Clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country

Clostridium difficile infection (CDI) is increasingly found in children worldwide, but limited data are available from children living in southern Europe. A 6-year retrospective study was performed to investigate the epidemiology, clinical features, treatment, and risk of recurrence in Italy. Data of children with community- and hospital-acquired CDI (CA-CDI and HA-CDI, respectively) seen at seven pediatric referral centers in Italy were recorded retrospectively. Annual infection rates/10,000 hospital admissions were calculated. Logistic regression was used to investigate risk factors for recurrence. A total of 177 CDI episodes was reported in 148 children (83 males, median age 55.3 months), with a cumulative infection rate of 2.25/10,000 admissions, with no significant variability over time. The majority of children (60.8 %) had CA-CDI. Children with HA-CDI (39.2 %) had a longer duration of symptoms and hospitalization (p = 0.003) and a more common previous use of antibiotics (p = 0.0001). Metronidazole was used in 70.7 % of cases (87/123) and vancomycin in 29.3 % (36/123), with similar success rates. Recurrence occurred in 16 children (10.8 %), and 3 (2 %) of them presented a further treatment failure. The use of metronidazole was associated with a 5-fold increase in the risk of recurrence [odds ratio (OR) 5.18, 95 % confidence interval (CI) 1.1-23.8, p = 0.03]. Short bowel syndrome was the only underlying condition associated with treatment failure (OR 5.29, 95 % CI 1.17-23.8, p = 0.03). The incidence of pediatric CDI in Italy is low and substantially stable. In this setting, there is a limited risk of recurrence, which mainly concerns children treated with oral metronidazole and those with short bowel syndrome

Swiss clinical practice guidelines on field cancerization of the skin.

Actinic keratosis (AK) affects millions of people worldwide, and its prevalence continues to increase. AK lesions are caused by chronic ultraviolet radiation exposure, and the presence of two or more AK lesions along with photodamage should raise the consideration of a diagnosis of field cancerization. Effective treatment of individual lesions as well as field cancerization is essential for good long-term outcomes. The Swiss Registry of Actinic Keratosis Treatment (REAKT) Working Group has developed clinical practice guidelines for the treatment of field cancerization in patients who present with AK. These guidelines are intended to serve as a resource for physicians as to the most appropriate treatment and management of AK and field cancerization based on current evidence and the combined practical experience of the authors. Treatment of AK and field cancerization should be driven by consideration of relevant patient, disease, and treatment factors, and appropriate treatment decisions will differ from patient to patient. Prevention measures and screening recommendations are discussed, and special considerations related to management of immunocompromised patients are provided

The data processing pipeline for the Herschel SPIRE Fourier Transform Spectrometer

We present the data processing pipeline to generate calibrated data products from the Spectral and Photometric Imaging Receiver (SPIRE) imaging Fourier Transform Spectrometer on the Herschel Space Observatory. The pipeline processes telemetry from SPIRE observations and produces calibrated spectra for all resolution modes. The spectrometer pipeline shares some elements with the SPIRE photometer pipeline, including the conversion of telemetry packets into data timelines and calculation of bolometer voltages.We present the following fundamental processing steps unique to the spectrometer: temporal and spatial interpolation of the scan mechanism and detector data to create interferograms; Fourier transformation; apodization; and creation of a data cube. We also describe the corrections for various instrumental effects including first- and second-level glitch identification and removal, correction of the effects due to emission from the Herschel telescope and from within the spectrometer instrument, interferogram baseline correction, temporal and spatial phase correction, non-linear response of the bolometers, and variation of instrument performance across the focal plane arrays. Astronomical calibration is based on combinations of observations of standard astronomical sources and regions of space known to contain minimal emission

A Cloud Telemedicine Platform Based on Workflow Management System: A Review of an Italian Case Study

The paper aims to describe a new technological and organizational approach in order to manage teleconsultation and telemonitoring processes involving a Physician, who remotely interacts with one or more Specialists, in order to evaluate and discuss the specific clinical conditions of a patient, based primarily on the sharing of digital clinical data, reports and diagnostic images. In the HINT project (Healthcare INtegration in Telemedicine), a teleconsultation and telemonitoring cloud platform has been developed using a Hub and Spoke architecture, based on a Business Process Management System (BPMS). The specialized clinical centres (Hubs) operate in connection with the territorial hospital centres (Spokes), which receive specific diagnostic consultations and telemonitoring data from the appropriate Specialist, supported by advanced AI systems. The developed platform overcomes the concepts of a traditional and fragmented teleconsultation and consequently the static organization of Hubs and Spokes, evolving towards an integrated clinical workflow management. The project platform adopts international healthcare standards, such as HL7 FHIR, IHE (XDS and XDW) and DICOM for the acquisition and management of healthcare data and diagnostic images. A Workflow Management System implemented in the platform allows to manage multiple and contemporaneous processes through a single platform, correctly associating the tasks to the Physicians responsible for their execution, monitoring the status of the health activities and managing possible clinical issues

HF-SCA: Hands-Free Strong Customer Authentication Based on a Memory-Guided Attention Mechanisms

