University of Udine
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A Randomized Trial of Acute Normovolemic Hemodilution in Cardiac Surgery
No full textBackground Patients undergoing cardiac surgery often receive red-cell transfusions, along with the associated risks and costs. Early intraoperative normovolemic hemodilution (i.e., acute normovolemic hemodilution [ANH]) is a blood-conservation technique that entails autologous blood collection before initiation of cardiopulmonary bypass and reinfusion of the collected blood after bypass weaning. More data are needed on whether ANH reduces the number of patients receiving allogeneic red-cell transfusion. Methods In a multinational, single-blind trial, we randomly assigned adults from 32 centers and 11 countries who were undergoing cardiac surgery with cardiopulmonary bypass to receive ANH (withdrawal of ≥650 ml of whole blood with crystalloids replacement if needed) or usual care. The primary outcome was the transfusion of at least one unit of allogeneic red cells during the hospital stay. Secondary outcomes were death from any cause within 30 days after surgery or during the hospitalization for surgery, bleeding complications, ischemic complications, and acute kidney injury. Results A total of 2010 patients underwent randomization; 1010 were assigned to ANH and 1000 to usual care. Among patients with available data, 274 of 1005 (27.3%) in the ANH group and 291 of 997 (29.2%) in the usual-care group received at least one allogeneic red-cell transfusion (relative risk, 0.93; 95% confidence interval, 0.81 to 1.07; P=0.34). Surgery for postoperative bleeding was performed in 38 of 1004 patients (3.8%) in the ANH group and 26 of 995 patients (2.6%) in the usual-care group. Death within 30 days or during hospitalization occurred in 14 of 1008 patients (1.4%) in the ANH group and 16 of 997 patients (1.6%) in the usual-care group. Safety outcomes were similar in the two groups. Conclusions Among adults undergoing cardiac surgery, ANH did not reduce the number of patients receiving allogeneic red-cell transfusion
Scalable Inference via Averaged Robbins-Monro Bootstrap
No full textBootstrap procedures represent a straightforward approach to assessing the uncertainty around estimates of interest in statistical models. However, with the rising prevalence of massive datasets in statistical problems, the computational cost of bootstrap methods can quickly become prohibitive in many settings. To this end, this paper proposes the Averaged Robbins-Monro Bootstrap (ARM-B), a scalable tool for estimating parameter variability via multiple chains of Robbins-Monro updates. The method is illustrated in large-scale Poisson regression and logistic regression settings and compared with the alternative scalable method given by the bag of little bootstraps (BLB). Some simulation experiments and an illustrative analysis on a large-scale dataset show that ARM-B has comparable accuracy with ordinary bootstrap, but, at the same time, it is significantly less computationally demanding and quite competitive with BLB
Communicating bad news in oncology and hematology settings: A statistic and Large Language Model for interpreting nurses’ difficulties and emotions
No full textBackground. An effective communication seemed to be crucial in all the cancer care phases, like diagnosis, prognosis, and treatment options. Objectives. To analyze and interpret structured and open-ended questionnaire responses, focusing on the communication of bad news in onco-hematology: health care professionals’ attitudes, communication methods, and perceived stress levels. Methods. By employing a free Large Language Model, we identified and summarized the main emotions and perspectives shared by professionals. Results. A total of 221 Italian nurses and physicians employed in onco-hematology field were enrolled. The analysis revealed key emotional themes, offering insights into the professionals’ emotional states and coping mechanisms when delivering difficult news. Significance of results. Data highlighted the duality of emotions experienced by nurses when delivering bad news – balancing professional composure with emotional distress, underscoring the critical role of empathy, team support, and adequate preparation in helping nurses navigate these challenging conversations
Spatio-temporal interactions between wild and free-ranging domestic ungulates in the Central Pyrenees
No full textTargeted Deep Learning System Boundary Testing
