National Institute of Statistics

In this letter, we present a physics-assisted design strategy for tapered suspended slot waveguides operating at 2 μm. The proposed methodology enables a precise control of the optical field, specifically tailored for laser-driven dielectric accelerating structures. By using calibration curves that link the silicon waveguide strips width to both the effective refractive index and the accelerating field amplitude, we ensure local phase synchronism along the propagation axis. The design was performed for an input energy of 79 keV, and validated by HFSS simulations as far as the optical field computation is concerned, and by ASTRA-code for the single-particle beam dynamics. The results show an output energy of 102 keV with the optimized structure, corresponding to 20% increase compared to the previous constant-field approach.

To evaluate the effect of a cellulose-based oral wound dressing (OWD) stabilized with flowable resin (FR), in combination with hemostatic sponges, on patient-reported outcomes (PROMs) after palatal graft harvesting. This randomized clinical trial included patients requiring soft tissue augmentation with dental implants. Participants were allocated to three groups: OWD and FR (OWDFR), cyanoacrylate (CY), or palatal plate (PP). The primary outcome was postoperative pain, assessed with a 10-cm visual analog scale (VAS) over 14 days. Secondary outcomes were analgesic consumption, oral health-related quality of life (OHIP-14), postoperative bleeding, and willingness to repeat the procedure. Sixty-one patients were enrolled. The OWDFR group reported lower VAS values on Days 1, 2, 3, and 7 compared with CY and PP (p < 0.05). On Day 2, VAS scores were significantly lower in OWDFR, with mean differences of -1.94 versus CY and -2.12 versus PP (p < 0.01). Analgesic intake differed significantly on Days 3 and 5; on Day 3, OWDFR consumed -0.89 tablets compared to PP and CY consumed -0.95 tablets compared to PP (both p < 0.05). OHIP-14 scores were similar across groups, but OWDFR patients reported greater early postoperative comfort. No bleeding or adverse events occurred. All OWDFR patients were willing to repeat the procedure, compared with 90% in CY and 85% in PP. The combination of a bioadhesive OWD with FR appears to be a safe and minimally invasive method for protecting palatal donor sites. It reduces postoperative pain and analgesic use while enhancing comfort, supporting its incorporation into routine clinical protocols. Protocol registered at clinicaltrials.gov (NCT06408792).

The European Health Data Space (EHDS) is an European Union (EU) initiative, aimed at helping facilitate the secure and standardized sharing of health data to improve continuity of care, research and innovation. However, the successful implementation of such an ecosystem requires the active participation and cooperation of EU Member States (MS), each of which needs to adapt its local health data infrastructure to meet the requirements at the European level. The specific characteristics of the various European countries, such as size, number of citizens, and internal organization greatly influence the ease with which a country can integrate its health data structure into this supra-national system. States with higher levels of local autonomy are experiencing significant challenges in this process. For instance, the Italian National Healthcare System (NHS) is highly decentralized, with significant variability among regions and localities. This fragmentation raises problems for health data sharing and the integration of the Italian health ecosystem into the broader EHDS framework. This paper explores Italy’s organizational and regulatory challenges, the technical barriers to interoperability, and the implications of data sharing in a decentralized environment. Moreover, by examining key Italian projects, such as Digital Health Solutions in Community Medicine (DHEAL-COM), and the tools developed by Standards Developing Organizations (SDOs) and affiliated bodies, such as Health Level 7 (HL7) Europe and Italy, the paper identifies successful initiatives and proposes strategies to overcome existing obstacles, also including security and privacy aspects of healthcare data.

The US experiences significant excess mortality compared to peer countries. The literature indicates that a similar disadvantage affects morbidity and, more generally, the prevalence of risk factors for major diseases within the US population. In this study, we assess the impact of multi-morbidity at death on the mortality gap between the US and three other high-income countries with comparable data, namely France, Italy, and Spain. The study relies on an analysis of the multiple cause-of-death information available on all death certificates for 2017, used to classify morbid processes leading to death into three categories: simple, multi-morbid, and ill-defined. The results show disproportionately high rates of multi-morbid processes in the US compared with the other three countries. Multi-morbid processes contribute 51% of the US gap in life expectancy at birth with Italy, 73% with Spain, and 75% with France, with a particular concentration at ages 20–85 years. The prevalence of multi-morbid processes in the US is consistent with the hypothesis that multiple factors, rather than a single culprit, are at play in the disadvantage in mortality and it could explain, at least in part, the extraordinarily high cost of health care in this country.

Abstract Future fusion reactors will produce radioactive waste, primarily neutron activation products and tritium, necessitating robust decommissioning strategies. This study compares radiological characterization techniques for fusion waste management, focusing on destructive versus non-destructive methods, and evaluates the advantages and disadvantages of both by applying them to two case studies of nuclear fusion plant decommissioning, namely the ENEA Frascati Tokamak Upgrade (FTU) and the planned ITER, the International Thermonuclear Experimental Reactor. Gamma emitters can be readily quantified using solid-state detectors, while almost pure beta emitters like Fe-55 and Ni-59 traditionally require destructive methods. However, for ITER-scale inventories, Cadmium Telluride (CdTe)-based X-ray spectrometry offers a viable non-destructive alternative, combining good energy resolution, compactness, and potential reduced secondary waste. In contrast, the FTU decommissioning, which is a peculiar case due to its stringent clearance levels for material reuse and recycling (below 1E+03 Bq/kg), necessitates destructive methods for nuclides such as Fe-55 and Ni-59 because non-destructive X-ray spectrometry would require impractically long measurement times. This comparative analysis highlights the importance of tailored characterization approaches, balancing accuracy, efficiency, and radiation protection, and provides insights applicable to decommissioning in different nuclear facilities.

