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Introduction The purpose of our work was to evaluate the feasibility of prostate multiparametric MR imaging at 1.5-T without endorectal coil using an 8 channel pelvic phased array coil. Material and methods A total of 154 patients who underwent mp-MRI were retrospectively included. Patients received a standardized mp-MRI, compliant with 2012 European Society of Uro-Radiology guidelines, with 1·5 T magnetic field strength and an 8 channel pelvic phased-array coil. Two blinded readers graded the image quality of mp-MRI on a three-point scale and they scored the prostate lesions according to PI-RADS v2. All PI-RADS of 4 or 5 underwent biopsy. A third radiologist and a pathologist verified the correspondence between the MRI images and the results of the biopsy. Results 64 (41.6%) patients showed a Pi-rads of 4 or 5. At biopsy, 79.7% showed a Gleason score ≥7, 12.5% showed a Gleason score of 6 and 7.8% showed a negative biopsy. In the group of Pi-rads ≤ 3, 12 patients underwent a biopsy with the following results: negative biopsy in 33.3%, atypical Small Acinar Proliferation in 16.7%, prostatic intraepithelial neoplasia in 25% and indolent PCa 25%. Mp-MRI in the identification of clinically significant cancer provided a low percentage of false positive (7.8%) while in 79.7% of cases it was capable to detect clinically significant prostate cancer. In 92.2% of patients mp-MRI identified a prostate cancer with a Gleason score ≥6. The inter-reader agreement was excellent in defining both the quality of the examination and the PI-RADS category (k = 0.83 and k = 0.70, respectively). Conclusions mp-MRI at 1.5-T without endorectal coil using an 8 channel phased array is an appropriate tool for early detection of clinically significant prostate cancer. Implications for practice 8 channel pelvic phased array is still an appropriate tool for early detection of clinically significant prostate cancer and for obtaining a reduction in overdiagnosis of indolent PCa.

Medical robots can play an important role in mitigating the spread of infectious diseases and delivering quality care to patients during the COVID-19 pandemic. Methods and procedures involving medical robots in the continuum of care, ranging from disease prevention, screening, diagnosis, treatment, and homecare have been extensively deployed and also present incredible opportunities for future development. This paper provides an overview of the current state-of-the-art, highlighting the enabling technologies and unmet needs for prospective technological advances within the next 5-10 years. We also identify key research and knowledge barriers that need to be addressed in developing effective and flexible solutions to ensure preparedness for rapid and scalable deployment to combat infectious diseases., 8 pages, 9 figures, publish in RA-magazine

Background Breast cancer (BC) presents important physical and psychological challenges that should be appropriately addressed through continuous, integrated and individualized rehabilitation programs after treatment. In this study, we aimed to collect more information on the rehabilitation patterns and utilization of healthcare services by women with BC. Methods We retrospectively analyzed data from two archives of the Lazio Regional Health System Database to assess rehabilitation patterns in women diagnosed with BC in the Lazio region (Italy) in 2008. Results A total of 5538 women diagnosed with BC were considered in the present study. Most patients (81.7%) received outpatient rehabilitative care, consisting mainly of pathology-related interventions and, more rarely, disability-related interventions (mainly motor rehabilitation and rarely cognitive or psychological therapy). Few patients followed an inpatient (1.3%) or an intensive outpatient rehabilitation program (1.0%). Conclusion Most patients do not receive adequate rehabilitation care during the first year after diagnosis. More information and better rehabilitation services should be provided to help patients with BC access rehabilitation programs. The study also suggests the importance of psychosocial and cognitive interventions, which is a major unmet need in women with BC.

Objective Endocannabinoids have been implicated in the pathophysiology of Major Depressive Disorder (MDD) and might represent potential targets for therapeutic intervention. Objectives of the study were: (1) to measure plasma levels of endocannabinoids in a group of antidepressant-free depressed outpatients; (2) to explore their relationship with the severity of depressive symptoms as subjectively perceived by the patients; and (3) to investigate the effect of the selective serotonin reuptake inhibitor escitalopram on endocannabinoid levels. Methods We measured plasma levels of the two major endocannabinoids, 2-arachidonoylglycerol (2-AG) and N-arachidonoylethanolamine (anadamide), in 12 drug-free outpatients diagnosed with MDD and in 12 matched healthy controls. In the patient group, endocannabinoids plasma levels were assessed at baseline and after 2 months of treatment with escitalopram. Results Baseline plasma levels of the two endocannabinoids did not differ between depressed patients and healthy controls. However, there was a significant inverse correlation between 2-arachidonoylglycerol levels and the severity of subjectively perceived depressive symptoms. Treatment with escitalopram did not change endocannabinoid levels in depressed patients, although it caused the expected improvement of depressive symptoms. Conclusions Our results suggest that 2-arachidonylglycerol, the most abundant endocannabinoid in the central nervous system, might act to mitigate depressive symptoms, and raise the interesting possibility that 2-arachidonylglycerol and anandamide are differentially regulated in patients affected by MDD. Also, our data suggest but do not prove that the endocannabinoid system is not regulated by serotonergic transmission, at least in depressed patients.

Enterococci are ubiquitous, facultative, anaerobic Gram-positive bacteria that mainly reside, as part of the normal microbiota, in the gastrointestinal tracts of several animal species, including humans. These bacteria have the capability to turn from a normal gut commensal organism to an invasive pathogen in patients debilitated by prolonged hospitalization, concurrent illnesses, and/or exposed to broad-spectrum antibiotics. The majority of vancomycin-resistant enterococcus (VRE) infections are linked to the vanA genotype; however, outbreaks caused by vanB-type VREs have been increasingly reported, representing a new challenge for effective antimicrobial treatment. Teicoplanin, daptomycin, fosfomycin, and linezolid are useful antimicrobials for infections due to vanB enterococci. In addition, new drugs have been developed (e.g., dalbavancin, telavancin, and tedizolid), new molecules will soon be available (e.g., eravacycline, omadacycline, and oritavancin), and new treatment strategies are progressively being used in clinical practice (e.g., combination therapies and bacteriophages). The aim of this article is to discuss the pathogenesis of infections due to enterococci harboring the vanB operon (vanBVRE) and their therapeutic, state-of-the-art, and future treatment options and provide a comprehensive and easy to use review for clinical purposes.

