Background: Prolonged endurance exercise is associated with an increased risk of atrial fibrillation (AF) in men. Left atrial (LA) dilation is a marker of pathological atrial remodeling and associated with AF in the general population. In athletes, however, atrial dilation is part of a physiological response to exercise, and functional parameters may help separate physiological from pathological atrial remodeling in this group. LA mechanical dispersion (LA MD) is a novel marker of LA mechanical dyssynchrony associated with AF in the general population. The associations between prolonged endurance exercise, LA MD and AF are yet to be investigated. Purpose: To investigate LA MD in male veteran athletes who had regularly participated in an annual 54-kilometer cross-country (XC) ski race in Norway with and without paroxysmal AF and to investigate the ability of LA MD to identify veteran athletes with paroxysmal AF. Methods: Two hundred and ninety-three men from four groups, veteran XC skiers with (n=57) and without (n=87) AF, and men from a non-athletic population with (n=61) and without AF (n=88) underwent an echocardiographic exam while in sinus rhythm. Using speckle-tracking echocardiography, LA strain was measured in each of the six atrial segments in an atrial-focused apical four-chamber view. We defined LA MD as the standard deviation of time-to-peak strain (SD-TPS) and report the average from three consecutive loops. Results: XC-skiers (mean age 70.9 ± 5.7 years) reported an average of 40-50 years of regular endurance exercise and an average of 16 completed annual Birkebeiner XC ski races. LA volumes were associated with both AF and athletic status (p<0.001). SD-TPS was associated with AF (p<0.001), but not with athletic status (p=0.173). We found no significant trend between years of endurance exercise and SD-TPS in individuals without AF (p=0.846). SD-TPS did not add incremental value in identifying athletes with AF in addition to clinical markers, QRS width, LA volume, and LA reservoir strain (p=0.056). Conclusion: LA MD was associated with paroxysmal AF regardless of athletic status. However, it was not associated with years of performing endurance exercise, suggesting LA MD could be a promising marker of pathological atrial remodeling in endurance athletes, less affected by physiological exercise-induced atrial remodeling than absolute volumetric measurements. We found no incremental value of LA MD in identifying veteran athletes with paroxysmal AF when LA reservoir strain was included in the model.

Background: Reactive thrombocytosis (Platelets >500K/μl) is estimated between 3-13% in hospitalized children and has been associated with RSV infection and younger age. We aimed to examine the clinical significance of thrombocytosis in children admitted to the hospital with an influenza-like illness (ILI). Methods: We performed an analysis of a database of patients evaluated at our Medical Centers with an ILI between 2009 and 2013. We included pediatric patients and examined the association between platelet count, respiratory viral infections, and admission outcomes (hospital length of stay (LOS) and admission to the pediatric intensive care unit (PICU() using regression models adjusting for laboratory, clinical and demographic parameters. Results: Of 19,192 adults and children in the database, 5,171 children met inclusion criteria (median age 0.8 years (Interquartile range, 0.2-1.8), 58% male, median LOS of 3 days (Interquartile range, 2-5)). Younger age and not the type of viral infection was associated with a high platelet count (p<0.001). Elevated platelet count independently predicted admission outcomes, adjusted for multiple covariates (p≤0.006). Furthermore, the presence of thrombocytosis was associated with an increased risk for a prolonged LOS (odds ratio=1.2 (95% Confidence interval=1.1-1.4, p=0.003)) and admission to the PICU (odds ratio=1.5 (95% Confidence interval =1.1-2.0, p=0.002)). Conclusions: In children admitted with an ILI, a high platelet count is associated with younger age and is an independent predictor of hospital LOS and admission to the PICU. Our results show that platelet count may be used to improve risk assessment and management decisions in these pediatric patients.

