Recent publications
Background
Model transformations play a crucial role in Model‐Driven Engineering (MDE), with the ATLAS Transformation Language (ATL) being a powerful technology for developing model‐to‐model transformations.
Methods
This paper presents a comprehensive investigation into the energy consumption of ATL transformations, aiming to identify possible correlations among transformation rules, model size, and metamodel structural characteristics. We conducted experiments on 52 ATL transformations, analyzing power usage and extending our inquiry to understand the impact of mutations on both models and transformations.
Results
The experimental findings reveal relationships between the energy utilization of ATL transformations and the structural characteristics of metamodels. Furthermore, we establish a connection between energy consumption, model size, and the complexity of transformation processes.
Conclusion
The insights gained from this research lay the groundwork for devising future energy‐efficient strategies while developing model transformations.
BACKGROUND
High adherence to the enhanced recovery after surgery pathway reduces morbidity and mortality rates after elective colorectal surgery.
OBJECTIVE
To evaluate the effect of adherence to the enhanced recovery after surgery pathway on the failure to rescue rates after elective colorectal surgery.
DESIGN
Retrospective analysis of a prospective database.
PATIENTS
Adults (≥ 18 years old) who underwent elective colorectal resection with anastomosis for benign and malignant disease.
SETTINGS
Prospective enrolment in 78 centers in Italy from 2019 to 2021.
INTERVENTIONS
All the outcomes were measured at 60 days after surgery. Several patient-, disease-, treatment-, hospital-, and complication-related variables were analyzed for the outcomes. After univariate analyses, independent predictors of the endpoints were identified through logistic regression analyses, presenting odds ratios and 95% confidence intervals.
MAIN OUTCOME MEASURES
Failure to rescue after any adverse event, defined as the ratio between the number of deaths and the number of patients showing any adverse event; failure to rescue after any major adverse event, with the denominator represented by the number of patients showing any major adverse event.
RESULTS
An adverse event was recorded in 2,321 out of 8,359 patients (27.8%), a major adverse event in 523 patients (6.3%), and death in 88 patients (1.0%). The failure to rescue rates were 3.8% after any adverse event and 16.8% after any major adverse event. Independent predictors of primary endpoints were identified among patient- (age, American Society of Anesthesiologists class, nutritional status), treatment- (type of resection), and complication-related (anastomotic leakage, reoperation) variables. Enhanced recovery pathway adherence > 70% independently reduced failure to rescue rates.
LIMITATIONS
Clustering from multicenter data, and unmeasured confounding from observational data.
CONCLUSIONS
Following elective colorectal resection, adherence > 70% to the enhanced recovery pathway independently decreased failure to rescue rates, along with other patient- or treatment-related factors. See Video Abstract .
Targeted memory reactivation represents an established technique for promoting sleep-dependent memory consolidation in laboratory studies. This investigation aimed to test the potentiality of a wearable electroencephalography-based closed-loop targeted memory reactivation system to boost vocabulary learning in home settings. In the evening, 24 adults (23.58 years ± 3.36 years, 19 females) were asked to learn the Italian translation of 40 pseudowords (test session). Subsequently, participants slept at their home wearing an electroencephalography headband (Dreem 2), and half of the pseudo-words were acoustically represented (cued) following the real-time detection of slow waves. After the awakening, memory recall of the Italian translations was retested. The stimulation effect was evaluated by comparing the test-retest variations in memory accuracy between cued and uncued pseudowords. Moreover, we assessed the event-related potentials and spectral perturbations induced by the cued stimuli during sleep, comparing the electrophysiological correlates of correctly translated pseudowords with incorrectly translated ones at the retest session. Closed-loop targeted memory reactivation increased the translation accuracy for cued pseudowords (+8.6%), while no significant test-retest variation for uncued items was observed (-4.6%). Time-frequency analysis indicated a spectral power increase in the spindle frequency band coinciding with the second positive peak of the sound-elicited slow wave as the correlate of successful morning recall. This study extended the targeted memory reactivation effectiveness in enhancing vocabulary learning to an ecological home environment, providing further support to the role of spindle activity in the targeted memory reactivation effect. A wearable closed-loop targeted memory reactivation system could represent a memory-enhancement tool in real-world settings by promoting the hallmark sleep electroencephalographic rhythms of memory consolidation.
