An Efficient Hybrid Planning Framework for In-Station Train Dispatching

In-station train dispatching is the problem of optimising the effective utilisation of available railway infrastructures for mitigating incidents and delays. This is a fundamental problem for the whole railway network efficiency, and in turn for the transportation of goods and passengers, given that stations are among the most critical points in networks since a high number of interconnections of trains’ routes holds therein. Despite such importance, nowadays in-station train dispatching is mainly managed manually by human operators. In this paper we present a framework for solving in-station train dispatching problems, to support human operators in dealing with such task. We employ automated planning languages and tools for solving the task: PDDL+ for the specification of the problem, and the ENHSP planning engine, enhanced by domain-specific techniques, for solving the problem. We carry out a in-depth analysis using real data of a station of the North West of Italy, that shows the effectiveness of our approach and the contribution that domain-specific techniques may have in efficiently solving the various instances of the problem. Finally, we also present a visualisation tool for graphically inspecting the generated plans

Portuguese Recommendations for the management of Raynaud’s phenomenon and digital ulcers in systemic sclerosis and other connective tissue diseases

Objective: To develop evidence-based recommendations for the non-pharmacological and pharmacological management of Raynaud’s phenomenon (RP) and digital ulcers (DUs) in patients with systemic sclerosis and other im-mune-mediated connective tissue diseases (CTDs). Methods: A task force comprising 21 rheumatologists, 2 surgeons (vascular and plastic), 2 nurses, and 1 patient representative was established. Following a systematic literature review performed to inform the recommendations, statements were formulated and discussed during two meetings (one online and one in-person). Levels of evidence, grades of recommendation (GoR), and level of agreement (LoA) were determined. Results: Five overarching principles and 13 recommendations were developed. GoR ranged from A to D. The mean ± standard difference (SD) LoA with the overarching principles and recommendations ranged from 7.8±2.1 to 9.8±0.4. Briefly, the management of RP and DUs in patients with CTDs should be coordinated by a multidisci-plinary team and based on shared decisions with patients. Nifedipine should be used as first-line therapy for RP and/ or DUs. Sildenafil, tadalafil, and/or iloprost IV are second-line options for severe and/or refractory patients with RP and/or DUs. Sildenafil, tadalafil and/or Iloprost IV, should be prescribed for healing and prevention (also including bosentan) of DUs. In patients with RP and/or DUs, non-pharmacological interventions might be considered as add-ons, but there is limited quality and quantity of scientific evidence supporting their use. Conclusions: These recommendations will inform rheumatologists, specialist nurses, other healthcare profession-als, and patients about a comprehensive and personalized management of RP and DUs. A research agenda was developed to address unmet needs, particularly for non-pharmacologic interventions.publishersversionpublishe

Gastroesophageal reflux disease is associated with a more severe interstitial lung disease in systemic sclerosis in the EUSTAR cohort

Objectives Gastroesophageal reflux disease (GERD) is frequent in systemic sclerosis (SSc) and could predict progression of interstitial lung disease (ILD). We aimed to analyse (1) the prevalence of GERD among SSc-ILD patients, (2) its association with disease characteristics and (3) predictive factors for ILD progression in SSc-ILD patients with GERD. Methods SSc patients from the EUSTAR database with ILD were included. GERD was labelled as present if reflux/dysphagia was reported at the baseline visit or before. Disease characteristics of patients with and without GERD were compared at baseline. ILD progression was defined as relative FVC decline ≥10% or relative FVC decline between 5–9% in association with relative DLCO decline of ≥15% over 12 ± 3 months of follow-up. Prognostic factors for ILD progression, overall survival and progression-free survival in SSc-ILD patients with GERD were tested by multivariable Cox regression. Results A total of 5462 SSc-ILD patients were included, 4400 (80.6%) had GERD. Patients with GERD presented more frequently with diffuse cutaneous SSc (OR: 1.44 [1.22–1.69], P < 0.001) and more severe lung involvement with lower FVC (85.8 ± 22.1 vs 90.2 ± 20.1, P < 0.001), lower DLCO (60.8 ± 19.7 vs 65.3 ± 20.6, P < 0.001) and worse performance at the 6-min walking test. Female sex (HR: 1.39 [1.07–1.80], P = 0.012) and older age (HR: 1.02 [1.01–1.03], P < 0.001) independently predicted ILD progression in SSc-ILD patients with GERD. Conclusion SSc-ILD patients with GERD appear to suffer from a more severe SSc disease. In this population, female sex may be considered a risk factor for ILD progression

In-Station Train Dispatching: A PDDL+ Planning Approach

In railway networks, stations are probably the most critical points for interconnecting trains’ routes: in a restricted geographical area, a potentially large number of trains have to stop according to an official timetable, with the concrete risk of accumulating delays that can then have a knockout effect on the rest of the network. In this context, in-station train dispatching plays a central role in maximising the effective utilisation of available railway infrastructures and in mitigating the impact of incidents and delays. Unfortunately, in-station train dispatching is still largely handled manually by human operators in charge of a group of stations. In this paper we make a step towards supporting the operator with some automatic tool, by describing an approach for performing in-station dispatching by means of automated planning techniques. Given the mixed discrete-continuous nature of the problem, we employ PDDL+ for the specification of the problem, and the ENHSP planning engine enhanced by domain-specific solving techniques. Results on a range of scenarios, using real-data of a station of the North West of Italy, show the potential of our approach