Scrub typhus caused by Orientia tsutsugamushi is a vector-borne, zoonotic disease which is common in the tsutsugamushi triangle. Scrub typhus causes AUFI in patients with non-specific clinical features and is difficult to diagnose when the highly characteristic but not pathognomonic eschar is not seen. As the eschar is not always present, laboratory tests are needed for confirmation. Serological assays are the main stay of laboratory diagnosis of scrub typhus thus far. In this review, we present the salient clinical features and clinical algorithms suggestive of this disease that help in better selection of diagnostics. The various scrub typhus assays along with their advantages and disadvantages have also been discussed. Furthermore, we have also discussed the upcoming diagnostics, both serological and molecular assays which can be available in the near future.

Background: Croup caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging disease, and data on the risk factors associated with disease severity are still limited. The Westley croup score (WS) is widely used to assess croup severity. The current study aimed to analyze biomarkers associated with the WS and clinical outcomes in patients with croup and coronavirus disease 2019 in the pediatric emergency department (PED). Population and Method: Patients diagnosed with croup caused by SARS-CoV-2 were admitted at two PEDs. Clinical data including age, WS, length of hospital stay, initial laboratory data, and treatment were analyzed. Clinical parameters were evaluated via multivariate logistic regression analysis. The best cutoff values for predicting croup severity and outcomes were identified using the receiver operating characteristic curve. Result: In total, 250 patients were assessed. Moreover, 128 (51.2%) patients were discharged from the PED, and 122 (48.8%) were admitted to the hospital. Mild, moderate, and severe croup accounted for 63.6% (n = 159), 32% (n = 80), and 4.4% (n = 11) of all cases, respectively. A high mean age (years), neutrophil count (%), neutrophil-to-lymphocyte ratio (NLR), ALT (U/L), procalcitonin (ng/mL), and hemoglobin (g/dL) level, and length of hospital stay (days), and a low lymphocyte count (%) and blood pH were associated with croup severity and need for intensive care. Based on the multivariate logistic regression model, the NLR remained independent factors associated with croup severity and prognosis. Further, NLR was significantly correlated with WS. The area under the receiver operating characteristic curve of NLR for predicting a WS of ≥ 3 was 0.895 (0.842–0.948, p < 0.001), and that for predicting ICU admission was 0.795 (0.711–0.879, p < 0.001). The best cutoff values for a WS of ≥3 and ICU admission were 1.65 and 2.06, respectively. Conclusion: WS is associated with the severity of croup caused by SARS-CoV-2. Furthermore, NLR is correlated with WS and is a cost effective, easily accessible prognostic biomarker in the PED.

In this paper, we will derive the Formable integral transform of the Hilfer-Prabhakar and its regularized version of the Hilfer-Prabhakar fractional derivative. Then, we will use the Formable and Fourier transforms, which involve the three-parameter Mittag-Leffler function, to find the solution of some Cauchy type fractional differential equations with Hilfer-Prabhakar fractional derivatives.

Working memory (WM) impairment has been well characterized in normal ageing. Various studies have explored changes in either the regional activity or the interregional connectivity underlying the WM ageing process. We proposed that brain activity and connectivity would independently alter with ageing and affect WM performance. WM was assessed with a classical N-back task during functional magnetic resonance imaging in a community-based sample comprising 168 elderly subjects (aged 55 to 86 years old). Following the rationale of background functional connectivity, we assessed age-related alterations in brain activity and seed-based interregional connectivity independently. Analyses revealed age-related decrease in the activity of the inferior parietal lobule (IPL) and an increase in the activity of the ventral anterior cingulate cortex (ACC), and the local functional dysfunctions were accompanied by alterations in their connectivity to other cortical regions. Importantly, regional activity impairments in the IPL and ACC could mediate age-related effects on accuracy rate and reaction time, respectively, and those effects were further counterbalanced by enhancement of their background functional connectivity. We thus claimed that age-induced alterations in regional activity and interregional connectivity occurred independently and contributed to WM changes in ageing. Our findings presented the way brain activity and functional connectivity interact in the late adulthood, thus providing a new perspective for understanding WM and cognitive ageing.

