technological progress and safety protocols in shaping the risk landscape of hydrogen production and storage facilities. The insights from this analysis help to propose possible risk management strategies, emphasising the importance of proactive safety measures, early detection systems and effective emergency response plans. By elucidating the typical incident scenarios in hydrogen production plants, this article seeks to enhance industry awareness, facilitate knowledge sharing, and drive continuous improvement in the design, operation, and maintenance of hydrogen facilities. The findings presented herein offer valuable insights for engineers, researchers, and policymakers working towards the widespread adoption of hydrogen as a clean and sustainable energy solution.

The management of dust hazards within industrial environments remains a critical concern, as sadly testified by the catastrophic events occurred in recent history. Dust Hazard Analysis (DHA) is a risk assessment technique used for identifying, managing, and mitigating the risks related to the handling, production, and storage of combustible dusts. This study explores the efficacy of employing a semi-quantitative approach within the framework of DHA, leveraging a Risk Matrix to assess and define the severity and likelihood of potential hazardous events associated with combustible dust. The semi-quantitative method presented herein integrates qualitative expert judgments with quantitative data, fostering a comprehensive evaluation of various scenarios involving dust-related hazards: central to this approach is the utilization of a Risk Matrix, where severity and likelihood classes are intersected to generate risk levels associated with identified dust-related scenarios. This allows the prioritization of mitigation strategies, focusing resources on high-risk scenarios while acknowledging lower-risk occurrences. Furthermore, the use of a common Risk Matrix facilitates the decision-making process, allowing the same benchmark to be applied to the recommendations and actions emerging from different risk assessment techniques (e.g., HazOp). The study underscores the value of a semi-quantitative approach in DHA, highlighting the potential and the limitations of the current model, offering a structured methodology that aids stakeholders in decision-making processes concerning risk mitigation and control measures, ensuring the safety and integrity of industrial operations.

The main goal of process safety is to analyse and reduce risks related to industrial processes in order to ensure that the final risk on people and environment is as low as possible. To establish whether the risk related to the process is tolerable or not it is therefore necessary to calculate the risk associated with the events under consideration and to compare the result with the selected tolerability criteria: this is the common approach used in Quantitative Risk Assessment (QRA) analysis. The risk associated with an event, whatever is its nature (on people, on the environment or financial) is a function of the likelihood of the event (generally expressed in events/year) and the consequences (expressed in terms of damage) of the event itself. The aim of this article is to focus on the first parameter (frequency evaluation): the main goal is not to write a math paper on frequency calculation (there are a lot of articles and specialised sources in the scientific literature that deal with the theory of probability calculation and, therefore, it would not make sense to focus on math) but to report the main conceptual errors in frequency calculation found in existing risk analysis reports. Frequency calculation depends especially on the quality of the performed hazard identification study (e.g HAZOP) and on the proper identification of the common cause failures present within a complex system which, if not properly identified, can lead to an incorrect assessment of the likelihood of a dangerous event. The final scope is to show how it is possible to fall into pitfalls during frequencies calculation if the hazards identification is not properly performed and if dependencies between safeguards are not properly assessed: usually these errors lead to obtain frequency values that have no physical meaning.

Abstract Earthworms are known to stimulate soil greenhouse gas (GHG) emissions, but the majority of previous studies have used simplified model systems or lacked continuous high-frequency measurements. To address this, we conducted a 2-year study using large lysimeters (5 m2 area and 1.5 m soil depth) in an ecotron facility, continuously measuring ecosystem-level CO2, N2O, and H2O fluxes. We investigated the impact of endogeic and anecic earthworms on GHG emissions and ecosystem water use efficiency (WUE) in a simulated agricultural setting. Although we observed transient stimulations of carbon fluxes in the presence of earthworms, cumulative fluxes over the study indicated no significant increase in CO2 emissions. Endogeic earthworms reduced N2O emissions during the wheat culture (− 44.6%), but this effect was not sustained throughout the experiment. No consistent effects on ecosystem evapotranspiration or WUE were found. Our study suggests that earthworms do not significantly contribute to GHG emissions over a two-year period in experimental conditions that mimic an agricultural setting. These findings highlight the need for realistic experiments and continuous GHG measurements.

