To assess whether arterial umbilical cord bilirubin (aUCB) level at delivery predicts predischarge neonatal hyperbilirubinemia, facilitating a safe discharge from the hospital.
Prospective analysis ...of hospital biochemistry records identified near term and term infants with recorded aUCB and predischarge, at 36 h of life, capillary heal bilirubin (cHB), to identify those with a cutoff of bilirubin levels >9 mg/ml, >75th percentile on the nomogram of Bhutani et al.
Of 616 study neonates, median (IQR) aUCB and cHB levels were 1.5 mg % (IQR 0.7-2.2) and 7.7 mg % (IQR 6.6-8.9), respectively. The values resulted statistically correlated (Pearson correlation coefficient 0.26, p < .0001) and an increment of 1 mg/dl in aUCB was associated with an increment (Regression coefficient, 95% confidence interval) of mean cHB 0.49 (0.33-0.65, p < .0001). Among these, 143 (23.2%) neonates developed bilirubin levels >9 mg/ml at 36 h of life and multivariable analysis confirmed that cHB levels (OR 1.49, 95% CI 1.22-1.82; p < .0001) and vaginal delivery (OR 2.34, 95% CI 1.33-4.36; p = .005) were significantly associated with bilirubin levels >9 mg/ml.
These data suggest that aUCB should be added to the list of major risk factors for neonatal hyperbilirubinemia.
In SPIDER, the full-scale prototype of the negative ion source of the ITER Heating Neutral Beam Injectors, negative ions of hydrogen or deuterium are extracted and accelerated by a set of grids. This ...article describes the process and the technical solutions that allowed achieving the asseveration to operate the Acceleration Grid Power Supply of SPIDER at full voltage (−96 kV), reports the first experimental results, and discusses some possible enhancements that have been identified.
Childhood trauma (CT) is a major yet elusive psychiatric risk factor, whose multidimensional conceptualization and heterogeneous effects on brain morphology might demand advanced mathematical ...modeling. Therefore, we present an unsupervised machine learning approach to characterize the clinical and neuroanatomical complexity of CT in a larger, transdiagnostic context.
We used a multicenter European cohort of 1076 female and male individuals (discovery: n = 649; replication: n = 427) comprising young, minimally medicated patients with clinical high-risk states for psychosis; patients with recent-onset depression or psychosis; and healthy volunteers. We employed multivariate sparse partial least squares analysis to detect parsimonious associations between combinations of items from the Childhood Trauma Questionnaire and gray matter volume and tested their generalizability via nested cross-validation as well as via external validation. We investigated the associations of these CT signatures with state (functioning, depressivity, quality of life), trait (personality), and sociodemographic levels.
We discovered signatures of age-dependent sexual abuse and sex-dependent physical and sexual abuse, as well as emotional trauma, which projected onto gray matter volume patterns in prefronto-cerebellar, limbic, and sensory networks. These signatures were associated with predominantly impaired clinical state- and trait-level phenotypes, while pointing toward an interaction between sexual abuse, age, urbanicity, and education. We validated the clinical profiles for all three CT signatures in the replication sample.
Our results suggest distinct multilayered associations between partially age- and sex-dependent patterns of CT, distributed neuroanatomical networks, and clinical profiles. Hence, our study highlights how machine learning approaches can shape future, more fine-grained CT research.
SPIDER is the full-scale prototype of the ion source of the ITER Heating Neutral Beam Injector, where negative ions of Hydrogen or Deuterium are produced by a RF generated plasma and accelerated with ...a set of grids up to ∼100 keV. SPIDER Beam Source design complies with the ITER specific requirements, being fully installed within a vacuum vessel, and with the electrical circuits operating at the residual background pressure. The Power Supply System is composed of high voltage dc power supplies capable of handling frequent grid breakdowns, high current dc generators for the magnetic filter field and RF generators for the plasma generation.
During the first 3 years of SPIDER operation different electrical issues were discovered, understood and addressed thanks to deep analyses of the experimental results supported by modeling activities.
One of the main issues encountered was the presence of RF discharges on the RF circuit on the backside of the beam source, limiting the operating pressure within the source.
The self-excited RF oscillators showed frequency instabilities that were found to be intrinsic limits of the application of this technology to the resonant loads of Neutral Beam Injectors; their understanding allowed assessing the technical basis for the final decision to replace the RF generators in SPIDER and MITICA and change the current ITER baseline to solid-state amplifier technology.
Other issues faced regard the effect of the mutual coupling between the RF circuits on board the source, various electromagnetic compatibility problems, the limitation in the operational space to be mitigated improving the SPIDER operating strategies, the revision of the configuration of the magnetic filter field layout to avoid plasma quench.
