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An International Expert-Based CONsensus on Indications and Techniques for aoRtic balloOn occLusion in the Management of Ruptured Abdominal Aortic Aneurysms (CONTROL-RAAA)
No full textObjective: To report on the recommendations of an expert-based consensus on the indications, timing, and techniques of aortic balloon occlusion (ABO) in the management of ruptured abdominal aortic aneurysms (rAAA). Methods: Eleven facilitators created appropriate statements regarding the study issues that were voted on using a 4-point Likert scale with open-comment fields, by a selected panel of international experts (vascular surgeons and interventional radiologists) using a 3-round modified Delphi consensus procedure (study period: January-April 2023). Based on the experts’ responses, only the statements reaching grade A (full agreement ≥75%) or B (overall agreement ≥80% and full disagreement <5%) were included in the final study report. The consistency of each round’s answers was also graded using Cohen’s kappa, the intraclass correlation coefficient, and, in case of double resubmission, Fleiss kappa. Results: Sixty-three experts were included in the final analysis and voted on 25 statements related to indication and timing (n=6), and techniques (n=19) of ABO in the setting of rAAA. Femoral sheath or ABO should be preferably placed in the operating room, via a percutaneous transfemoral access, on a stiff wire (grade B, consistency I), ABO placement should be suprarenal and last less than 30 minutes (grade B, consistency II), postoperative peripheral vascular status (grade A, consistency II) and laboratory testing every 6 to 12 hours (grade B, consistency) should be assessed to detect complications. Formal training for ABO should be implemented (grade B, consistency I). Most of the statements in this international expert-based Delphi consensus study might guide current choices for indications, timing, and techniques of ABO in the management of rAAA. Clinical practice guidelines should incorporate dedicated statements that can guide clinicians in decision-making. Conclusions: At arrival and during both open or endovascular procedures for rAAA, selective use of intra-aortic balloon occlusion is recommended, and it should be performed preferably by the treating physician in aortic pathology. Clinical Impact: This is the first consensus study of international vascular experts aimed at defining the indications, timing, and techniques of optimal use of ABO in the clinical setting of rAAA. Aortic occlusion by endovascular means (or ABO) is a quick procedure in properly trained hands that may play an important role as a temporizing measure until the definitive aortic repair is achieved, whether by endovascular or open means. Since data on its use in hemodynamically unstable patients are limited in the literature, owing to practical challenges in the performance of well-conducted prospective studies, understanding real-world use by experts is of importance in addressing critical issues and identifying main gaps in knowledge
Enrico Baj: artista polimaterico nel contesto culturale del XX secolo
No full textIl contributo, scritto insieme ad Antonio Sgamellotti, ripercorre il progetto di analisi non invasive su alcune opere del periodo nucleare di Enrico Baj, per poi portare nuove considerazioni sul contesto culturale e soprattutto sulle genealogie storiche del polimaterismo pittorico praticato da Baj fin dagli anni che precedono il vero e proprio assemblage polimaterico con cui si è affermato negli anni '60
Changes of Airway Space and Flow in Patients Treated with Rapid Palatal Expander (RPE): An Observational Pilot Study with Comparison with Non-Treated Patients
Get PDFBackground/Objectives. With a rapid palatal expander (RPE) is reported to be effective in increasing the volume of nasal cavities, with a restoration of physiological nasal airflow. The purpose of this retrospective clinical study was to evaluate, using Cone Beam Computed Tomography (CBCT), the volumetric changes and airflow velocity changes in the nasal cavities, retro-palatal and retro-glossal airways, resulting from the use of RPE with dental anchorage (group A), also comparing these data with patients non treated with RPE (group B). Methods. Sixteen subjects (aged 9.34 years) with transverse maxillary deficiency and unilateral posterior crossbite were treated with RPE with dental anchorage. Additionally, 8 patients (aged 11.11 years) with juvenile idiopathic arthritis, who did not undergo any orthodontic treatment, were selected as a control group. Expansion was performed until overcorrection was achieved, and the device was left in place for 6 months as fixed retention, followed by another 6 months of night-time removable retention. From the retrospective evaluation, all patients presented two CBCT scans at baseline (T0) and 1-year follow-up (T1). The 3D-Slicer software was used for each CBCT to measure the nasal (VN), retropalatal (VRP), and retroglossal (VRG) volumes, while an iterative Excel spreadsheet allowed for a pilot approximated modeling and calculation of airway flow-related data. Results. Regarding mean age, a statistically significant difference (p = 0.01 *) was found between groups, suggesting that group B is closer to the pubertal growth peak. Analysis between T0 and T1 revealed: (i) a statistically significant increase for volumes VN, VRP and VRG in group A; (ii) a statistically significant increase for VN in group B; (iii) a statistically significant decrease for all variables related to airflow velocity in both groups. Furthermore, comparison between group A and B, regarding variations between T0 and T1, found a statistically significant difference only for VN. Conclusions. Within the limitations of this pilot evaluation, the treatment with RPE revealed promising outcomes for retro-palatal, retro-glossal and nasal volumes, together with clinical changes in airflow velocities
Blockchain-based Data Immutability and Traceability in the Era of GDPR
