A dynamic Bayesian network model for predicting organ failure associations without predefining outcomes

Critical care medicine has been a field for Bayesian networks (BNs) application for investigating relationships among failing organs. Criticisms have been raised on using mortality as the only outcome to determine the treatment efficacy. We aimed to develop a dynamic BN model for detecting interrelationships among failing organs and their progression, not predefining outcomes and omitting hierarchization of organ interactions. We collected data from 850 critically ill patients from the national database used in many intensive care units. We considered as nodes the organ failure assessed by a score as recorded daily. We tested several possible DBNs and used the best bootstrapping results for calculating the strength of arcs and directions. The network structure was learned using a hill climbing method. The parameters of the local distributions were fitted with a maximum of the likelihood algorithm. The network that best satisfied the accuracy requirements included 15 nodes, corresponding to 5 variables measured at three times: ICU admission, second and seventh day of ICU stay. From our findings some organ associations had probabilities higher than 50% to arise at ICU admittance or in the following days persisting over time. Our study provided a network model predicting organ failure associations and their evolution over time. This approach has the potential advantage of detecting and comparing the effects of treatments on organ function

Ni(0) catalysed homo-coupling reactions: a novel route towards the synthesis of multinuclear ruthenium polypyridine complexes featuring made-to-order properties.

A new synthetic procedure for the efficient preparation of dinuclear ruthenium(II) polypyridyl complexes is reported. The compounds synthesised are [(bpy)2Ru(BPBT)Ru(bpy)2](PF6)2 and [(bpy)2Ru(BPZBT)Ru(bpy)2](PF6)2 (bpys2,29-bipyridine; H2BPBTs5,59- bis(pyridin-2-yl)-3,39-bis(1,2,4-triazole); H2BPZBTs5,59-bis(pyrazin-2-yl)-3,39-bis(1,2,4-triazole). Electrochemical experiments show that the two dinuclear systems investigated exhibit pH switchable intercomponent interactions

Exploiting Web Technologies to Connect Business Process Management and Engineering

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Promoting the psychological well-being of healthcare providers facing the burden of adverse events: a systematic review of second victim support resources

Given the negative impact of adverse events on the wellbeing of healthcare providers, easy access to psychological support is crucial. We aimed to describe the types of support resources available in healthcare organizations, their benefits for second victims, peer supporters' experiences, and implementation challenges. We also explored how these resources incorporate aspects of Safety I and Safety II. We searched six databases up to 19 December 2019 and additional literature, including weekly search alerts until 21 January 2021. Two reviewers independently performed all methodological steps (search, selection, quality assessment, data extraction, formal narrative synthesis). The 16 included studies described 12 second victim support resources, implemented between 2006 and 2017. Preliminary data indicated beneficial effects not only for the affected staff but also for the peer responders who considered their role to be challenging but gratifying. Challenges during program implementation included persistent blame culture, limited awareness of program availability, and lack of financial resources. Common goals of the support programs (e.g., fostering coping strategies, promoting individual resilience) are consistent with Safety II and may promote system resilience. Investing in second victim support structures should be a top priority for healthcare institutions adopting a systemic approach to safety and striving for just culture

Dry Hydrogen Production in a Tandem Critical Raw Material-Free Water Photoelectrolysis Cell Using a Hydrophobic Gas-Diffusion Backing Layer

A photoelectrochemical tandem cell (PEC) based on a cathodic hydrophobic gas-diffusion backing layer was developed to produce dry hydrogen from solar driven water splitting. The cell consisted of low cost and non-critical raw materials (CRMs). A relatively high-energy gap (2.1 eV) hematite-based photoanode and a low energy gap (1.2 eV) cupric oxide photocathode were deposited on a fluorine-doped tin oxide glass (FTO) and a hydrophobic carbonaceous substrate, respectively. The cell was illuminated from the anode. The electrolyte separator consisted of a transparent hydrophilic anionic solid polymer membrane allowing higher wavelengths not absorbed by the photoanode to be transmitted to the photocathode. To enhance the oxygen evolution rate, a NiFeOX surface promoter was deposited on the anodic semiconductor surface. To investigate the role of the cathodic backing layer, waterproofing and electrical conductivity properties were studied. Two different porous carbonaceous gas diffusion layers were tested (Spectracarb® and Sigracet®). These were also subjected to additional hydrophobisation procedures. The Sigracet 35BC® showed appropriate ex-situ properties for various wettability grades and it was selected as a cathodic substrate for the PEC. The enthalpic and throughput efficiency characteristics were determined, and the results compared to a conventional FTO glass-based cathode substrate. A throughput efficiency of 2% was achieved for the cell based on the hydrophobic backing layer, under a voltage bias of about 0.6 V, compared to 1% for the conventional cell. For the best configuration, an endurance test was carried out under operative conditions. The cells were electrochemically characterised by linear polarisation tests and impedance spectroscopy measurements. X-Ray Diffraction (XRD) patterns and Scanning Electron Microscopy (SEM) micrographs were analysed to assess the structure and morphology of the investigated materials.Authors gratefully acknowledge funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 760930 (FotoH2 project)

