The growing diffusion of the latest information and communication technologies in different contexts allowed the constitution of enormous sensing networks that form the underlying texture of smart ...environments. The amount and the speed at which these environments produce and consume data are starting to challenge current spatial data management technologies. In this work, we report on our experience handling real-world spatiotemporal datasets: a stationary dataset referring to the parking monitoring system and a non-stationary dataset referring to a train-mounted railway monitoring system. In particular, we present the results of an empirical comparison of the retrieval performances achieved by three different off-the-shelf settings to manage spatiotemporal data, namely the well-established combination of
PostgreSQL
+
PostGIS
with standard indexing, a clustered version of the same setup, and then a combination of the basic setup with
Timescale
, a storage extension specialized in handling temporal data. Since the non-stationary dataset has put much pressure on the configurations above, we furtherly investigated the advantages achievable by combining the TSMS setup with state-of-the-art indexing techniques. Results showed that the standard indexing is by far outperformed by the other solutions, which have different trade-offs. This experience may help researchers and practitioners facing similar problems managing these types of data.
The use of allogeneic blood products to restore hemostasis during pediatric cardiac surgery is associated with major risks. Consequently, there has been a growing interest in new patient blood ...management strategies, such as those based on the use of fibrinogen concentrate (FC). Accumulating evidence has shown FC supplementation to be safe and effective. Nevertheless, no guidelines are available on using FC in the pediatric setting, and few objective evaluations have been provided in clinical practice. The endpoint of this monocenter retrospective study was the hemostatic effect of additional FC in infants undergoing complex cardiac surgery with cardiopulmonary bypass to manage persistent clinically relevant bleeding. After weaning from cardiopulmonary bypass and after protamine administration, patients were transfused with conventional allogeneic products such as packed red blood cells, fresh frozen plasma (FFP), and platelets. In the case of redo surgery, according to the institutional protocol, patients also received tranexamic acid. In case of clinically persistent relevant bleeding, according to the anesthesiologist's judgment and thromboelastography, patients received FC supplementation (group with FC) or further FFP transfusions without receiving FC supplementation (group without FC). The primary endpoint was the hemostatic effects of FC. Secondary endpoints were the functional hypofibrinogenemia threshold value (expressed as maximum amplitude fibrinogen, MA-Fib) and postoperative MA-Fib, fibrinogenemia, intraoperative transfusions, and adverse events (AEs). In total, 139 patients who underwent cardiac surgery with CPB and aged less than 2 years were enrolled: 70 patients received allogeneic blood products and FC supplementation (group FC); 69 patients received allogeneic products without FC supplementation (group without FC). Patients that received FC supplementation were characterized by a significantly longer time of extracorporeal circulation (p < 0.001) and aortic cross-clamping (p < 0.001), a significantly lower minimum temperature (p = 0.011), increased use of concentrated prothrombin complex (p = 0.016) and tranexamic acid (p = 0.010), and a significantly higher amount of packed red blood cells, platelets (p < 0.001) and fresh frozen plasma (p = 0.03). Postoperative bleeding and severe bleeding were not statistically different between patients treated with FC and those not treated with FC supplementation (p = 0.786 and p = 0.695, respectively); after adjustment, a trend toward reduced bleeding can be observed with FC (p = 0.064). Overall, 88% of patients with severe bleeding had MA-Fib < 10 mm; a moderate association between severe bleeding and MA-Fib (odds ratio 1.7, 95% CI 0.5-6.5, p = 0.425) was found. Increased MA-Fib and postoperative fibrinogen were higher in the FC group (p = 0.003 and p < 0.001, respectively) than in FFP. AEs in the FC group were comparable to those observed in less complicated surgeries. Our results suggest a potential role of FC in complex surgery in maintaining postoperative bleeding at a level comparable to less complicated surgical procedures and favoring the increase in postoperative MA-Fib and fibrinogen.The use of allogeneic blood products to restore hemostasis during pediatric cardiac surgery is associated with major risks. Consequently, there has been a growing interest in new patient blood management strategies, such as those based on the use of fibrinogen concentrate (FC). Accumulating evidence has shown FC supplementation to be safe and effective. Nevertheless, no guidelines are available on using FC in the pediatric setting, and few objective evaluations have been provided in clinical practice. The endpoint of this monocenter retrospective study was the hemostatic effect of additional FC in infants undergoing complex cardiac surgery with cardiopulmonary