The COVID-19 pandemic has highlighted key challenges for patient care and health provider safety. Adaptable robotic systems, with enhanced sensing, manipulation and autonomy capabilities could help address these challenges in future infectious disease outbreaks.

Federated networks represent a remunerable operational way, allowing federated partners to increase their incomes through a sharing resource process. They have been primarily used in the context of cloud computing; nowadays, they are also used to provide connectivity services, like virtual private networks. However, providing such a service by using standard technologies in federated networks requires a nonnegligible effort from different points of view (e.g., configuration effort). In this paper, we propose an software‐defined network (SDN)–based framework aiming at overcoming limitations in currently adopted best practices to issue virtual private networks in federated networks. Relying on the SDN architecture, we propose a method allowing federated providers to quickly and easily create federated networks, reducing unneeded costs (e.g., new hardware), and a way for customers to fast‐access federated services, without any explicit actions from providers. We evaluate our framework by using SDNetkit. We focus on analyzing the impact of our implementation on both control and data plane, in terms of number of control messages exchanged in the network and size of the forwarding tables, respectively.

Sherri Di Lallo,1 Keren Schoenberger,2 Laura Graham,2 Ashley Drobot,2 Mubashir Aslam Arain3 1Stollery Awasisak Indigenous Health, Alberta Health Services, Edmonton, Alberta, Canada; 2Health Systems Evaluation and Evidence, Alberta Health Services, Edmonton, Alberta, Canada; 3Health Systems Evaluation and Evidence, Alberta Health Services, Calgary, Alberta, CanadaCorrespondence: Mubashir Aslam ArainHealth Systems Evaluation and Evidence, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, T2W 1S7, CanadaTel +1 403-943-0783Fax +1 403-943-2875Email mubashiraslam.arain@ahs.caObjective: The Stollery Children’s Hospital in Edmonton, Alberta, introduced the Stollery Awasisak team to provide targeted support to Indigenous families and their children. Talking Circles were conducted across northern communities from 2017 to 2019 to better understand how Indigenous people perceive the current state of healthcare services delivered by the Stollery Hospital.Methods: The 2019 Talking Circles were held in six cities: Grande Prairie, Slave Lake, High Level, Fort McMurray, Edmonton, and Cold Lake, which were the biggest circles held to date with an attendance of 160 participants. Participants included members of Treaties 6 and 8, and Metis Nations of Alberta, as well as healthcare professionals in those regions.Results: Talking Circles identified challenges Indigenous (First Nation, Inuit and Metis) pediatric patients and their families experienced from accessing care to transitioning home to exploring their positive experiences with the Stollery Hospital and other frontline collaborates. Through these circles guided by Elders in ceremonies, priorities and recommendations were made to help support pediatric patients and their families.Conclusion: Multiple perspectives provided rich data on how best to adhere to the Truth Reconciliation of Canada 19th mandate and ensure equitable healthcare access to all Indigenous children. Together, leaders, healthcare providers, service providers and community members reflected on the lessons of the Medicine Wheel quadrants and the Seven Sacred Teachings, and brought forward four priorities; capacity building, continuity of care, culturally responsive care and increased communication.Keywords: discharge planning, Indigenous Health, Talking Circles, cultural safety

Exposure in utero has been suggested to influence health later in life. The aim of this study was to investigate, if the use of prenatal food supplements was associated with atopic dermatitis in the offspring. Mothers who gave birth in the hospital G. B. Grassi were invited to participate in the study (n = 395). Information on socio-demographic characteristics, clinical data of the mothers and babies, vegetables and fruit intake, food avoidance, and food supplements use during pregnancy, depression status, and environmental exposure was obtained for all subjects in the hospital at the time of delivery. Data on breastfeeding practice, introduction of weaning foods, day care attendance, and atopic dermatitis were collected in the postnatal follow-ups. Logistic regression was applied to estimate odds ratio (OR) and 95% confidence intervals (CI). Children in which mothers used both iron and folic acid supplementation had a fourfold decreased risk of developing atopic dermatitis [OR = 0.22; 95% confidence interval (CI) 0.06-0.79, p = 0.02], after adjusting for possible confounding factors. Findings suggest an independent and protective effect of prenatal folic acid and iron supplementation for atopic dermatitis in children.

Objective The endocannabinoid system hypertonicity features obesity. Excess circulating 2-arachidonoylglycerol was variously associated with obesity-related metabolic impairment; however, unstandardized experimental and analytical settings have clouded its usefulness as a dysmetabolism biomarker. We aimed at assessing the influence of body mass index (BMI), menopause in women, and aging in men on 2-arachidonoylglycerol relationship with metabolic parameters. Methods Adult, unmedicated women (premenopausal (preMW): n = 103; menopausal (MW): n = 81) and men (n = 144) were stratified in normal weight (NW; BMI: 18.5–24.9 kg/m2), overweight (OW; BMI: 25.0–29.9 kg/m2), and obese (OB; BMI ≥ 30.0 kg/m2) classes. Anthropometric and metabolic parameters were determined. Plasma 2-arachidonoylglycerol was measured by a validated liquid chromatography-mass spectrometry assay. Results 2-arachidonoylglycerol level was raised by menopause (P, Highlights • Plasma 2AG is a biomarker of dysmetabolism rather than obesity. • Menopause is a major determinant of plasma 2AG levels in females. • Increased plasma 2AG level features obese premenopausal females and obese males. • 2AG is a biomarker of dyslipidemia and insulin resistance in lean menopausal women. • 2AG is a biomarker of dyslipidemia and age-related insulin resistance in lean men.

