Cognitive impairment in patients with atrial fibrillation: What is the importance of anticoagulant therapy?

Atrial fibrillation represents one of the most significant aging markers and its prevalence increases with age, reaching 11.1% in men and 9.1% in women aged over 85 years. Fragility is nowadays defined according to two different phenotypes: the biologic-physiologic phenotype developed by L. Fried and Baltimora School and the clinic-multidimensional phenotype, proposed by Rockwood and Halifax School. If the clinical characteristics of elder patients hospitalized in acute geriatric unit care are considered, differences appear in the clinical features, in co-morbidity, in therapy and prognosis

dunuen a user friendly formal verification tool

Abstract Formal verification allows checking the design and the behaviour of a system. One of the main limitations to the adoption of formal verification techniques is the process of model creation using specification languages. For this reason a tool supporting this activity is necessary. Actually, there are several tools allowing analysts to verify models expressed into specification languages. These tools provide support for automatically checking whether a system satisfies a property. However, to use such tools it is important to deeply know a precise notation for defining a system, i.e., the Calculus of Communicating Systems. Since systems are often expressed as time-series, to overcome this problem, we provide an user-friendly tool able to automatically generate a system model starting from the CSV - Comma-Separated Values format (the most widespread format considered to release dataset). In this way we hide the details about the model construction form the analyst, which can only focus immediately on the properties to verify. We introduce Dunuen, a tool allowing the user to firstly perform a kind of pre-processing operation starting from a CSV file, as discretization or removing attributes; subsequently it automatically creates a formal model from the pre-processed CSV file and, by invoking the model checker we embedded in Dunuen, it finally verifies whether the generated model satisfies a property expressed in temporal logic through a graphic interface, proposing formal methods as an alternative to machine learning for classification tasks

Il fenomeno dell’abbandono universitario precoce. Uno studio di caso sui corsi di laurea del Dipartimento di Scienze della Formazione dell’Università “Roma Tre”

The paper presents the results of early abandonment research conducted on students enrolled in 2013-2014 to degree courses of the Department of Education of “Roma Tre” University.The research was conducted with the use of a structured questionnaire and two standardized scales of measurement. The questionnaire, designed to detect the main traits of the university experience of respondents, it was administered using the CATI procedure universe of students who have left and to a representative sample of students who have continued their studies. The measurement scales concern the Self-efficacy perceived and the motivational profile of the students. They were administered by CAWI procedure to a self-selected sample of participants. The results emerging from the sectoral analysisof intervening variables in early drop out, which are compared with the findingsin the literature specification, are then supplemented by a unique reference to the role that in the issue have the orientation deficits of students.Il contributo presenta i risultati di una ricerca sull’abbandono precoce svolta sugli studenti immatricolati nel 2013-2014 ai corsi di laurea del Dipartimento di Scienze della Formazione della Università Roma Tre. La ricerca è statacondotta con l’impiego di un questionario strutturato e di due scale di misurazione standardizzate. Il questionario, destinato a rilevare i tratti principali della esperienza universitaria degli intervistati e il giudizio che su di essa vieneespresso, è stato somministrato con procedura CATI all’universo degli studenti che hanno abbandonato e ad un campione rappresentativo degli studenti che hanno proseguito negli studi. Le scale di misurazione dell’autoefficacia percepita e dell’assetto motivazionale sono state somministrate con procedura CAWI ad un campione autoselezionato di studenti a cui era stato somministrato il questionario. I risultati che emergono dall’analisi settoriale delle variabili intervenienti nell’abbandono precoce, che vengono messi a confrontocon i riscontri presenti nella letteratura disciplinare, sono quindi integrati da un univoco richiamo al ruolo che nella questione riveste il deficit di orientamento formativo degli studenti

Image convolution: a linear programming approach for filters design

AbstractImage analysis is a branch of signal analysis that focuses on the extraction of meaningful information from images through digital image processing techniques. Convolution is a technique used to enhance specific characteristics of an image, while deconvolution is its inverse process. In this work, we focus on the deconvolution process, defining a new approach to retrieve filters applied in the convolution phase. Given an image I and a filtered image $$I' = f(I)$$ I ′ = f ( I ) , we propose three mathematical formulations that, starting from I and $$I'$$ I ′ , are able to identify the filter $$f'$$ f ′ that minimizes the mean absolute error between $$I'$$ I ′ and $$f'(I)$$ f ′ ( I ) . Several tests were performed to investigate the applicability of our approaches in different scenarios. The results highlight that the proposed algorithms are able to identify the filter used in the convolution phase in several cases. Alternatively, the developed approaches can be used to verify whether a specific input image I can be transformed into a sample image $$I'$$ I ′ through a convolution filter while returning the desired filter as output

Faecalibacterium prausnitzii is not decreased in symptomatic uncomplicated diverticular disease of the colon

