BORDER: A Benchmarking Framework for Distributed MQTT Brokers

[EN] Message queuing telemetry transport (MQTT), one of the most popular application layer protocols for the Internet of Things, works according to a publish/subscribe paradigm where clients connect to a centralized broker. Sometimes (e.g., in high scalability and low-latency applications), it is required to depart from such a centralized approach and move to a distributed one, where multiple MQTT brokers cooperate together. Many MQTT brokers (both open source or commercially available) allow to create such a distributed environment: however, it is challenging to select the right solution due to the many available choices. This article proposes, therefore benchmarking framework for distributed MQTT brokers (BORDER), a framework for creating and evaluating distributed architectures of MQTT brokers with realistic and customizable network topologies. Based on isolated Docker containers and emulated network components, the framework provides quantitative metrics about the overall system performance, such as End-to-End latency as well as network and physical resources consumed. We use BORDER to compare five of the most popular MQTT brokers that allow the creation of distributed architectures and we release it as an open-source project to allow for reproducible researches.This work was supported in part by the Project BASE5G under Project 1155850 funded by Regione Lombardia within the framework POR FESR 2014-2020.Longo, E.; Redondi, A.; Cesana, M.; Manzoni, P. (2022). BORDER: A Benchmarking Framework for Distributed MQTT Brokers. IEEE Internet of Things. 9(18):17728-17740. https://doi.org/10.1109/JIOT.2022.3155872177281774091

Il contributo allo sviluppo della professione infermieristica delle congregazioni religiose del XIX secolo

RIASSUNTO Lo scopo del presente lavoro di ricerca storica è di esaminare il contributo allo sviluppo della professione infermieristica delle congregazioni religiose del XIX secolo prendendo come esempio le Suore di Maria Bambina conosciute anche come Suore della Carití  delle Sante Bartolomea Capitanio e Vincenza Gerosa. Sono state analizzate 63 fonti bibliografiche reperite nell'archivio storico Casa Madre delle Suore di Maria Bambina a Milano in via S. Sofia n.13, ad esclusione di una fonte reperita presso la Biblioteca Nazionale Braidense di Milano. Il lavoro di ricerca ha posto una lente d'ingrandimento sul contributo che le Suore di Maria Bambina hanno fornito, rispetto alle aree professionali e allo sviluppo degli attributi distintivi della professione infermieristica nell'ottica sociologica (Greenwood, 1980). Per l'analisi delle fonti documentarie è stato applicato il metodo di ricerca storica secondo Chabod (2006). Per l'esegesi delle fonti si è creata una griglia di analisi della fonte documentaria. Dall'aggregazione dei dati sono emersi due filoni d'indagine: il primo riguarda il ruolo di Suor Emilia Vinante come esperta per la professione infermieristica e il secondo per quanto attiene alla politica professionale promossa dalla Federazione Italiana Religiose Ospedaliere ( FIRO). Alla luce dei risultati della ricerca si può affermare che le congregazioni religiose hanno operato nell'ambito della professione infermieristica diventando una forza sociale in grado di incidere in modo determinante sullo sviluppo culturale e professionale degli infermieri. Parole Chiave: formazione, storia dell'assistenza infermieristica, infermiere religioseContribution of 19th-century religious congregations in the development of the nursing professionABSTRACT The purpose of this historical research project is to examine the contribution of 19th-century religious congregations in the development of the nursing profession, based on the historical example of the Sisters of Charity of Sts. Bartolomea Capitanio and Vincenza Gerosa (or the Sisters of the Holy Child Mary). To this end, sixty three volumes were analysed, all taken from the historical archive of the Generalate of the Sisters of the Holy Child Mary in Milan, in via S. Sofia n.13, with the exception of just one, taken from the Braidense National Library, also in Milan. This research project has highlighted the sociological contribution provided by the Sisters of the Holy Child Mary to the professional nature of nursing, and to the development of the distinctive features of the nursing profession (Greenwood, 1980). All documentary sources were analysed in line with the Chabod historical research method (2006), and for their critical interpretation, a scheme of analysis was created. Two lines of investigation emerged from the data collected: the role of Sister Emilia Vinante as an expert with regard to the nursing profession, and the professional strategies promoted by FIRO (Federation of Italian Religious Nurses). Based on the conclusions of the research project, it may be stated that religious congregations contributed greatly to the nursing profession, leaving a decisive mark on the cultural and professional development of nurses. Key words: nursing education, historical research, religiuos nurs