Background Italy was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020. We describe how the pandemic affected Emergency Department (ED) accesses in a tertiary children’s hospital, composed by two different pediatric centers, one located in Rome’s city center and the second, Palidoro (regional COVID-19 center), in its surrounding metropolitan area, both in the Lazio region, analyzing the profile of admitted patients during the pandemic period in terms of their general characteristics (at presentation in the ED’s) and urgent hospitalizations compared to prepandemic period. Methods The study compare the period between the 21st of February and the 30th of April 2020, covering the three phases of the national responses (this period will be referred to as the pandemic period) with the same period of 2019 (prepandemic period). The study analyzes the number of ED visits and urgent hospitalizations and their distribution according to selected characteristics. Results The reduction of ED visits was 56 and 62%, respectively in Rome and Palidoro centers. The higher relative decline was encountered for Diseases of Respiratory System, and for Diseases of the Nervous System and Sense Organs. A doubling of the relative frequency of hospitalizations was observed, going from 14.2 to 24.4% in Rome and from 6.4 to 10.3% in Palidoro. In terms of absolute daily numbers the decrease of urgent hospitalizations was less sharp than ED visits. For pathologies such as peritonitis, tumors or other possible life-treathening conditions we did not observe a significative increase due to delayed access. Conclusions In the pandemic period there was a general reduction in the number of children referred to ED, such reduction was greater in low-acuity levels. The reduction for respiratory tract infections and other communicable diseases during school closure and the national lockdown must make us reflect on the possible impact that these conditions may have on the health system, in particular the ED, at the reopening of schools. The major problem remains the fear for possible diagnostic delays in life-threatening or crippling diseases; our study doesn’t demonstrate an increase in number or significant delay in some serious conditions such as tumors, peritonitis, diabetic ketoacidosis, ileo-colic intussusception and testis/ovary torsion. A continuous, deep re-organizational process step by step of the ED is nececessary in the present and upcoming pandemic situation.

Aim To estimate healthcare use and related costs for 2-year-old very preterm (VP) children after discharge from the neonatal unit. Methods As part of a European project, we recruited an area-based cohort including all VP infants born in three Italian regions (Lazio, Emilia-Romagna and Marche) in 2011-2012. At 2 years corrected age, parents completed a questionnaire on their child health and healthcare use (N = 732, response rate 75.6%). Cost values were assigned based on national reimbursement tariffs. We used multivariable analyses to identify factors associated with any rehospitalisation and overall healthcare costs. Results The most frequently consulted physicians were the paediatrician (85% of children), the ophthalmologist (36%) and the neurologist/neuropsychiatrist (26%); 38% of children were hospitalised at least once after the initial discharge, for a total of 513 admissions and over one million euros cost, corresponding to 75% of total healthcare costs. Low maternal education and parental occupation index, congenital anomalies and postnatal prematurity-related morbidities significantly increased the risk of rehospitalisation and total healthcare costs. Conclusion Rehospitalisation and outpatient care are frequent in VP children, confirming a substantial health and economic burden. These findings should inform the allocation of resources to preventive and rehabilitation services for these children.

BackgroundThe intratracheal (IT) administration of budesonide using surfactant as a vehicle has been shown to reduce the incidence of bronchopulmonary dysplasia (BPD) in preterm infants. The objective of this study was to characterize the in vitro characteristics and in vivo safety and efficacy of the extemporaneous combination of budesonide and poractant alfa.MethodsThe stability, minimum surface tension, and viscosity of the preparation were evaluated by means of high-performance liquid chromatography (HPLC), Wilhelmy balance, and Rheometer, respectively. The safety and efficacy of the IT administration of the mixture were tested in two respiratory distress syndrome (RDS) animal models: twenty-seventh day gestational age premature rabbits and surfactant-depleted adult rabbits.ResultsA pre-formulation trial identified a suitable procedure to ensure the homogeneity and stability of the formulation. Wilhelmy Balance tests clarified that budesonide supplementation has no detrimental effect on poractant alfa surface tension activity. The addition of budesonide to poractant alfa did not affect the physiological response to surfactant treatment in both RDS animal models, and was associated to a significant reduction of lung inflammation in surfactant-depleted rabbits.ConclusionOur in vitro and in vivo analysis suggests that the IT administration of a characterized extemporaneous combination of poractant alfa and budesonide is a safe and efficacious procedure in the context of RDS.

In critical infrastructures, communication networks are used to exchange vital data among elements of Industrial Control Systems (ICSes). Due to the criticality of such systems and the increase of the cybersecurity risks in these contexts, best practices recommend the adoption of Intrusion Detection Systems (IDSes) as monitoring facilities. The choice of the positions of IDSes is crucial to monitor as many streams of data traffic as possible. This is especially true for the traffic patterns of ICS networks, mostly confined in many subnetworks, which are geographically distributed and largely autonomous. We introduce a methodology and a software architecture that allow an ICS operator to use the spare bandwidth that might be available in over-provisioned networks to forward replicas of traffic streams towards a single IDS placed at an arbitrary location. We leverage certain characteristics of ICS networks, like stability of topology and bandwidth needs predictability, and make use of the Software-Defined Networking (SDN) paradigm. We fulfill strict requirements about packet loss, for both functional and security aspects. Finally, we evaluate our approach on network topologies derived from real networks.

The name comes from an Ancient Greek wind instrument because AULOS is a passive radar family system developed by SELEX Sistemi Integrati (now Finmeccanica) that exploits electromagnetic energy already present in the environment such as FM frequency radio and DVB-T (digital video broadcast - terrestrial) emissions, and is completely environmentally friendly. The new green system is the result of many years of R&D, some undertaken in concert with the Terrestrial Armaments Department [1], [2], [3], [4]. It is a technologically advanced family of sensors developed entirely on the basis of a "soft radar" approach, involving signal sampling directly at carrier frequency using COTS (commercial off the shelf) devices for signal reception and digital processing. The resulting biband family offers great flexibility for potential use in a variety of operating conditions, along with enhanced target monitoring distance and position estimate performance.