In this letter, assessment of the amount of fecal Faecalibacterium prausnitzii in symptomatic uncomplicated diverticular disease (SUDD) is described. Among 44 consecutive patients, comprising 15 SUDD patients, 13 patients with asymptomatic diverticulosis (AD), and 16 healthy controls (HC), the fecal amount of Faecalibacterium prausnitzii was not found to be significantly different between HC, AD and SUDD subjects (p=0.871). Moreover, its count in the HC microbiota (-4.57 +/- 2.15) was lower compared with those in the AD (-4.11 +/- 1.03) and SUDD subjects (-4.03 +/- 1.299). This behavior seems to be different from that occurring in inflammatory bowel disease (IBD) and similar to that of other mucin-degrading species in a SUDD setting

Intrahepatic cholestasis of pregnancy after ovarian hyperstimulation syndrome with wild-type ABCB4 gene: a peculiar case and literature review

Background: Intrahepatic cholestasis of pregnancy (ICP) in the first trimester occurring after ovarian hyperstimulation syndrome (OHSS) is a rare condition and few cases are reported in the literature. Hyperestrogenism may explain this problem in genetically predisposed women. The objective of this article is to report one of these rare cases and offer an overview of the other published cases. Case presentation: We report a case of severe OHSS followed by ICP in the first trimester. The patient was admitted to the intensive care unit and was treated according to the guidelines for the management of OHSS. Moreover, the patient also received ursodeoxycholic acid for ICP, which brought to an improvement of her clinical conditions. The pregnancy continued without other complications until the 36th week of gestation, when the patient developed ICP in the third trimester and underwent cesarean section for increased bile acid levels and cardiotocographic (CTG) pathologic alterations. The newborn was a healthy baby weighing 2500 gr. We also reviewed other case reports published by other authors about this clinical condition. We present what is, to our knowledge, the first case of ICP developed in the first trimester of pregnancy after OHSS in which genetic polymorphisms of ABCB4 (MDR3) have been investigated. Conclusions: ICP in the first trimester might be induced by elevated serum estrogen levels after OHSS in genetically predisposed women. In these women, it might be useful to check for genetic polymorphisms to know if they have a predisposition for ICP recurrence in the third trimester of pregnancy

COVID-19 and the Endocrine System: A Comprehensive Review on the Theme

The review aimed to summarize advances in the topic of endocrine diseases and coronavirus disease 2019 (COVID-19). Scientific and institutional websites and databases were searched and data were collected and organized, when plausible, to angle the discussion toward the following clinical issues. (1) Are patients with COVID-19 at higher risk of developing acute or late-onset endocrine diseases or dysfunction? (2) May the underlying endocrine diseases or dysfunctions be considered risk factors for poor prognosis once the infection has occurred? (3) Are there defined strategies to manage endocrine diseases despite pandemic-related constraints? Herein, the authors considered only relevant and more frequently observed endocrine diseases and disorders related to the hypothalamic-pituitary region, thyroid and parathyroid glands, calcium-phosphorus homeostasis and osteoporosis, adrenal glands, and gonads. Main. Data highlight the basis of some pathophysiological mechanisms and anatomical alterations of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)-induced endocrine dysfunctions. Some conditions, such as adrenal insufficiency and cortisol excess, may be risk factors of worse clinical progression once the infection has occurred. These at-risk populations may require adequate education to avoid the SARS-CoV-2 infection and adequately manage medical therapy during the pandemic, even in emergencies. Endocrine disease management underwent a palpable restraint, especially procedures requiring obligate access to healthcare facilities for diagnostic and therapeutic purposes. Strategies of clinical triage to prioritize medical consultations, laboratory, instrumental evaluations, and digital telehealth solutions should be implemented to better deal with this probably long-term situation

The Value and Sustainability of Ocrelizumab in Relapsing Multiple Sclerosis: A Cost-Effectiveness and Budget Impact Analysis

INTRODUCTION: The availability of ocrelizumab for the relapsing forms of multiple sclerosis (MS) in the Italian markets raised some questions about its economic impact and value compared to the alternative treatment options available.AIM: To assess the cost-effectiveness and budget impact of ocrelizumab compared to the most used second line disease modifying therapies (DMTs) in Italy.METHODS: The study was divided in two phases: Phase 1 – based on the development of a decision analytical Markov model to assess the cost-effectiveness of ocrelizumab compared to natalizumab and fingolimod, and Phase 2 – based on the development of a budget impact model to assess the economic impact of ocrelizumab in Italy. Both models used the National Health System perspective; a lifetime horizon was applied in the cost-effectiveness analysis and a 3-year time horizon in the budget impact. The cost-effectiveness analysis results were reported as incremental cost-effectiveness ratio (ICER) expressed as € per Quality Adjusted Life Year (QALY) gained, the budget impact analysis results were reported as difference in the overall budget (€) between a scenario with and without ocrelizumab.RESULTS: The two analyses reported ocrelizumab as a cost-effective option compared to natalizumab and fingolimod with a positive impact on the overall NHS budget. In the base-case analysis, the ICER was € 2,023 for ocrelizumab compared to fingolimod; while ocrelizumab resulted cost-saving compared to natalizumab. The sensitivity analysis confirmed the base-case analysis results. Further, the use of ocrelizumab was associated to a budget decrease of € 21 million (-2.6%) in a 3-year time horizon.CONCLUSION: The results of our cost-effectiveness and budget impact models reported ocrelizumab as an effective and efficient treatment in patients with relapsing forms of MS who failed a first line DMTs from the Italian NHS perspective