XNOR Neural Engine: a Hardware Accelerator IP for 21.6 fJ/op Binary Neural Network Inference

Binary Neural Networks (BNNs) are promising to deliver accuracy comparable to conventional deep neural networks at a fraction of the cost in terms of memory and energy. In this paper, we introduce the XNOR Neural Engine (XNE), a fully digital configurable hardware accelerator IP for BNNs, integrated within a microcontroller unit (MCU) equipped with an autonomous I/O subsystem and hybrid SRAM / standard cell memory. The XNE is able to fully compute convolutional and dense layers in autonomy or in cooperation with the core in the MCU to realize more complex behaviors. We show post-synthesis results in 65nm and 22nm technology for the XNE IP and post-layout results in 22nm for the full MCU indicating that this system can drop the energy cost per binary operation to 21.6fJ per operation at 0.4V, and at the same time is flexible and performant enough to execute state-of-the-art BNN topologies such as ResNet-34 in less than 2.2mJ per frame at 8.9 fps.Comment: 11 pages, 8 figures, 2 tables, 3 listings. Accepted for presentation at CODES'18 and for publication in IEEE Transactions on Computer-Aided Design of Circuits and Systems (TCAD) as part of the ESWEEK-TCAD special issu

Fast and Accurate Multiclass Inference for MI-BCIs Using Large Multiscale Temporal and Spectral Features

Accurate, fast, and reliable multiclass classification of electroencephalography (EEG) signals is a challenging task towards the development of motor imagery brain-computer interface (MI-BCI) systems. We propose enhancements to different feature extractors, along with a support vector machine (SVM) classifier, to simultaneously improve classification accuracy and execution time during training and testing. We focus on the well-known common spatial pattern (CSP) and Riemannian covariance methods, and significantly extend these two feature extractors to multiscale temporal and spectral cases. The multiscale CSP features achieve 73.70$\pm$15.90% (mean$\pm$ standard deviation across 9 subjects) classification accuracy that surpasses the state-of-the-art method [1], 70.6$\pm$14.70%, on the 4-class BCI competition IV-2a dataset. The Riemannian covariance features outperform the CSP by achieving 74.27$\pm$15.5% accuracy and executing 9x faster in training and 4x faster in testing. Using more temporal windows for Riemannian features results in 75.47$\pm$12.8% accuracy with 1.6x faster testing than CSP.Comment: Published as a conference paper at the IEEE European Signal Processing Conference (EUSIPCO), 201

Always-On 674uW @ 4GOP/s Error Resilient Binary Neural Networks with Aggressive SRAM Voltage Scaling on a 22nm IoT End-Node

Binary Neural Networks (BNNs) have been shown to be robust to random bit-level noise, making aggressive voltage scaling attractive as a power-saving technique for both logic and SRAMs. In this work, we introduce the first fully programmable IoT end-node system-on-chip (SoC) capable of executing software-defined, hardware-accelerated BNNs at ultra-low voltage. Our SoC exploits a hybrid memory scheme where error-vulnerable SRAMs are complemented by reliable standard-cell memories to safely store critical data under aggressive voltage scaling. On a prototype in 22nm FDX technology, we demonstrate that both the logic and SRAM voltage can be dropped to 0.5Vwithout any accuracy penalty on a BNN trained for the CIFAR-10 dataset, improving energy efficiency by 2.2X w.r.t. nominal conditions. Furthermore, we show that the supply voltage can be dropped to 0.42V (50% of nominal) while keeping more than99% of the nominal accuracy (with a bit error rate ~1/1000). In this operating point, our prototype performs 4Gop/s (15.4Inference/s on the CIFAR-10 dataset) by computing up to 13binary ops per pJ, achieving 22.8 Inference/s/mW while keeping within a peak power envelope of 674uW - low enough to enable always-on operation in ultra-low power smart cameras, long-lifetime environmental sensors, and insect-sized pico-drones.Comment: Submitted to ISICAS2020 journal special issu

An IoT Endpoint System-on-Chip for Secure and Energy-Efficient Near-Sensor Analytics

Near-sensor data analytics is a promising direction for IoT endpoints, as it minimizes energy spent on communication and reduces network load - but it also poses security concerns, as valuable data is stored or sent over the network at various stages of the analytics pipeline. Using encryption to protect sensitive data at the boundary of the on-chip analytics engine is a way to address data security issues. To cope with the combined workload of analytics and encryption in a tight power envelope, we propose Fulmine, a System-on-Chip based on a tightly-coupled multi-core cluster augmented with specialized blocks for compute-intensive data processing and encryption functions, supporting software programmability for regular computing tasks. The Fulmine SoC, fabricated in 65nm technology, consumes less than 20mW on average at 0.8V achieving an efficiency of up to 70pJ/B in encryption, 50pJ/px in convolution, or up to 25MIPS/mW in software. As a strong argument for real-life flexible application of our platform, we show experimental results for three secure analytics use cases: secure autonomous aerial surveillance with a state-of-the-art deep CNN consuming 3.16pJ per equivalent RISC op; local CNN-based face detection with secured remote recognition in 5.74pJ/op; and seizure detection with encrypted data collection from EEG within 12.7pJ/op.Comment: 15 pages, 12 figures, accepted for publication to the IEEE Transactions on Circuits and Systems - I: Regular Paper

Serum Albumin Is Inversely Associated With Portal Vein Thrombosis in Cirrhosis

We analyzed whether serum albumin is independently associated with portal vein thrombosis (PVT) in liver cirrhosis (LC) and if a biologic plausibility exists. This study was divided into three parts. In part 1 (retrospective analysis), 753 consecutive patients with LC with ultrasound-detected PVT were retrospectively analyzed. In part 2, 112 patients with LC and 56 matched controls were entered in the cross-sectional study. In part 3, 5 patients with cirrhosis were entered in the in vivo study and 4 healthy subjects (HSs) were entered in the in vitro study to explore if albumin may affect platelet activation by modulating oxidative stress. In the 753 patients with LC, the prevalence of PVT was 16.7%; logistic analysis showed that only age (odds ratio [OR], 1.024; P = 0.012) and serum albumin (OR, -0.422; P = 0.0001) significantly predicted patients with PVT. Analyzing the 112 patients with LC and controls, soluble clusters of differentiation (CD)40-ligand (P = 0.0238), soluble Nox2-derived peptide (sNox2-dp; P < 0.0001), and urinary excretion of isoprostanes (P = 0.0078) were higher in patients with LC. In LC, albumin was correlated with sCD4OL (Spearman's rank correlation coefficient [r(s)], -0.33; P < 0.001), sNox2-dp (r(s), -0.57; P < 0.0001), and urinary excretion of isoprostanes (r(s), -0.48; P < 0.0001) levels. The in vivo study showed a progressive decrease in platelet aggregation, sNox2-dp, and urinary 8-iso prostaglandin F2 alpha-III formation 2 hours and 3 days after albumin infusion. Finally, platelet aggregation, sNox2-dp, and isoprostane formation significantly decreased in platelets from HSs incubated with scalar concentrations of albumin. Conclusion: Low serum albumin in LC is associated with PVT, suggesting that albumin could be a modulator of the hemostatic system through interference with mechanisms regulating platelet activation

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

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 < 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