This letter presents the design and measurement results of a 2.5 GS/s 7-bit successive approximation register (SAR) analog-to-digital converter (ADC) with real-time data output via the JESD204B protocol using two lanes at 12.5 Gb/s each. The ADC is implemented in a 22-nm fully-depleted silicon-on-insulator (FDSOI) technology and consists of four time interleaved ADC cores. It consumes 43 mW overall, while the analog frontend including the four ADC cores and the interleaver consumes only 7.8 mW. In the first Nyquist zone, the effective number of bits (ENOB) is larger than 6.1 bit leading to a Walden Figure-of-Merit (FOM_W) of 45 fJ/conv.-step and a Schreier Figure-of-Merit (FOM_S) of 150.5 dB. Integral (INL) and differential nonlinearity (DNL) are both well below 0.5 LSB for all measurement scenarios.

A robust distributed state estimation algorithm for AC/DC system with AC tie lines and high voltage direct current (LCC-HVDC) tie line is proposed. The proposed algorithm consists of the robust distributed AC state estimation and the robust DC state estimation in the coordinator. For AC state estimation, a distributed state estimation algorithm based on the bilinear algorithm is designed, which can not only achieve the same accuracy as the centralized algorithm, but also simplify the nonlinear iterative process of the exponential objective function robust algorithm and reduce the operation scale. For DC state estimation, the objective function adopts the maximum absolute value of exponential to make it better convergent. Finally, the correctness and effectiveness of the algorithm are verified by the simulation of three IEEE 118 bus interconnected systems.

Considering the sensitivity of HVDC-transmission system protection and the difficulty in identifying high-resistance earth-faults,this paper presents three methods for fault location and classification in VSC-HVDC transmission lines.These methods are evaluated in terms of efficiency and reliability.The current and voltage signals obtained from the network are pre-processed by performing DWT,and then using feature extraction methods,special and unique features are extracted for different states of the signals,and then using these features and proposed algorithms,network learning was performed to detect faults.In addition,the effectiveness of the proposed plan has been confirmed for different fault scenarios related to extensive changes in fault resistance,fault starting angle and fault location.These algorithms were also investigated in unwanted noise-conditions and the reliability of these algorithms was confirmed.In this article methods,k nearest neighbor(KNN),support vector machine(SVM) and deep-neural network(DNN) have been investigated.The strength of this research is use of a new method of extracting features from the fractal dimension,which has been able to provide outstanding capabilities that can lead to improved diagnosis with a small number of study data and different conditions.The main advantages of proposed-method are higher speed and accuracy than conventional methods.The test results show that the proposed method can reliably and accurately identify and classify high-impedance faults.

Disturbance by humans and climatic change are thought to be two important factors contributing to ongoing declines in migratory bird species, especially during the breeding season when they may impact productivity. Ground-nesting species with precocial offspring are likely to be susceptible to both disturbance and extreme weather events, but more work is needed to understand these processes. Here, we investigate the factors affecting reproductive success in the common sandpiper (Actitis hypoleucos), a declining, ground-nesting migratory wader. We colour-ringed individuals and monitored nests over three years to study the impact of disturbance, habitat and rainfall on hatching success and fledging success. First, we investigated whether the distance of nests from footpaths and rivers, and the amount of vegetation cover, predicted hatching success. We also recorded the distance at which incubating adults flushed from the nest in response to an approaching observer. Second, we investigated whether fledging success was associated with rainfall in the period following hatching. We found that hatching success was higher when nests were further away from footpaths, but only when nests were also far from rivers. Also, individuals on nests that were far from footpaths left their nests more readily when approached by observers, particularly when their nests had less vegetation cover. Further, our data showed that adults sitting tightly on nests, and having large amounts of vegetation cover around them, had higher hatching success. Finally, our results showed that fledging success was correlated with heavy rainfall in the week after hatching. This suggests that extreme rainfall events are likely to have important consequences for chick survival. Further work is needed to determine the interacting effects of human disturbance and predation events on both hatching and fledging success, particularly in the face of the increasing frequency of extreme weather events.

