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The purpose of this work is to provide an understanding of the medicolegal landscape with regards to ambulatory surgery centers and physician owned hospitals, trends in our healthcare system, the benefits of facility ownership for both outpatient and inpatient spine surgery, and the effect of each on physicians and patients.

This study is focused on the effect of the light source (LEDs emitting visible and UV-A light) on the activation of photo-Fenton processes for the Fe3+-iminodisuccinic acid/H2O2catalytic system. The catalyst enables visible light for the hydroxyl radical’s formation by H2O2conversion. This study shows, for the first time, the central role of visible light to accelerate the process kinetics favoring the complete degradation of a probe molecule ([gallic acid] = 25.0 mg L–1(0.147 mM)), in water solutions in 90 min using a [H2O2]/catalyst molar ratio (R) of 75, in comparison with data obtained under dark conditions (99% under visible radiation vs 67% in dark conditions). A kinetic model able to correlate the electrical nominal power of the used LEDs, the light absorption properties of Fe3+-iminodisuccinic acid (Fe-IDS), and LEDs emission spectra was developed to estimate the degradation kinetic constants for the process in dark conditions and in the presence of light. The accuracy of the calculated kinetic constants was tested under different Rvalues to verify the predictive ability of the model. A very good agreement between the experimental data and the mathematical model calculations was achieved. These results highlight the promising use of the Fe-IDS catalyst for environmental remediation considering low energy consumption conditions. A reasonable explanation is that the presence of Fe-IDS significantly promoted the generation of reactive oxygen species using visible light and H2O2, which led to gallic acid removal.

Here is proposed an easy, fast, and economic technique to investigate plant physiological traits in response to salt stress by using castor bean (Ricinus communisL.). Four Ricinus communisL. cultivars (TUNI 1, TUNI 4, C1012, and C1028) were grown in a growth chamber for 15 days on a sand substrate and were watered regularly with deionised water or NaCl solution (water electrical conductivity (EC) 4, or 8 dS m− 1) to keep soil moisture close to field capacity. According to roots, stem, and germination traits and derived indices, TUNI 1 and TUN4 showed the best growth performance on sand irrigated with 4 dS m− 1and 8 dS m− 1, respectively. Besides, comparing C1028 and C1012, the former showed a higher tolerance at the maximum electrical conductivity tested related to the latter, increasing salt tolerance index (STI) of roots (+ 25%) and stem (+ 20%). In conclusion, the present findings suggest that the TUNI 4 cultivar of Ricinus communisL. demonstrates superior overall performance, even under highly saline conditions, such as irrigation with 8 dS m− 1. Conversely, the TUNI 1 cultivar shows a good ability to perform in marginal soils with moderate salinity levels, such as those irrigated with 4 dS m− 1. Our results represent the first step towards optimization of a cost-effective method/bioassay for the selection of salt tolerant Ricinus communisL. cultivars and genotypes.

Objectives: Petrous bone cholesteatoma (PBC) is a rare condition of the petrous portion of the temporal bone. Treatment of choice consists of radical surgical removal, paying attention to protect the facial nerve and inner ear as far as possible. The aim of the present study was to evaluate the efficacy of modified translabyrinthine techniques in preserving hearing function and the use of the adjuvant endoscopic techniques in a group of PBC patients. Methods: This study comprised 16 cases of PBCs surgically treated in our Department. Pre- and post-operative hearing status was assessed with pure tone audiometry and speech discrimination and graded according to the Gardner- Robertson classification system. Facial function was based on the House Brackman (HB) classification. PBCs were grouped using Sanna’s classification. The choice of surgical technique was based on the above findings together with preoperative evidence. Post-operative follow-up ranged from 1 to 10 years and also included Computed Tomography and Magnetic Resonance Imaging assessment. Results: PBCs were classified as follows: 37.5% infralabyrinthine; 43.75% supralabyrinthine; and 18.75% massive. Preservation of the bone conduction threshold was feasible in 62.5% of patients. For supralabyrinthine PBCs a subtotal petrosetomy was performed in all cases and hearing preservation was possible in 57% of them: an adjuvant endoscopic approach was performed in 43%. Infralabyrinthine PBCs were treated using a modified translabyrinthine approach with preservation of bone conduction in 83% of patients; an adjuvant endoscopic approach was performed in 50% cases. One patient with a massive cholesteatoma was treated by modified translabyrinthine approach, preserving a serviceable level of hearing. In all massive cases, an adjuvant endoscopic approach was performed. In 2 patients with preoperative palsy, facial nerve function showed an improvement. The follow-up period revealed evidence of limited recurrence at CT imaging in 2 patients. Conclusions: The introduction of modified surgical approaches, able to preserve the anatomical-functional structures, have shown an improvement of post-operative hearing outcomes.