Objective: This cross-sectional study aimed to identify potential predictors of poor mental health outcomes among healthcare workers in two different waves of the COVID-19 emergency in Italy. Methods: An online survey collected data from N = 557 healthcare workers (21–77 years). The study predictors were sociodemographic characteristics, occupational status, factors related to the work environment, COVID-19-related adverse events, and lifetime traumatic events. The poor mental health outcomes that were considered were depersonalization/derealization, anxiety, depression, and somatization symptoms. Results: The main predictors of poor mental health outcomes were sleeping less than six hours per night, inadequate protective equipment measures, female gender, personal and familiar infection, living alone, working as a nurse, and working in a COVID-19 ward. Healthcare workers in 2021 reported experiencing more serious accidents and stressful events than those of the first wave. Depressive symptoms and COVID-19-related adverse events were higher in the second pandemic outbreak than in the first. Conclusions: Preventive strategies against poor mental health outcomes should be particularly focused on female nurses who live alone, work in areas with high infection rates, and have experienced the COVID-19 infection personally or who are close to people that have experienced the infection.

Human infection by Baylisascaris procyonis can result in larva migrans syndromes, which can cause severe neurological sequelae and fatal cases. The raccoon serves as the definitive host of the nematode, harboring adult worms in its intestine and excreting millions of eggs into the environment via its feces. Transmission to paratenic hosts (such as rodents, birds and rabbits) or to humans occurs by accidental ingestion of eggs. The occurrence of B. procyonis in wild raccoons has been reported in several Western European countries. In France, raccoons have currently established three separate and expanding populations as a result of at least three independent introductions. Until now the presence of B. procyonis in these French raccoon populations has not been investigated. Between 2011 and 2021, 300 raccoons were collected from both the south-western and north-eastern populations. The core parts of the south-western and north-eastern French raccoon populations were free of B. procyonis. However, three worms (molecularly confirmed) were detected in a young raccoon found at the edge of the north-eastern French raccoon population, close to the Belgian and Luxemburg borders. Population genetic structure analysis, genetic exclusion tests and factorial correspondence analysis all confirmed that the infected raccoon originated from the local genetic population, while the same three approaches showed that the worms were genetically distinct from the two nearest known populations in Germany and the Netherlands. The detection of an infected raccoon sampled east of the northeastern population raises strong questions about the routes of introduction of the roundworms. Further studies are required to test wild raccoons for the presence of B. procyonis in the area of the index case and further east towards the border with Germany.

Digitaria insularis é uma Poaceae disseminada majoritariamente por sementes que pode ocasionar problemas em agroecossistemas. O objetivo deste trabalho foi avaliar a influência da idade de D. insularis submetida a roçada sobre características morfofisiológicas. Plantas foram cultivadas em casa de vegetação e cortadas rente ao substrato aos 21, 35, 49 e 77 dias após a emergência (DAE) ou não cortadas, com avaliação das variáveis até 105 DAE. Com exceção da clorofila b, as demais variáveis foram influenciadas pela idade das plantas no corte (p

Abstract Smartphones are increasingly widespread throughout the world and, although smartphones provide various benefits, excessive and maladaptive use is often reported. Given the penetration of smartphones in the individual’s daily life, it is relevant to identify the mechanisms sustaining their use, including the affective bond that the owner may develop with the device. The aim of the current study is to test a novel model to explain smartphone and Social Network Sites (SNS) use from an interpersonal perspective. We hypothesized that adult attachment style and interpersonal patterns (i.e., features of interpersonal dependency) generalize to the emotional bond with the mobile device, interacting with psychological correlates and background factors to predict smartphone and SNS consumption. 341 nonclinical adults (57.2% females; age M = 35.5, SD = 14.6) completed a battery consisting of the Attachment Style Questionnaire, the Relationship Profile Test, the Rosenberg Self-Esteem Scale, the Toronto Alexithymia Scale, the Young Adult Attachment to Phone Scale, and the Social Network Intensity and Social Network Access via Mobile phone Applications. A multi-mediation model supported the hypothesis regarding the influence of interpersonal style in the relationship of the individual with their smartphone and use of SNS. A parallel between attachment style and the emotional bond with the smartphone emerged, with anxious attachment style and destructive overdependence being potential risk factors for maladaptive smartphone use especially in individuals involved in a romantic relationship. Findings are discussed in terms of theoretical implications and intervention strategies towards smartphone dependency.