bypass to manage persistent clinically relevant bleeding. After weaning from cardiopulmonary bypass and after protamine administration, patients were transfused with conventional allogeneic products such as packed red blood cells, fresh frozen plasma (FFP), and platelets. In the case of redo surgery, according to the institutional protocol, patients also received tranexamic acid. In case of clinically persistent relevant bleeding, according to the anesthesiologist's judgment and thromboelastography, patients received FC supplementation (group with FC) or further FFP transfusions without receiving FC supplementation (group without FC). The primary endpoint was the hemostatic effects of FC. Secondary endpoints were the functional hypofibrinogenemia threshold value (expressed as maximum amplitude fibrinogen, MA-Fib) and postoperative MA-Fib, fibrinogenemia, intraoperative transfusions, and adverse events (AEs). In total, 139 patients who underwent cardiac surgery with CPB and aged less than 2 years were enrolled: 70 patients received allogeneic blood products and FC supplementation (group FC); 69 patients received allogeneic products without FC supplementation (group without FC). Patients that received FC supplementation were characterized by a significantly longer time of extracorporeal circulation (p < 0.001) and aortic cross-clamping (p < 0.001), a significantly lower minimum temperature (p = 0.011), increased use of concentrated prothrombin complex (p = 0.016) and tranexamic acid (p = 0.010), and a significantly higher amount of packed red blood cells, platelets (p < 0.001) and fresh frozen plasma (p = 0.03). Postoperative bleeding and severe bleeding were not statistically different between patients treated with FC and those not treated with FC supplementation (p = 0.786 and p = 0.695, respectively); after adjustment, a trend toward reduced bleeding can be observed with FC (p = 0.064). Overall, 88% of patients with severe bleeding had MA-Fib < 10 mm; a moderate association between severe bleeding and MA-Fib (odds ratio 1.7, 95% CI 0.5-6.5, p = 0.425) was found. Increased MA-Fib and postoperative fibrinogen were higher in the FC group (p = 0.003 and p < 0.001, respectively) than in FFP. AEs in the FC group were comparable to those observed in less complicated surgeries. Our results suggest a potential role of FC in complex surgery in maintaining postoperative bleeding at a level comparable to less complicated surgical procedures and favoring the increase in postoperative MA-Fib and fibrinogen.
The field effect transistor based on carbon nanotubes (CNT) is a very promising candidate for post-CMOS microelectronics. Transport in the CNT channel is dominated by the Schottky barriers existing ...at the metal source contacts. The nature of the metal and the geometry of the contact appear to influence strongly the electrical behavior, but the mechanism is still rather obscure. Extensive calculations based on density functional theory performed for both end and side contacts and for two metals of very different nature, namely, Al and Pd, allow us to identify a clear connection between the character of the chemical bonding and the height of the Schottky barrier (SBH). Our results emphasize that a low SBH for hole conduction in a CNT implies that the π-electron system of the latter is almost exclusively involved in the chemical bonding with the metal atoms at the interface and that the bonding is not too strong so that both orbital hybridization and topology are preserved. This is the case for Pd in both end and side configurations and to a large extent for Al but in the side geometry only. On the other hand, the coupling of the metal states with the σ-like system or, in other words, the perturbation of the conjugation of the π-system via sp3 C-hybridization is the mechanism that enhances the SBH. This is especially evident in the end contact with Al. By showing how the chemistry at the interfaces determines the SBH, our findings open the possibility of better controlling and designing “good contacts”.
The Automatic Pain Assessment (APA) relies on the exploitation of objective methods to evaluate the severity of pain and other pain-related characteristics. Facial expressions are the most ...investigated pain behavior features for APA. We constructed a binary classifier model for discriminating between the absence and presence of pain through video analysis.
A brief interview lasting approximately two-minute was conducted with cancer patients, and video recordings were taken during the session. The Delaware Pain Database and UNBC-McMaster Shoulder Pain dataset were used for training. A set of 17 Action Units (AUs) was adopted. For each image, the OpenFace toolkit was used to extract the considered AUs. The collected data were grouped and split into train and test sets: 80 % of the data was used as a training set and the remaining 20 % as the validation set. For continuous estimation, the entire patient video with frame prediction values of 0 (no pain) or 1 (pain), was imported into an annotator (ELAN 6.4). The developed Neural Network classifier consists of two dense layers. The first layer contains 17 nodes associated with the facial AUs extracted by OpenFace for each image. The output layer is a classification label of "pain" (1) or "no pain" (0).
