Respiratory patterns and baroreflex function in heart failure

Little is known on the effects of respiratory patterns on baroreflex function in heart failure (HF). Patients with HF (n = 30, age 61.6 ± 10 years, mean ± SD) and healthy controls (CNT, n = 10, age 58.9 ± 5.6 years) having their R-R interval (RRI, EKG), systolic arterial blood pressure (SBP, Finapres) and respiratory signal (RSP, Respitrace) monitored, were subjected to three recording sessions: free-breathing, fast- (≥ 12 bpm) and slow- (6 bpm) paced breathing. Baroreflex sensitivity (BRS) and power spectra of RRI, SBP, and RSP signals were calculated. During free-breathing, compared to CNT, HF patients showed a significantly greater modulation of respiratory volumes in the very-low-frequency (< 0.04 Hz) range and their BRS was not significantly different from that of CNT. During fast-paced breathing, when very-low-frequency modulations of respiration were reduced, BRS of HF patients was significantly lower than that of CNT and lower than during free breathing. During slow-paced breathing, BRS became again significantly higher than during fast breathing. In conclusion: (1) in free-breathing HF patients is present a greater modulation of respiratory volumes in the very-low-frequency range; (2) in HF patients modulation of respiration in the very-low and low frequency (around 0.1 Hz) ranges contributes to preserve baroreflex-mediated control of heart rate

A new indoor LiDAR-based MMS challenging complex architectural environments

The use of moving devices equipped with range- and image-based sensor, generically defined Mobile Mapping systems (MMS), have been quite a disruptive innovation in the development of Geomatics techniques for 3D surveying large indoor-outdoor spaces and offer multiple solutions. The recent expansion of portable devices in the form of trolleys, backpacks, handheld tools largely implements SLAM (Simultaneous Localization and Mapping) algorithms and technology based on both Lidar and/or visual solutions for answering to the positioning and the 3D reconstruction problems. The research on MMS is directed to improve both multi-sensor integration implementation and usability of systems in diversified use contexts and application fields. The aim of the presented research is the evaluation of the potential of the Swift system recently developed by FARO Technologies, that has been fine-tuned for regular and large extent interiors mapping (such as factories, hospitals, airports, offices). The work tries to preliminary investigate the data delivery and usability of the integrated system. This is based on three elements mounted on a sliding trolley moved by the operator walking: the ScanPlan profilometer working for the 2D SLAM mapping, the static TLS Focus S-series, and the smartphone managing the sensors operation and the acquisition progress. The evaluation strategy undertaken will be based on the global and local performance analysis related to the trajectory, the data accuracy, the metric content and consistency. Two test studies belonging to the 20th century. architecture are presented in a preliminary framework of evaluation and validation: a Liberty-style cinema and the Torino Esposizioni Hall B designed in ferrocement by pier Luigi Nervi

Techno-Economic Optimisation for a Wave Energy Converter via Genetic Algorithm

Although sea and ocean waves have been widely acknowledged to have the potential of providing sustainable and renewable energy, the emergence of a self-sufficient and mature industry is still lacking. An essential condition for reaching economic viability is to minimise the cost of electricity, as opposed to simply maximising the converted energy at the early design stages. One of the tools empowering developers to follow such a virtuous design pathway is the techno-economic optimisation. The purpose of this paper is to perform a holistic optimisation of the PeWEC (pendulum wave energy converter), which is a pitching platform converting energy from the oscillation of a pendulum contained in a sealed hull. Optimised parameters comprise shape; dimensions; mass properties and ballast; power take-off control torque and constraints; number and characteristics of the pendulum; and other subcomponents. Cost functions are included and the objective function is the ratio between the delivered power and the capital expenditure. Due to its ability to effectively deal with a large multi-dimensional design space, a genetic algorithm is implemented, with a specific modification to handle unfeasible design candidate and improve convergence. Results show that the device minimising the cost of energy and the one maximising the capture width ratio are substantially different, so the economically-oriented metric should be preferred

physical activity monitoring devices energy expenditure comparison in a setting of free living activities

The aim of this study was to evaluate the validity of Energy Expenditure (EE) estimation provided by 3 wearable devices [Fitbit-One (FO), Sensewear Armband (AR) and Actiheart (AC)] in a setting of free-living activities. 43 participants (24 females; 23.4±.4,5yrs) performed 9 activities: sedentary (watching video, reading), walking (on treadmill and outdoor), running (on treadmill and outdoor) and moderate-to-vigorous activities (Wii gaming, taking the stairs and playing football). Mean Absolute Percentage Error (MAPE) and Pearson's correlation were calculated to assess the validity of each instrument in comparison to a portable metabolic analyser (PMA). In overall comparison MAPE's were 7,7% for AR (r=.86; p<.0001), 8,6% for FO (r=.69; P<.001), and 11.6% for AC (r=.81; p<.0001). These findings support the accuracy of the wearables. The AR was the most accurate in the whole protocol. However, MAPE results suggest that devices algorithms should be improved for better measure of EE during moderate-to-vigorous activities

Growing old with antiretroviral therapy or elderly people in antiretroviral therapy: two different profiles of comorbidity?