The paper gives an overview on the observed phenomena and relevant analyses to understand them, on the effectiveness of the short-term modifications provided to SPIDER to face the encountered issues and on the design principle of long-term solutions to be introduced during the currently ongoing long shutdown.
In children and adolescents, schizophrenia is one of the ten main causes of disability-adjusted life years. The identification of people at Clinical High Risk of developing Psychosis (CHR-P) is one ...of the most promising strategies to improve outcomes. However, in children and adolescents research on the CHR-P state is still in its infancy and the clinical validity of at-risk criteria appears understudied in this population. Furthermore, only few studies have evaluated the psychopathological, neuropsychological, neuroimaging characteristics and, especially, long-term outcomes of adolescents at high risk. We present here the protocol of an innovative longitudinal cohort study of adolescents aged 12-17. The sample will consist of patients admitted to a third level neuropsychiatric unit, belonging to one of the following three subgroups: 1) adolescents with established Diagnostic and Statistical Manual of Mental Disorder-Fifth Edition psychosis, 2) adolescents with CHR-P, and 3) adolescents with psychiatric symptoms other than established psychosis or CHR-P. The primary aim of our study is to evaluate the 2-year prognosis across the three groups. We will measure transition to psychosis (or the stability of the diagnosis of psychosis in the psychotic group), the risk of development of other psychiatric disorders, as well as socio-occupational functioning at outcome. The secondary aim will be to explore the effect of specific predictors (clinical, neuropsychological and neuroimaging factors) on the prognosis. At baseline, 1-year and 2-year follow-up participants will be assessed using standardized semi-structured interviews and instruments. Psychopathological and functioning variables, as well as neuropsychological domains will be compared across the three subgroups. Moreover, at baseline and 2-year follow-up all recruited patients will undergo a 3-Tesla magnetic resonance imaging examination and diffusion tensor imaging parameters will be analyzed. We believe that this study will advance our ability to predict outcomes in underage CHR-P samples. In particular, our data will enable a better understanding of the clinical significance of CHR-P in adolescents, and shed new light on prognostic factors that can be used to refine the prediction of clinical outcomes and the implementation of preventive interventions.
BACKGROUND: The container breeding species belonging to the genus Aedes (Meigen) are frequently recorded out of their place of origin. Invasive Aedes species are proven or potential vectors of ...important Arboviruses and their establishment in new areas pose a threat for human and animal health. A new species of exotic mosquito was recorded in 2011 in north-eastern Italy: Aedes (Finlaya) koreicus Hulecoeteomyia koreica. The aim of this study was to characterize the biology, the environment and the current distribution of this mosquito in north-eastern Italy. Morphological details useful to discriminate this species from other invasive Aedes mosquitoes are also given (see Additional files). METHODS: All possible breeding sites for larval development were monitored. In addition, ovitraps and traps for adults were used to collect eggs and adults. The mosquitoes (larvae and adults) were identified morphologically and molecularly. Environmental data and climatic variables during the period of mosquito activity (from April to October) were considered. RESULTS: Aedes koreicus was found in 37 municipalities (39.4%) and was detected in 40.2% of places and in 37.3% of larval habitats monitored, in a range of altitude from 173 to 1250 m.a.s.l.. Garden centres were the most common locations (66.7%), followed by streets/squares (57.1%), private gardens (46.4%) and cemeteries (21.1%) (p < 0.01). The main larval habitats were catch basins (48.5%) and artificial water containers (41.8%). As for Aedes albopictus Stegomyia albopicta, ovitraps were attractive for adult females resulting in the higher rate of positivity (15/21; 71.4%) among breeding sites. The period of Ae. koreicus activity ranged from March 29 to October 29. CONCLUSION: The species is clearly established in the area and is now overlapping with other vectors such as Ae. albopictus and colonizing areas over 800 m.a.s.l, not yet or sporadically reached by the tiger mosquito. The data collected are essential to assess the risk of colonization of other parts of Italy and Europe, as well as the risk of spreading of pathogens transmitted. These findings stress the importance of implementing entomological surveillance for early detection of invasive species, which is necessary for eradication or limitation of its further spread.
Previous analyses of the GIM (Gruppo Italiano Mammella) 2 study showed that addition of fluorouracil to epirubicin, cyclophosphamide, and paclitaxel in patients with node-positive early breast cancer ...does not improve outcome, whereas dose-dense chemotherapy induces a significant improvement in both disease-free survival and overall survival as compared with a standard schedule. Here, we present long-term results of the study.