The classifier obtained an accuracy of ∼94 % after about 400 training epochs. The Area Under the ROC curve (AUROC) value was approximately 0.98.
This study demonstrated that the use of a binary classifier model developed from selected AUs can be an effective tool for evaluating cancer pain. The implementation of an APA classifier can be useful for detecting potential pain fluctuations. In the context of APA research, further investigations are necessary to refine the process and particularly to combine this data with multi-parameter analyses such as speech analysis, text analysis, and data obtained from physiological parameters.
OBJECTIVES
The aim of this study was to compare high-flow nasal cannula (HFNC) and conventional O2 therapy (OT) in paediatric cardiac surgical patients; the primary objective of the study was to ...evaluate whether HFNC was able to improve PaCO2 elimination in the first 48 h after extubation postoperatively.
METHODS
We conducted a randomized, controlled trial in pediatric cardiac surgical patients under 18 months of age. At the beginning of the weaning of ventilation, patients were randomly assigned to either of the following groups: OT or HFNC. Arterial blood samples were collected before and after extubation at the following time points: 1, 6, 12, 24 and 48 h. The primary outcome was comparison of arterial PaCO2 postextubation; secondary outcomes were PaO2 and PaO2/fractional inspired oxygen (FiO2) ratio, rate of treatment failure and need of respiratory support, rate of extubation failure, rate of atelectasis, simply to complications and the length of paediatric cardiac intensive care unit stay.
RESULTS
Demographic and clinical variables were comparable in the two groups. Analysis of variance for repeated measures showed that PaCO2 was not significantly different between the HFNC and OT groups (P = 0.5), whereas PaO2 and PaO2/FiO2 were significantly improved in the HFNC group (P = 0.01 and P = 0.001). The rate of reintubation was not different in the two groups (P = 1.0), whereas the need for noninvasive respiratory support was 15% in the OT group and none in the HFNC group (P = 0.008).
CONCLUSIONS
HFNC had no impact on PaCO2 values. The use of HFNC appeared to be safe and improved PaO2 in paediatric cardiac surgical patients.
Purpose
To evaluate the safety and efficacy of levosimendan in neonates with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Methods
Neonates undergoing ...risk-adjusted classification for congenital heart surgery (RACHS) 3 and 4 procedures were randomized to receive either a 72 h continuous infusion of 0.1 μg/kg/min levosimendan or standard post-CPB inotrope infusion.
Results
Sixty-three patients (32 cases and 31 controls) were recruited. There were no differences between groups regarding demographic and baseline clinical data. No side effects were observed. There were no significant differences in mortality (1 vs. 3 patients,
p
= 0.35), length of mechanical ventilation (5.9 ± 5 vs. 6.9 ± 8 days,
p
= 0.54), and pediatric cardiac intensive care unit (PCICU) stay (11 ± 8 vs. 14 ± 14 days,
p
= 0.26). Low cardiac output syndrome occurred in 37 % of levosimendan patients and in 61 % of controls (
p
= 0.059, OR 0.38, 95 % CI 0.14–1.0). Postoperative heart rate, with a significant difference at 6 (
p
= 0.008), 12 (
p
= 0.037), and 24 h (
p
= 0.046), and lactate levels, with a significant difference at PCICU admission (
p
= 0.015) and after 6 h (
p
= 0.048), were lower in the levosimendan group. Inotropic score was significantly lower in the levosimendan group at PCICU admission, after 6 h and after 12 h, (
p
< 0.0001). According to multivariate analysis, a lower lactate level 6 h after PCICU admission was independently associated with levosimendan administration after correction for CPB time and the need for deep hypothermic circulatory arrest.
Conclusions
Levosimendan infused in neonates undergoing cardiac surgery was well tolerated with a potential benefit of levosimendan on postoperative hemodynamic and metabolic parameters of RACHS 3–4 neonates.