Predictive Role of Serum Thyroglobulin after Surgery and before Radioactive Iodine Therapy in Patients with Thyroid Carcinoma

Introduction: Thyroidectomy followed by radioactive iodine therapy (RAI) is the treatment of choice for differentiated thyroid carcinoma (DTC). Serum thyroglobulin (Tg) measurement has proved to be useful for predicting persistent and/or recurrent disease during follow-up of DTC patients. In our study, we evaluated the risk of disease recurrence in patients with papillary thyroid carcinoma (PTC), who were treated with thyroidectomy and RAI, by measuring serum Tg at different time-points: at least 40 days after surgery, in euthyroidism with TSH < 1.5 and usually 30 days before RAI (Tg−30), on the day of RAI (Tg0), and seven days after RAI (Tg+7). Methods: One hundred and twenty-nine patients with PTC were enrolled in this retrospective study. All patients were treated with 131I for thyroid remnant ablation. Disease relapse (nodal disease or distant disease) during at least 36 months follow-up was evaluated by serum measurements of Tg, TSH, AbTg at different time points and by imaging techniques (neck ultrasonography, 131I-whole body scan (WBS) after Thyrogen® stimulation). Typically, patients were assessed at 3, 6, 12, 18, 24, and 36 months after RAI. We classified patients in five groups: (i) those who developed nodal disease (ND), (ii) those who developed distant disease (DD), (iii) those with biochemical indeterminate response and minimal residual thyroid tissue (R), (iv) those with no evidence of structural or biochemical disease + intermediate ATA risk (NED-I), and (v) those with no evidence of structural or biochemical disease + low ATA risk (NED-L). ROC curves for Tg were generated to find potential discriminating cutoffs of Tg values in all patients’ groups. Results: A total of 15 out of 129 patients (11.63%) developed nodal disease and 5 (3.88%) distant metastases, during the follow-up. We found that Tg−30 (with suppressed TSH) has the same sensitivity and specificity than Tg0 (with stimulated TSH), and it is slightly better than Tg+7, which can be influenced by the size of the residual thyroid tissue. Conclusion: Serum Tg−30 value, measured in euthyroidism 30 days before RAI, is a reliable prognostic factor to predict future nodal or distant disease, thus allowing to plan the most appropriate therapy and follow-up

Enhanced Photoelectrochemical Water Splitting at Hematite Photoanodes by Effect of a NiFe-Oxide co-Catalyst

Tandem photoelectrochemical cells (PECs), made up of a solid electrolyte membrane between two low-cost photoelectrodes, were investigated to produce “green” hydrogen by exploiting renewable solar energy. The assembly of the PEC consisted of an anionic solid polymer electrolyte membrane (gas separator) clamped between an n-type Fe2O3 photoanode and a p-type CuO photocathode. The semiconductors were deposited on fluorine-doped tin oxide (FTO) transparent substrates and the cell was investigated with the hematite surface directly exposed to a solar simulator. Ionomer dispersions obtained from the dissolution of commercial polymers in the appropriate solvents were employed as an ionic interface with the photoelectrodes. Thus, the overall photoelectrochemical water splitting occurred in two membrane-separated compartments, i.e., the oxygen evolution reaction (OER) at the anode and the hydrogen evolution reaction (HER) at the cathode. A cost-effective NiFeOx co-catalyst was deposited on the hematite photoanode surface and investigated as a surface catalytic enhancer in order to improve the OER kinetics, this reaction being the rate-determining step of the entire process. The co-catalyst was compared with other well-known OER electrocatalysts such as La0.6Sr0.4Fe0.8CoO3 (LSFCO) perovskite and IrRuOx. The Ni-Fe oxide was the most promising co-catalyst for the oxygen evolution in the anionic environment in terms of an enhanced PEC photocurrent and efficiency. The materials were physico-chemically characterized by X-ray diffraction (XRD), transmission electron microscopy (TEM) and scanning electron microscopy (SEM).Authors gratefully acknowledge funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 760930 (FotoH2 project)

