Ruolo prognostico dell'ipertensione endocranica precoce nell'ESA

RIASSUNTO L’emorragia sub-aracnoidea rimane una patologia devastante con una mortalità immediata prima di ricevere cure mediche del 12%, una mortalità aggiuntiva del 40-50% entro un mese dal ricovero ospedaliero e un 30% di invalidità tra i sopravvissuti. Nonostante i progressi in ambito chirurgico, anestesiologico e radiologico, mortalità e morbidità rimangono elevate, soprattutto per le forme ad alto grado (H-H 4-5). Mentre tradizionalmente la letteratura si concentra sugli eventi tardivi che portano al vasospasmo tra il III e il XIV giorno dall’emorragia subaracnoidea, nuovi studi si focalizzano sul danno cerebrale precoce (EBI) e sui meccanismi fisiopatologici che insorgono immediatamente dopo la rottura dell’aneurisma. Sebbene siano numerosi i fattori chiamati in causa come responsabili di EBI, il principale evento immediato al momento della rottura e nelle prime 24-48 h è l’incremento della pressione intracranica, che costituisce il trigger per una serie di modificazioni fisiopatologiche che portano alla morte neuronale. L’incremento della pressione endocranica nel paziente con trauma cranico è stato ampiamente studiato e riconosciuto come fattore in grado di condizionare negativamente la prognosi; al contrario è poco studiato l’effetto dell’ipertensione endocranica precoce sull’outcome dei pazienti con ESA. Il monitoraggio della pressione intracranica è una procedura diffusamente impiegata nei pazienti con ESA-grave, ma il timing del posizionamento non è precisamente standardizzato e sono scarsi i dati in letteratura sulla misurazione della PIC nelle prime 24 h. Tipologia di studio: osservazionale retrospettivo. Obiettivi dello studio: valutazione dell’incidenza dell’ipertensione endocranica precoce nei pazienti con ESA di alto grado (H-H 4-5). Valutazione dell’impatto dell’ipertensione endocranica precoce sulla mortalità, sull’outcome neurologico a 15 e 30 giorni e sull’insorgenza di lesioni ischemiche. Pazienti arruolati: 62 pazienti con emorragia sub aracnoidea ad alto grado (H-H 4-5) sottoposti ad early treatment (chirurgico o endovascolare) e monitoraggio precoce della pressione endocranica (entro 24 ore) e ricoverati presso la Terapia Intensiva Neurochirurgica dell’Azienda Ospedaliera Pisana nel periodo compreso tra gennaio 2005 e dicembre 2011. Risultati e conclusioni: nel nostro studio si è osservato un'incidenza di ipertensione endocranica precoce nel 45% dei casi, contro un’incidenza di vasospasmo e di risanguinamento del 20% e del 3%. Allo scopo di valutare l’impatto dell’ipertensione endocranica precoce su mortalità, outcome e lesioni ischemiche, sono stati esclusi pazienti che presentavano fattori di rischio aggiuntivi per ischemie cerebrali e danno neurologico e complicanze che condizionavano la prognosi quali il risanguinamento ed il vasospasmo. Tra i 47 pazienti selezionati abbiamo individuato due gruppi in base della presenza o meno di ipertensione endocranica precoce (gruppo1: 21 pazienti PIC>20 mmHg, gruppo 2: 26pazienti PIC<20mmhg). I due gruppi studiati omogenei per età media, SAPS II score, gravità del quadro neurologico, timing del trattamento e tipologia di trattamento medico, differiscono in modo statisticamente significativo per mortalità (χ2 Yates =18,31;p< 0,0001), per outcome neurologico a 15 giorni ( χ2 Yates = 25,061; p<0,0001) e 30 giorni(χ2 Yates = 26,535; p<0,0001) e per l’insorgenza di lesioni ischemiche precoci (χ2 Yates = 10,365; p<0,0013). Le curve di sopravvivenza eseguite sul gruppo senza ipertensione endocranica precoce (PIC30 mmHg) differiscono in modo statisticamente significativo (LogRank test p<0,0001); si deduce che non solo la presenza di ipertensione endocranica precoce, ma anche il valore che questa raggiunge nelle prime 24 ore condiziona la sopravvivenza dei pazienti studiati. Con i limiti legati allo studio retrospettivo e al piccolo campione di pazienti indagato, il nostro lavoro evidenzia un’incidenza di ipertensione endocranica precoce in quasi la metà dei pazienti con ESA di alto grado e suggerisce un ruolo prognostico negativo dell’ipertensione endocranica precoce.

I Valori del Museo. Politiche di indirizzo e strategie di gestione.

Il volume tratta i temi più recenti nell'ambito della Museologia Scientifica: dai nuovi criteri per la valutazione del bene culturale alle recenti tecnologie per il restauro di un bene scientifico; dalle schede catalografiche approntate con l'ICCD per le varie tipologie di beni scientifici alle moderne indicazioni per gli allestimenti delle Collezioni scientifiche

A new system for quantitative evaluation of infant gaze capabilities in a wide visual field.