The aim of this work was to analyse inequalities in oral health services utilisation (OHSU) in older Peruvian adults through comparative analysis of the years 2019 and 2021.

Our aim was to assess the association between different types of stigma and physical, behavioural and emotional wellbeing, and to evaluate whether these associations were mediated by the level of social support, age, education, sex and time from HIV diagnosis in an Italian cohort of people living with HIV (PLWH). We enrolled 96 PLWH and had them complete a cross-sectional online survey that included the “HSS-12”, the “SF-12” and the “DASS-21”. We performed linear regression analyses to explore the associations between the HSS-12 scores and cART adherence, viral load, SF-12 and DASS-21 scores, and a mediation analysis to identify mediators in the significant associations. We showed that higher level of depression and worse perception of mental health were significantly associated with higher HSS-12 “personalised stigma” (p= .009, p= .020) “disclosure concerns” (p= .012, p= .039), “concerns about public attitudes” (p=.007, p= .005) and “negative self-image” scores; (p< .001, p= .001); worse perception of physical health status was associated with higher HSS-12 “personalised stigma” scores (p= .018); higher level of anxiety and stress were associated with higher ”negative self-image” scores (0.001 and p< .001). The association between higher HSS-12 “negative self-image” and higher levels of depression, anxiety and stress were mediated by lower age (a*b = +0.10; a*b = +0.12; a*b = +0.11). This study may have important implications for clinical practice as it contributes to understanding the characteristics and consequences of HIV-related stigma in a population of PLWH with excellent viroimmunological status and therapeutic adherence.

Excess aldosterone accelerates chronic kidney disease progression. This phase 2 clinical trial assessed BI 690517, an aldosterone synthase inhibitor, for efficacy, safety, and dose selection.

When implementing a cryptographic algorithm, efficient operations have high relevance both in hardware and in software. Since a number of operations can be performed via polynomial multiplication, the arithmetic of polynomials over finite fields plays a key role in real-life implementations—e.g., accelerating cryptographic and cryptanalytic software (pre- and post-quantum) (Chou in Accelerating pre-and post-quantum cryptography. Ph.D. thesis, Technische Universiteit Eindhoven, 2016). One of the most interesting papers that addressed the problem has been published in 2009. In Bernstein (in: Halevi (ed) Advances in Cryptology—CRYPTO 2009: 29th Annual International Cryptology Conference, Santa Barbara, CA, USA, August 16–20, 2009. Proceedings, pp 317–336. Springer Berlin Heidelberg, Berlin, Heidelberg, 2009), Bernstein suggests to split polynomials into parts and presents a new recursive multiplication technique which is faster than those commonly used. In order to further reduce the number of bit operations (Bernstein in High-speed cryptography in characteristic 2: minimum number of bit operations for multiplication, 2009. http://binary.cr.yp.to/m.html) required to multiply n-bit polynomials, researchers adopt different approaches. In CMT: Circuit minimization work. http://www.cs.yale.edu/homes/peralta/CircuitStuff/CMT.htmla greedy heuristic has been applied to linear straight-line sequences listed in Bernstein (High-speed cryptography in characteristic 2: minimum number of bit operations for multiplication, 2009. http://binary.cr.yp.to/m.html). In 2013, D’angella et al. (Applied computing conference, 2013. ACC’13. WEAS. pp. 31–37. WEAS, 2013) skip some redundant operations of the multiplication algorithms described in Bernstein (in: Halevi (ed) Advances in Cryptology—CRYPTO 2009: 29th Annual International Cryptology Conference, Santa Barbara, CA, USA, August 16–20, 2009. Proceedings, pp 317–336. Springer Berlin Heidelberg, Berlin, Heidelberg, 2009). In 2015, Cenk et al. (J Cryptogr Eng 5(4):289–303, 2015) suggest new multiplication algorithms. In this paper, (a) we present a “k-1”-level recursion algorithmthat can be used to reduce the effective number of bit operations required to multiply n-bit polynomials, and (b) we use algebraic extensions of $$\mathbb {F}_2$$F2combined with Lagrange interpolation to improve the asymptotic complexity.