Abstract Background Traumatic brain injury (TBI) is a significant cause of death and disability, with no effective neuroprotective drugs currently available for its treatment. Mesenchymal stromal cell (MSC)-based therapy shows promise as MSCs release various soluble factors that can enhance the injury microenvironment through processes, such as immunomodulation, neuroprotection, and brain repair. Preclinical studies across different TBI models and severities have demonstrated that MSCs can improve functional and structural outcomes. Moreover, clinical evidence supports the safety of third-party donor bank-stored MSCs in adult subjects. Building on this preclinical and clinical data, we present the protocol for an academic, investigator-initiated, multicenter, double-blind, randomised, placebo-controlled, adaptive phase II dose-finding study aiming to evaluate the safety and efficacy of intravenous administration of allogeneic bone marrow-derived MSCs to severe TBI patients within 48 h of injury. Methods/design The study will be conducted in two steps. Step 1 will enrol 42 patients, randomised in a 1:1:1 ratio to receive 80 million MSCs, 160 million MSCs or a placebo to establish safety and identify the most promising dose. Step 2 will enrol an additional 36 patients, randomised in a 1:1 ratio to receive the selected dose of MSCs or placebo. The activity of MSCs will be assessed by quantifying the plasmatic levels of neurofilament light (NfL) at 14 days as a biomarker of neuronal damage. It could be a significant breakthrough if the study demonstrates the safety and efficacy of MSC-based therapy for severe TBI patients. The results of this trial could inform the design of a phase III clinical trial aimed at establishing the efficacy of the first neurorestorative therapy for TBI. Discussion Overall, the MATRIx trial is a critical step towards developing an effective treatment for TBI, which could significantly improve the lives of millions worldwide affected by this debilitating condition. Trial Registration EudraCT: 2022-000680-49.

Background: Obesity is a global epidemic that affects millions worldwide and can be a deterrent to surgical procedures in the population waiting for kidney transplantation. However, the literature on the topic is controversial. This study evaluates the impact of body mass index (BMI) on complications after renal transplantation, and identifies factors associated with major complications to develop a prognostic risk score. Methods: A correlation analysis between BMI and early and late complications was first performed, followed by a univariate and multivariate logistic regression analysis. The 302 included patients were divided into obese (BMI ≥ 30 kg/m2) and non-obese (BMI ≤ 30 kg/m2) groups. Correlation analysis showed that delayed graft function (DGF) was the only obesity-associated complication (p = 0.044). Logistic regression analysis identified female sex, age ≥ 57 years, BMI ≥ 25 and ≥30 kg/m2, previous abdominal and/or urinary system surgery, and Charlson morbidity Score ≥ 3 as risk factors for significant complications. Based on the analyzed data, we developed a nomogram and a prognostic risk score. Results: The model’s area (AUC) was 0.6457 (95% IC: 0.57; 0.72). The percentage of cases correctly identified by this model retrospectively applied to the entire cohort was 73.61%. Conclusions: A high BMI seems to be associated with an increased risk of DGF, but it does not appear to be a risk factor for other complications. Using an easy-to-use model, identification, and stratification of individualized risk factors could help to identify the need for interventions and, thus, improve patient eligibility and transplant outcomes. This could also contribute to maintaining an approach with high ethical standards.

Background and Objectives: Transgender people are defined as individuals whose gender identity does not entirely match their sex assigned at birth. Gender surgery typically represents the conclusive and irreversible step in the therapeutic process, especially for the impact on the reproductive sphere. The increased awareness of gender dysphoria and the expanding array of medical and surgical options, including minimally invasive techniques, contribute to the gradual increase in the social impact of transgender surgery. There are several surgical techniques for “gender assignment”, such as vaginal, laparotomic, laparoscopic, and robotic, and the novel approach of vaginal natural orifice transluminal endoscopic surgery to perform a hysterectomy and bilateral salpingo-oophorectomy (BSO). The purpose of this review is to assess the various surgical approaches (hysterectomy and salpingo-oophorectomy) for gender reassignment in order to determine the best option in clinical practice for the female-to-male population in terms of surgical outcomes such as operative time, surgical complication, hospital discharge, postoperative pain, and bleeding. Materials and Methods: This systematic review includes studies from 2007 to 2024. Special consideration was given to articles documenting the characteristics and management of female-to-male reassignment surgery. Finally, eight papers were included in this review. Results: The literature analysis considered surgical techniques ranging from traditional surgery to innovative methods like vaginal natural orifice transluminal endoscopic surgery and robotic-assisted laparoscopic hysterectomy. Vaginal natural orifice transluminal endoscopic surgery and the robotic approach offer potential benefits such as reduced postoperative pain and shorter hospital stays. While vaginal natural orifice transluminal endoscopic surgery may encounter challenges due to narrow access and smaller vaginal dimensions, robotic single-site hysterectomy may face instrument conflict. Conclusions: The conventional laparoscopic approach remains widely used, demonstrating safety and efficacy. Overall, this review underscores the evolving landscape of surgical techniques for gender affirmation and emphasizes the necessity for personalized approaches to meet the specific needs of transgender patients.

In the original publication [...]

Message Queue Telemetry Transport (MQTT) is a common communication protocol used in the Internet of Things (IoT). MQTT is a simple, lightweight messaging protocol used to establish communication between multiple devices relying on the publish–subscribe model. However, the protocol does not provide authentication, and most proposals to incorporate it lose their lightweight feature and do not consider the future risk of quantum attacks. IoT devices are generally resource-constrained, and postquantum cryptography is often more computationally resource-intensive compared to current cryptographic standards, adding to the complexity of the transition. In this paper, we use the postquantum digital signature scheme CRYSTALS-Dilithium to provide authentication for MQTT and determine what the CPU, memory and disk usage are when doing so. We further investigate another possibility to provide authentication when using MQTT, namely a key encapsulation mechanism (KEM) trick proposed in 2020 for transport level security (TLS). Such a trick is claimed to save up to 90% in CPU cycles. We use the postquantum KEM scheme CRYSTALS-KYBER and compare the resulting CPU, memory and disk usages with traditional authentication. We found that the use of KEM for authentication resulted in a speed increase of 25 ms, a saving of 71%. There were some extra costs for memory but this is minimal enough to be acceptable for most IoT devices.

In the context of online banking, new users have to register their information to become clients through mobile applications; this process is called digital onboarding. Fraudsters often commit identity fraud by impersonating other people to obtain access to banking services by using personal data obtained illegally and causing damage to the organisation’s reputation and resources. Detecting fraudulent users by their onboarding process is not a trivial task, as it is difficult to identify possible vulnerabilities in the process to be exploited. Furthermore, the modus operandi for differentiating the behaviour of fraudulent actors and legitimate users is unclear. In this work, we propose the usage of a process mining (PM) approach to detect identity fraud in digital onboarding using a real fintech event log. The proposed PM approach is capable of modelling the behaviour of users as they go through a digital onboarding process, while also providing insight into the process itself. The results of PM techniques and the machine learning classifiers showed a promising 80% accuracy rate in classifying users as fraudulent or legitimate. Furthermore, the application of process discovery in the event log dataset produced an insightful visual model of the onboarding process.

The social stratification of material consequences of individual‐level disruptive events is a widely researched topic. Less is known about the stratification of psychological outcomes in response to contextual‐level disruptive events. We aim to fill this gap by investigating the aftermath of the Covid‐19 pandemic on individuals’ dispositional optimism and the stratification based on unequal wealth resources. The study focuses on Italy, the first European country to be strongly hit by Covid‐19, and one characterised by high levels of private savings and homeownership. Theoretically, we draw on the conventional social inequalities framework informed by insights from the literature on natural disasters, positing that wealth‐related resource disparities may have stratified the socioemotional response to the pandemic. Empirically, we leverage a combination of individual‐level longitudinal survey data (Bank of Italy’s Special Survey of Italian Households) and municipality‐level official statistics on excess mortality (Italian National Institute of Statistics), covering the first 17 months of the Covid‐19 pandemic in Italy. Results indicate overall negative consequences of severe exposure to risks associated with the pandemic on optimism. However, we found evidence in line with a post‐traumatic growth scenario, as optimism slightly increased over the course of the pandemic. The insurance function of wealth emerges in the higher optimism of individuals with more resources. Nevertheless, resource disparities are not translated into stark differences in susceptibility to risk exposure or post‐traumatic growth. Overall, our findings support a limited insurance function of wealth in the socioemotional sphere.