A LoRa-based protocol for connecting IoT edge computing nodes to provide small-data-based services

[EN] Data is becoming increasingly personal. Individuals regularly interact with a variety of structured data, ranging from SQLite databases on the phone to personal sensors and open government data. The ¿digital traces left by individuals through these interactions¿ are sometimes referred to as ¿small data¿. Examples of ¿small data¿ include driving records, biometric measurements, search histories, weather forecasts and usage alerts. In this paper, we present a flexible protocol called LoRaCTP, which is based on LoRa technology that allows data ¿chunks¿ to be transferred over large distances with very low energy expenditure. LoRaCTP provides all the mechanisms necessary to make LoRa transfer reliable by introducing a lightweight connection setup and allowing the ideal sending of an as-long-as necessary data message. We designed this protocol as communication support for small-data edge-based IoT solutions, given its stability, low power usage, and the possibility to cover long distances. We evaluated our protocol using various data content sizes and communication distances to demonstrate its performance and reliability.This work was partially supported by the "Conselleria de Innovacion, Universidades, Ciencia y Sociedad Digital", Proyectos AICO/2020, Spain, under Grant AICO/2020/302 and "Ministerio de Ciencia, Innovacion y Universidades, Programa Estatal de Investigacion, Desarrollo e Innovacion Orientada a los Retos de la Sociedad, Proyectos IDI 2018", Spain, under Grant RTI2018-096384-B-I00.Nakamura, K.; Manzoni, P.; Redondi, A.; Longo, E.; Zennaro, M.; Cano, J.; Tavares De Araujo Cesariny Calafate, CM. (2022). A LoRa-based protocol for connecting IoT edge computing nodes to provide small-data-based services. Digital Communications and Networks. 8(3):257-266. https://doi.org/10.1016/j.dcan.2021.08.0072572668

Current Role of Minimally Invasive Radical Cholecystectomy for Gallbladder Cancer

Background. For Tis and T1a gallbladder cancer (GbC), laparoscopic cholecystectomy can provide similar survival outcomes compared to open cholecystectomy. However, for patients affected by resectable T1b or more advanced GbC, open approach radical cholecystectomy (RC), consisting in gallbladder liver bed resection or segment 4b-5 bisegmentectomy, with locoregional lymphadenectomy, is considered the gold standard while minimally invasive RC (MiRC) is skeptically considered. Aim. To analyze current literature on perioperative and oncologic outcomes of MiRC for patients affected by GbC. Methods. A Medline review of published articles until June 2016 concerning MiRC for GbC was performed. Results. Data relevant for this review were presented in 13 articles, including 152 patients undergoing an attempt of MiRC for GbC. No randomized clinical trial was found. The approach was laparoscopic in 147 patients and robotic in five. Conversion was required in 15 (10%) patients. Postoperative complications rate was 10% with no mortality. Long-term survival outcomes were reported by 11 studies, two of them showing similar oncologic results when comparing MiRC with matched open RC. Conclusions. Although randomized clinical trials are still lacking and only descriptive studies reporting on limited number of patients are available, current literature seems suggesting that when performed at highly specialized centers, MiRC for GbC is safe and feasible and has oncologic outcomes comparable to open RC

Outcomes After Minimally-invasive Versus Open Pancreatoduodenectomy: A Pan-European Propensity Score Matched Study