Fluid flow and pore-pressure cycling are believed to control slow slip events (SSEs), such as those that frequently occur at the northern Hikurangi margin (HM) of New Zealand. To better understand fluid flow in the forearc system, we examined the relationship between elastic properties, compaction, porosity, and permeability of Cretaceous-to-Pliocene sedimentary rocks from the Raukumara peninsula. We found that the permeability of the deep wedge is too low to drain fluids, but fracturing increases permeability by orders of magnitude, making fracturing key for fluid flow. In weeks to months, plastic deformation and clay swelling heal the fractures, restoring the initial permeability. We conclude that overpressures at the northern HM might partly dissipate during SSEs due to enhanced permeability near faults. However, in the weeks to months following an SSE, healing in the prism will lower permeability, forcing pore pressure to rise and a new SSE to occur.

The thermal interface material technologies used for electronic packages encompass several classes of materials. However, there is still a need for thermal interface materials and methods for making thermal interface materials having improved thermal conductivity property by maximizing the anisotropic benefit of exfoliated graphite platelets to the fullest extent. The effect of filler volume fraction on the thermal resistivity of the thermal contact and the thermal conductivity of the thermal interface material is investigated for graphite platelets and carbon black. The effect of pressure on the bond line thickness of the thermal interface material is evaluated for smooth and rough surfaces. The present study aims to provide a thermal interface material with aligned graphite nanofibers in the thermal interface material to enhance the material performance. Particular emphasis is placed upon the heat conduction properties of thermally conductive interface materials with exfoliated graphite platelets. The results indicate that polymeric elastomer materials offer both high thermal performance and reasonable gap filling capability to enable good contact between a semiconductor component and a heat sink. Under mechanical pressure, the soft thermal interface material conforms to the microscopic surface contours of the adjacent solid surfaces and increases the microscopic area of contact between the thermal solution surface and the silicon die surface and therefore reduces the temperature drop across this contact. The heat dissipating component should advantageously be relatively anisotropic, as compared to a metal and exhibit a relatively high ratio of thermal conductivity to weight. Thermal interface materials provide a limited heat-conduction path and may include flexible heat-spreading materials and one or more layers of soft thermal interface material. Reducing the strain on the thermal interface material may reduce the potential for pump-out and the associated increase in thermal resistance due to loss of material from the interface. Thermal conductivity is driven primarily by the nature of the filler, which is randomly and homogeneously distributed throughout the matrix. Pump-out of the thermal interface material results in increased thermal resistance due to loss of material from the interface. The thermal interface material can migrate out of the interface volume between the thermal conducting members and onto the power input pads, resulting in excessive heating and part failure at the power interconnect.Keywords: Interface materials; Thermoplastic materials; Smooth surfaces; Rough surfaces; Graphite platelets; Carbon black

Crop growth model simulates the response of photosynthetic rate to nitrogen (N) dynamic by calculating critical N concentration. However, critical N concentration cannot describe the physiological effect of N dynamic to photosynthesis. In this paper, a Two-leaf Photosynthetic Model Sensitive to Chlorophyll Content (TPMSCC) was developed and coupled with the crop growth model (WheatGrow) to improve the mechanism of N dynamics on photosynthesis. The simulating results of TPMSCC revealed the high sensitivity of LCC on photosynthesis. The relationships of LCC to the maximum photosynthetic rate (A max) and the initial light use efficiency (ɑ) simulated by TPMSCC were linear and logarithmic. In addition, canopy photosynthetic rate benefited from the increase of diffuse radiation fraction (DRF) except for the condition of dense canopy at high solar zenith angle. The optimized WheatGrow performed better than WheatGrow on describing the response of N level on biomass accumulation and distribution in different organs.