Small forest holders own approximately 55 % of European forests. Forest certification can effectively support smallholders in environmental and socio-economic terms and increasing their access to certification is a priority for all the certification systems. With the aim of gaining a better insight into the smallholder certification scenario, this study identifies and analyzes the main factors influencing the diffusion of the Forest Stewardship Council (FSC) smallholder certification in Europe. Potential strategies to help FSC meet the requirement of smallholders—and as a consequence enhance their access to certification—are pointed out. First, European FSC certification reports were reviewed; second, a Strengths, Weaknesses, Opportunities and Threats-Analytic Network Process (SWOT-ANP) analysis was applied. The review of the reports shows that FSC certification allows achieving substantial environmental and social improvements, making a valuable contribution to ordinary management. The SWOT-ANP analysis reveals a common awareness that the FSC scheme has been customized for the small-scale forestry over the last years—indeed, the certificates issued annually are increasing—but the need to make further progress and to provide adequate technical-managerial support to smallholders during all certification phases still emerge. Results from the economic analysis highlight that certification may be a good opportunity to increase commercial relationships and exchanges, by facilitating the entrance of certified products to dedicated high-value markets. Findings also highlight social and environmental shortcomings concerning forest workers conditions and management practices.

Cloud computing services provide several benefits in terms of flexibility, scalability and cost reductions. Container technology allows to further lower the overhead of virtualization making it possible to run more components per server. Designing and deploying a cloud platform requires significant effort and it should be possibly dealt with automation tools. Automation can be dealt through either an imperative or declarative approach. We present how we designed and deployed a cloud container platform using declarative modeling. A model of the architecture of the service is described through a declarative specification and then passed to an orchestration tool that generates the actual plan of steps to be performed in the deployment.

Many surveys estimated prevalence of parkinsonism, with results varying largely. We used prescription records of medications for parkinsonism to estimate the prevalence of this condition. Retrospective survey based on Lazio (Italy) regional drugs' prescriptions registry. Cases of parkinsonism were defined as those who received a medication for parkinsonism (Dopa and dopa derivatives or Monoamine oxidase B-inhibitors) for at least 6 months in a 5-year period (2005-2009). Crude and standardized prevalence rates at June 2009 were calculated. Crude and standardized prevalence rates of parkinsonism in Lazio were, respectively, 283 per 100,000 (95 % CI 278-287), and 294 per 100,000 (95 % CI 289-298), higher in men than in women (292 per 100,000 vs. 274 per 100,000). The highest overall prevalence rate was observed among people aged 85-89 years (246 per 100,000), while the lowest in subjects aged

This study was aimed at evaluating differences in breastfeeding initiation rates by maternal place of birth among women giving birth in one of 14 hospitals in Lazio, Italy, between 2006 and 2011.The data on 14 hospitals for this study were taken from a survey on healthy newborns carried out during the month of October each year. It collected information on maternal characteristics and infant feeding during the hospital stay. The exposure variable was maternal place of birth. The outcome variable was infant feeding during hospital stay classified as exclusive breastfeeding, predominant breastfeeding (PBF), complementary feeding or formula feeding. Both a descriptive analysis and a logistic regression on infant feeding (exclusive/PBF versus partial or non-breastfeeding) by maternal place of birth were carried out. The logistic regression model was adjusted for confounding factors. A random effect model was used to take into account the correlation of data among the hospitals.Among the 6505 mothers included in this study, 18.7% were born in non-industrialized countries. Overall, 64.9% of mothers exclusively breastfed their babies, with lower prevalence among Asiatic mothers. The logistic model confirmed that breastfeeding was lower among infants born to Asian mothers (OR: 0.52; 95% CI: 0.35-0.77) compared with other groups, taking into account the effect of the other variables included in this model. Intracluster correlation was equal to 26%, showing that the hospital's model of care is a strong predictor of the initiation of breastfeeding.These data are useful for targeting disadvantaged groups when promoting breastfeeding.

Background Size at birth is an important predictor of neonatal outcomes, but there are inconsistencies on the definitions and optimal cut-offs. Aims The aim of this study is to compute birth size percentiles for Italian very preterm singleton infants and assess relationship with hospital mortality. Study design Prospective area-based cohort study. Subjects All singleton Italian infants with gestational age 22–31weeks admitted to neonatal care in 6 Italian regions (Friuli Venezia-Giulia, Lombardia, Marche, Tuscany, Lazio and Calabria) (n. 1605). Outcome measure Hospital mortality. Methods Anthropometric reference charts were derived, separately for males and females, using the lambda (λ) mu (μ) and sigma (σ) method (LMS). Logistic regression analysis was used to estimate mortality rates by gestational age and birth weight centile class, adjusting for sex, congenital anomalies and region. Results At any gestational age, mortality decreased as birth weight centile increased, with lowest values observed between the 50th and the 89th centiles interval. Using the 75th–89th centile class as reference, adjusted mortality odds ratios were 7.94 (95% CI 4.18–15.08) below 10th centile; 3.04 (95% CI 1.63–5.65) between the 10th and 24th; 1.96 (95% CI 1.07–3.62) between the 25th and the 49th; 1.25 (95% CI 0.68–2.30) between the 50 h and the 74th; and 2.07 (95% CI 1.01–4.25) at the 90th and above. Conclusions Compared to the reference, we found significantly increasing adjusted risk of death up to the 49th centile, challenging the usual 10th centile criterion as risk indicator. Continuous measures such as the birthweight z-score may be more appropriate to explore the relationship between growth retardation and adverse perinatal outcomes.