Background: The visual assessment of infants poses specific challenges: many techniques that are used on adults are based on the patient’s response, and are not suitable for infants. Significant advances in the eye-tracking have made this assessment of infant visual capabilities easier, however, eye-tracking still requires the subject’s collaboration, in most cases and thus limiting the application in infant research. Moreover, there is a lack of transferability to clinical practice, and thus it emerges the need for a new tool to measure the paradigms and explore the most common visual competences in a wide visual field. This work presents the design, development and preliminary testing of a new system for measuring infant’s gaze in the wide visual field called CareToy C: CareToy for Clinics. Methods: The system is based on a commercial eye tracker (SmartEye) with six cameras running at 60 Hz, suitable for measuring an infant’s gaze. In order to stimulate the infant visually and audibly, a mechanical structure has been designed to support five speakers and five screens at a specific distance (60 cm) and angle: one in the centre, two on the right-hand side and two on the left (at 30° and 60° respectively). Different tasks have been designed in order to evaluate the system capability to assess the infant’s gaze movements during different conditions (such as gap, overlap or audiovisual paradigms). Nine healthy infants aged 4–10 months were assessed as they performed the visual tasks at random. Results: We developed a system able to measure infant’s gaze in a wide visual field covering a total visual range of ±60° from the centre with an intermediate evaluation at ±30°. Moreover, the same system, thanks to different integrated software, was able to provide different visual paradigms (as gap, overlap and audio-visual) assessing and comparing different visual and multisensory sub-competencies. The proposed system endowed the integration of a commercial eye-tracker into a purposive setup in a smart and innovative way. Conclusions: The proposed system is suitable for measuring and evaluating infant’s gaze capabilities in a wide visual field, in order to provide quantitative data that can enrich the clinical assessment

Fair Inputs and Fair Outputs: The Incompatibility of Fairness in Privacy and Accuracy

Fairness concerns about algorithmic decision-making systems have been mainly focused on the outputs (e.g., the accuracy of a classifier across individuals or groups). However, one may additionally be concerned with fairness in the inputs. In this paper, we propose and formulate two properties regarding the inputs of (features used by) a classifier. In particular, we claim that fair privacy (whether individuals are all asked to reveal the same information) and need-to-know (whether users are only asked for the minimal information required for the task at hand) are desirable properties of a decision system. We explore the interaction between these properties and fairness in the outputs (fair prediction accuracy). We show that for an optimal classifier these three properties are in general incompatible, and we explain what common properties of data make them incompatible. Finally we provide an algorithm to verify if the trade-off between the three properties exists in a given dataset, and use the algorithm to show that this trade-off is common in real data

Privacy by Design in Distributed Mobility Data

Movement data are sensitive, because people’s whereabouts may allow re- identification of individuals in a de-identified database and thus can poten- tially reveal intimate personal traits, such as religious or sexual preferences. In this thesis, we focus on a distributed setting in which movement data from individual vehicles are collected and aggregated by a centralized station. We propose a novel approach to privacy-preserving analytical processing within such a distributed setting, and tackle the problem of obtaining aggregated traffic information while preventing privacy leakage from data collection and aggregation. We study and analyze three different solutions based on the differential privacy model and on sketching techniques for efficient data compression. Each solution achieves different a trade-off between privacy protection and utility of the transformed data. Using real-life data, we demonstrate the effectiveness of our approaches in terms of data utility preserved by the data transformation, thus bringing empirical evidence to the fact that the privacy-by-design paradigm in big data analysis has the potential of delivering high data protection combined with high quality even in massively distributed techno-social systems

A data mining approach to assess privacy risk in human mobility data

Human mobility data are an important proxy to understand human mobility dynamics, develop analytical services, and design mathematical models for simulation and what-if analysis. Unfortunately mobility data are very sensitive since they may enable the re-identification of individuals in a database. Existing frameworks for privacy risk assessment provide data providers with tools to control and mitigate privacy risks, but they suffer two main shortcomings: (i) they have a high computational complexity; (ii) the privacy risk must be recomputed every time new data records become available and for every selection of individuals, geographic areas, or time windows. In this article, we propose a fast and flexible approach to estimate privacy risk in human mobility data. The idea is to train classifiers to capture the relation between individual mobility patterns and the level of privacy risk of individuals. We show the effectiveness of our approach by an extensive experiment on real-world GPS data in two urban areas and investigate the relations between human mobility patterns and the privacy risk of individuals

Towards a Digital Ecosystem of Trust: Ethical, Legal and Societal Implications

The European vision of a digital ecosystem of trust rests on innovation, powerful technological solutions, a comprehensive regulatory framework and respect for the core values and principles of ethics. Innovation in the digital domain strongly relies on data, as has become obvious during the current pandemic. Successful data science, especially where health data are concerned, necessitates establishing a framework where data subjects can feel safe to share their data. In this paper, methods for facilitating data sharing, privacy-preserving technologies, decentralization, data altruism, as well as the interplay between the Data Governance Act and the GDPR, are presented and discussed by reference to use cases from the largest pan-European social science data research project, SoBigData++. In doing so, we argue that innovation can be turned into responsible innovation and Europe can make its ethics work in digital practice

Privacy-by-design in big data analytics and social mining

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Cultural dimensions in online purchase behavior: Evidence from a cross-cultural study

The objective of this research is to investigate how cultural differences affect con- sumers’ online purchase behavior. We reviewed the recent literature on cross-cul- tural studies on online behavior and building on Hofstede’s theory of cultural dimen- sions and the theory of planned behavior (TPB), we developed a conceptual model exploring how the dimensions of national culture influence perceptions of website usability, trust, and perceived risk, which in turn impact on intention to use and online purchase behavior. A web-based questionnaire was distributed to a sample of 350 European and Asian consumers actively using Alibaba e-commerce platforms. The conceptual model was validated through a confirmatory factor analysis (CFA), while structural equation modelling (SEM) was used to empirically test the hypothe- sized relationships among variables. Results showed how culture significantly influ- enced website usability and perceived risk in European consumers and, in turn, their intention and behavior. Differently, culture significantly influenced trust of Asian consumers, as well as their intention and online behavior. With this study, we con- tribute to the literature on consumer online purchase behavior from a cross-cultural perspective. As culture emerged among the significant antecedents of mechanisms explaining online purchase behavior, e-tailers should tailor digital marketing strate- gies according to consumer cultural differences