No full textEvaluating the behavioral boundaries of deep learning (DL) systems is crucial for understanding their reliability across diverse, unseen inputs. Existing solutions fall short as they rely on untargeted, random perturbations with limited controlled input variations. In this work, we introduce Mimicry, a novel black-box test generator for fine-grained, targeted exploration of DL system boundaries. Mimicry performs boundary testing by leveraging the probabilistic nature of DL outputs to identify promising directions for exploration. By using style-based GANs to disentangle inputs into content and style components, Mimicry generates boundary test inputs by mimicking features from both source and target classes. We evaluated Mimicry’s effectiveness in generating boundary inputs for five DL image classification systems, comparing it to two baselines from the literature. Our results show that Mimicry consistently identifies inputs up to 25× closer to the theoretical decision boundary,
outperforming the baselines with statistical significance. Moreover, it generates semantically meaningful boundary test cases that reveal new functional misbehaviors, while the baselines mostly produce corrupted or invalid inputs. Thanks to its enhanced control over latent space manipulations, Mimicry remains effective as dataset complexity grows, resulting in a up to 36% higher validity rate and competitive diversity, as supported by a comprehensive human assessment
VHE γ-ray observations of bright BL Lacs with the Large-Sized Telescope prototype (LST-1) of the CTAO
No full textCherenkov Telescope Array Observatory (CTAO) is the next-generation ground-based -ray observatory operating in the energy range from up to, with two sites in La Palma (Spain) and Paranal (Chile). It will consist of telescopes of three sizes, covering different parts of the large energy range. We report on the performance of Large-Sized Telescope prototype (LST-1) in the detection and characterization of extragalactic -ray sources, with a focus on the reconstructed -ray spectra and variability of classical bright BL Lacertae objects, which were observed during the early commissioning phase of the instrument. LST-1 data from known bright -ray blazars - Markarian 421, Markarian 501, 1ES 1959+650, 1ES 0647+250, and PG 1553 + 113 - were collected between 2020 July 10, and 2022 May 23, covering a zenith angle range of 4 to 57. The reconstructed light curves were analysed using a Bayesian block algorithm to distinguish the different activity phases of each blazar. Simultaneous Fermi-LAT data were utilized to reconstruct the broad-band -ray spectra for the sources during each activity phase. High-level reconstructed data in a format compatible with gammapy are provided together with measured light curves and spectral energy distributions (SEDs) for several bright blazars and an interpretation of the observed variability in long and short time-scales. Simulations of historical flares are generated to evaluate the sensitivity of LST-1. This work represents the first milestone in monitoring bright BL Lacertae objects with a CTAO telescope
Effects of dietary sodium butyrate supplementation on fat metabolism in lamb adipose and liver tissues
No full textObjective: Sodium butyrate (SB) is a potentially useful feed additive; however, its effects on lipid metabolism in adipose and liver tissues of lambs are still not fully explored. This study systematically examined the effects and underlying mechanisms of dietary SB supplementation on lipid metabolism in lamb adipose and liver tissues from an adipose-blood-liver perspective. Methods: Twelve 3-month-old male lambs (22.37±2.05 kg) were randomly divided into a control group and an SB group. We measured the adipose tissue cellular morphology and lipid metabolism-related indices in both adipose and liver tissues. Results: The results indicated that SB significantly reduces abdominal and perirenal adipose tissue mass, as well as the average area and diameter of adipocytes (p<0.05). Dietary supplementation with SB activated adenosine 5’-monophosphate-activated protein kinase α1 (AMPKα1) in lamb adipose tissue, resulting in upregulated mRNA expression of hormone-sensitive triglyceride lipase (HSL) and downregulated mRNA expression of sterol regulatory element-binding protein 1 and fatty acid synthase (p<0.05). Simultaneously, adiponectin secretion and receptor expression in adipose tissue, as well as serum adiponectin levels, were significantly elevated (p<0.05). Moreover, dietary supplementation with SB increased the levels of tricarboxylic acid cycle metabolites in lamb liver, including oxaloacetate, citrate, cis-aconitate, and succinate (p<0.05), while simultaneously activating the liver AMPKα1 signaling pathway. These changes led to upregulated HSL, platelet glycoprotein 4, and long-chain acyl-CoA synthetase mRNA expression (p<0.05), thereby enhancing liver fatty acid metabolism. Conclusion: In summary, dietary supplementation with SB alters adiponectin levels in lambs, activates the AMPK signaling pathway, promotes adipose tissue lipolysis, and regulates liver lipid metabolism. The findings provide valuable insights into the use of SB for managing lamb body fat reserves and offer a robust basis for further research in animal bioscience