Federated networking is a promising approach to resource sharing that supports cost-effective services involving multiple parties. Research in this field largely focused on architectures and cost models, making limited progress on the technological side. On the other hand, the widely adopted Software-Defined Networking (SDN) model found its most successful application in data centers, exhibiting very little penetration in other scenarios. We leverage the unexplored potential of SDN on the edge of a network to introduce an approach that supports end-to-end connectivity among different federated partners. Our approach is based on simple Network Address and Port Translation (NAPT), making it applicable in standard IP networks. It is also very flexible, because it exploits SDN, and scalable, because address translations are performed on Customer Premises Equipment, where SDN is being progressively supported by device vendors. We define various alternative NAPT strategies and evaluate their effectiveness with simulations as well as emulated scenarios.

Software-Defined Networking (SDN) is a de-facto established approach that separates the packet switching functions of a device from its operational logic, which is controlled by a piece of software. Due to its potential for realizing new network architectures and services, a whole thread of scientific literature is devoted to SDN and its most adopted incarnation, OpenFlow. However, limited attention has been put in verifying the viability of the proposed approaches on currently available hardware. We address this deficiency through the following contributions: i) a critical review of the literature about SDN in terms of applicability issues stemming from publicly documented limitations of OpenFlow implementations; ii) a methodology for verifying the support of SDN-related functions in a network device, comprising an OpenFlow compliance test as well as custom targeted tests; iii) an application of the methodology to devices from 7 different vendors, unveiling extensive anomalous behaviors affecting even the most basic features; iv) a discussion of this outcome in terms of relevance of the discovered anomalies and of their implications on the applicability of state-of-the-art contributions on SDN. Besides taking a snapshot of the viability of research results, with this paper we intend to highlight aspects that operators should consider when picking SDN devices.

The Address Resolution Protocol (ARP) enables communication between IP-speaking nodes in a local network by reconstructing the hardware (MAC) address associated with the IP address of an interface. This is not needed in a Software-Defined Network (SDN), because each device can forward packets without the need to learn this association. We tackle the interoperability problem arising between standard network devices (end systems, routers), that rely on ARP, and SDN datapaths, that do not handle ARP packets natively. In particular, we propose a general approach to handle ARP in a SDN, that is applicable in several network scenarios, is transparent for existing devices, and can coexist with any packet forwarding logic implemented in the controller. Our approach reduces ARP traffic by confining it to the edge of SDNs and requires a minimal set of flow entries in the datapaths. We argument about its applicability and confirm it with experiments performed on SDN datapaths from a range of different vendors.

ObjectiveThe documented benefits of maternal milk for very preterm infants have raised interest in hospital policies that promote breastfeeding. We investigated the hypothesis that more liberal parental policies are associated with increased breastfeeding at discharge from the neonatal unit.DesignProspective area-based cohort study.SettingNeonatal intensive care units (NICUs) in 19 regions of 11 European countries.PatientsAll very preterm infants discharged alive in participating regions in 2011–2012 after spending >70% of their hospital stay in the same NICU (n=4407).Main outcome measuresWe assessed four feeding outcomes at hospital discharge: any and exclusive maternal milk feeding, independent of feeding method; any and exclusive direct breastfeeding, defined as sucking at the breast. We computed a neonatal unit Parental Presence Score (PPS) based on policies regarding parental visiting in the intensive care area (range 1–10, with higher values indicating more liberal policies), and we used multivariable multilevel modified Poisson regression analysis to assess the relation between unit PPS and outcomes.ResultsPolicies regarding visiting hours, duration of visits and possibility for parents to stay during medical rounds and spend the night in unit differed within and across countries. After adjustment for potential confounders, infants cared for in units with liberal parental policies (PPS≥7) were about twofold significantly more likely to be discharged with exclusive maternal milk feeding and exclusive direct breastfeeding.ConclusionUnit policies promoting parental presence and involvement in care may increase the likelihood of successful breastfeeding at discharge for very preterm infants.

Forty years of cross-disciplinary academic and industrial research & development work on radar tracking systems is surveyed, starting from the former implementations based on the α — β, the Kalman filter up to the modern implementations based on random set filters.

Mininet is the de-facto standard simulation environment for experimenting with SDN enabled networks based on the OpenFlow protocol. Although Mininet is powerful and not resource hungry, it has a strong limitation: it is not possible to use it for networks in which both OpenFlow and standard distributed routing protocols (e.g. Open Short Path First, OSPF) simultaneously run. In this paper we present SDNetkit, an enhanced release of the widely used Netkit network emulator that overcomes the limitation imposed by Mininet. We improved Netkit by adding all needed software to run OpenFlow based networks (e.g. OpenVSwitch and the Ryu framework). We show two use cases in which OpenFlow and standard protocols coexist. In particular, we address interoperability problems by presenting one use case in which OpenFlow nodes interact with standard ones (e.g. OSPF routers) in multi-domain networks, as well as one use case in which the OpenFlow protocol and OSPF run on the same machine, discussing some problems related to specific configurations. We believe that having the possibility to experiment SDN also in presence of interoperability scenarios results in opening to new research perspectives.

Federated networks have primarily emerged to support cloud computing services, in order to reduce costs for providers, as well as to increase their incomes. Up to now, the research activity has been mostly focused on architectures and cost models, setting aside technological aspects. In this paper, we propose SDNS, an SDN-system that opens the application fields of federated networks to federated connectivity services. By exploiting the centralized architecture offered by SDN and relying on the OpenFlow protocol, the most adopted enabler for SDN, we propose a way to easily interact with the Domain Name System (DNS) traffic in order to allow communication among multiple customers connected to different providers in presence of any type of IP address plan. We tested the scalability of our approach in a prototype implementation based on Netkit, a widely adopted simulation environment. We measured several control-plane overhead metrics, like the number of DNS, OpenFlow, and SDNS messages exchanged in the network. Our experiments show that the scalability of our method is essentially the same of the DNS service.