Full article title: Social media and the rise of the far rightAcknowledgments and credits: Not applicable Each author’s complete name and institutional affiliation(s): Ryan Thomas Williams, University of SunderlandGrant numbers and/or funding information: Not applicable Key words (four or five): social media, digital communication, think piece, reflection Corresponding author (name, address, phone/fax, e-mail): Ryan Thomas Williams, University of Sunderland, Sir Tom Cowie Campus, St Peter's Way, Sunderland, SR6 0DD, ryan.williams@sunderland.ac.uk 

Disturbance and environmental change may cause communities to converge on a steady state, diverge towards multiple alternative states, or remain in long-term transience. Yet, empirical investigations of successional trajectories are rare, especially in systems experiencing multiple concurrent anthropogenic drivers of change. We examined succession in old field grassland communities subjected to disturbance and nitrogen fertilization using data from a long-term (22-year) experiment. Regardless of initial disturbance, after a decade communities converged on steady states largely determined by resource availability, where species turnover declined as communities approached dynamic equilibria. Species favored by the disturbance were those that eventually came to dominate the highly fertilized plots. Furthermore, disturbance made successional pathways more direct under low nutrients, revealing an important interaction effect between nutrients and disturbance as drivers of community change. Our results underscore the dynamical nature of grassland and old field succession, demonstrating how community properties such as beta-diversity change through transient and equilibrium states.

Accurate diagnosis of Alzheimer’s disease(AD) and Mild Cognitive Impairment(MCI) was identified on an early stage is essential in the healthcare industry to stop degeneration. The Smooth Support Vector Machine (SSVM) model, Principal Component Analysis (PCA), feature extraction, and Magnetic Resonance Imaging (MRI) image preprocessing are the components for the diagnosis of AD is proposed in this research at early stage. To assist in the classifier’s training, we proposed a novel Improved Weighed Quantum Lion Optimization (IWQLO). The SSVM parameters are specifically proposed to be optimized using a new Switching delayed Lion Optimization (SLO) algorithm.The IWQLO-SSVM approach was effectively used to classify AD and MCI utilizing MRI scans of the [Alzheimer’s disease Neuroimaging Initiative](https://adni.loni.usc.edu/)(ADNI) database and Outcome and Assessment Information Set (OASIS) database. For six example scenarios, the classification accuracy of our proposed method is acceptable. Testing show that the proposed approach improves the performance measures such as accuracy, precision, specificity, sensitivity and recallfor detecting the early stage AD diagnosis.

Background: Deprescribing is a complex process requiring a patient-centred approach. One frequently expressed deprescribing barrier is patients’ attitudes and beliefs toward reducing or stopping a medication. This study aims to identify the willingness to deprescribe predictors in a sample of Portuguese older patients. Methods: Cross-sectional study with community-dwelling patients aged ≥ 65 and taking at least one regular medication. Data collection included patients’ demographic and clinical characteristics and the Portuguese Revised Patients’ Attitudes Towards Deprescribing (rPATD) Questionnaire. Descriptive statistics were used to present patients’ characteristics and attitudes towards deprescribing. A multiple binary logistic regression analysis was performed to identify willingness to desprescribe predictors. Results: 192 participants (median age 72 years; 65.6% female) were included. A large majority (83.33%) were willing to deprescribe if recommended by their doctor. The willingness to desprescribe predictors were age (adjusted odds ratio (aOR)= 1.136), female sex (aOR= 3.036), and the rPATD concerns about stopping (aOR= 0.391). Conclusions: Most patients were willing to deprescribe if recommended by their doctor. Older age and female sex increase the odds of willingness to deprescribe; conversely, higher concerns about stopping medications decrease the odds. These findings suggest that addressing patients’ concerns about stopping their medicines may contribute to deprescribing success.