OBJECTIVE: To assess short-term outcomes after minimally invasive (laparoscopic, robot-assisted, and hybrid) pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) among European centers. BACKGROUND: Current evidence on MIPD is based on national registries or single expert centers. International, matched studies comparing outcomes for MIPD and OPD are lacking. METHODS: Retrospective propensity score matched study comparing MIPD in 14 centers (7 countries) performing ≥10 MIPDs annually (2012-2017) versus OPD in 53 German/Dutch surgical registry centers performing ≥10 OPDs annually (2014-2017). Primary outcome was 30-day major morbidity (Clavien-Dindo ≥3). RESULTS: Of 4220 patients, 729/730 MIPDs (412 laparoscopic, 184 robot-assisted, and 130 hybrid) were matched to 729 OPDs. Median annual case-volume was 19 MIPDs (interquartile range, IQR 13-22), including the first MIPDs performed in 10/14 centers, and 31 OPDs (IQR 21-38). Major morbidity (28% vs 30%, P = 0.526), mortality (4.0% vs 3.3%, P = 0.576), percutaneous drainage (12% vs 12%, P = 0.809), reoperation (11% vs 13%, P = 0.329), and hospital stay (mean 17 vs 17 days, P > 0.99) were comparable between MIPD and OPD. Grade-B/C postoperative pancreatic fistula (POPF) (23% vs 13%, P < 0.001) occurred more frequently after MIPD. Single-row pancreatojejunostomy was associated with POPF in MIPD (odds ratio, OR 2.95, P < 0.001), but not in OPD. Laparoscopic, robot-assisted, and hybrid MIPD had comparable major morbidity (27% vs 27% vs 35%), POPF (24% vs 19% vs 25%), and mortality (2.9% vs 5.2% vs 5.4%), with a fewer conversions in robot-assisted- versus laparoscopic MIPD (5% vs 26%, P < 0.001). CONCLUSIONS: In the early experience of 14 European centers performing ≥10 MIPDs annually, no differences were found in major morbidity, mortality, and hospital stay between MIPD and OPD. The high rates of POPF and conversion, and the lack of superior outcomes (ie, hospital stay, morbidity) could indicate that more experience and higher annual MIPD volumes are needed

Learning Curves of Minimally Invasive Distal Pancreatectomy in Experienced Pancreatic Centers

IMPORTANCE Understanding the learning curve of a new complex surgical technique helps to reduce potential patient harm. Current series on the learning curve of minimally invasive distal pancreatectomy (MIDP) are mostly small, single-center series, thus providing limited data.OBJECTIVE To evaluate the length of pooled learning curves of MIDP in experienced centers.DESIGN, SETTING, AND PARTICIPANTS This international, multicenter, retrospective cohort study included MIDP procedures performed from January 1, 2006, through June 30, 2019, in 26 European centers from 8 countries that each performed more than 15 distal pancreatectomies annually, with an overall experience exceeding 50 MIDP procedures. Consecutive patients who underwent elective laparoscopic or robotic distal pancreatectomy for all indications were included. Data were analyzed between September 1, 2021, and May 1, 2022.EXPOSURES The learning curve for MIDP was estimated by pooling data from all centers.MAIN OUTCOMES AND MEASURES The learning curvewas assessed for the primary textbook outcome (TBO), which is a composite measure that reflects optimal outcome, and for surgical mastery. Generalized additive models and a 2-piece linear model with a break point were used to estimate the learning curve length of MIDP. Case mix-expected probabilities were plotted and compared with observed outcomes to assess the association of changing case mix with outcomes. The learning curve also was assessed for the secondary outcomes of operation time, intraoperative blood loss, conversion to open rate, and postoperative pancreatic fistula grade B/C.RESULTS From a total of 2610 MIDP procedures, the learning curve analysis was conducted on 2041 procedures (mean [SD] patient age, 58 [15.3] years; among 2040 with reported sex, 1249 were female [61.2%] and 791 male [38.8%]). The 2-piece model showed an increase and eventually a break point for TBO at 85 procedures (95% CI, 13-157 procedures), with a plateau TBO rate at 70%. The learning-associated loss of TBO rate was estimated at 3.3%. For conversion, a break point was estimated at 40 procedures (95% CI, 11-68 procedures); for operation time, at 56 procedures (95% CI, 35-77 procedures); and for intraoperative blood loss, at 71 procedures (95% CI, 28-114 procedures). For postoperative pancreatic fistula, no break point could be estimated.CONCLUSION AND RELEVANCE In experienced international centers, the learning curve length of MIDP for TBO was considerable with 85 procedures. These findings suggest that although learning curves for conversion, operation time, and intraoperative blood loss are completed earlier, extensive experience may be needed to master the learning curve of MIDP

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p &lt; 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes