A municipality-level analysis of excess mortality in Italy in the period January-April 2020

BACKGROUND: the first confirmed cases of COVID-19 in WHO European Region was reported at the end of January 2020 and, from that moment, the epidemic has been speeding up and rapidly spreading across Europe. The health, social, and economic consequences of the pandemic are difficult to evaluate, since there are many scientific uncertainties and unknowns. OBJECTIVES: the main focus of this paper is on statistical methods for profiling municipalities by excess mortality, directly or indirectly caused by COVID-19. METHODS: the use of excess mortality for all causes has been advocated as a measure of impact less vulnerable to biases. In this paper, observed mortality for all causes at municipality level in Italy in the period January-April 2020 was compared to the mortality observed in the corresponding period in the previous 5 years (2015-2019). Mortality data were made available by the Ministry of Internal Affairs Italian National Resident Population Demographic Archive and the Italian National Institute of Statistics (Istat). For each municipality, the posterior predictive distribution under a hierarchical null model was obtained. From the posterior predictive distribution, we obtained excess death counts, attributable community rates and q-values. Full Bayesian models implemented via MCMC simulations were used. RESULTS: absolute number of excess deaths highlights the burden paid by major cities to the pandemic. The Attributable Community Rate provides a detailed picture of the spread of the pandemic among the municipalities of Lombardy, Piedmont, and Emilia-Romagna Regions. Using Q-values, it is clearly recognizable evidence of an excess of mortality from late February to April 2020 in a very geographically scattered number of municipalities. A trade-off between false discoveries and false non-discoveries shows the different values of public health actions. CONCLUSIONS: despite the variety of approaches to calculate excess mortality, this study provides an original methodological approach to profile municipalities with excess deaths accounting for spatial and temporal uncertainty

PP179—Identification of Drug–Drug Interactions Through a Digital Health Service

e74 Volume 35 Number 8S accounting for 21.2% and 16.2% of total AED consumption (DDD 163.7 and 125.2, respectively). In the same year, oxcarbazepine and lamotrigine were the most used new AEDs (10.91% and 10.79% of total; DDD 84.1 and 83.2, respectively), while gabapentin and pregabalin exhibited the higher incidence of use. The main indication of use was epileptic disorders for older AEDs and neuropathic pain for newer AEDs. A high number of patients treated with older AEDs, in particular carbamazepine, phenobarbital, and valproic acid, received coprescription at clinically relevant interaction risk. Among newer AEDs, lamotrigine showed a high annual rate of possible interaction. Conclusion: Significant differences were shown in the prescribing pattern of newer and older medications: older AEDs were mainly used in the treatment of epileptic disorders, while newer compounds were also preferred for conditions other than epilepsy, in particular neuropathic pain. The fall in the use of newer AEDs during 2007 agreed with revised reimbursement criteria for gabapentin and pregabalin. The coprescription should be evaluated with caution and avoided if possible. Drugs at risk of interactions should be replaced with others having same indication of use. Disclosure of Interest: None declared

Catenary-Powered Electric Traction Network Modeling: A Data-Driven Analysis for Trolleybus System Simulation

In the context of smart cities, direct current overhead contact lines, usually adopted to power urban transportation systems such as trolleybuses, tramways, metros, and railways, can serve as a backbone to connect different modern emerging technologies. Among these, in-motion charging (IMC) trolleybuses with on-board batteries are expected to be very impactful on the DC network’s power flow and may require specific voltage and current control. These factors motivate the development of a simulation tool able to emulate these devices’ absorption and their effect on the supply infrastructure. The main innovative value of the work is to improve a simulation model of a trolleybus grid through a data-driven approach by using measurements of voltage and current output from a traction substation. The measurements are essential for understanding the behavior of vehicle weight variation throughout the day. Thanks to this information, a characterization of the current draw by conventional trolleybuses and IMC trolleybuses is then provided for each trolleybus route in a specific power section of the Bologna trolleybus system. By integrating the variation in vehicle weight within the model, a simulation of a possible daily operation of a trolleybus feeding section has been performed, obtaining a 7% error between the daily energy calculated from the simulation and that obtained through measurements. This analysis demonstrates the feasibility of the adopted simulation tool, which can also be used to evaluate additional hypothetical trolleybus operation scenarios. One of these possible scenarios considers IMC vehicles, and it is also evaluated in this paper

Novel Multi‐Vehicle Motion‐Based Model of Trolleybus Grids towards Smarter Urban Mobility

Trolleybus systems are resurfacing as a steppingstone to carbon-neutral urban transport. With an eye on smart city evolution, the study and simulation of a proper monitoring system for trolleybus infrastructures will be essential. This paper merges the authors’ engineering knowledge and sources available in the literature on designing and modeling catenary-based electric traction networks and performs a critical review of them to lay the foundations for proposing possible optimal alternatives. A novel multi-vehicle motion-based model of the DC catenary system is then devised and simulated in Matlab-Simulink, which could prove useful in predicting possible technical obstacles arising from the next-future introduction of smart electric traction grids, inevitably featuring greater morphological intricacy. The modularity property characterizing the created model allows an accurate, detailed, and flexible simulation of sophisticated catenary systems. By means of graphical and numerical results illustrating the behavior of the main electrical line parameters, the presented approach demonstrates today’s obsolescence of conventional design methods used so far. The trolleybus network of the city of Bologna was chosen as a case study

Median-to-ulnar nerve communication in carpal tunnel syndrome: An electrophysiological study

The median-to-ulnar communicating branch (MUC) is an asymptomatic variant of the upper limb innervation that can lead to interpretation errors in routine nerve conduction studies. The diagnosis of carpal tunnel syndrome (CTS) or ulnar nerve lesions can be complicated by the presence of MUC. In this study, we describe electrophysiological features of MUC in CTS patients presenting to our clinic. We enrolled MUB cases from consecutive CTS patients referred to our laboratory between the years 2014 and 2019. MUC was present in 53 limbs (36 patients) from the studied population. MUC was bilateral in 53% of patients. MUC type II was the most common subtype (74%), followed by types III and I; more coexisting MUC types were found in the majority of tested limbs. A positive correlation was demonstrated between the severity of CTS and the presence of positive onset, faster CV, or a double component of the compound muscle action potentials. We emphasize the importance of suspecting the presence of MUC in CTS in the presence of a positive onset or a double component in routine motor conduction studies

Inflammatory polyradiculoneuropathies: Clinical and immunological aspects, current therapies, and future perspectives

Inflammatory polyradiculoneuropathies are heterogeneous disorders characterized by immune-mediated leukocyte infiltration of peripheral nerves and nerve roots leading to demyelination or axonal degeneration or both. Inflammatory polyradiculoneuropathies can be divided into acute and chronic: Guillain–Barré syndrome and chronic inflammatory demyelinating polyneuropathy and their variants. Despite major advances in immunology and molecular biology have been made in the last years, the pathogenesis of these disorders is not completely understood. This review summarizes the current literature of the clinical features and pathogenic mechanisms of inflammatory polyradiculoneuropathies and focuses on current therapies and new potential treatment for the future

Rhodolith beds heterogeneity along the apulian continental shelf (Mediterranean sea)

Rhodolith beds represent a key habitat worldwide, from tropical to polar ecosystems. Despite this habitat is considered a hotspot of biodiversity, providing a suite of ecosystem goods and services, still scarce quantitative information is available thus far about rhodolith beds occurrence and ecological role, especially in the Mediterranean Sea. This study reports the composition and patterns of distribution of rhodolith assemblages found in four study areas along ca. 860 km of coast in the Central Mediterranean Sea. These rhodolith beds were studied for the first time and significant differences at all spatial scales have been highlighted, documenting the high variability of this habitat. Rhodolith species composition, morphology and distribution have been discussed considering the potential role of environmental factors in driving these patterns. The need for improving their protection is discussed to complement present conservation and management initiatives, particularly in the frame of the EU Marine Strategy Framework Directive