Digital signatures are widely deployed to authenticate the source of incoming information, or to certify data integrity. Common signature verification procedures return a decision (accept/reject) only at the very end of the execution. If interrupted prematurely, however, the verification process cannot infer any meaningful information about the validity of the given signature. This limitation is due to the algorithm design solely, and it is not inherent to signature verification. In this work, we provide a formal framework to extract information from prematurely interrupted signature verification, independently of why the process halts: we propose a generic verification procedure that progressively builds confidence on the final decision. Our transformation builds on a simple but powerful intuition and applies to a wide range of existing schemes considered to be post-quantum secure, including some lattice-based and multivariate equations based constructions. We demonstrate the feasibility of our approach through an implementation on off-the-shelf resource-constrained devices. In particular, an intensive testing activity has been conducted measuring the increase of performance on three IoT boards—i.e., Arduino, Raspberry, and Espressif—and a consumer-grade laptop. While the primary motivation of progressive verification is to mitigate unexpected interruptions, we show that verifiers can leverage it in two innovative ways. First, progressive verification can be used to intentionally adjust the soundness of the verification process. Second, our transformation splits verification into a computationally intensive offline set-up (run once), and an efficient online verification that is faster than the original algorithm. We conclude showing how to tweak our compiler for progressive verification to work on a wide range of signatures with properties, on three real-life use cases, and in combination with efficient verification.

Objectives: Although transfusion support is commonly used in oncological palliative care, there is still a paucity of literature. We examined the transfusion support provided in the terminal stage of the disease and compared the approach at a pediatric oncology unit and a pediatric hospice.Case description This case series analyzed patients treated at the Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT)’s pediatric oncology unit who died between January 2018 and April 2022. We compared these with those who died at the VIDAS hospice and analyzed the number of complete blood counts taken in a patient’s last 14 days of life, and the number of transfusions performed in the same period. We analyzed 44 patients (22 in pediatric oncology unit; 22 in hospice) in total. Twenty-eight complete blood counts were performed (7/22 patients at the hospice; 21/22 patients at the pediatric oncology unit). Nine patients were given transfusions, three at the hospice, six at our pediatric oncology unit (24 transfusions in total): 20 transfusions at the pediatric oncology unit, four at the hospice. In total 17/44 patients were given active therapies in the last 14 days of life: 13 at the pediatric oncology unit, four at the pediatric hospice. Ongoing cancer treatments did not correlate with a greater likelihood of receiving a transfusion (p=0.91).Conclusions: The hospice’s approach was more conservative than the pediatric oncology one. In the in-hospital setting, the need for a transfusion cannot always be decided on by a combination of numerical values and parameters alone. The family’s emotional-relational response must be considered too.

Review of: Drag: A British History, Jacob Bloomfield (2023)Oakland, CA: University of California Press, 245 pp.,ISBN 978-0-52039-332-5, h/bk, USD 29.95ISBN 978-0-52039-333-2, e-book, USD 29.95

Background Rapid antiretroviral therapy initiation (R-ART) for treatment of HIV has been recommended since 2017, however it has not been adopted widely across the US.Purpose The study purpose was to understand facilitators and barriers to R-ART implementation in the U.S.Research Design This was a qualitative design involving semi-structured interviews.Study Sample The study sample was comprised of the medical leadership of nine US HIV clinics that were early implementers of R-ART.Data Collection and Analysis In-depth, semi-structured interviews were performed. The Consolidated Framework for Implementation Research (CFIR) was used to guide thematic analysis.Results We identified three main content areas: strong scientific rationale for R-ART, buy-in from multiple key stakeholders, and the condensed timeline of R-ART. The CFIR construct of Evidence Strength and Quality was cited as an important factor in R-ART implementation. Buy-in from key stakeholders and immediate access to medications ensured the success of R-ART implementation. Patient acceptance of the condensed timeline for ART initiation was facilitated when presented in a patient-centered manner, including empathetic communication and addressing other patient needs concurrently. The condensed timeline of R-ART presented logistical challenges and opportunities for the development of intense patient-provider relationships.Conclusions Results from the analysis showed that R-ART implementation should address the following: 1) logistical planning to implement HIV treatment with a condensed timeline 2) patients’ mixed reactions to a new HIV diagnosis and 3) the high cost of HIV medications.

