Critical COVID-19 Patients Through First, Second And Third Wave: Retrospective Observational Study Comparing Outcomes In ICU.

Introduction- The time-course of the COVID-19 pandemic was characterized by subsequent waves identified by peaks of Intensive Care Unit (ICU) admission rates. During these periods, progressive knowledge of the disease led to the development of specific therapeutic strategies. This retrospective study investigates whether this led to improvement in outcomes of COVID-19 patients admitted to ICU. Methods- Outcomes were evaluated in consecutive adult COVID19 patients admitted to our ICU, divided into three waves based on the admission period: the first wave from February 25th, 2020, to July 6th, 2020; the second wave from September 20th, 2020, to February 13th, 2021; the third wave from February 14th, 2021 to April 30th, 2021. Differences were assessed comparing outcomes and by using different multivariable Cox models adjusted for variables related to outcome. Further sensitivity analysis was performed in patients undergoing invasive mechanical ventilation. Results- Overall, 428 patients were included in the analysis: 102, 169 and 157 patients in the first, second and third wave. The ICU and in-hospital crude mortalities were lower by 7% and 10% in the third wave compared to the other 2 waves (p>0.05). A higher number of ICU and hospital free days at day 90 was found in the third wave when compared to the other 2 waves (p=0.001). Overall, 62.6% underwent invasive ventilation, with decreasing requirement during the waves (p=0.002). The adjusted Cox model showed no difference in the Hazard Ratio for mortality among the waves. In the propensity-matched analysis the hospital mortality rate was reduced by 11% in the third wave (p=0.044). Conclusions - With application of best practice as known by the time of the first three waves of the pandemic, our study failed to identify a significant improvement in mortality rate when comparing the different waves of the COVID-19 pandemic, notwithstanding, the sub-analyses showed a trend in mortality reduction in the third wave. Rather, our study identified a possible positive effect of dexamethasone on mortality rate reduction and the increased risk of death related to bacterial infections in the three waves

Cytomegalovirus blood reactivation in COVID-19 critically ill patients: risk factors and impact on mortality.

Purpose: Cytomegalovirus (CMV) reactivation in immunocompetent critically ill patients is common and relates to a worsening outcome. In this large observational study, we evaluated the incidence and the risk factors associated with CMV reactivation and its effects on mortality in a large cohort of COVID-19 patients admitted to the intensive care unit (ICU). Methods: Consecutive patients with confirmed SARS-CoV-2 infection and acute respiratory distress syndrome admitted to three ICUs from February 2020 to July 2021 were included. The patients were screened at ICU admission and once or twice per week for quantitative CMV-DNAemia in the blood. The risk factors associated with CMV blood reactivation and its association with mortality were estimated by adjusted Cox proportional hazards regression models. Results: CMV blood reactivation was observed in 88 patients (20,4%) of the 431 patients studied. SAPS II score (HR 1,031, 95% CI 1,010-1,053, p=0,006), platelet count (HR 0,0996, 95% CI 0,993-0,999, p=0,004), invasive mechanical ventilation (HR 2,611, 95% CI 1,223-5,571, p=0,013) and secondary bacterial infection (HR 5,041; 95% CI 2,852-8,911, p<0,0001) during ICU stay were related to CMV reactivation. Hospital mortality was higher in patients with (67,0%) than in patients without (24,5%) CMV reactivation but the adjusted analysis did not confirm this association (HR 1,141, 95% CI 0,757-1,721, p=0,528). Conclusion: The severity of illness and the occurrence of secondary bacterial infections were associated with an increased risk of CMV blood reactivation, which, however, does not seem to influence the outcome of COVID-19 ICU patients independently

Euclid Near Infrared Spectrometer and Photometer instrument concept and first test results obtained for different breadboards models at the end of phase C

The Euclid mission objective is to understand why the expansion of the Universe is accelerating through by mapping the geometry of the dark Universe by investigating the distance-redshift relationship and tracing the evolution of cosmic structures. The Euclid project is part of ESA's Cosmic Vision program with its launch planned for 2020 (ref [1]). The NISP (Near Infrared Spectrometer and Photometer) is one of the two Euclid instruments and is operating in the near-IR spectral region (900- 2000nm) as a photometer and spectrometer. The instrument is composed of: - a cold (135K) optomechanical subsystem consisting of a Silicon carbide structure, an optical assembly (corrector and camera lens), a filter wheel mechanism, a grism wheel mechanism, a calibration unit and a thermal control system - a detection subsystem based on a mosaic of 16 HAWAII2RG cooled to 95K with their front-end readout electronic cooled to 140K, integrated on a mechanical focal plane structure made with molybdenum and aluminum. The detection subsystem is mounted on the optomechanical subsystem structure - a warm electronic subsystem (280K) composed of a data processing / detector control unit and of an instrument control unit that interfaces with the spacecraft via a 1553 bus for command and control and via Spacewire links for science data This presentation describes the architecture of the instrument at the end of the phase C (Detailed Design Review), the expected performance, the technological key challenges and preliminary test results obtained for different NISP subsystem breadboards and for the NISP Structural and Thermal model (STM)

NI-DPU Application Software Product Assurance Plan

The purpose of this Software Product Assurance Plan is to establish the goals, processes, and responsibilities required to implement effective quality assurance functions for the Euclid NISP DPU Application Software. The Euclid NISP DPU Application Software Quality Assurance Plan provides the framework necessary to ensure a consistent approach to software quality assurance throughout the project life cycle. It defines the approach that will be used by the Product Assurance personnel to monitor and assess software development processes and products to provide objective insight into the maturity and quality of the software. The systematic monitoring of Euclid NISP DPU ASW products and processes will be planned to ensure they meet requirements and comply with ESA and Euclid policies, standards, and procedures. The NISP DPU ASW is the application SW, instrument control and data processing, running on NISP DPU. The NISP DPU ASW will be provided by INAF OAPd/OAS Bologna. This plan is not applicable to the NISP DCU firmware nor to the DPU boot software, which will be provided by the company that will actually design and build the DPU/DCU HW. The related PA plan will be then provided separately. This plan includes the compliance matrix

DPU ASW File List

The scope of this document is to show the file structure of the DPU-ASW project. The DPU-ASW is composed separated software modules; each DPU-ASW task belong to a single module i.e. DPU_1553, DPU_CmdExec, DPU_CmdHandler, DPU_CPULoad, DPU_Deathreport, DPU_ErrorHandling, DPU_HskScan, DPU_Process, DPU_Start and DPU_Watchdog_Lib. There are separated modules for include files DPU_Include, for accessory functions DPU_Utils, and a dedicated module for compilation ASW_image. Details about the architecture can be found in AD-1, and details about the commands and housekeeping structures are in RD-1. The documentation presented here is automatically generated with doxygen 1.8.18, and the source code of the DPU-ASW comments were prepared under doxygen conventions

NI-DPU DCU ASW Requirement Compliance Matrix

A list of the compliance of each one of the NI-DPU ASW requirements is provide

NI-DPU ASW Product Assurance Management Report

The main purpose of this document is to provide at project milestones the reporting on the software Product Assurance activities performed during the different project phases

NI-DPU ASW Verification Control Document

This document is an evolvement of RD-8 and its goal is to assess the verification status of the DPU ASW requirements at the qualification stage of DPU-ASW. It also contains the verification of the requirement tests in an integrated NISP system, with a target hardware fully representative of the nominal NISP setup. It also contains the verification status of requirements presented in AD-4

NI-DPU DCU Application Software Requirement Specifications

The purpose of this document is to provide requirement specifications for the NI-DPU application software. The DCU is entirely based on FPGA devices with internal HW configuration defined during the development phase and not modifiable in operation. This document is not applicable to the NISP DPU Boot and Basic SW nor to the NISP DCU FPGA firmware, which will be provided by the Italian company which will design and build the DPU and DCU HW. The related documents will be provided separately

NI-DPU ASW Test Specifications

This document is focused on the DPU-ASW applicative software test phases between the first delivery of the DPU-WE HW model and the delivery of the ASW final version (Flight) tested with the NISP-WE Flight configuration. All tests - within the limitations of each specific HW, will cover different functional and performance aspects of the ASW features; they will be specified in each case. A consistent part of tests will be based on data-processing procedures (basically final science frame extraction and compression of the same). In this specific case the needed hardware environment can be reduced to the Maxwell CPU board. In an initial phase, tests were carried out with the aid of simulators for some missing HW parts. They are described along the present document. Some End-to-end preliminary tests required the full EM hardware plus MMU simulator, ICU simulator and Quick-Look procedure as described in RD-9. The availability of the EQM model allow to verify the handling of multiple DCUs/SCEs and the synchronization of exposures. During the AIV campaign two DPUs are used contemporary (DPU-EM and DPU-EQM); with this setup the synchronization mechanism of the two DPUs was verified. Using more complete setups during the NI-EM-TV and TV3 test campaigns (described in Section 5) DPU flight modes were used, and the operations using the complete DPU HW setup (using the two DPU-Flight models) and using the entire NISP flight focal plane (multiplicity of 16 DCUs-SCEs) were verified. As well as the performances of the scientific data production, processing and transmission using 16 Flight detectors (16xSCA-CFC-SCE triplets) connected to the 16xDCUs. It is assumed in this document that the HW and SW parts specifically committed and delivered by the industry to cover the needs of all the WE development models have passed a set of electrical, functional and performance tests, as described in the documentation provided with the DPU HW CDR and QR closeouts. It is also assumed that all the HW and Boot SW, basic SW and middleware (HDSW) is completely and correctly operating and those tests will not be repeated. But both basic SW and HW functionalities will be verified and validated only indirectly during the different DPU-ASW testing phases. We also assume that all stress and long duration tests have been passed for all the HW components, and that those are not under DPU-ASW development team responsibility, that is HW parts, Boot SW and Basic SW