(1) Background: Appetitive traits in adults can be measured through the Adult Eating Behavior Questionnaire (AEBQ), a questionnaire adapted from the Child Eating Behavior Questionnaire (CEBQ). The AEBQ has been validated in several countries. The aim of the present study was to explore and validate the factor structure of the Italian version of the AEBQ. Furthermore, convergent validity and correlations between factors and BMI were explored to assess its criterion validity. (2) Methods: Participants (N = 624, mean age of 32.08 ± 14.94 years) completed the AEBQ, the Eating Attitude Test (EAT-40), and the Dutch Eating Behavior Questionnaire (DEBQ). They also self-reported demographic and anthropometric data. A Confirmatory Factor Analysis (CFA) was used to test three different alternative models that emerged in previous validations. (3) Results: The CFA revealed a good model fit (RMSEA = 0.0634, TLI = 0.894, CFI = 0.907) for the 7-factor structure, without the Hunger items, showing a valid and reliable (Cronbach’s α > 0.7) structure. Convergent and divergent validity of the AEBQ yielded favorable results, and relationships between the AEBQ and BMI factors revealed that the Food Approach traits were positively associated with BMI. (4) Conclusions: Finally, this study provides initial support for the use of the AEBQ as a valid and reliable tool to measure a wide range of appetitive traits in the adult Italian population.

El artículo propone un abordaje del modelo de gestión gubernamental fundado en el paradigma de Gobierno Abierto (GA), particularmente a uno de sus ejes rectores, la transparencia, a partir de aproximarse en clave comparada a las experiencias de su implementación en el conurbano bonaerense en los últimos años. Más específicamente, se apunta a dar cuenta de las políticas de transparencia y apertura de datos públicos desarrolladas en los 24 municipios bonaerenses mediante la construcción de un índice basado en el análisis de cuatro grandes dimensiones: a) disposición de los sitios webs oficiales de los gobiernos locales; b) apertura pasiva de la información; c) apertura activa de la información; d) marco normativo. El análisis estará acompañado de una indagación de probables causas estructurales que induzcan a la aplicación del modelo. Los resultados y lecturas obtenidas de la aplicación preliminar del índice se espera que aporten al conocimiento especializado en el modelo de gestión del GA en gobiernos locales. El artículo recupera una práctica de investigación llevada adelante por la autora en la Carrera de Ciencia Política, de la Universidad de Buenos Aires, articulada con la labor profesional en el Municipio de Quilmes.

Abstract One of the main causes of post-transplant-associated morbidity and mortality is cancer. The aims of the project were to study the neoplastic risk within the kidney transplant population and identify the determinants of this risk. A cohort of 462 renal transplant patients from 2010 to 2020 was considered. The expected incidence rates of post-transplant cancer development in the referenced population, the standardized incidence ratios (SIR) taking the Italian population as a comparison, and the absolute risk and the attributable fraction were extrapolated from these cohorts of patients. Kidney transplant recipients had an overall cancer risk of approximately three times that of the local population (SIR 2.8). A significantly increased number of cases were observed for Kaposi’s sarcoma (KS) (SIR 195) and hematological cancers (SIR 6.8). In the first 3 years post-transplant, the risk to develop either KS or hematological cancers was four times higher than in the following years; in all cases of KS, the diagnosis was within 2 years from the transplant. Post-transplant immunosuppression represents the cause of 99% of cases of KS and 85% of cases of lymphomas, while only 39% is represented by solid tumors. Data related to the incidence, the percentages attributable to post-transplant immunosuppression, and the time of onset of neoplasms, particularly for KS and hematological tumors could help improve the management for the follow-up in these patients.

