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Assessment of frailty in patients with heart failure: A new Heart Failure Frailty Score developed by Delphi consensus
No full textAims: The Heart Failure Frailty Score (HFFS) is a novel, multidimensional tool to assess frailty in patients with heart failure (HF). It has been developed to overcome limitations of existing frailty assessment tools while being practical for clinical use. The HFFS reflects the concept of frailty as a multidimensional, dynamic and potentially reversible state, which increases vulnerability to stressors and risk of poor outcomes in patients with HF. Methods and results: The HFFS was developed through a Delphi consensus process involving 54 international experts. This approach involved iterative rounds of questionnaires and interviews, where a panel of experts provided their opinions on specific questions prepared by the Steering Committee. The experts were invited to vote and share their views anonymously, using a 5-point Likert scale over iterative rounds. An 80% threshold was set for agreement or disagreement for each statement. Twenty-two variables from four domains (clinical, functional, psycho-cognitive and social) have been selected for inclusion in the HFFS after the third round of the Delphi process. A shorter version (S-HFFS), including 10 variables, has also been developed for daily clinical use. Conclusions: The HFFS is a new multidimensional tool for the identification of frailty in patients with HF. It should also enables healthcare providers to identify potential ‘red flags’ for frailty in order to develop personalized care plans. The next step will be to validate the new score in patients with HF
Socio-economic status and the effect of guideline-directed medical therapy in the STRONG-HF study
No full textAims: Acute heart failure (AHF) impacts millions globally, with outcomes varying based on socio-economic status (SES). Methods: SES measured by annual household income, years of education and medical insurance coverage. Each patient's income and education level relative to the median or mean, respectively, in the country was calculated, and categorized into tertiles (0, 1 or 2 from lowest to highest). SES scores (0–5) were computed as the sum of these levels plus insurance coverage (0 = no or 1 = yes). Patients' baseline characteristics, outcomes (HF readmission, death and their composite) and the effect of high-intensity care (HIC) vs. usual care (UC) were examined by SES scores 0–2, 3 and 4–5. Results: Lower SES patients, who were younger, predominantly female, Black and non-European, had fewer comorbidities such as atrial fibrillation, diabetes and ischaemic heart disease and exhibited milder HF, indicated by a lower NYHA class, lower creatinine and higher cholesterol before discharge. Despite having milder HF and less comorbidities, after adjusting for baseline characteristics, patients with higher SES had numerically better outcomes, though differences were not statistically significant. 180-day hazard ratios (HRs) for HF readmission or death were 0.75 (95% CI 0.48–1.16) for SES scores of 3 and 0.85 (95% CI 0.58–1.23) for scores of 4–5, compared to 0–2. Higher SES patients had numerically better treatment effect from HIC, with HRs of 0.69 for SES 0–2, 0.72 for SES 3 and 0.50 for SES 4–5. Conclusions: In this post hoc analysis of the STRONG-HF study, lower SES was associated with milder acute HF but similar 180-day outcomes. Higher SES patients benefitted more from HIC
A top-down approach for climate change mitigation strategies
Get PDFThis research examined the effects of various GHG reduction policies on climate change via optimization techniques using a top-down approach. The aim was to examine how different aspects of policies to reduce CO2 and CH4 emissions would affect changes in temperature compared to pre-industrial levels from 2025 to 2100. The proposed top-down approach allows for the investigation of several factors that may influence the results: (i) the objective function, (ii) the reduction pathway, and (iii) the starting point of the optimization. Two different objective functions were minimized: the overall sum of the temperature between 2025–2100 and the value at 2100. The results were also compared in terms of the reduction trajectories: two different emission trends were assumed: a gradual (gaussian) fall in emissions or a fast (exponential) decline, starting in 2025, in 2030, and in 2035. The mitigation of greenhouse gas (GHG) emissions was limited to a certain range of scenarios outlined by the Intergovernmental Panel on Climate Change (IPCC). These scenarios were determined by analyzing economic, social, and technical developments expected to occur in the next few decades. The analysis also included the interaction in global warming of air pollutant emission variations due to climate policies. The results revealed that exponential trajectories, depending on the initial year, can facilitate the stabilization of global temperatures below 1.5 °C. In contrast, gaussian trajectories were more likely to overtake this threshold if implementation is delayed beyond 2025
Proprietà e principio verde. Riflessioni storico comparatistiche in margine al nuovo Codice argentino
No full textDEFINIZIONE DI UN CORE OUTCOME SET PER GLI STUDI CLINICI RIGUARDANTI IL TRATTAMENTO DELLA CUFFIA DEI ROTATORI Ricerca degli Outcome e confronto tra letteratura e pazienti
Get PDFObiettivo: Lo scopo di questo studio è individuare in modo esaustivo tutti gli outcome per il trattamento della cuffia dei rotatori, allo scopo di definire un Core Outcome Set (COS) specifico per la patologia.
