The original and innovative aspect of this article is to verify whether an investor's risk attitude is influenced (not only) by his/her sociodemographic characteristics (e.g., age and gender), but ...also by the emotional meaning he/she associates with money (e.g., power, security, love, and freedom) and by the financial advisor's characteristics. For this purpose, we collected information on a sample of real-world asset allocation choices made by 177 Italian investors with their respective financial advisors. Our results demonstrate that some investor's characteristics indicated in the literature as variables having an impact on investor risk appetite no longer turn out to be so when the advisor is professionally recognized and he/she has been able to build a stable and lasting relationship over time. Moreover, the different emotional meaning investor associates to money affect his/her risk appetite. In particular, security and power mitigate and amplify investor's risk attitude, respectively. Our results may be useful for banks, financial advisors, and possibly the creators of artificial intelligence algorithms, in providing guidance toward optimal portfolio asset allocations in line with investor's emotional associations as regards money.
Understanding climate change awareness and its related risks is crucial to plan efficient climate-smart strategies. An online survey was conducted on Italian consumers with the aim to understand ...consumers’ inclination toward food products obtained with climate-smart strategies. Specifically, consumers’ awareness about climate change and willingness to choose and pay for products derived from climate-smart agriculture were investigated. Results highlighted two targeted consumers, one more interested in economic issues and more “conservative” and the second one more concerned with climate changes risks with a higher interest in environmental and ethical values (fair trade), representing the primary target consumers for climate-smart foods. This segmentation can be useful to identify expectations and purchase drivers that can facilitate climate-smart policies and the establishment of the climate-smart foods on the market.
The choice of antithrombotic prophylaxis in the so-called “medium-risk” patients (i.e., CHA2DS2-VASc score = 1 in males or 2 in females) is one of the major enigmatic issues in clinical management of ...atrial fibrillation (AF).
We retrospectively evaluated 30-day and 1-year thromboembolic events in all consecutive medium-risk patients visited for first diagnosed AF in the local Emergency Department during a 10-year period. The main aim was to establish whether anticoagulant or antiplatelet therapy was effective to lower the thromboembolic risk in patients receiving these drugs. Bleeding events, related to anticoagulant or antiplatelet therapy, was defined as secondary end point.
The final study population consisted of 6389 (3640 males and 2749 females) patients for whom a complete dataset regarding targeted follow-up was available. Patients were then subdivided into two subgroups, according to performance of cardioversion and spontaneous sinus rhythm restoring. In both genders, no significant difference in thromboembolic or bleeding events was noted between patients who underwent cardioversion and were discharged with oral anticoagulant therapy or antiplatelet treatment versus those who were not treated with antithrombotic drugs. Moreover, no difference was also observed in thromboembolic or hemorrhagic event rate between low risk and “medium-risk” patients.
The results of this study suggest that anticoagulant or antiplatelet therapy would not produce clinical benefits in “medium-risk” AF patients.
•Anticoagulation in the medium-risk AF patients is one major enigmatic issue.•We evaluated 30-day and 1-year strokes and bleeding in a 10-year period.•No difference between medium-risk pts discharged on OAC and those not treated.•Same results for males and females•Anticoagulant therapy would not produce clinical benefits in medium-risk AF pts.
Highlights•Malignant lymphomas subtype classification with machine learning.•Texture features extracted from FDG-PET volumes of interest.•Multiple-instance learning SVM for patient-level ...categorization.•Random forests exploited for feature selection.
Malignant lymphomas are cancers of the immune system and are characterized by enlarged lymph nodes that typically spread across many different sites. Many different histological subtypes exist, whose diagnosis is typically based on sampling (biopsy) of a single tumor site, whereas total body examinations with computed tomography and positron emission tomography, though not diagnostic, are able to provide a comprehensive picture of the patient. In this work, we exploit a data-driven approach based on multiple-instance learning algorithms and texture analysis features extracted from positron emission tomography, to predict differential diagnosis of the main malignant lymphomas subtypes.
