Unidirectional endobronchial valves for management of persistent air-leaks. Results of a multicenter study

Background: To evaluate the efficacy of Endo-Bronchial Valves in the management of persistent air-leaks (PALs) and the procedural cost. Methods: It was a retrospective multicenter study including consecutive patients with PALs for alveolar pleural fistula (APF) undergoing valve treatment. We assessed the efficacy and the cost of the procedure. Results: Seventy-four patients with persistent air leaks due to various etiologies were included in the analysis. In all cases the air leaks were severe and refractory to standard treatments. Sixty-seven (91%) patients underwent valve treatment obtaining a complete resolution of air-leaks in 59 (88%) patients; a reduction of air-leaks in 6 (9%); and no benefits in 2 (3%). The comparison of data before and after valve treatment showed a significant reduction of air-leak duration (16.2±8.8 versus 5.0±1.7 days; P<0.0001); chest tube removal (16.2±8.8 versus 7.3±2.7 days; P<0.0001); and length of hospital stay (LOS) (16.2±8.8 versus 9.7±2.8 days; P=0.004). Seven patients not undergoing valve treatment underwent pneumo-peritoneum with pleurodesis (n=6) or only pleurodesis (n=1). In only 1 (14%) patient, the chest drainage was removed 23 days later while the remaining 6 (86%) were discharged with a domiciliary chest drainage removed after 157±41 days. No significant difference was found in health cost before and after endobronchial valve (EBV) implant (P=0.3). Conclusions: Valve treatment for persistent air leaks is an effective procedure. The reduction of hospitalization costs related to early resolution of air-leaks could overcome the procedural cost

Mount control system of the ASTRI SST-2M prototype for the Cherenkov Telescope Array

The ASTRI SST-2M telescope is an end-to-end prototype proposed for the Small Size class of Telescopes (SST) of the future Cherenkov Telescope Array (CTA). The prototype is installed in Italy at the INAF observing station located at Serra La Nave on Mount Etna (Sicily) and it was inaugurated in September 2014. This paper presents the software and hardware architecture and development of the system dedicated to the control of the mount, health, safety and monitoring systems of the ASTRI SST-2M telescope prototype. The mount control system installed on the ASTRI SST-2M telescope prototype makes use of standard and widely deployed industrial hardware and software. State of the art of the control and automation industries was selected in order to fulfill the mount related functional and safety requirements with assembly compactness, high reliability, and reduced maintenance. The software package was implemented with the Beckhoff TwinCAT version 3 environment for the software Programmable Logical Controller (PLC), while the control electronics have been chosen in order to maximize the homogeneity and the real time performance of the system. The integration with the high level controller (Telescope Control System) has been carried out by choosing the open platform communications Unified Architecture (UA) protocol, supporting rich data model while offering compatibility with the PLC platform. In this contribution we show how the ASTRI approach for the design and implementation of the mount control system has made the ASTRI SST-2M prototype a standalone intelligent machine, able to fulfill requirements and easy to be integrated in an array configuration such as the future ASTRI mini-array proposed to be installed at the southern site of the Cherenkov Telescope Array (CTA)

Shedding light on typical species : implications for habitat monitoring

Habitat monitoring in Europe is regulated by Article 17 of the Habitats Directive, which suggests the use of typical species to assess habitat conservation status. Yet, the Directive uses the term “typical” species but does not provide a definition, either for its use in reporting or for its use in impact assessments. To address the issue, an online workshop was organized by the Italian Society for Vegetation Science (SISV) to shed light on the diversity of perspectives regarding the different concepts of typical species, and to discuss the possible implications for habitat monitoring. To this aim, we inquired 73 people with a very different degree of expertise in the field of vegetation science by means of a tailored survey composed of six questions. We analysed the data using Pearson's Chi-squared test to verify that the answers diverged from a random distribution and checked the effect of the degree of experience of the surveyees on the results. We found that most of the surveyees agreed on the use of the phytosociological method for habitat monitoring and of the diagnostic and characteristic species to evaluate the structural and functional conservation status of habitats. With this contribution, we shed light on the meaning of “typical” species in the context of habitat monitoring

Effectiveness of lithium in subjects with treatment-resistant depression and suicide risk: results and lessons of an underpowered randomised clinical trial