Strong customer authentication (SCA) is a requirement of the European Union Revised Directive on Payment Services (PSD2) which ensures that electronic payments are performed with multifactor authentication. While increasing the security of electronic payments, the SCA impacted seriously on the shopping carts abandonment: an Italian bank computed that 22% of online purchases in the first semester of 2021 did not complete because of problems with the SCA. Luckily, the PSD2 allows the use of transaction risk analysis tool to exempt the SCA process. In this paper, we propose an unsupervised novel combination of existing machine learning techniques able to determine if a purchase is typical or not for a specific customer, so that in the case of a typical purchase the SCA could be exempted. We modified a well-known architecture (U-net) by replacing convolutional blocks with squeeze-and-excitation blocks. After that, a memory network was added in a latent space and an attention mechanism was introduced in the decoding side of the network. The proposed solution was able to detect nontypical purchases by creating temporal correlations between transactions. The network achieved 97.7% of AUC score over a well-known dataset retrieved online. By using this approach, we found that 98% of purchases could be executed by securely exempting the SCA, while shortening the customer’s journey and providing an elevated user experience. As an additional validation, we developed an Alexa skill for Amazon smart glasses which allows a user to shop and pay online by merely using vocal interaction, leaving the hands free to perform other activities, for example driving a car

The importance of camera calibration and distortion correction to obtain measurements with video surveillance systems

Video surveillance systems are commonly used as important sources of quantitative information but from the acquired images it is possible to obtain a large amount of metric information. Yet, different methodological issues must be considered in order to perform accurate measurements using images. The most important one is the camera calibration, which is the estimation of the parameters defining the camera model. One of the most used camera calibration method is the Zhang's method, that allows the estimation of the linear parameters of the camera model. This method is very diffused as it requires a simple setup and it allows to calibrate cameras using a simple and fast procedure, but it does not consider lenses distortions, that must be taken into account with short focal lenses, commonly used in video surveillance systems. In order to perform accurate measurements, the linear camera model and the Zhang's method are improved in order to take nonlinear parameters into account and compensate the distortion contribute. In this paper we first describe the pinhole camera model that considers cameras as central projection systems. After a brief introduction to the camera calibration process and in particular the Zhang's method, we give a description of the different types of lens distortions and the techniques used for the distortion compensation. At the end some numerical example are shown in order to demonstrate the importance of the distortion compensation to obtain accurate measurements

A Multicenter Retrospective Survey regarding Diabetic Ketoacidosis Management in Italian Children with Type 1 Diabetes

We conducted a retrospective survey in pediatric centers belonging to the Italian Society for Pediatric Diabetology and Endocrinology. The following data were collected for all new-onset diabetes patients aged 0-18 years: DKA (pH < 7.30), severe DKA (pH < 7.1), DKA in preschool children, DKA treatment according to ISPAD protocol, type of rehydrating solution used, bicarbonates use, and amount of insulin infused. Records (n = 2453) of children with newly diagnosed diabetes were collected from 68/77 centers (87%), 39 of which are tertiary referral centers, the majority of whom (n = 1536, 89.4%) were diagnosed in the tertiary referral centers. DKA was observed in 38.5% and severe DKA in 10.3%. Considering preschool children, DKA was observed in 72%, and severe DKA in 16.7%. Cerebral edema following DKA treatment was observed in 5 (0.5%). DKA treatment according to ISPAD guidelines was adopted in 68% of the centers. In the first 2 hours, rehydration was started with normal saline in all centers, but with different amount. Bicarbonate was quite never been used. Insulin was infused starting from third hour at the rate of 0.05-0.1 U/kg/h in 72% of centers. Despite prevention campaign, DKA is still observed in Italian children at onset, with significant variability in DKA treatment, underlying the need to share guidelines among centers

Polarimetric and spectroscopic optical observations of the ultra-compact X-ray binary 4U 0614+091

Aims: We present a polarimetric and spectroscopic study of the persistent ultra compact X-ray binary 4U 0614+091 aimed at searching for the emission of a relativistic particle jet and at unveiling the orbital period of the system. Methods: We obtained r-band polarimetric observations with the Telescopio Nazionale Galileo (TNG) equipped with the PAOLO polarimeter and with the Nordic Optical Telescope (NOT) equipped with the ALFOSC instrument, covering ~ 2 hours and ~ 0.5 hours observations, respectively. We carried out low resolution spectroscopy of the system using the ESO Very Large Telescope equipped with FORS1 for ~ 1.5 hours (16 spectra covering the range 430-800 nm). Results: The polarimetric analysis performed starting from the TNG dataset revealed a polarisation degree in the r-band of 3 % +/- 1 %. From the NOT dataset, due to the lower S/N ratio, we could obtain only a 3 sigma upper limit of 3.4 %. From the joining of a spectroscopic and photometric analysis, through the study of the equivalent width variations of the CII 724 nm line and the r-band light curve, we could find a hint of a ~ 45 min periodicity. Conclusions: A polarisation degree P of ~ 3 % in the r-band is consistent with the emission of a relativistic particle jet, which is supposed to emit intrinsically linearly polarised synchrotron radiation. Since no variations of P with time have been detected, and the accretion disc of the system does not contain ionised hydrogen, scattering by free electrons in the accretion disc has been rejected. The period of ~ 45 min obtained through the analysis of the system light curve and of the equivalent width variations of the selected spectral line is probably linked to the presence of a hot spot or a superhump in the accretion disc, and lead to an orbital period > 1 hour for the binary system.Comment: 8 pages, 6 figures, 4 tables. Accepted for publication in Astronomy & Astrophysics (Section 7