No full textBlockchain technology and smart contracts have recently emerged as valid tools for implementing applications dealing with data due to their ability to provide immutability, traceability, and availability properties. However, in recent years, applications dealing with data need to comply with some data protection regulations, such as the GDPR in Europe. These regulations typically specify a set of rights for data subjects, like the right to be forgotten or the right to rectification, that are apparently in contrast with the blockchain properties mentioned above. This paper investigates how the eight data subject rights prescribed by the GDPR could be supported by a proper combination of blockchain, smart contracts, and encryption techniques. The discussion will proceed in an incremental way by describing how increased support for the GDPR rights requires increased sophistication of the provided solution
AI-Driven Circular Waste Management Tool for Enhancing Circular Economy Practices in Healthcare Facilities
Get PDFThe increasing complexity in hospital waste management requires innovative solutions that integrate sustainability and regulatory compliance. This study proposes an AI-based decision tool to support the circular management of healthcare waste. The approach combines two key elements: (i) the systematic qualitative analysis of international, European, and national regulations, scientific literature, and best practices aimed at identifying strategic actions; (ii) the prioritization of these actions through machine learning, using a Random Forest classifier. We identified 55 actions, grouped into 13 thematic areas, and used them as input variables to assess their impact on regulatory compliance. The variable importance analysis allowed us to classify actions according to their strategic relevance, guiding the structure of the tool and its user interface. Validation, conducted on four simulated case studies, demonstrated the system's ability to improve compliance monitoring, operational efficiency, and the implementation of circular economy and Zero-Waste strategies. The proposed model represents a scalable and evidence-based solution capable of supporting the ecological transition of healthcare facilities in line with EU directives and the Sustainable Development Goals
Prefix-Free Parsing for Merging Big BWTs
No full textWhen building Burrows-Wheeler Transforms (BWTs) of truly huge datasets, prefix-free parsing (PFP) can use an unreasonable amount of memory. In this paper we show how if a dataset can be broken down into small datasets that are not very similar to each other—such as collections of many copies of genomes of each of several species, or collections of many copies of each of the human chromosomes—then we can drastically reduce PFP’s memory footprint by building the BWTs of the small datasets and then merging them into the BWT of the whole dataset
A stress-induced paralog of Lhcb4 controls the photosystem II functional architecture in Arabidopsis thaliana
Get PDFPhotosystem II (PSII) is the pigment-protein complex catalysing light-induced water oxidation. In Arabidopsis thaliana, it includes three Lhcb4-6 proteins linking the core complex to peripheral trimeric antennae. While Lhcb5 and Lhcb6 are encoded by single genes, Lhcb4 is encoded by three isoforms: Lhcb4.1 and Lhcb4.2, constitutively expressed, and Lhcb4.3 (Lhcb8), which accumulates under prolonged abiotic stress. Lhcb8 substitutes for Lhcb4, preventing Lhcb6 accumulation and resulting in a smaller PSII with high quantum yield. Cryo-electron microscopy reveals that Lhcb8 has a shorter carboxy-terminal domain, lacks two chlorophylls, and interacts more tightly with the PSII core, inducing structural changes in the PSII antenna system, ultimately inhibiting the formation of PSII arrays and favouring plastoquinone diffusion. We suggest that dynamic Lhcb4 vs Lhcb8 expression allows for PSII acclimation to contrasting light conditions, offering the potential for engineering crops with improved light use efficiency
Targeting axial and peripheral psoriatic arthritis: a retrospective observational study on the clinical relevance of upadacitinib
No full textObjective: To evaluate upadacitinib (UPA) effectiveness on axial and peripheral manifestations of PsA by assessing the proportion of patients achieving low disease activity (LDA) and inactive disease (ID) status for axial involvement, and MDA and DAPSA-defined remission/LDA for peripheral domain. Methods: This retrospective study included PsA patients from 27 Italian rheumatology centres. Demographic, clinical and outcome data were collected at baseline, 6 and 12 months. Kaplan-Meier curves assessed treatment persistence. Multivariate models identified predictors of discontinuation and outcomes. Results: Among the 425 patients, 282 (66.4%) had peripheral PsA and 143 (33.6%) mixed (peripheral and axial) PsA. The 12-month UPA survival rate was 75.1%, higher in peripheral than mixed PsA (P = 0.039). Fibromyalgia was the strongest predictor of discontinuation (aHR 1.72; 95% CI: 1.08-2.75; P = 0.022). At 12 months, 38.2% of patients achieved ASDAS-LDA and 20.6% reached ASDAS-ID (LUNDEX-adjusted rates were 29.4% and 15.8%, respectively). The crude 12-month MDA rate was 59.9% (47.4% after LUNDEX adjustment). Enthesitis resolved in 80.2% of patients (P < 0.001), and NSAIDs use decreased to 32.9% (P < 0.001). Overall, VAS pain decreased significantly from 71.4 to 40 (mean change -31.4; 95% CI: -42.5 to -33.6; P < 0.0001), with a 44% reduction, well above the minimal clinically important improvement. No major cardiovascular events were reported; most adverse events were mild, including gastrointestinal intolerance (19%), infections (9.5%) and elevated liver enzymes (14.2%). Conclusion: Our study confirms UPA effectiveness across PsA domains, with clinically meaningful improvements in axial involvement and pain
Hegels Begriff des freien Willens als Grundlage der Selbstbestimmung der Moderne
No full textDer Beitrag untersucht Hegels Begriff des freien Willens als Grundlage seiner Theorie der Selbstbestimmung und der modernen Freiheit. Ausgehend von einer Analyse der einleitenden Paragraphen der Grundlinien der Philosophie des Rechts wird gezeigt, dass die Selbstbestimmung erst im dritten logischen Moment – der Einzelheit – voll realisiert wird. Darauf aufbauend richtet sich die Aufmerksamkeit auf die Rolle der Willkür als Form abstrakter Selbstbestimmung, die zwar begrenzt bleibt, aber die Möglichkeit zur wahren Freiheit eröffnet. Abschließend wird dargelegt, wie diese Momente und Formen des Willens in Hegels Rechtsphilosophie miteinander verflochten sind und wie die subjektive, individuelle Wahl – typisch für die moderne Freiheit – auf verschiedenen Ebenen zur Geltung kommt