The clinical pathway of a patient who experiences cardiac arrest and subsequently dies (with or without organ donation) is complex. It involves uncontrolled (u-) donation after circulatory death (DCD), controlled (c-) DCD, and donor after brain death (DBD). The present paper aims to summarize existing evidence on organ donation rates among out-of-hospital cardiac arrest (OHCA) patients, with a focus on these three donor categories (uDCD, DBD, and cDCD). Furthermore, the potential to expand each donor pathway in OHCA patients will be highlighted, based on available evidence. Among non-survivor OHCA patients, the prevalence of brain death (BD) is estimated to be low, though reported data are not uniform. The diagnosis of BD is made 3 to 6 days after return of spontaneous circulation. The implementation of uDCD is known to be quite challenging due to logistical, ethical, and resource issues. Its rationale is still well grounded, mainly considering two factors: (a) the high incidence of OHCA, such that uDCD donors can be considered an existing pool of potential donors; (b) the uDCD pathway shows feasibility both under organizational (i.e., only lung uDCD program) and clinical views (normothermic regional perfusion, ex vivo machine perfusion, and an appropriate donor-recipient match). Controlled DCDs are donors who died after a planned withdrawal of life-sustaining therapy (WLST). Data on the percentage of cDCD among OHCA patients is not uniform since the percentage of utilized cDCD has been estimated at around 10%. According to available evidence, each donor pathway in OHCA has the potential to be expanded, mainly by the identification of potential donors and the implementation of DCD programs.

<bold>INTRODUCTION:</bold> Chronic pulmonary graft-versus-host disease (PcGVHD) is a non-infectious complication of allogeneic hematopoietic stem cell transplantation (HSCT) manifesting beyond 100 days after transplantation. The aim of this study is to identify hallmarks of PcGVHD <bold>MATERIALS AND METHODS:</bold> a retrospective cohort study (January 2003 - December 2024) was conducted in consecutive patients with a history of HSCT with new-onset or worsening respiratory symptoms. Inclusion criteria were : age ≥18 years, availability of a CT scan at the time of evaluation, HSCT performed at least 100 days prior to the hospital admission, pulmonary function tests (PFTs) performed contemporaneously with CT scanning and clinical assessment. <bold>STATISTICAL ANALYSIS:</bold> Cluster analysis using Gower distance was conducted on clinical, radiological and histological data in order to identify different profiles. <bold>RESULTS:</bold> 40 patients were included (19 males, mean age 45 year-old), respiratory symptoms included: cough (82.5%), dyspnea (75%), fever (27.5%). Lung biopsy was performed in 12 patients (2 obstructive, 10 restrictive patients); the histology showed: BO; elastosis; OP; NSIP. CT scan showed findings related to airways-disease (air-trapping), and/or to ILD (reticulation, PPFE, OP). <bold>CONCLUSIONS:</bold> The cluster analysis showed two well-distinct clusters (silhouette index: 0.46) the first with obstructive impairment-airways disease but minimal lung fibrosis, the second a restrictive profile with lung fibrotic changes but interestingly still with evidence of small airways disease in CT scan and histology. Phenotyping might be based on imaging, PFTs and histology.

IntroductionFood insecurity and poverty mechanisms often intertwine, negatively affecting the well-being of families and children, particularly those with acute malnutrition. In urban Angola, limited evidence exists on how socioeconomic deprivations influence household food security and treatment outcomes for malnourished children. Drawing on the Amartya Sen Capability Approach, this study investigates the determinants of household food consumption, weight gain during hospitalization, and outpatient treatment duration among children with acute malnutrition.MethodsWe combined analyses from an original household survey of 84 families with hospital records from 1,259 children admitted to the Divina Providencia Hospital in Luanda between January 2019 and June 2021. Data included socioeconomic indicators, anthropometric measurements at admission and discharge, and treatment duration. Classification and Regression Trees (CART) were applied to identify key socioeconomic and clinical predictors across multiple dependent variables.ResultsLower household food consumption was observed when families could not afford at least 2.5 meals per day, had a monthly income below 30,000 Kwanzas, and when the mother’s education was less than 9.5 years. Anthropometric indicators at admission significantly influenced children’s ability to gain weight during hospitalization. Poverty and food insecurity were associated with longer outpatient treatment durations.DiscussionThe findings highlight the effects of socioeconomic deprivations on food insecurity and recovery from acute malnutrition in children. Targeted interventions addressing low income, inadequate maternal education, and poor dietary access are essential to break the cycle of intergenerational poverty and malnutrition. Stronger policy implementation and integration of social protection with nutrition services are recommended to improve child health outcomes in peri-urban settings.