Background In persons living with HIV (PLWH), the burden of non-communicable chronic diseases increased over time, because of aging associated with chronic inflammation, systemic immune activation, and long-term exposure to the combination antiretroviral therapy (ART). Methods To explore the association of chronological age, age at first ART, and exposure to ART with non-communicable chronic diseases, we performed a cross-sectional analysis to evaluate the prevalence of comorbidities in patients enrolled in the SCOLTA Project, stratified by groups of chronological age (50-59 and 60-69 years) and by years of antiretroviral treatment (ART, &lt;= 3 or &gt; 3 years). Results In 1394 subjects (23.8% women), mean age at enrollment was 57.4 (SD 6.5) years, and at first ART 45.3 (SD 10.7). Men were older than women both at enrollment (57.6 vs 56.8, p = 0.06) and at first ART (45.8 vs 43.6, p = 0.0009). ART duration was longer in women (13.1 vs 11.7 years, p = 0.01). The age- and sex-adjusted rate ratios (aRRs, and 95% confidence interval, CI) showed that longer ART exposure was associated with dyslipidemia (aRR 1.35, 95% CI 1.20-1.52), hypertension (aRR 1.52, 95% CI 1.22-1.89), liver disease (aRR 1.78, 95% CI 1.32-2.41), osteopenia/osteoporosis (aRR 2.88, 95% CI 1.65-5.03) and multimorbidity (aRR 1.36, 95% CI 1.21-1.54). These findings were confirmed in strata of age, adjusting for sex. Conclusions Our data suggest that longer ART exposure was associated with increased risk of dyslipidemia, hypertension, and osteopenia/osteoporosis, hence the presence of multimorbidity, possibly due to the exposition to more toxic antiretrovirals. We observed different comorbidities, according to ART exposure and age

How to communicate with families living in complete isolation

The global emergency caused by the SARS-CoV-2 pandemic has suddenly changed how we communicate with families in all the CoViD19 care settings, on account of the need to maintain complete social isolation. Far-reaching mental suffering manifests itself in widespread anxiety. Health workers are isolated from their families, and must manage the consequences of this isolation just like the patients under their care. Patients and their families perceive not only the clinical results but also the personal attitudes, closeness and psychological support from the care teams. This perception of genuine participation by the health worker in the course of the treatment is especially important when a patient dies, and may influence the whole process of grief

Efficacy and safety of reparixin in patients with severe covid-19 Pneumonia. A phase 3, randomized, double-blind placebo-controlled study

Introduction: Polymorphonuclear cell influx into the interstitial and bronchoalveolar spaces is a cardinal feature of severe coronavirus disease 2019 (COVID-19), principally mediated by interleukin-8 (IL-8). We sought to determine whether reparixin, a novel IL-8 pathway inhibitor, could reduce disease progression in patients hospitalized with severe COVID-19 pneumonia. Methods: In this Phase 3, randomized, double-blind, placebo-controlled, multicenter study, hospitalized adult patients with severe COVID-19 pneumonia were randomized 2:1 to receive oral reparixin 1200&nbsp;mg three times daily or placebo for up to 21&nbsp;days or until hospital discharge. The primary endpoint was the proportion of patients alive and free of respiratory failure at Day 28, with key secondary endpoints being the proportion of patients free of respiratory failure at Day 60, incidence of intensive care unit (ICU) admission by Day 28 and time to recovery by Day 28. Results: Of 279 patients randomized, 182 received at least one dose of reparixin and 88 received placebo. The proportion of patients alive and free of respiratory failure at Day 28 was similar in the two groups {83.5% versus 80.7%; odds ratio 1.63 [95% confidence interval (CI) 0.75, 3.51]; p = 0.216}. There were no statistically significant differences in the key secondary endpoints, but a numerically higher proportion of patients in the reparixin group were alive and free of respiratory failure at Day 60 (88.7% versus 84.6%; p = 0.195), fewer required ICU admissions by Day 28 (15.8% versus 21.7%; p = 0.168), and a higher proportion recovered by Day 28 compared with placebo (81.6% versus 74.9%; p = 0.167). Fewer patients experienced adverse events with reparixin than placebo (45.6% versus 54.5%), most mild or moderate intensity and not related to study treatment. Conclusions: This trial did not meet the primary efficacy endpoints, yet reparixin showed a trend toward limiting disease progression as an add-on therapy in COVID-19 severe pneumonia and was well tolerated. Trial registration: ClinicalTrials.gov: NCT04878055, EudraCT: 2020-005919-51

The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population