We present results and discuss methods for computing the melting temperature of dense molecular hydrogen using a machine learned model trained on quantum Monte Carlo data. In this newly trained model, we emphasize the importance of accurate total energies in the training. We integrate a two phase method for estimating the melting temperature with estimates from the Clausius–Clapeyron relation to provide a more accurate melting curve from the model. We make detailed predictions of the melting temperature, solid and liquid volumes, latent heat, and internal energy from 50 to 180 GPa for both classical hydrogen and quantum hydrogen. At pressures of roughly 173 GPa and 1635 K, we observe molecular dissociation in the liquid phase. We compare with previous simulations and experimental measurements.
Atopic dermatitis (AD) is a T helper 2-mediated chronic inflammatory skin disease that affects children and adults. Patients with AD are prone to recurrent infections of the skin and other organs, which can severely worsen the disease course. This review summarises the current evidence on the aetiology, pathogenesis, treatment and prevention of infections in patients with AD. PubMed was searched for English-language research articles, systematic reviews, meta-analyses and guidelines published until February 2023 using the key term “atopic dermatitis” and terms relevant to infections. Patients with AD have an increased risk of bacterial, viral and fungal infections of the skin, mainly due to impaired barrier function, altered immune response and frequent scratching. The most common pathogens are Staphylococcus aureus and herpes simplex virus, which can cause impetigo, folliculitis, abscesses, eczema herpeticum and other complications. They also appear to increase susceptibility to systemic infections, including respiratory and urinary tract infections and sepsis. Certain systemic treatments for AD, such as mycophenolate mofetil and Janus kinase inhibitors, increase the risk of viral infections. Prevention and treatment of recurrent infections in patients with AD require a multifaceted approach that includes topical and systemic antimicrobials, skin care and effective control of AD symptoms (to break the itch–scratch cycle). Preventing and limiting the development of infections are important considerations in choosing an AD treatment.
BACKGROUND
Patients with heart failure (HF) treated with mechanical thrombectomy (MT) for acute ischemic stroke were underrepresented in clinical trials on MT. Our systematic review and meta‐analysis aim to assess differences in outcomes between patients with HF and their counterparts without HF treated with MT for acute ischemic stroke.
METHODS
A systematic review of the English language literature from inception up to March 7, 2024, was conducted using PubMed, Embase, Cochrane Library, and Web of Science databases. Studies focused on patients with and without HF who were treated with MT for acute ischemic stroke were included. The primary outcome of interest was the rate of modified Rankin Scale scores of 0–2 at 90 days. Secondary outcomes of interest included rates of 90‐day mortality, successful reperfusion, and symptomatic intracranial hemorrhage.
RESULTS
Of 5394 initially retrieved studies, 5 studies were included in the systematic review with a final population of 44 385 patients with ischemic stroke with and without HF treated with MT. Four studies were combined for the primary outcome and showed comparable rates of 0–2 modified Rankin Scale scores between patients with HF and patients without HF (odds ratio, 0.86 [95% CIs, 0.70–1.06]; P = 0.15). Ninety‐day mortality was significantly higher in the HF group (odds ratio, 1.92 [95% CIs, 1.66–2.23]; P <0.0001) although the sample size was small (n of study = 3) and only unadjusted estimates were used. Successful reperfusion and symptomatic intracranial hemorrhage rates were similar between the groups.
CONCLUSION
In this systematic review and meta‐analysis, patients with HF experienced worse 90‐day mortality post‐MT. Our data encourage further research on MT outcomes in patients with large vessel‐occlusion ischemic stroke and concomitant HF.
Cardiovascular diseases (CVD) represent the leading cause of morbidity and mortality for women worldwide, yet they are often unaware of this heavy burden.
To assess cardiovascular risk awareness among Italian women.
Following World Heart Day 2023, a cardiovascular prevention campaign was conducted in Italian pharmacies to evaluate the effectiveness of screening activities offered by pharmacies and raise awareness of cardiovascular health status among Italian women. Cardiovascular risk profile and perception of CVD burden relative to other common female-specific diseases were assessed. Blood pressure (BP) measurement and ECG recording were performed.
A total of 1510 women (84.7% < 70 years), enrolled at 91 pharmacies, were included. The most prevalent cardiovascular risk factor was sedentary lifestyle (57.9%), followed by overweight/obesity (44.3%), hypercholesterolemia (37.9%), hypertension (31.3%), family history of early CVD (28.7%), smoking (20.6%), and diabetes (5%). CVD and/or kidney disease were uncommon (3.6%), but 1 in 4 women was classified as being at increased cardiovascular risk, and 47.5% had some type of ECG abnormalities, requiring further assessments in 18% cases. Less than 1 in 3 women was aware of the burden represented by CVD, being the majority mostly concerned with breast cancer and osteoporosis as potential health threats.