Internet eXchange Points (IXPs) serve as landmarks where many network service providers meet to obtain reciprocal connectivity. Some of them, especially the largest, offer route servers as a convenient technology to simplify the setup of a high number of bi-lateral peerings. Due to their potential to support a quick and easy interconnection among the networks of multiple providers, IXPs are becoming increasingly popular and widespread, and route servers are exploited increasingly often. However, in an ever-growing level of market competition, service providers are pushed to develop concerns about many aspects that are strategic for their business, ranging from commercial agreements with other members of an IXP to the policies that are adopted in exchanging routing information with them. Although these aspects are notoriously sensitive for network service providers, current IXP architectures offer no guarantees to enforce the privacy of such business-critical information. We re-design a traditional route server and propose an approach to enforce the privacy of peering relationships and routing policies that it manages. Our proposed architecture ensures that nobody, not even a third party, can access such information unless it is the legitimate owner (i.e., the IXP member that set up the policy), yet allowing the route server to apply the requested policies and each IXP member to verify that such policies have been correctly deployed. We implemented the route server and tested our solutions in a simulated environment, tracking and analyzing the number of exchanged control plane messages. QC 20180207

Observational prospective population-based incidence study. The main objective of this study was to assess the incidence of traumatic spinal cord injuries (TSCIs) and incidence rates, in order to provide estimates by age, gender, characteristics and cause. This study was conducted at acute-care spinal cord injury (SCI) hospitals and SCI centers from 11 Italian regions, between 1 October 2013 and 30 September 2014. Data of all consecutive patients with acute TSCI who met the inclusion criteria were obtained through case reporting by clinicians. The data were collected into a web database. Incidence rates and incidence rate ratios were calculated and stratified by age, gender, cause, level and completeness. From 50% of the entire population of Italy, 445 new cases of TSCI were included. The crude incidence rate of TSCI was 14.7 cases per million per year (95% CI: 13.4–16.4); the overall male to female ratio was 4:1 and the mean age was 54. Complete information was available in 85% of the sample and revealed tetraplegia in 58% and incomplete lesion in 67% of cases. The leading cause of TSCI was falls (40.9%) followed by road traffic accidents (33.5%). The leading cause was falls for patients over 55 and road traffic accidents for patients under 55. The changing trend of TSCI epidemiology concerns the increase in the average age of TSCI people and the increase of both cervical and incomplete lesions. The etiology shows the primacy of falls over road traffic accidents and suggests the need for a change in prevention policies.

In this paper, we consider the possibility to jointly exploit multiple frequency channels emitted by the same transmitter to improve target detection capability in a DVB-T based passive radar. In particular, appropriate multi-frequency techniques are presented for target detection to be effective in the considered application. The proposed approaches are validated and compared with reference to several experimental data for maritime surveillance applications. The reported results show that the considered multi-frequency techniques yield a significant enhancement in target detection performance with respect to the single frequency operation.

A study was conducted with 542 women, who gave birth in the hospital G.B. Grassi in Rome, to investigate risk factors for exclusive breastfeeding. Clinical data was collected from clinical records at delivery. Information on psycho-socio-demographic characteristics was obtained by standardized questionnaires at delivery. Data on breastfeeding practice and the use of pacifier were collected at delivery and for 24 weeks’ postpartum. The outcome of the study was exclusive breastfeeding for at least 4 months (yes/no). In the multivariate analysis, planned caesarean (OR 2.40, 95 % CI 1.06–5.43) and women with two or more psychological distress conditions (past episodes of depression, insomnia, perceive birth as a traumatic event) versus none were at a greater odds of stopping exclusive breastfeeding before 4 months (OR 3.42, 95 % CI 1.15–10.2). The use of pacifiers within the first 2 weeks postpartum (OR 2.38, 95 % CI 1.35–4.20) but not after 2 weeks (OR 0.86, 95 % CI 0.43–1.72) versus no use was also associated with an increased odds. A protective effect was found for antenatal classes (OR 0.57, 95 % CI 0.35–0.95). Conclusion: This study suggests that the type of delivery, antenatal classes, psychological distress conditions and the use of pacifiers in the first 2 weeks of a baby’s life are independent factors associated with exclusive breastfeeding.

Primary aromatic amines (PAAs) can migrate from packaging into food from different sources such as polyurethanic adhesives used for the manufacture of multilayer films, which may contain residual aromatic isocyanates, or recycled paperboard, because of the presence of azo dyes in the printed paper massively used in the recycling process. In the present work, a reliable analytical method, exploiting a conventional high-performance liquid chromatography-(selected ion monitoring)-mass spectrometry system, for PAAs compliance assessment in food contact materials was developed as an effective alternative to the current standard spectrophotometric one, moving in this way from the screening to the accurate and selective quantitation perspective for the analysis of PAAs both in aqueous and acidic food simulants. The main validation parameters were verified achieving very satisfactory results in terms of linearity range, limit of detection (ranging from 0.1 to 1.0 µg kg−1) and quantitation (ranging from 0.1 to 3.6 µg kg−1), repeatability and accuracy. Suitability of the method was demonstrated for a wide range of commercial samples, chosen among different producers of the most common used food packaging plastic and paperboard categories and then analyzed to assess the risk related to PAAs migration. Finally, the method was also successfully exploited to monitor the evolution of potential PAAs migration during the industrial curing process of multilayer plastic laminates, prior to their release for delivery to the food industry end user. Copyright © 2014 John Wiley & Sons, Ltd.