The purpose of this paper is to utilize adaptive dynamic programming to solve an optimal consensus problem for double-integrator multi-agent systems with completely unknown dynamics. In double-integrator multi-agent systems, flocking algorithms that neglect agents' inertial effect can cause unstable group behavior. Despite the fact that an inertias-independent protocol exists, the design of its control law is decided by dynamics and inertia. However, inertia in reality is difficult to measure accurately, therefore, the control gain in the consensus protocol was solved by developing adaptive dynamic programming to enable the double-integrator systems to ensure the consensus of the agents in the presence of entirely unknown dynamics. Firstly, we demonstrate in a typical example how flocking algorithms that ignore the inertial effect of agents can lead to unstable group behavior. And even though the protocol is independent of inertia, the control gain depends quite strongly on the inertia and dynamic of the agent. Then, to address these shortcomings, an online policy iteration-based adaptive dynamic programming is designed to tackle the challenge of double-integrator multi-agent systems without dynamics. Finally, simulation results are shown to prove how effective the proposed approach is.

Allergic diseases were recently reported related to both SARS-CoV-2 infection and severe COVID-19 through observational studies. However, their causal relationship remains unclear. Herein, we performed univariate and multivariate Mendelian randomization (MR) studies to investigate the causal association between various allergic diseases and COVID-19. Genome-wide association studies (GWAS) summaries were used in this study, with 360838 participants in the allergic disease database, 455449 in asthma, 217914 in allergic rhinitis (AR), and 205764 in atopic dermatitis (AD). In univariate MR analysis, the allergic disease was not causally in connection with SARS‐CoV‐2 infection but have a causal protective effect on severe COVID-19. In contrast, no significant causal effect was found of SARS-CoV-2 infection/severe COVID-19 on the allergic disease. AD, mixed asthma, and childhood asthma were causal protective factors for severe COVID-19. Multivariate MR analysis further revealed the dominant role of asthma in allergic diseases and the dominance of childhood asthma in asthma subtypes. In summary, this study, based on the population genetic variation model, pointed out the protective effect of allergic diseases against severe COVID-19, which may provide some inspiration for further exploration of the pathophysiological mechanisms of COVID-19.

Rotavirus A (RVA) is an important cause of acute gastroenteritis (AGE) in children. This study aims to investigate the molecular epidemiology of RVA children hospitalized with AGE in Chiang Rai, Thailand in 2018-2020 by RT-PCR. Of 302 samples, RVA was detected in 11.6% (35 samples): 11.3% (19/168) in 2018-2019 and 11.9% (16/134) in 2019-2020. Surprisingly, G8P[8] was detected as the predominant genotype at 68.4% in 2018-2019 and 81.2% in 2019-2020. In addition, other genotypes were also detected, including G1P[8] (15.8%), G2P[4] (5.3%), G3P[8] (10.5%) in 2018-2019 and G9P[8] (18.8%) in 2019-2020. Analysis of genomic constellation of G8P[8] strains, represented by RVA/Human-wt/ THA/5CR11/2019/G8P[8], revealed a DS-1-like genetic backbone: G8-P[8]-I2-R2-C2-M2-A2-N2-T2-E2-H2. Phylogenetic analysis of the VP7 gene showed that the DS-1-like G8P[8] strains clustered in a distinct sublineage A together with 13 G8P[8] strains reported from Thailand and China, and these sublineage A G8P[8] strains contained unique amino acid substitutions in two positions (A125S and N147D) on the VP7 antigenic epitopes. Homology modeling of the VP7 capsid protein confirmed that these two amino acid changes were located on the surface exposed area of the virion. Phylogenetic trees of the VP1, VP6, NSP2, NSP3, and NSP4 genes have demonstrated that DS-1-like G8P[8] strains in the present study and 51 DS-1-like G8P[8] reference strains published formerly clustered in separate lineages. To the best of our knowledge, this is the first report of the emergence of novel DS-1-like G8P[8] strains that might have evolved genetically through reassortment events with locally or globally circulating genotypes.