The burden of cardiovascular risk factors is high, and the perception of related health threat is low among the examined sample of Italian women, supporting the urgent need to raise awareness of CVD in women as a major health issue and to undertake effective, tailored preventive strategies to reduce such risk in a timely fashion.
Background: The time lapse between the acute event and the beginning of rehabilitation seems to play a significant role in determining the effectiveness of rehabilitation together with the severity of neurological deficits and impairments of motor and cognitive functions. The present study aims to further explore the prognostic role of cognitive and motor functions, concerning the different times of the beginning of neurorehabilitation. Methods: A secondary examination was conducted by applying a cluster analysis on the data of 386 stroke patients in the subacute phase who were enrolled in the Cognitive and Recovery of Motor Functions (CogniReMo) study. Results: The Barthel Index at the admission predicts clinical outcome: if BI was 0, it was on average 28.7 ± 24.1 at discharge. For patients with Barthel Index <15 at discharge, the discriminant was unaltered executive functions having an average output of 61.3 instead of 45.5. In the range of BI at admission between 16 and 45, the discriminant variable was to have an NIHSS ≤ 5 to obtain a high outcome (BI = 75.4 instead of BI = 61.9). Subjects with a BI at admission >45 were the best responders to rehabilitation, with a mean BI at discharge of 85 if they have alteration in spatial attention, and 95.3 if they have no deficits in spatial attention. Also, for inpatients hospitalized in a period ranging from the 20th to the 37th day after stroke, spatial attention was a discriminant variable to have a poor outcome (BI = 34.3) vs. a good one (BI = 76.7). Conclusions: The algorithm identified a hierarchical decision tree that might assume a significant role for clinicians in defining an appropriate rehabilitation pathway, depending on the time of rehabilitation beginning and the severity of motor and cognitive deficits.
This paper reports on the design of a novel, fully integrated stand-alone light-to-digital converter for optoelectronic sensors in wearable/implantable biomedical applications. The architecture designed in TSMC 180 nm standard Si CMOS technology integrates a Si photodiode, a ring oscillator, two digital counters, and a voltage-to-pulse-width modulation stage as the basic block of the light-to-digital converter in a Si area of 0.018 mm
2
. The modulation stage, composed of ten transistors and a capacitor, provides a square waveform whose pulse width varies as a function of its input voltage provided by the Si photodiode operating in a photovoltaic mode that linearly depends on the light intensity impinging on its sensitive area. The value of the pulse width is digitalized by two digital counters driven by the ring oscillator. The complete system, powered at 0.3 V, has been fully characterized by post-layout simulations demonstrating an overall sensitivity of 0.062 LSB/lx, a power consumption of 335 nW, and a sample rate of 3 kS/s. A comparison with similar solutions in the Literature shows that the proposed system achieves the best performance in power consumption, Si area, and supply voltage with a good sample rate value.
Introduction
Nurses' job satisfaction in hospitals is fundamental for the quality of care and the safety of patients. However, sociodemographic trends require moving care to patients' homes, and the predictors of job satisfaction for nurses working in the home care settings remain largely unknown. Therefore, the aim of this study was to investigate job satisfaction of nurses working in Italian home care settings and its determinants.
Design
Multicenter observational cross‐sectional study.
Methods
This study was conducted in the districts of 70 local health authorities in Italy. Data on the characteristics of the organization and nurses were collected. Nursing job satisfaction was evaluated on a four‐point scale ranging from “very satisfied” to “very dissatisfied.” Additionally, the following variables were assessed: workload, quality of leadership, work–private life conflict, burnout symptoms, possibility for development, staffing and resource adequacy, nurse manager ability, safety climate, and teamwork climate. A logistic regression analysis was conducted to identify factors influencing job satisfaction.
Results
Only organizational variables had a predictive value for nurses' job satisfaction. Workload (OR = 1.01; p = 0.033), work–private life conflict (OR = 1.02; p < 0.001), burnout (OR = 1.02; p < 0.001), and staffing inadequacy (OR = 1.44; p = 0.003) predicted higher levels of nurse dissatisfaction. Instead, high‐quality leadership (OR = 0.981; p < 0.001), possibility for development (OR = 0.973; p < 0.001), and good teamwork climate (OR = 0.994; p = 0.003) were predictors of better levels of satisfaction.