We exploit a multiple-instance learning setting where support vector machines and random forests are used as classifiers both at the level of single VOIs (instances) and at the level of patients (bags). We present results on two datasets comprising patients that suffer from four different types of malignant lymphomas, namely diffuse large B cell lymphoma, follicular lymphoma, Hodgkin’s lymphoma, and mantle cell lymphoma.
Despite the complexity of the task, experimental results show that, with sufficient data samples, some cancer subtypes, such as the Hodgkin’s lymphoma, can be identified from texture information: in particular, we achieve a 97.0% of sensitivity (recall) and a 94.1% of predictive positive value (precision) on a dataset that consists in 60 patients.
The presented study indicates that texture analysis features extracted from positron emission tomography, combined with multiple-instance machine learning algorithms, can be discriminating for different malignant lymphomas subtypes.
Post-traumatic haemorrhage is the leading cause of death in trauma patients. The development of coagulopathy substantially contributes to bleeding severity and to the ensuing unfavourable outcome. ...Trauma-induced coagulopathy (TIC) can be seen in 10-25% of patients with major trauma, and its early and appropriate therapeutic management leads to considerable reduction of mortality risk. Due to the extreme complexity of TIC pathophysiology, the limitations of conventional coagulation tests (CCTs) have become evident in recent years. Unlike these routine tests, point of care viscoelastic tests (VET) such as thromboelastogram (TEG) or rotational thromboelastography (ROTEM) provide valuable clinical information by real time assessment of changes in viscoelastic properties of blood throughout clot formation. This review was aimed to collect and discuss available evidence on goal-directed hemostatic resuscitation, based on TEG or ROTEM data. We included studies with patients aged 18 years or older, major trauma, and needing massive transfusions. Overall, 6 studies totalling 1533 patients were finally included. A total number of 288 patients died, 98 of whom in the TEG- or ROTEM-guided cohorts (i.e., intervention groups). A 36% reduction of death was observed in the intervention groups (relative risk, 0.641; 95% CI 0.517-0.795; P<0.001). Our results show that VET-guided management is effective to reduce mortality compared to conventional management with CCTs. Except for mortality, all others endpoints were heterogeneous across the studies. This emphasize the need of scheduling new and well-designed trials, aimed to better define the optimal strategy for TIC management.
To evaluate the prognostic utility of serial assessment on the Coma Recovery Scale-Revised (CRS-R) during the first 4 weeks of intensive rehabilitation in patients surviving a severe brain injury.
...Prospective cohort study.
An intensive rehabilitation unit.
Patients (N=110) consecutively admitted to the intensive rehabilitation unit. Inclusion criteria were (1) a diagnosis of unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) caused by an acquired brain injury, and (2) aged >18 years.
All patients underwent clinical evaluations using the Italian version of the CRS-R during the first month of hospital stay.
Behavioral classification on the CRS-R and the score on the Glasgow Outcome Scale (GOS) at final discharge. Patients transitioning from UWS to MCS or emergence from MCS (E-MCS), and from MCS to E-MCS were classified as patients with improved responsiveness (IR).
After a mean ± SD hospital stay of 5.3±2.7 months, 59 of 110 patients (53.6%) achieved IR. In the multivariable analysis, a higher CRS-R score change at week 4 (odds ratio =1.99; 95% confidence interval CI, 1.49-2.66; P<.001) was the only significant predictor of IR at discharge. Fifty-three patients (48.2%) were classified as severely impaired at discharge (GOS=3). In the multivariable analysis, higher GOS scores were related to a higher CRS-R score at admission (B=.051; 95% CI, .027-.074; P<.001), a higher CRS-R score change at week 4 (B=.087; 95% CI, .064-.110; P<.001), and an absence of severe infections (B=-.477; 95% CI, -.778 to -.176; P=.002).
An improvement on the total CRS-R score and on different subscales across the first 4 weeks of inpatient rehabilitation discriminates patients who will have a better outcome at discharge, providing information for rehabilitation planning and for communication with patients and their caregivers.