Abstract Background Coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) seems to differ from the “classic ARDS”, showing initial significant hypoxemia in the face of relatively preserved compliance and evolving later in a scenario of poorly compliant lungs. We tested the hypothesis that in patients with COVID-19 ARDS, the initial value of static compliance of respiratory system (Crs) (1) depends on the previous duration of the disease (i.e., the fewer days of illness, the higher the Crs and vice versa) and (2) identifies different lung patterns of time evolution and response to prone positioning. Methods This was a single-center prospective observational study. We enrolled consecutive mechanically ventilated patients with a diagnosis of COVID-19 who met ARDS criteria, admitted to intensive care unit (ICU). Patients were divided in four groups based on quartiles of initial Crs. Relationship between Crs and the previous duration of the disease was evaluated. Respiratory parameters collected once a day and during prone positioning were compared between groups. Results We evaluated 110 mechanically ventilated patients with a diagnosis of COVID-19 who met ARDS criteria admitted to our ICUs. Patients were divided in groups based on quartiles of initial Crs. The median initial Crs was 41 (32–47) ml/cmH2O. No association was found between the previous duration of the disease and the initial Crs. The Crs did not change significantly over time within each quartile. Positive end-expiratory pressure (PEEP) and driving pressure were respectively lower and greater in patients with lower Crs. Prone positioning significantly improved PaO2/FiO2 in the 4 groups, however it increased the Crs significantly only in patients in lower quartile of Crs. Conclusions In our cohort, the initial Crs is not dependent on the previous duration of COVID-19 disease. Prone positioning improves oxygenation irrespective to initial Crs, but it ameliorates respiratory mechanics only in patients with lower Crs.

Two factors are crucial for the effective operation of modern-day smart services: Initially, IoT-enabled technologies have to capture and combine huge amounts of data on data subjects. Then, all these data have to be processed exhaustively by means of techniques from the area of big data analytics. With regard to the latter, thorough data refinement in terms of data cleansing and data transformation is the decisive cornerstone. Studies show that data refinement reaches its full potential only by involving domain experts in the process. However, this means that these experts need full insight into the data in order to be able to identify and resolve any issues therein, e.g., by correcting or removing inaccurate, incorrect, or irrelevant data records. In particular for sensitive data (e.g., private data or confidential data), this poses a problem, since these data are thereby disclosed to third parties such as domain experts. To this end, we introduce SMARTEN, a sample-based approach towards privacy-friendly data refinement to smarten up big data analytics and smart services. SMARTEN applies a revised data refinement process that fully involves domain experts in data pre-processing but does not expose any sensitive data to them or any other third-party. To achieve this, domain experts obtain a representative sample of the entire data set that meets all privacy policies and confidentiality guidelines. Based on this sample, domain experts define data cleaning and transformation steps. Subsequently, these steps are converted into executable data refinement rules and applied to the entire data set. Domain experts can request further samples and define further rules until the data quality required for the intended use case is reached. Evaluation results confirm that our approach is effective in terms of both data quality and data privacy.

A syndrome occurring after adenoviral vector anti-SARS-CoV-2 vaccination, characterized by thrombocytopenia, venous thrombosis, and circulating anti-PF4 antibodies, known as vaccine-induced immune thrombotic thrombocytopenia (VITT), is well described. Data on the long-term course of this syndrome are lacking. Our aim is to report the clinical and laboratory features of a patient with VITT from diagnosis and during 21 months of follow-up. Cerebral venous thrombosis associated with elevated D-dimer, low fibrinogen, thrombocytopenia, and anti-PF4 antibodies positivity occurred in this patient after ChAdOx1 nCoV-19 vaccination. Cerebral thrombosis required a revascularization procedure and decompressive craniectomy. Upon dexamethasone and anticoagulant treatment initiation, the platelet count recovered. However, a persistently high anti-PF4 antibody titer, without thrombosis recurrence, was observed. Little is known about the long-term persistence of anti-PF4 antibodies, their clinical significance, and their possible role in guiding therapeutic decisions. In our patient, we decided to continue anticoagulant treatment beyond 21 months with parallel anti-PF4 antibody monitoring.