POS0858 NAILFOLD VIDEOCAPILLAROSCOPY FINDINGS AND ASSOCIATIONS WITH ORGAN INVOLVEMENT IN MIXED CONNECTIVE TISSUE DISEASE

BackgroundMixed connective tissue disease (MCTD) is a rare autoimmune condition characterized by Raynaud’s phenomenon, positivity of antibodies targeting the U1 small nuclear ribonucleoprotein particle (U1 snRNP), various clinical features and potential risk of severe cardio-pulmonary involvement (interstitial lung disease, ILD, and pulmonary hypertension, PH) (1), (2).Nailfold videocapillaroscopy (NVC) is a simple, non-invasive and inexpensive imaging technique that allows a detailed assessment of skin microcirculation. NVC abnormalities have been barely described in MCTD and associations between NVC features and MCTD disease characteristics have only been partially investigated.ObjectivesTo describe the NVC patterns observed in MCTD and assess their potential association with disease characteristics.MethodsCross-sectional study based on the retrospective analysis of patients hospitalized in the department of Rheumatology, Cochin Hospital, Paris France. To be included, patients were required to fulfil at least one classification criteria used in MCTD (3). The following data were collected: demographics, clinical features, para-clinical and laboratory data, treatment, and NVC findings.Results51 patients met the inclusion criteria. Mean age was 51±12 years, 44 (86%) were women, mean disease duration was 13.8±11.1 years and 16 patients (31%) had ILD.Three different NVC patterns have been identified in our cohort (Figure 1): A) normal findings in 6 patients (11,7 %); B) non-specific organic microangiopathy in 16 patients (31,4%) and C) scleroderma pattern in 18 patients (35.3%), defined by the presence of at least 3 of the 4 following features: at least 1 giant capillary, decreased capillary density (&lt;7/mm), avascular areas and disorganization of capillary bed architecture (4).Scleroderma pattern was associated with clinical features of systemic sclerosis: skin sclerosis (9/18 vs. 5/33; p=0.008) and digital ulcers (6/18 vs. 2/31; p=0.017). Conversely, no association was observed between the normal or the non-specific NVC pattern and disease specific characteristics.Interestingly, we observed, a significant reduction in the number of capillaries in patients with ILD (4.80±1.87 vs. 6.03±1.47; p=0.039), and patients with severe reduction of capillary density (≤4/mm) were more likely to have ILD (5/7 vs. 5/33; p=0.002). Neoangiogenesis was also more frequent in patients with ILD (6/13 vs. 4/27; p=0.034).Multivariate logistic regression analysis showed that the association between severe reduction of capillary density and ILD was observed independently of the presence of a scleroderma NVC pattern and skin fibrosis.Figure 1.ConclusionWe identified three main NVC patterns in MCTD patients. The scleroderma NVC pattern was associated with clinical scleroderma characteristics whereas non-specific microangiopathy and normal NVC were not associated with a specific phenotype. Moreover, severe capillary loss was independently associated with the presence of ILD. These data suggest that NVC may be helpful for disease risk stratification in MCTD, and that NVC findings, and particularly severe capillary loss, may be a warning for the presence of ILD.References[1]Sharp GC, Irvin WS, Tan EM, Gould RG, Holman HR. Mixed connective tissue disease--an apparently distinct rheumatic disease syndrome associated with a specific antibody to an extractable nuclear antigen (ENA). Am J Med. févr 1972;52(2):148‑59.[2]Gunnarsson R, Hetlevik SO, Lilleby V, Molberg Ø. Mixed connective tissue disease. Best Pract Res Clin Rheumatol. févr 2016;30(1):95‑111.[3]John KJ, Sadiq M, George T, Gunasekaran K, Francis N, Rajadurai E, et al. Clinical and Immunological Profile of Mixed Connective Tissue Disease and a Comparison of Four Diagnostic Criteria. Int J Rheumatol. 2020;2020:9692030.[4]Boulon C, Devos S, Mangin M, Decamps-Le Chevoir J, Senet P, Lazareth I, et al. Reproducibility of capillaroscopic classifications of systemic sclerosis: results from the SCLEROCAP study. Rheumatol Oxf Engl. 1 oct 2017;56(10):1713‑20.Disclosure of InterestsGonçalo Boleto: None declared, Camille Kasser: None declared, Yannick Allanore Speakers bureau: YA reports personal fees from Actelion, Bayer, BMS, Boehringer, Curzion, Inventiva, Roche and Sanofi and research grants from Inventiva, Sanofi and Alpine Immunosciences., Jerôme Avouac: None declared</jats:sec

A Planning-based Approach for In-Station Train Dispatching

In-station train dispatching is the problem of optimising the effective utilisation of available railway infrastructures for mitigating incidents and delays. In this paper, we describe an approach for dealing with the in-station dispatching problem by means of automated planning techniques