Intravenous iodinated contrast (IVIC) medium is routinely administered to dogs. Scattered information exists regarding the serum biochemical or urinary profiles associated with the administration of ...IVIC in dogs. The aim of the study was to describe, compare, and discuss from the perspective of previous studies the alterations in serum biochemical and urinary parameters before (T0) and within one week (T1) of the IVIC administration during routine computed tomography (CT) scan evaluation of 22 dogs. Mature dogs presenting for CT scan evaluation for preoperative oncology staging/surgical planning were included. T1 evaluation was performed within one week of IVIC administration. Statistically significant differences in serum total protein, albumin, chloride, calcium, and phosphorus concentrations, urine protein to creatinine ratio, and urine specific gravity were found between T1 and T0. At T1, the serum creatinine concentration was within reference ranges in all dogs but one. An increase in the urine protein to creatinine ratio was observed in four samples, one of which was non-proteinuric at T0. Changes in biochemistry and urine parameters between T0 and T1 were not considered clinically significant.
Patients with colorectal cancer often present with anaemia and require red blood cell transfusions (RBCT) during their peri-operative course. Evidence suggests a significant association between RBCT ...and poor long-term outcomes in surgical patients, but the findings in colorectal cancer are contradictory.
The aim of this retrospective, single-centre, cohort study was to investigate the prognostic role of peri-operative RBCT in a large cohort of patients with stage I-III colorectal cancer submitted to curative surgery between 2005 and 2017. The propensity score matching technique was applied to adjust for potential confounding factors.
Among 1,414 patients operated within the study period, 895 fulfilled the inclusion criteria: 29.6% (n=265) received peri-operative RBCT. The group that received peri-operative RBCT was significantly older (p<0.001), had more comorbidities (p<0.001), more advanced tumours (p<0.001) and more colon tumours (p=0.002) and stayed in hospital longer (p<0.001). Post-operative mortality was 7-fold higher (2.3 vs 0.3%, p=0.01) in this group. Survival outcomes were significantly worse in the group receiving RBCT than in the group not receiving RBCT for both overall (64.5 vs 80.1%, p<0.001) and cancer-specific survival (74.3 vs 85.1%, p<0.001). On multivariable analysis, peri-operative RBCT was significantly associated with poorer overall survival (hazard ratio 1.51, p=0.009). When transfused and non-transfused cases were paired through the propensity score matching technique considering main clinico-pathological features, no differences in overall and cancer-specific survival were found.
Our data suggest that, after adjustment for potential confounding factors, no significant association exists between RBCT and prognosis in colorectal cancer.
To evaluate whether electroencephalographic (EEG) features recorded during the post-acute stage in patients with severe disorders of consciousness (DoC) after acute brain injury (ABI), contribute to ...neurological outcome prediction of these patients at discharge from the intensive rehabilitation unit (IRU).
We retrospectively evaluated all patients consecutively admitted to the IRU from August 2012 to December 2016. Inclusion criteria were: 1) age >18years, 2) patients with unresponsive wakefulness syndrome (UWS) or in a minimally conscious state (MCS), and 3) EEG and a coma recovery scale-revised (CRS-R) score available within the first week after admission. Clinical evaluation was performed using the Italian version of the CRS-R score. EEGs were classified according to American Clinical Neurophysiology Society (ACNS) terminology. Clinical state at final discharge was evaluated using the CRS-R score.
In total, 102 patients were included in the analysis. After a mean of five months of IRU stay, among the 61 UWS subjects, 19 transitioned to MCS and 11 recovered to exit-MCS (E-MCS); twenty-three of the 41 subjects in MCS progressed to E-MCS. Using logistic regression, consciousness level (UWS/MCS-OR=13.4), CRS-R score at admission (OR=1.33) and use of activating drugs (OR=4.7) were significant predictors of clinical improvement. Multivariable analysis showed that specific EEG patterns were independent predictors of improved consciousness at discharge in UWS patients.
EEG performed within the first week after IRU admission, classified according to ACNS-terminology in patients with UWS at admission, can provide useful prognostic contribution.
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