Materiali e Metodi: La prima fase del lavoro ha esplorato la letteratura tramite una revisione sistematica dal 1945 a Dicembre 2023. La seconda fase, di ricerca qualitativa, ha indagato il punto di vista dei pazienti tramite interviste semi-strutturate. L’analisi delle interviste è stata eseguita con il metodo dell’analisi tematica secondo Braun e Clark.
Risultati: Sono stati selezionati 430 studi da una lista iniziale di 4066 studi. Sono stati descritti 58 differenti outcome. Il dolore è stato l’outcome più indagato (87%), seguito dalla funzionalità della spalla nelle attività quotidiane (83%), il Range of Motion (79%), la forza (72%), la soddisfazione (40%), l’ integrità strutturale (39%), la funzionalità della spalla nelle attività lavorative (30%) e la qualità del sonno (23%). Nella parte di ricerca qualitativa i pazienti hanno descritto come outcome rilevanti nella loro esperienza di malattia il recupero del movimento e della forza, il rientro nelle attività lavorative, il dolore, la capacità di eseguire attività di svago e attività quotidiane, il sonno. Quest’ultimo in particolare è stato indicato dai pazienti come outcome molto rilevante nonostante in letteratura sia poco esplorato.
Conclusioni: La letteratura scientifica presenta una ampia varietà di outcome per valutare l’efficacia del trattamento delle lesioni della cuffia dei rotatori. La comparazione dei risultati della revisione di letteratura e delle opinioni dei pazienti evidenzia un generale allineamento nella valutazione degli outcome più rilevanti Tuttavia, si è riscontrata una significativa discrepanza riguardo alla rilevanza attribuita all’outcome sonno. Questo sottolinea l’importanza del coinvolgimento dei pazienti nella definizione del Core Outcome Set.Aim: The objective of this study is to comprehensively identify all outcomes associated with rotator cuff treatment in order to define a disease-specific core outcome set (COS).
Materials and Methods: The initial phase of the study entailed a systematic review of the literature from 1945 to December 2023. The second phase of the study employed qualitative research methods to investigate patients' perspectives through semi-structured interviews. Thematic analysis, as described by Braun and Clark, was employed to analyze the data obtained from the interviews.
Results: From an initial list of 4,066 studies, 430 were selected for further analysis. A total of 58 distinct outcomes were identified. The outcome most frequently investigated was pain (87%), followed by shoulder function in daily activities (83%), range of motion (79%), strength (72%), satisfaction (40%), structural integrity (39%), shoulder function in work activities (30%), and sleep quality (23%). In the qualitative research component, patients delineated recovery of movement and strength, resumption of work activities, pain, capacity to perform leisure and daily activities, and sleep as pivotal outcomes in their disease experience. In particular, the latter was identified by patients as a highly relevant outcome, despite being relatively under-researched in the existing literature.