Introduction and Aims: Serum p-cresyl sulfate associates with cardiovascular disease in patients at different stages of chronic kidney disease. p-Cresyl sulfate concentrations are determined by intestinal uptake of p-cresol, human metabolism to p-cresyl sulfate and renal clearance. Whether intestinal uptake of p-cresol itself is associated with cardiovascular disease in patients with renal disease has not been studied to date. Methods: We performed a prospective study in patients with chronic kidney disease stage 1-5 (clinicaltrials.gov NCT00441623). Intestinal uptake of p-cresol, under steady state conditions, was estimated from 24h urinary excretion of p-cresyl sulfate. Primary endpoint was time to first cardiovascular event, i.e. cardiac death, myocardial infarction/ischemia, ventricular arythmia, cardiovascular surgery, cerebrovascular accident or symptomatic peripheral arterial disease. Statistical analysis was done using Kaplan Meier estimates and Cox proportional hazard analyses. Results: In a cohort of 200 patients, median 24h urinary excretion of p-cresyl sulfate was 457.47 µmol (IQR 252.68-697.17). After a median follow-up of 52 months, 25 patients reached the primary endpoint (tertile 1/2/3: 5/6/14 events, log rank P 0.0368, see figure). Higher urinary excretion of p-cresyl sulfate was related with cardiovascular events (univariate hazard ratio per 100 µmol increase: 1.112, P 0.0015). In multivariate analysis, urinary excretion of p-cresyl sulfate remained a predictor of cardiovascular events, independent of markers of renal function (Hazard ratio 1.120, P 0.0022) and in different models with other cardiovascular risk factors (Framingham risk factors, cardiovascular history, diabetes mellitus and biochemical parameters). The independent association between urinary excretion of p-cresyl sulfate and outcome persisted after correction for serum p-cresyl sulfate. Conclusions: Intestinal uptake of p-cresol associates with cardiovascular disease independent of renal function. Insights into mechanisms governing intestinal generation and absorption of p-cresol may lead to identification of novel therapeutic targets to reduce cardiovascular disease risk in patients with chronic kidney disease.

The Aboriginal Prenatal Wellness Program (APWP) in Canada represents a culturally safe approach to prenatal care. By understanding the history of colonization and residential schools and how this history has contributed to health disparities, a multidisciplinary team provides culturally competent and integrated prenatal care to Aboriginal women and their families. This article describes the APWP and discusses how increased participation in health care by historically marginalized populations can lead to better maternal and neonatal health outcomes.

Background Although very preterm infants are recommended to receive immunizations, according to their chronological age, immunization start in these infants is often delayed. Aim To measure coverage and timeliness of routine immunizations in Italian very preterm infants and to assess determinants of delay. Methods We followed up infants 22–31 completed weeks of gestational age discharged from intensive care. We measured the proportion of children with one dose of diphtheria–tetanus–pertussis–poliohepatitis, B-Hib vaccine (DTP–Pol–HBV-Hib), measles–mumps–rubella vaccine (MMR), conjugate pneumococcal vaccine (Pnc), conjugate meningococcal C vaccine (MenC), and varicella vaccine (Var) by 24 months. We used the Kaplan Meier method and Cox proportional hazard models to estimate the age, at immunization start and determinants of timeliness for each vaccine. Results Data on 1102 (92.1%) children out of 1196 included in the cohort were analyzed. Immunization start by 24 months of age occurred in 95.9% of children for DTP–Pol–HBV-Hib; 84.0% for MMR; 49.7% for Pnc; 38.5% for MenC; and 4.1% for Var. Eighty-seven percent of participants received the first dose of DTP–Pol–HBV-Hib by 6 months of age, and 66.7% had their first MMR administered by 18 months. Hospitalization was associated with delay for all vaccines with the exception of MenC and Var. Maternal employment was associated with earlier immunization for MMR, Pnc, and MenC. DTP–Pol–HBV-Hib timeliness improved with increasing birthweight and paternal employment and decreased with a larger number of siblings in the household. MMR was delayed in children with cerebral palsy, and in those with a larger number of children in the household. Immunization for Pnc was delayed in children with larger number of siblings. Conclusions Immunization start for all vaccines was considerably delayed in many very preterm infants. Public health strategies taking into account determinants of delay should be implemented to improve coverage and timeliness of vaccination in this group of infants.

Internet Exchange Points (IXPs) play a crucial role in the Internet ecosystem. However, existing literature fails in quantitatively assessing the advantage for an Internet Service Provider (ISP) to peer at an IXP. We give a contribution to bridge such a gap by collaborating with three medium-sized ISPs in Italy to compare key performance indicators (round-trip delay, hop count, packet loss, and jitter) as measured from several vantage points in presence and absence of IXP peerings. Our findings are that IXP-based paths exhibit better and more stable performance, whereas avoiding IXPs introduces performance deterioration and higher variability. Moreover, our measurements confirm that IXP-based paths tend to preserve the locality of traffic.

We propose a robust fuzzy clustering model for classifying time series, considering the autoregressive metric based. In particular, we suggest a clustering procedure which: 1) considers an autoregressive parameterization of the time series, capable of representing a large class of time series; 2) inherits the benefits of the partitioning around medoids approach, classifying time series in classes characterized by prototypal observed time series (the “medoid” time series), which synthesize the structural information of each cluster; 3) inherits the benefits of the fuzzy approach, capturing the vague (fuzzy) behaviour of particular time series, such as “middle” time series (time series with middle features in respect of the considered clusters in all time period) and “switching” time series (time series with a pattern typical of a given cluster during a certain time period and a completely different pattern, similar to another cluster, in another time period); 4) is capable of suitably neutralizing the negative influence of the presence of “outlier” time series in the clustering procedure, i.e., the “outlier” time series are classified in the so-called “noise cluster” and therefore cluster structure is not altered. To illustrate the effectiveness of the proposed model, a simulation study and an application to real time series are carried out.

Objective To investigate the association between body temperature at admission to neonatal intensive care and in-hospital mortality in very preterm infants, stratified by postnatal age of death. Moreover, we assessed the association between admission temperature and neonatal morbidity. Study design In this cohort study from 19 regions in 11 European countries, we measured body temperature at admission for infants admitted for neonatal care after very preterm birth (

This paper investigates the possibility to improve target detection capability in a DVB-T- based passive radar sensor by jointly exploiting multiple digital television channels broadcast by the same transmitter of opportunity. Based on the remarkable results obtained by such a multi-frequency approach using other signals of opportunity (i.e., FM radio broadcast transmissions), we propose appropriate modifications to the previously devised signal processing techniques for them to be effective in the newly considered scenarios. The resulting processing schemes are extensively applied against experimental DVB-T-based passive radar data pertaining to different surveillance applications. The obtained results clearly show the effectiveness of the proposed multi-frequency approaches and demonstrate their suitability for application in the considered scenarios.