Conclusions
This study suggested that home care nurses are generally satisfied with their jobs. To enhance job satisfaction, it is essential to improve nurses' work environment, the leadership quality and ensure professional development.
Clinical Relevance
Our results are globally relevant as they contribute to the limited evidence available on this topic in home care settings. This study emphasizes the need of measuring nurses' job satisfaction and implementing interventions to promote healthy work environments.
Metabolic-associated steatotic liver disease (MASLD) represents the most common chronic hepatopathy worldwide and an independent risk factor for cardiovascular disease and mortality, particularly when liver fibrosis occurs. Epigenetic alterations, such as DNA methylation, may influence MASLD susceptibility and progression; yet mechanisms underlying this process are limited. This study aimed to investigate whether active DNA demethylation in peripheral blood mononuclear cells (PBMCs) from individuals with MASLD, alongside the methylation and mRNA levels of inflammation- and fibrosis-related candidate genes, is associated with liver fibrosis. For this study, global demethylation intermediates (5-hydroxymethylcytosine [5hmC], 5-formylcytosine [5fC]) were quantified in PBMCs from 89 individuals with/without MASLD using ELISA. Site-specific DNA methylation of SOCS3, SREBF1, and TXNIP was analyzed by mass spectrometry-based bisulfite sequencing; mRNA expression was assessed via RT-PCR. Individuals with MASLD and moderate-to-high fibrosis risk (estimated by the fibrosis non-alcoholic steatohepatitis (NASH) index, FNI) progressively exhibited greater global 5hmC and 5fC levels. Higher FNI was associated with reduced methylation of the SOCS3 gene and increased mRNA expression of the SOCS3, TXNIP, IL-6, and MCP-1 genes. In conclusion, elevated fibrosis risk in MASLD is associated with active global DNA demethylation, as well as differential methylation and expression patterns of genes, which are key regulators of inflammation and fibrosis. These epigenetic alterations in PBMCs may mirror DNA methylation changes in the liver, which may potentially contribute to liver fibrogenesis and represent novel biomarkers for MASLD progression toward fibrosis.
Background
Congenital heart disease (CHD) is the most common fetal malformation, and it can result first in cardiac remodeling and dysfunction and later in cardiac failure and hydrops. A limited number of studies have evaluated cardiac function in fetuses affected by CHD. Functional parameters could potentially identify fetuses at risk of cardiac failure before its development. However, these techniques have not translated from research to clinical settings, due to a lack of standardization and poor repeatability. We seek to evaluate whether application of automated techniques to a cohort with fetal pathology could overcome these factors.
Methods
A multicenter cohort study will be carried out in eight teaching hospitals across Europe, Australia, and Middle East. Based on a previous observed standard deviation, a total sample of 381 pregnancies is required to achieve 80% power to detect a difference of 0.03 in mean myocardial performance index (MPI) with a two-sided type I error rate of 5%. After adjustments allowing for patient exclusions or incomplete datasets, a total of 330 healthy singleton pregnancies and 165 diagnosed with CHD will be recruited. Two fetal cardiac function evaluations at 19 + 6–28 + 6 and 32 + 6–36 + 6 weeks will be offered assessing automated pulsed wave doppler (PWD) MPI, spatio-temporal image correlation (STIC) annular and septal plane excursion (TAPSE, MAPSE and SAPSE), alongside cardiac morphometric and Doppler evaluations of flow across the valves. A secondary nested case–control study will evaluate fetuses with hydrops compared to those without. Differences in functional parameters between cases and controls and over time will be assessed using generalized linear mixed models. Logistic regression will estimate the association between cardiac parameters and hydrops’ incidence.
Discussion
This study will provide evidence as to whether automated functional parameters could be significantly different in pregnancy affected by CHD versus healthy pregnancies. The primary objective is to compare automated PWD-MPI and STIC TAPSE, MAPSE and SAPSE in fetuses affected by CHD versus healthy. The secondary objective is to estimate whether these automated parameters could improve the predictive value of the classical cardiovascular profile score in case of hydrops.
Trial registration
The study protocol has been registered in the ClinicalTrials.gov Protocol Registration System, identification number NCT05698277.
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