The climate in the European Union and the enlarged European Region is a determinant of the COVID-19 case fatality ratio

Climate could influence the COVID-19 pandemic, but while no evidence has been advanced on the influence of colder climates, some studies have provided data to support a possible heat-related protective factor. The objective is to verify whether areas with a Cold Temperate Climate (TC) have a higher Case Fatality Ratio (CFR) for COVID-19 than areas with a Cold Climate (CC) or with a Mediterranean Climate (MC) in the European Union and the Enlarged European Region. Countries or regions were subdivided into 3 groups according to the Köppen climate classification system: TC (Cfa, Cfb and Cfc in the Köppen system); MC (Csa, Csb); CC (D and E in the Köppen system). The total number of cases and the total number of deaths were detected on 13 August 2020 on the COVID-19 Map-Johns Hopkins Coronavirus Resource Center-the CFR was thus calculated by area. Living in TC areas is strongly associated with risk of a high Case Fatality Ratio for COVID-19, OR for MC =0.42, IC 95% 0.41-0.43; OR for CC=0.33, IC 95% 0.33-0.35. The results are confirmed in the EU, OR per MC=0.85, CI 95% 0.84-0.87; OR per CC=0.63, IC 95% 0.61-0.65.The study found that the IC in a humid temperate climate is associated with higher CFR with respect to the coldest and warmest temperate climates in Europe. This does not appear to be the only determinant of the pandemic

Sacrocolpopexy after sub-total hysterectomy vs. sacral hysteropexy for advanced urogenital prolapse: A propensity-matched study

ObjectiveTo compare objective and subjective outcomes of laparoscopic sacral colpopexy with supracervical hysterectomy (L-SCP) and robotic sacral hysteropexy (R-SHP). MethodsThis is a multicenter retrospective propensity score matched study. In the period between January 2014 and December 2018, we enrolled 161 patients with apical prolapse stage 2 or above, alone or with multicompartment descensus. ResultsAfter propensity-match analysis, there were 44 women for each group. Patients of the two groups had similar preoperative characteristics. No difference was found in terms of estimated blood loss, hospital stay, operative time, and intraoperative or postoperative complications. Subjective success rate, 12 months after surgery, was statistically better in the L-SCP group (P = 0.034): 81.8% and 97.8% women had Patient Global Impression of Improvement scores less than 3, in R-SHP and L-SCP, respectively. The objective cure rate was high in both groups without any significant differences in recurrence rate (P = 0.266). ConclusionBoth procedures are safe and effective in pelvic organ prolapse treatment. Patients who no longer desire uterine preservation could be encouraged to consider L-SCP. R-SHP is an alternative in women who are strongly motivated to preserve their uterus in the absence of abnormal uterine findings

Is the Inversion in the Trend of the Lethality of the COVID-19 in the Two Hemispheres due to the Difference in Seasons and Weather?

The climate has an influence on the COVID-19 virus lethality. The aim of this study is to verify if the summer weather coincided with the decrease of the Case Fatality Ratio (CFR) in Europe and if, on the contrary, an inverse trend was observed in Australia and New Zealand. To verify our hypothesis, we considered the largest European countries (Germany, UK, France, Italy, and Spain), plus Belgium and the Netherlands. Furthermore, we compared these countries with Australia and New Zealand. For each country considered, we have calculated the CFR from the beginning of the pandemic to May 6th and from May 6th to September 21st (late summer in Europe, late winter in the southern hemisphere). The CFRs were calculated from the John Hopkins University database. According to the results, in all European countries, a progressive decrease in CFR is observed. A diametrically opposite result is found in Australia where, on the contrary, the CFR is much higher at the end of September (at the end of winter) than on May 6th (mid-autumn), and the risk of dying if we count the infection is higher in September. In New Zealand, there are no statistically significant differences between the two surveys. The present study was based on public access macro data