Although previous studies have demonstrated the efficacy of rehabilitation programs for brain tumor (BT) patients and the positive impact on quality of life of functional gain, there are few studies focusing on specific rehabilitation management of brain tumor patients. With the aim to evaluate the pattern of rehabilitation care and health services utilization in patients with brain tumor, we retrospectively analyzed administrative data on a large cohort of brain tumor patients diagnosed during the period 2008–2009 in the Lazio Region. Pattern of rehabilitation care was analyzed during a follow-up of 12 months after diagnosis. Data for this study were gathered and linked from two sources: (1) hospital discharge records stored into the Lazio Regional Health System database and (2) rehabilitation pathways database including inpatient and outpatient interventions files. We identified 789 patients with an ICD-9-CM code of 191.** in the Regional Health System databases in the study period. Among 719 patients included in this study, 92 (12.8 %) were treated with inpatient rehabilitation program, 22 (3.1 %) received an outpatient personalized program with intensive rehabilitation plan, and 85 (11.8 %) received outpatients rehabilitation interventions. Our retrospective analysis on the rehabilitation service utilization in a large cohort of BT patients shows that a limited number of patients received rehabilitation interventions during the first year after diagnosis. Nevertheless, the rehabilitation needs in BT patients are largely unmet and the lack of defined physical and cognitive rehabilitation strategies may negatively affect the functional independence and the short- and long-term quality of life.

Objective To investigate the relationship between maternal education and breastfeeding in very preterm infants admitted to neonatal intensive care units. Study design This prospective, population-based cohort study analyzed the data of all very preterm infants admitted to neonatal care during 1 year in 3 regions in Italy (Lazio, Emilia-Romagna, and Marche). The use of mothers' own milk was recorded at initial enteral feedings and at hospital discharge. We used multilevel logistic analysis to model the association between maternal education and breastfeeding outcomes, adjusting for maternal age and country of birth. Region was included as random effect. Results There were 1047 very preterm infants who received enteral feeding, and 975 were discharged alive. At discharge, the use of mother's own milk, exclusively or not, and feeding directly at the breast were significantly more likely for mothers with an upper secondary education or higher. We found no relationship between maternal education and type of milk at initial enteral feedings. However, the exclusive early use of the mother's own milk at initial feedings was related significantly with receiving any maternal milk and feeding directly at the breast at discharge from hospital, and the association with feeding at the breast was stronger for the least educated mothers. Conclusion In this population-based cohort of very preterm infants, we found a significant and positive association between maternal education and the likelihood of receiving their mother's own milk at the time of discharge. In light of the proven benefits of maternal milk, strategies to support breastfeeding should be targeted to mothers with less education.

The article discussed two main topics: 1. It illustrated the need for increasing the performance of the passive sensor signal processor. The GPU appears to be a solution especially for the computational request of a dual-band system simultaneously receiving and processing FM and DVB-T data. 2. It presented of the AULOS passive system already in the field.

Background Implant stability is one of the key factors for a successful osseointegration. At present, several techniques are available to regenerate bone tissue, but it is not clear whether implants placed in grafted bone are as stable as implants in native bone over time. Purpose The aim of the present study was to compare, by means of resonance frequency analysis (RFA), the stability of implants placed in sinus-grafted and -nongrafted sites during 12-month follow-up. Methods Twenty-five patients received a total of 38 implants. Nineteen implants were placed in maxillary native bone (group A) and 19 implants following maxillary sinus floor augmentation using anorganic bovine bone and autogenous bone (group B) in a 50:50 ratio. Group B was divided into groups B1 and B2 depending on the timing of implant insertion, that is, B1 simultaneously and B2 6 months after sinus lift. The implants were inserted according to a two-stage procedure. RFA values were collected at baseline, 6 and 12 months after implant placement. Results Between the tested groups, no statistically significant difference was found in RFA values of implants placed in sinus-grafted and -nongrafted sites after the surgery as well as at 6 and 12 months, while a significant difference was recorded in group B1 (p = .0297) when RFA values were compared over time. Conclusions The results of the present study suggest that regenerated bone can offer good stability for dental implants.

Fuzzy clustering enables the simultaneous membership of objects in two or more clusters. This is particularly pertinent where time series are concerned, because very often patterns of time series change over time. Thus, a time series might belong to different clusters over different periods of time, in which case, crisp clustering is unable to capture this multi-cluster membership. In this paper, we adopt a Fuzzy C-Medoids approach to clustering time series based on autoregressive estimates of models fitted to the time series. We illustrate very good performance of this approach in a range of simulation studies. By means of two applications, we also show the usefulness of this clustering approach in the air pollution monitoring, by considering air pollution time series, i.e., CO time series, CO2 time series and NO time series monitored on world and urban scales. In particular, we show that, by considering in the clustering process, the autoregressive representation of these air pollution time series, we are able to detect possible information redundancy in the monitoring networks and then, decreasing the number of monitoring stations, to reduce the monitoring costs and then to increase the monitoring efficiency of the networks.

The aim of this population-based study was to estimate the risk of postpartum maternal complications associated with mode of delivery in a population of low-risk pregnancies. Data from 324,883 full-term singleton births between 2001 and 2007 were retrieved from birth and hospital discharge databases of the Lazio Region, Central Italy. Women with breech presentation births and those with chronic/pregnancy-related diseases in the mother/fetus were excluded. The association between mode of delivery and maternal outcome was estimated for women by odds ratios (ORs), adjusted for potential confounders. Of nulliparous women 78.6% intended vaginal delivery, while for multiparous this was 68.6%. Elective cesarean section was associated with a higher risk of hysterectomy, obstetric shock and anesthetic complications compared with women in the intended vaginal delivery group. This suggests there is a need for a program to reduce unnecessary elective cesarean sections.