Conclusion: A review of the scientific literature reveals a multitude of outcomes pertaining to the efficacy of rotator cuff injury treatment. A comparison of the results of the literature review and patient opinions reveals a general alignment in the assessment of the most relevant outcomes. However, there was a notable discrepancy in the perceived relevance of the sleep outcome. This highlights the necessity of patient involvement in the definition of the core outcome set
Prognostic value of changes in pre- and postoperative inflammatory blood markers in HPV-negative head and neck squamous cell carcinomas
Get PDFObjective: Neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) are inflammatory markers easily obtained from a routine complete blood count, and their preoperative values have recently been correlated with oncological outcomes in patients with HPV-negative head and neck squamous cell carcinoma (HNSCC). The aim of this study is to evaluate the prognostic value of NLR and LMR before and after treatment in patients with HPV-negative HNSCC undergoing up-front surgical treatment. Methods: This multicentric retrospective study was performed on a consecutive cohort of patients treated by upfront surgery for HPV-negative HNSCC between April 2004 and June 2018. Only patients whose pre- and postoperative NLR and LMR were available were included. Their association with local, regional and distant failure, progression-free survival (PFS) and overall survival (OS) was calculated. Results: A total of 493 patients (mean age 68 years) were enrolled. The mean follow-up time was 54 months. Pre-surgical NLR ≥ 3.76 was associated with a high risk of regional failure (HR = 2.21, 95% CI: 1.08-5.55), disease progression (HR = 1.55, 95% CI: 1.07-2.25) and death (HR = 1.40, 95% CI: 0.94-2.10). A post-surgical LMR < 2.92 had a significant impact on disease progression (HR = 1.92, 95% CI: 1.13-3.28) and OS (HR = 2.98, 95% CI: 1.53-5.81). Patients with stable NLR ≥ 3.76 in the pre- and postoperative period had worse OS and PFS. Conclusions: Our results support that pre- and postoperative NLR and LMR can be useful in identifying patients at risk of local, regional, or distant recurrence who may require closer follow-up or more aggressive treatment
Impacts of Racket Handle Design on Table Tennis Topspin Forehand Rally Performance Among Beginner Players
Get PDFPhysical inactivity is a major global public health concern, and table tennis offers a low-impact, engaging way to promote physical activity across various age groups. However, many beginners struggle to maintain effective participation due to their lower skill levels. Therefore, the development and reinforcement of stable grip techniques is crucial because it will help beginners achieve sustainable improvements in performance. This will provide additional opportunities to increase physical activity, and therefore overall health, across all age groups. Thus, in this study, we investigate the effects of a prototype table tennis handle on the racket angle and performance of beginners. The prototype handle features a 20° tilt to assist the player in maintaining a stable topspin forehand grip during play. The participants were randomized into three groups, Groups A, B, and C, which used the prototype handle, standard handle, and practiced with the prototype but performed tests with the standard handle, respectively. The participants executed topspin forehand strokes in approximately 30 min of practice, and data on racket angles, swing mechanics, success rates, and ball landing positions were collected. The results showed that Group A exhibited a larger racket open angle and a smaller racket face Angle than the other groups. However, the groups showed no significant differences in hit positions or overall success rates. Our results suggest that although the prototype handle can influence racket angles and some performance aspects, individual differences and swing mechanics should be considered
Meteorological data in Eccel & Ranzi, A Multi‐century Meteo‐hydrological Analysis for the Adige River Basin (Central Alps). Part I: Climate Variability (1862–2011) at Different Time Scales
No full textClimatic features of the Adige river basin (Italian Alps) were analyzed for a
one-century-and-half period. A monthly water balance model was applied to a dense grid and
then aggregated as a single series, representative of the whole basin. Time trends, climate
variability, presence of cyclicity and links with external forcings were assessed. Precipitation
regimes showed a prevailing trend of decreasing variability, but temperature showed
long-term opposite trends. Not always was climate variability directly attributable to a
climate change forcing.
ARTIFICIAL INTELLIGENCE-BASED INTEGRATED APPROACH FOR SKIN CANCER RECOGNITION
Get PDFIntroduzione: l'incidenza del melanoma è in continuo aumento ed è responsabile della maggior parte dei decessi per tumore della pelle. La diagnosi precoce e la rimozione completa del tumore prima che inizi la fase di invasione profonda costituiscono le principali armi per ridurne mortalità e morbidità. Per questo motivo sono state sviluppate diverse tecniche non invasive di imaging per consentire l'identificazione precoce e più accurata delle lesioni maligne.
Obiettivi dello studio: questo studio si propone di elaborare un modello basato sull’ utilizzo dell’intelligenza artificiale (AI), in grado di distinguere, partendo da immagini ottenute con la tomografia a coerenza ottica confocale (LC-OCT), lesioni melanocitiche sospette all’indagine dermoscopica in benigne, maligne o con significato prognostico incerto.
Materiali e metodi: è stato condotto uno studio retrospettivo per elaborare e valutare l'accuratezza di un modello AI nel distinguere le immagini di lesioni melanocitiche in tre categorie diagnostiche: nevi melanocitici, nevi melanocitici atipici/displastici e melanoma. Sono state analizzate sezioni verticali (DICOM standard) acquisite tramite LC-OCT. Il set di immagini LC-OCT è stato arricchito, per cercare di aumentare il rapporto segnale/rumore (SNR) con diversi filtri (RAW, Gaussiano, LOG e MERGED). Le immagini filtrate con filtro gaussiano e RAW sono state utilizzate per estrarre cluster di pixel, secondo l'algoritmo SLIC Superpixels e Affinity Propagation (AP) Clustering. Sono state estratte le regioni di interesse e i biomarcatori con una libreria in R, chiamata Moddicom.
