Grape Heterogeneity Index: Assessment of Overall Grape Heterogeneity Using an Aggregation of Multiple Indicators.

Uniform grape maturity can be sought by producers to minimise underripe and/or overripe proportions of fruit and limit any undesirable effects on wine quality. Considering that grape heterogeneity is a multifaceted phenomenon, a composite index summarising overall grape heterogeneity was developed to benefit vineyard management and harvest date decisions. A grape heterogeneity index (GHI) was constructed by aggregating the sum of absolute residuals multiplied by the range of values from measurements of total soluble solids, pH, fresh weight, total tannins, absorbance at 520 nm (red colour), 3-isobutyl-2-methoxypyrazine, and malic acid. Management of grape heterogeneity was also studied, using Cabernet Sauvignon grapes grown under four viticultural regimes (normal/low crop load, full/deficit irrigation) during the 2019/2020 and 2020/2021 seasons. Comparisons of GHI scores showed grape variability decreased throughout ripening in both vintages, then significantly increased at the harvest time point in 2020, but plateaued on sample dates nearing the harvest date in 2021. Irrigation and crop load had no effect on grape heterogeneity by the time of harvest in both vintages. Larger vine yield, leaf area index, and pruning weight significantly increased GHI score early in ripening, but no significant relationship was found at the time of harvest. Differences in the Ravaz index, normalised difference vegetation index, and soil electrical conductivity did not significantly change the GHI score.

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey.

BACKGROUND: Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. METHODS: Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society's website, and shared on the society's Twitter profile. RESULTS: A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. DISCUSSION: Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.

Surgeons' perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey.

BACKGROUND: Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons' knowledge and perception of using AI-based tools in clinical decision-making processes. METHODS: An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society's website and Twitter profile. RESULTS: 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust. DISCUSSION: The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI.

A systematic review and meta-analysis of vineyard techniques used to delay ripening.

Several vineyard techniques have been proposed to delay grape maturity in light of the advanced maturation driven by increasingly frequent water and heat stress events that are detrimental to grape quality. These studies differ in terms of their experimental conditions, and in the present work we have attempted to summarize previous observations in a quantitative, data-driven systematic review. A meta-analysis of quantitative data gathered across 43 relevant studies revealed the overall significance of the proposed treatments and evaluated the impact of different experimental conditions on the outcome of antitranspirants, delayed pruning and late source limitation. Antitranspirants were most effective when applied twice and closer to veraison, while di-1-p-menthene increased the ripening delay by about 1 °Brix compared to kaolin. Larger ripening delays were achieved with delayed pruning of low-yielding vines or by pruning at later stages of apical bud development. Late defoliation or shoot trimming delayed ripening in high-yielding vines and represent suitable solutions for late-harvested varieties, but became ineffective where the treatment decreased yield. This quantitative meta-analysis of 242 primary observations uncovers factors affecting the efficacy of vineyard practices to delay ripening, which should be carefully considered by grape growers attempting to achieve this outcome.

The effect of ripening rates on the composition of Cabernet Sauvignon and Riesling wines: Further insights into the sugar/flavor nexus.

Grape ripening accelerates under warmer and drier conditions, resulting in the accumulation of sugars ('technological' maturity) being decoupled from phenolic and aromatic composition. This study investigated the effect of different rates of ripening on the composition of Cabernet Sauvignon and Riesling wines. Manipulating crop load and irrigation led to distinct rates of berry ripening. In the resulting wines, reduced crop load affected the aroma composition, altering the profile and abundance of grape-derived compounds and fermentative esters. Phenolic composition was impacted by the irrigation regime, with color and tannin increased by late season irrigation. In Cabernet Sauvignon, the combination of treatments led to the largest ripening delay (3 weeks), resulting in less green and more fruity compounds, and improved phenolic composition. By mapping grape and wine metabolites and exploring their relationship, the outcomes of this study demonstrate the importance of ripening rates in determining wine quality.

Advanced robotics as a support in healthcare organizational response: A COVID-19 pandemic case study.

The use of robotics is becoming widespread in healthcare. However, little is known about how robotics can affect the relationship with patients during an emergency or how it impacts clinicians in their organization and work. As a hospital responding to the consequences of the COVID-19 pandemic "ASST dei Sette Laghi" (A7L) in Varese, Italy, had to react quickly to protect its staff from infection while coping with high budgetary pressure as prices of Personal Protection Equipment (PPE) increased rapidly. In response, it introduced six semi-autonomous robots to mediate interactions between staff and patients. Thanks to the cooperation of multiple departments, A7L implemented the solution in less than 10 weeks. It reduced risks to staff and outlay for PPE. However, the characteristics of the robots affected staff's perceptions. This case study reviews critical issues faced by A7L in introducing these devices and recommendations for the path forward.

Crop Load and Plant Water Status Influence the Ripening Rate and Aroma Development in Berries of Grapevine (Vitis vinifera L.) cv. Cabernet Sauvignon.

Wine made from grapes subjected to accelerated ripening, an increasingly frequent phenomenon occurring in many wine regions due to peaks of heat and water stress, displays higher alcohol levels and lacks balance with color and flavor compounds. Herein, the rate of sugar accumulation of grapes was manipulated by varying the crop load and irrigation regime and the development of secondary metabolites was monitored by gas chromatography-mass spectrometry (GC-MS) and high-performance liquid chromatography (HPLC). A 3-week delay in ripening correlated to an increase in the concentration of some monoterpenes and norisoprenoids and a greater decrease of green aroma compounds. Delayed ripening had a positive impact on the phenolic composition of grapes, displaying higher contents of total anthocyanins, total phenolics, quercetin glycosides, and polymeric pigments. A map of the chemical composition of grapes close to harvest allowed discrimination of compounds mainly responsive to delayed ripening from those driven by crop load or irrigation.

Forecast model for the evaluation of economic resources employed in the health care of patients with HIV infection.

BACKGROUND AND AIMS: The total health care cost for human immunodeficiency virus (HIV) patients has constantly grown in recent years. To date, there is no information about how this trend will behave over the next few years. The aim of the present study is to define a pharmacoeconomic model for the forecast of the costs of a group of chronically treated patients followed over the period 2004-2009. METHODS: A pharmacoeconomics model was built to describe the probability of transition among different health states and to modify the therapy over time. A Markov model was applied to evaluate the temporal evolution of the average cost. The health care resources exploited during hospitalization were analyzed by using an "activity-based costing" method. RESULTS: The Markov model showed that the mean total cost, after an initial increase, tended to remain stable. A total of 20 clinical records were examined. The average daily cost for each patient was EUR 484.42, with a cost for admission of EUR 6781.88. CONCLUSION: The treatment of HIV infection in compliance with the guidelines is also effective from the payer perspective, as it allows a good health condition to be maintained and reduces the need and the costs of hospitalizations.