In this letter, an attempt is made that, in low and extremely low cycle fatigue regime, applicability of the Wöhler Curve Method is examined using experimental fatigue data from the literature. The conclusion is that the Wöhler Curve Method is well suitable for fatigue life assessment of metallic materials in low and extremely low cycle fatigue regime.

China has just lifted its zero-Covid policy and made it more relaxed, which suggests the end of zero-Covid globally. Vietnam is one of a few countries that implemented zero-Covid at the very beginning, yet we decided to abandon it much sooner. Consequently, a spike in cases followed just after this opening. Healthcare workers (HCW)—the frontliners—are the most harmed and vulnerable, both physically and psychologically. HCW have been playing a vital role in a successful response against multiple Covid-19 pandemics, and patient safety will obviously be in jeopardy when the well-being of HCW is neglected. Nevertheless, literature has reported the anticipated repercussions of Covid-19 on HCW, especially on their mental health and well-being, mostly due to the shortage of resources and equipment, intense work hours, and lack of support for mental health. In this paper, we report on the burden of Vietnamese HCW during the fourth wave of the pandemic, raise awareness among both the community and the authorities, and also deliver feasible solutions adapted from Vietnam. These insights can also be learned by other countries and modified based on local circumstances to help better deal with future outbreaks.

Recently, the author specifically concerned with for low-cycle fatigue (LCF) of metals. An attempt was made that the well-known Wöhler Curve Method was used to perform LCF assessment of metals. From the author’s study, it is sure that the Wöhler Curve Method is well suitable for LCF life analysis of metals, in which the stress-based intensity parameter calculation is on the basis the linear-elastic analysis. In view of the fact that medium/high cycle fatigue lives of metals is well calculated by the Wöhler Curve Method, thus from the author’s study it appears to be possible that, for low/medium/high cycle fatigue (LHCF) of metals, the Wöhler Curve Method is well suitable for fatigue life assessment. This study specifically concern with such a subject. By using a number of the fatigue test data of metals from the literature, it has been proven that, in LHCF regime, the Wöhler Curve Method and the generalized Wöhler Curve Method are well suitably used to perform the fatigue life assessment of metals under uniaxial and multiaxial loading, respectively.

Background: Enhanced safety surveillance (ESS) of seasonal influenza vaccines is required by the European Medicines Agency (EMA). ESS is conducted during each Northern Hemisphere (NH) influenza season and aims to monitor the reactogenicity of influenza vaccines early in the season. A cell culture-based quadrivalent influenza vaccine (QIVc; Flucelvax® Tetra), which has an advantage of avoiding egg-adaptive mutations that may reduce vaccine effectiveness, has been available in Europe since the 2019/20 influenza season. The objective of this manuscript is to summarize ESS activity across three seasons for QIVc in all age groups. Methods: As per EMA guidelines, an enhanced passive safety surveillance (EPSS) approach was adopted. The EPSS envisages near-real-time surveillance of adverse events (AEs) that are reported spontaneously by vaccinees. The EPSS was conducted in primary care setting in Genoa (Italy) during the seasons 2019/20, 2020/21 and 2021/22. All AEs registered within the first 7 days following immunization were analyzed by season, type, age group and seriousness. Results: Over three seasons, a total of 3,603 QIVc exposures were recorded within EPSS. No safety signals were identified. The overall reporting rates of individual case safety reports (ICSRs) for the seasons 2019/20, 2020/21 and 2021/22 were 1.75% (18/1030), 0.48% (5/1032) and 0.40% (4/1001), respectively. The average number of AEs per ICSR was similar (range 3.3–3.8) across the three seasons. Most AEs were reactogenic in nature. The rate of AEs was similarly low in all age groups. Conclusions: These results support the favorable safety profile of QIVc in all indicated age groups.