Abnormal liver tests are one of the most common challenges in the primary care setting. Primary care practitioners order these tests for numerous reasons, including investigating abdominal signs and symptoms or suspected alcohol-use disorder, or to determine medication adverse effects. Evaluation should be guided by both the clinical presentation and the pattern of injury. In this article, we will focus on the epidemiology, pathophysiology, clinical presentation, diagnostic work-up, and management of elevated liver enzymes, with an emphasis on the most common causes of abnormal liver testing.

In this work, we discuss the role of different atmospheres and process conditions on the catalytic performances of Ru- and K/Ba-based dual-function materials (DFMs) for CO2capture and methanation. By a combination of microreactor experiments and Fourier transform infrared (FT-IR) spectroscopy, we clarify the effect of temperature and H2partial pressure during the hydrogenation step and the effect of water and oxygen during the CO2adsorption step. In particular, we show that between 250 and 400 °C CO2is rapidly adsorbed as bidentate carbonates on the basic sites (K or Ba) and as CO on Ru metal surfaces with decreasing storage capacity with increasing temperature. Increasing the operating temperature and the H2partial pressure, the methanation rate of the bidentate carbonates increases. We also show that during the CO2capture step, water not only reduces the amount of CO2adsorbed by competitively adsorbing on basic sites but also changes the nature of the adsorbed carbonates, increasing their ionic character and hence their stability. This is observed in the case of both a K-based DFM and a Ba-based DFM, though in the case of the alkaline earth, the phenomenon is more evident. Finally, we point out that the presence of O2during the CO2capture step removes metallic Ru as CO adsorption site and reduces the amount of bidentate carbonates, possibly due to the additional presence of water formed upon Ru reduction in the methanation step. The information presented in this work is of interest to improve the design of DFMs to be used for flue gas, where the partial pressure of water and oxygen is relevant.

Many interesting applications of hyperbolic systems of equations are stiff, and require the time step to satisfy restrictive stability conditions. One way to avoid small time steps is to use implicit time integration. Implicit integration is quite straightforward for first-order schemes. High order schemes instead also need to control spurious oscillations, which requires limiting in space and time also in the linear case. We propose a framework to simplify considerably the application of high order non-oscillatory schemes through the introduction of a low order implicit predictor, which is used both to set up the nonlinear weights of a standard high order space reconstruction, and to achieve limiting in time. In this preliminary work, we concentrate on the case of a third-order scheme, based on diagonally implicit Runge Kutta (DIRK) integration in time and central weighted essentially non-oscillatory (CWENO) reconstruction in space. The numerical tests involve linear and nonlinear scalar conservation laws.

In this paper, the processing of the data of a 3D light detection and distance measurement (LiDAR) sensor mounted on a mobile robot is demonstrated, introducing an innovative methodology to manage the data and extract useful information. The LiDAR sensor is placed on a mobile robot which has a modular design that permits the easy change of the number of wheels, was designed to travel through several environments, and saves energy by changing the number and arrangement of the wheels in each environment. In addition, the robot can recognize landmarks in a structured environment by using a classification technique on each frame acquired by the LiDAR. Furthermore, considering the experimental tests, a new simple algorithm based on the LiDAR data processing together with the inertial data (IMU sensor) through a Kalman filter is proposed to characterize the robot’s pose by the surrounding environment with fixed landmarks. Finally, the limits of the proposed algorithm have been analyzed, highlighting new improvements in the future prospective development for permitting autonomous navigation and environment perception with a simple, modular, and low-cost device.