Diversi modelli di machine learning (regressione logistica bivariata, albero decisionale e random forest) sono stati addestrati per capire se qualche biomarcatore fosse in grado di distinguere il melanoma dalle altre lesioni.
Discussione e conclusioni: In questo studio pilota abbiamo sviluppato e dimostrato, per la prima volta in letteratura, la possibilità di sviluppare un modello di intelligenza artificiale per la discriminazione in vivo tra lesioni melanocitiche benigne, lesioni a potenziale maligno incerto e melanoma, basato su immagini LC-OCT. Abbiamo identificato diversi biomarcatori potenzialmente utili a questo scopo.
Sebbene questo modello non abbia ancora dimostrato buoni risultati in termini di prestazioni, sono stati identificati e proposti diverse strade per migliorarlo.Introduction: the incidence of melanoma is continuously increasing and it is responsible for the majority of skin cancer deaths. Early diagnosis and complete removal of the tumor tissue before the onset of deep invasion are the main factors for the reduction of its mortality and morbidity. For this reason, different non-invasive imaging techniques to allow the early and more accurate identification of malignant lesions have been developed.
Objectives of the study: this study aims to elaborate an AI integrated approach, based on images made using Line-field confocal optical coherence tomography (LC-OCT), able to correctly identify dermoscopically suspicious melanocytic lesions as benign, malignant or at uncertain prognostic significance.
Materials and methods: A retrospective study was conducted to elaborate and evaluate the accuracy of an AI model in distinguishing images of melanocytic lesions into three diagnostic categories: melanocytic nevi, atypical/dysplastic melanocytic nevi and melanoma. The analyzed images consisted of vertical sections (DICOM) acquired via LC-OCT. The set of LC-OCT DICOM images was enriched, in order to try to increase the signal/noise ratio (SNR) with respect to the investigation outcome with different filters (RAW, Gaussian, LOG and MERGED). The images filtered with Gaussian and RAW filter were used to extract pixel clusters, according to the SLIC Superpixels and Affinity Propagation (AP) Clustering algorithm. Regions of interest were extracted and image biomarkers were extracted with a library in R, called Moddicom.
Different machine learning models (bivariate logistic regression, decision tree and random forest) were trained to understand if any biomarker was able to discern melanoma from benign moles.
Results: 127 variables showed a statistically significant p-value on univariate testing. The most promising bivariate regression models were extracted. The performances on the training set are high, while those on the testing set are lower: this means that apparently good results of this technique are probably due to overfitting. Similarly, the decision tree and the random forest also showed excellent levels of accuracy, positive predictive value (PPV) and negative predictive value (NPV) for the training test with a drop in performance on the independent internal testing set.
Discussion and conclusions: In this pilot study we developed and demonstrated, for the first time in the literature, the feasibility of an artificial intelligence model for the in-vivo discrimination between benign melanocytic lesions, uncertain malignant potential lesions and melanoma based on LC-OCT images. We have identified several biomarkers potentially useful for this purpose.
Although this model has not yet demonstrated good results in terms of performance, several ways for its improvement have been identified and proposed
Hybridizing Carousel Greedy and Kernel Search: A new approach for the maximum flow problem with conflict constraints
No full textThis work addresses a variant of the maximum flow problem where specific pairs of arcs are not allowed to carry positive flow simultaneously. Such restrictions are known in the literature as negative disjunctive constraints or conflict constraints. The problem is known to be strongly NP-hard and several exact approaches have been proposed in the literature. In this paper, we present a heuristic algorithm for the problem, based on two different approaches: Carousel Greedy and Kernel Search. These two approaches are merged to obtain a fast and effective matheuristic, named Kernousel. In particular, the computational results reveal that exploiting the information gathered by the Carousel Greedy to build the set of most promising variables (the kernel set ), makes the Kernel Search more effective. To validate the performance of the new hybrid method, we compare it with the two components running individually. Results are also evaluated against the best-known solutions available in the literature for the problem. The new hybrid method provides 15 new best-known values on benchmark instances