Bright, balanced white‐light electroluminescence has been achieved from a single active oligothiophene compound. White light is created by the superposition of a broad blue–green‐light emission ...originating from the single molecule and a red‐shifted narrow peak due to dimer formation. These results open the way to the fabrication of novel, low‐cost white‐light‐emitting devices with a single molecular material as the active compound.
Abstract
OBJECTIVES: To explore the association between lung ultrasound (LUS) and clinical variables in children undergoing cardiopulmonary bypass (CPB).
METHODS: A retrospective analysis was ...conducted in patients weighing <20 kg and with an Aristotle score <9, scanned with LUS on postoperative day (POD) 0, 1 and 2. We defined three LUS profiles: profile A: the prevalence of confluent B lines (“white lung”); profile B: the prevalence of B lines and profile C: the prevalence of A lines (normal lung).
RESULTS: Median (interquartile range IRQ) weight, age and Aristotle score were 5.6 kg IQR 4.0–6.0, 3.2 months IQR 3.0–7.0 and 6.75 IQR 6.0–8.0, respectively. No profile A patients were found. At POD1, we identified statistically significant differences between profile B and C patients: CPB time was 157 IQR138–235 vs 95 IQR 85–183 minutes (P < 0.005); aortic clamp duration was 104 IQR 87–142 vs 54 IQR 49–72 minutes (P = 0.007); time of mechanical ventilation was 41.5 IQR 31.0–56.0 vs 15 IQR 15–24 hours (P < 0.001); and ICU length of stay was 2 IQR 2–3 vs 4 IQR 3–4 days (P = 0.001), respectively. No differences were found between profile B and C patients at all the other time points. No statistically significant differences were found for blood gas values, urine output and fluid balance at all time points.
CONCLUSIONS: In a small cohort of children undergoing CPB, the LUS profile on POD1 was associated with CPB time, aortic cross-clamp time and mechanical ventilation duration.
Parking search is a highly relevant problem in many cities. Parking Guidance and Information (PGI) systems support drivers by recommending locations and routes with higher chance to find parking. ...However, the relevance of such systems for on-street parking spaces is barely studied. In this paper, we investigate the consequences of providing the drivers with different levels of parking information to the search. Based on real on-street parking data, we investigated the scenario in which a driver does not find a parking space at the destination and has to decide on the next road to go, given three possible kinds of contextual information: (I) No parking information; (II) static information about the capacity of a road segment and (temporary) parking limitations; (III) real-time information collected from stationary sensors. Clearly the latter has strong implications in terms of deployment and operational costs. These scenarios lead to three different guidance strategies for a PGI system. We conducted empirical experiments on real data from San Francisco and on an artificially altered version of that dataset, to simulate a more competitive parking scenario. Results show that there is a significant reduction of parking search with more informed strategies, and that the use of realtime information offers only a limited improvement over static one. Only in presence of very limited parking availabilities, real-time data becomes more beneficial.
Perception and expression of pain in cancer patients are influenced by distress levels, tumor type and progression, and the underlying pathophysiology of pain. Relying on traditional pain assessment ...tools can present limitations due to the highly subjective and multifaceted nature of the symptoms. In this scenario, objective pain assessment is an open research challenge. This work introduces a framework for automatic pain assessment. The proposed method is based on a wearable biosignal platform to extract quantitative indicators of the patient pain experience, evaluated through a self-assessment report. Two preliminary case studies focused on the simultaneous acquisition of electrocardiography (ECG), electrodermal activity (EDA), and accelerometer signals are illustrated and discussed. The results demonstrate the feasibility of the approach, highlighting the potential of EDA in capturing skin conductance responses (SCR) related to pain events in chronic cancer pain. A weak correlation (R = 0.2) is found between SCR parameters and the standard deviation of the interbeat interval series (SDRR), selected as the Heart Rate Variability index. A statistically significant (p < 0.001) increase in both EDA signal and SDRR is detected in movement with respect to rest conditions (assessed by means of the accelerometer signals) in the case of motion-associated cancer pain, thus reflecting the relationship between motor dynamics, which trigger painful responses, and the subsequent activation of the autonomous nervous system. With the objective of integrating parameters obtained from biosignals to establish pain signatures within different clinical scenarios, the proposed framework proves to be a promising research approach to define pain signatures in different clinical contexts.
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