BACKGROUND: As lithium treatment might be effective in reducing the risk of deliberate self-harm (DSH) in adult patients with unipolar affective disorders, we designed a pragmatic randomised trial to assess its efficacy in more than 200 patients with treatment-resistant depression. However, we randomised 56 patients only. The aim of this report is therefore twofold: first, to disseminate the results of this underpowered study which may be incorporated into future meta-analytical reviews; second, to analyse some critical aspects of the study which might explain failure to reach the target sample size.METHODS: We carried out a randomised, parallel group, assessor-blinded superiority clinical trial. Adults with a diagnosis of major depression, an episode of DSH in the previous 12 months and inadequate response to at least two antidepressants given sequentially at an adequate dose for an adequate time for the current depressive episode were allocated to add lithium to usual care (intervention arm) versus usual care alone (control arm). Suicide completion and acts of DSH during the 12 months of follow-up constituted the composite primary outcome.RESULTS: Of 58 patients screened for inclusion, 29 were allocated to lithium plus usual care and 27 were assigned to usual care without lithium. Six patients in the lithium plus usual care group and seven in the usual care group committed acts of DSH during the follow-up phase. The survival probability did not differ between the two treatment arms (Chi2 = 0.17, p =0.676). With regard to changes in the severity of depressive symptomatology from baseline to endpoint, no significant differences were detected.CONCLUSIONS: The present study failed to achieve the minimum sample size needed to detect a clinically meaningful difference between the two treatment arms. Consequently, the finding that lithium, in addition to usual care, did not exert a positive effect in terms of reduction of DSH after 12 months of follow-up is likely due to the lack of sufficient statistical power to detect a difference, if a difference existed. The dissemination of the results of this underpowered study will inform future meta-analytical reviews on lithium and suicide-related outcomes.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00927550

The ASTRI mini-array software system (MASS) implementation: a proposal for the Cherenkov Telescope Array

The ASTRI mini-array, composed of nine small-size dual mirror (SST-2M) telescopes, has been proposed to be installed at the southern site of the Cherenkov Telescope Array (CTA), as a set of preproduction units of the CTA observatory. The ASTRI mini-array is a collaborative and international effort carried out by Italy, Brazil and South Africa and led by the Italian National Institute of Astrophysics, INAF. We present the main features of the current implementation of the Mini-Array Software System (MASS) now in use for the activities of the ASTRI SST-2M telescope prototype located at the INAF observing station on Mt. Etna, Italy and the characteristics that make it a prototype for the CTA control software system. CTA Data Management (CTADATA) and CTA Array Control and Data Acquisition (CTA-ACTL) requirements and guidelines as well as the ASTRI use cases were considered in the MASS design, most of its features are derived from the Atacama Large Millimeter/sub-millimeter Array Control software. The MASS will provide a set of tools to manage all onsite operations of the ASTRI mini-array in order to perform the observations specified in the short term schedule (including monitoring and controlling all the hardware components of each telescope and calibration device), to analyze the acquired data online and to store/retrieve all the data products to/from the onsite repository

Rationale and design of an independent randomised controlled trial evaluating the effectiveness of aripiprazole or haloperidol in combination with clozapine for treatment-resistant schizophrenia

<p>Abstract</p> <p>Background</p> <p>One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study.</p> <p>Methods/Design</p> <p>The principal clinical question to be answered by the present project is the relative efficacy and tolerability of combination treatment with clozapine plus aripiprazole compared with combination treatment with clozapine plus haloperidol in patients with an incomplete response to treatment with clozapine over an appropriate period of time. This project is a prospective, multicentre, randomized, parallel-group, superiority trial that follow patients over a period of 12 months. Withdrawal from allocated treatment within 3 months is the primary outcome.</p> <p>Discussion</p> <p>The implementation of the protocol presented here shows that it is possible to create a network of community psychiatric services that accept the idea of using their everyday clinical practice to produce randomised knowledge. The employed pragmatic attitude allowed to randomly allocate more than 100 individuals, which means that this study is the largest antipsychotic combination trial conducted so far in Western countries. We expect that the current project, by generating evidence on whether it is clinically useful to combine clozapine with aripiprazole rather than with haloperidol, provides physicians with a solid evidence base to be directly applied in the routine care of patients with schizophrenia.</p> <p>Trial Registration</p> <p><b>Clincaltrials.gov Identifier</b>: NCT00395915</p