In this 2 × 2 factorial, open-label, randomised, phase 3 trial, we enrolled patients aged 18–70 years with operable, node-positive, breast cancer with Eastern Cooperative Oncology Group performance status of 0–1 from 81 hospitals in Italy. Eligible patients were randomly allocated (1:1:1:1) to one of the four following study groups: four cycles of standard-interval intravenous EC (epirubicin 90 mg/m2 and cyclophosphamide 600 mg/m2) on day 1 every 3 weeks, followed by four cycles of intravenous paclitaxel (175 mg/m2) on day 1 every 3 weeks (q3EC-P group); four cycles of intravenous FEC (fluorouracil 600 mg/m2, epirubicin 90 mg/m2, and cyclophosphamide 600 mg/m2) on day 1 every 3 weeks, followed by four cycles of intravenous paclitaxel (175 mg/m2) on day 1 every 3 weeks (q3FEC-P group); dose-dense EC-P regimen, with the same doses and drugs as the q3EC-P group but administered every 2 weeks (q2EC-P group); and the dose-dense FEC-P regimen, with the same doses and drugs as the q3FEC-P group but given every 2 weeks (q2FEC-P). Randomisation, with stratification by centre, with permuted blocks of size 12, was done with a centralised, interactive, internet-based system that randomly generated the treatment allocation. The primary endpoint was disease-free survival in the intention-to-treat population, comparing different chemotherapy schedule (dose-dense vs standard-dose intervals) and regimen (FEC-P vs EC-P). Safety population included all patients that received at least one dose of any study drug according to the treatment received. This trial is registered with ClinicalTrials.gov, NCT00433420, and is now closed.
Between April 24, 2003, and July 3, 2006, 2091 patients were randomly assigned to treatment: 545 to q3EC-P, 544 to q3FEC-P, 502 to q2EC-P, and 500 to q2FEC-P. 88 patients were enrolled in centres providing only standard interval schedule and were assigned only to q3FEC-P and q3EC-P; thus, 2091 patients were included in the intention-to-treat analysis for the comparison of EC-P (1047 patients) versus FEC-P (1044 patients) and 2003 patients were included in the intention-to-treat analysis for the comparison of dose-dense (1002 patients) versus standard interval analysis (1001 patients). After a median follow-up of 15·1 years (IQR 8·4–16·3), median disease-free survival was not significantly different between FEC-P and EC-P groups (17·09 years 95% CI 15·51–not reached vs not reached 17·54–not reached; unadjusted hazard ratio 1·12 95% CI 0·98–1·29; log-rank p=0·11). Median disease-free survival was significantly higher in the dose-dense interval group than the standard-interval group (not reached 95% CI 17·45–not reached vs 16·52 14·24–17·54; 0·77 95% CI 0·67–0·89; p=0·0004). The most common grade 3–4 adverse events were neutropenia (200 37% of 536 patients in the q3EC-P group vs 257 48% of 533 in the q3FEC-P group vs 50 10% of 496 q2EC-P vs 97 20% of 492) and alopecia (238 44% vs 249 47% vs 228 46% vs 235 48%). During extended follow-up, no further grade 3–4 adverse events or deaths related to toxic-effects were reported. Treatment-related serious adverse events were reported in nine (2%) patients in the q3EC-P group, seven (1%) in the q3FEC-P group, nine (2%) in the q2EC-P group, and nine (2%) in the q2FEC-P group. No treatment-related deaths occurred.
Updated results from the GIM2 study support that optimal adjuvant chemotherapy for patients with high-risk early breast cancer should not include fluorouracil and should use a dose-dense schedule.
Bristol-Myers Squibb, Pharmacia, Dompè Biotec Italy, Italian Ministry of Health, Fondazione Italiana per la Ricerca sul Cancro, and Alliance Against Cancer.
A Framework to Evaluate the Quality of Integrated Datasets Buono, Francesco Del; Faggioli, Guglielmo; Paganelli, Matteo ...
Applied computing review : a publication of the Special Interest Group on Applied Computing,
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Evaluation is a bottleneck in data integration processes: it is performed by domain experts through manual onerous data inspections. This task is particularly heavy in real business scenarios, where ...the large amount of data makes checking all integrated tuples infeasible. Our idea is to address this issue by providing the experts with an unsupervised measure, based on word frequencies, which quantifies how much a dataset is representative of another dataset, giving an indication of how good is the integration process. The paper motivates and introduces the measure and provides extensive experimental evaluations, that show the effectiveness and the efficiency of the approach.
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