Parkinson's disease (PD), to date, is widespread. It is a neurodegenerative disease that impairs the quality of life of the affected, as it is a slowly but progressively evolving disease. This paper presents a smart glove for evaluating PD patients by monitoring hand tremors and evaluating specific exercises involved by the MDS-UPDRS (Movement Disorder Society - Unified Parkinson Disease Rating Scale), enabling disease evolution assessment. The smart glove consists of a TPU flexible support, integrating two flexible MEMS piezoelectric sensors based on Aluminum Nitride and an inertial sensor to detect finger and arm movements. The smart glove integrates an electronic conditioning section for piezoelectric signals to make them suitable for the following acquisition by a microcontroller section based on nRF52840 SoC, which jointly processes the piezoelectric and inertial signals related to standard patient's hand and arm exercises (i.e., finger tapping, fist opening/closing of the hand, resting hand tremor), assigning them scores according to the MDS-UPDRS. Three embedded Machine Learning (ML) algorithms based on Neural Networks (NN) were deployed to classify piezoelectric and inertial signals. Seven individuals, six of them with diagnosed PD, were involved in developing ML models. Datasets were gathered to train and test the ML algorithms, constituted by signal samples related to three tests involved in the UPDRS scale according to PD severity. The tests demonstrated the proper operation of the proposed smart glove in tracking the movement changes induced by PD; also, the developed embedded ML algorithms showed performance in classifying hand/arm movements, reaching 95.12 %, 98.39 %, and 96.62 % for finger-tapping, hand-fist closure, and resting tremor, respectively.

The human microbiome is an integral component of the human body and a co-determinant of several health conditions1,2. However, the extent to which interpersonal relations shape the individual genetic makeup of the microbiome and its transmission within and across populations remains largely unknown3,4. Here, capitalizing on more than 9,700 human metagenomes and computational strain-level profiling, we detected extensive bacterial strain sharing across individuals (more than 10 million instances) with distinct mother-to-infant, intra-household and intra-population transmission patterns. Mother-to-infant gut microbiome transmission was considerable and stable during infancy (around 50% of the same strains among shared species (strain-sharing rate)) and remained detectable at older ages. By contrast, the transmission of the oral microbiome occurred largely horizontally and was enhanced by the duration of cohabitation. There was substantial strain sharing among cohabiting individuals, with 12% and 32% median strain-sharing rates for the gut and oral microbiomes, and time since cohabitation affected strain sharing more than age or genetics did. Bacterial strain sharing additionally recapitulated host population structures better than species-level profiles did. Finally, distinct taxa appeared as efficient spreaders across transmission modes and were associated with different predicted bacterial phenotypes linked with out-of-host survival capabilities. The extent of microorganism transmission that we describe underscores its relevance in human microbiome studies5, especially those on non-infectious, microbiome-associated diseases.

In hemodynamically stable adults sustaining a splenic trauma, non-operative management (NOM) represents the standard approach even in high-severity injuries. However, knowledge, structural, and logistic limitations still reduce its wider diffusion. This study aims to identify such issues to promote the safe and effective management of these injuries.

Several countries adopted the Google and Apple exposure notification system (GAEN) to slow the spread of the SARS-CoV-2 virus down. GAEN promised to guarantee security and privacy through a decentralized approach. In this article, we report several relevant privacy and integrity threats in GAEN, including new attacks. GAEN’s security issues are not inherent risks of contact tracing systems. Indeed, we also propose a system named Pronto-B2, which enjoys a much better resilience with respect to mass surveillance and replay attacks.

Objective: Review, qualify and synthesize the evidence that compared computed tomography (CT) images with magnetic resonance imaging (MRI) in detecting multiple myeloma (MM) lesions in the skull, through a systematic review. Methods: Searches were performed in six databases and the grey literature, up to August 2023, without restriction by date or publication language. Observational studies comparing CT images and MRI of the skull of patients previously diagnosed with MM were included. Data were extracted by two reviewers in a standardized and independent manner. The methodological quality assessment was performed using the QUADAS-2 tool and the evidence certainty assessment using the GRADE tool. Results: Of the 911 identified references, 11 were included, and they all used either positron emission computed tomography (PET/CT) and/or low-dose computed tomography (LDCT) to compare to MRI. In 6 of 7 studies, MRI demonstrated a greater capacity to detect MM lesions than PET/CT images. When compared with LDCT images, MRI showed lower detection capacity in 4 studies. Six of the 11 included articles had a low risk of bias. However, as observational data evidence, the assessed certainty of the evidence was considered very low. Conclusions: PET/CT and MRI images presented limitations in detecting MM lesions in the skull compared to LDCT images. The evidence suggested that the greatest detection capability could be achieved by employing whole-body MRI complemented by LDCT images of the skull. Future studies are needed to confirm this result.

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