Balancing pairs of interfering elements

Many decisions in different fields of application have to take into account the joined effects of two elements that can interfere with each other. For example, in Industrial Economics the demand of an asset can be influenced by the supply of another asset, with synergic or antagonistic effects. The same happens in Public Economics, where two differing economic policies can create mutual interference. Analogously in Medicine and Life Sciences with drugs whose combined administration can produce extra damages or synergies. Other examples occur in Agriculture, Zootechnics and so on. When it is necessary to intervene in such elements, there is sometimes a primary interest for one effect rather than another. For example, if the importance of the effect of an element is ten times greater than the importance of the effect of another, then it is convenient to take this importance into consideration in deciding to what extent it should be employed. With this in mind, the model proposed here allows the optimal quantities of two elements that interfere with each other to be calculated, taking into account the minimum quantities to be allocated. Algorithms for determining solutions for continuous effects' functions are given, together with software specifically for the case of bilinear functions. It concludes with the presentation of applications particularly to economical problems.Antagonist Elements; Interfering Elements; Optimal dosage; Combinations of interfering strategies; Synergies

Balancing pairs of interfering elements

Many decisions in different fields of application have to take into account the joined effects of two elements that can interfere with each other. For example, in Industrial Economics the demand of an asset can be influenced by the supply of another asset, with synergic or antagonistic effects. The same happens in Public Economics, where two differing economic policies can create mutual interference. Analogously in Medicine and Life Sciences with drugs whose combined administration can produce extra damages or synergies. Other examples occur in Agriculture, Zootechnics and so on. When it is necessary to intervene in such elements, there is sometimes a primary interest for one effect rather than another. For example, if the importance of the effect of an element is ten times greater than the importance of the effect of another, then it is convenient to take this importance into consideration in deciding to what extent it should be employed. With this in mind, the model proposed here allows the optimal quantities of two elements that interfere with each other to be calculated, taking into account the minimum quantities to be allocated. Algorithms for determining solutions for continuous effects' functions are given, together with software specifically for the case of bilinear functions. It concludes with the presentation of applications particularly to economical problems

Balancing pairs of interfering elements

Many decisions in different fields of application have to take into account the joined effects of two elements that can interfere with each other. For example, in Industrial Economics the demand of an asset can be influenced by the supply of another asset, with synergic or antagonistic effects. The same happens in Public Economics, where two differing economic policies can create mutual interference. Analogously in Medicine and Life Sciences with drugs whose combined administration can produce extra damages or synergies. Other examples occur in Agriculture, Zootechnics and so on. When it is necessary to intervene in such elements, there is sometimes a primary interest for one effect rather than another. For example, if the importance of the effect of an element is ten times greater than the importance of the effect of another, then it is convenient to take this importance into consideration in deciding to what extent it should be employed. With this in mind, the model proposed here allows the optimal quantities of two elements that interfere with each other to be calculated, taking into account the minimum quantities to be allocated. Algorithms for determining solutions for continuous effects' functions are given, together with software specifically for the case of bilinear functions. It concludes with the presentation of applications particularly to economical problems

Oropharyngeal Dysphagia After Hospitalization for COVID-19 Disease: Our Screening Results

A high percentage of patients suffered symptoms also after recovery from the Coronavirus Disease—2019 (COVID-19) infection. It is not well clear what are the specific long-term sequelae (complications and symptoms). During the acute phase the patients may develop a multi-organ system pathology including aerodigestive tract. As the pathophysiology of COVID-19 emerges, the aim of our study was to describe the prevalence of oropharyngeal dysphagia after COVID-19 disease. From March to July 2020 we enrolled patients recovered from SARS-CoV-2 infection who had been previously hospitalized for the disease. They were screened for dysphagia by mean of the Eating Assessment Tool-10 (EAT-10). The cases with EAT-10 score > 3 were graded for the aspiration risk by applying the Gugging Swallowing Screen (GUSS) and were submitted to the Swal-QoL questionnaire. The cases with a GUSS score > 19 were subjected to FEES. 8/117 (7%) patients had positive screening result. 4/8 (50%) revealed an abnormal health related quality of life in oropharyngeal dysphagia with a mean Swal-QoL score of 69.73. The most affected domain was the “time of meals” (mean score 65) following by the “sleep” (mean score 66) and “eating desire” (mean score 72). 1/8 cases showed increased risk for aspiration and did not showed endoscopic signs of oropharyngeal dysphagia. Our results showed that the prevalence of upper dysphagia after hospitalization for SARS-CoV-2 is not anecdotal and that probably this long-lasting sequela has a psychogenic etiology

COVID-19 and RA share SPP1 myeloid pathway that drives PD-L1pos neutrophils and CD14pos monocytes

We explored the potential link between chronic inflammatory arthritis and COVID-19 pathogenic and resolving macrophage pathways and their role in COVID-19 pathogenesis. We found that BALF macrophage clusters FCN1pos and FCN1posSPP1pos predominant in severe COVID-19 were transcriptionally related to synovial tissue macrophage (STM) clusters CD48highS100A12pos and CD48posSPP1pos that drive Rheumatoid Arthritis (RA) synovitis. BALF macrophage cluster FABP4pos predominant in healthy lung was transcriptionally related to STM cluster TREM2pos that governs resolution of synovitis in RA remission. Plasma concentrations of SPP1 and S100A12 (key products of macrophage clusters shared with active RA) were high in severe COVID-19 and predicted the need for Intensive Care Unit transfer, and remained high in post-COVID-19 stage. High plasma levels of SPP1 were unique to severe COVID-19 when compared to other causes of severe pneumonia, and immunohistochemistry localized SPP1pos macrophages in the alveoli of COVID-19 lung. Investigation into SPP1 mechanisms of action revealed that it drives pro-inflammatory activation of CD14pos monocytes and development of PD-L1pos neutrophils, both hallmarks of severe COVID-19. In summary, COVID-19 pneumonitis appears driven by similar pathogenic myeloid cell pathways as those in RA, and their mediators such as SPP1 might be an upstream activator of the aberrant innate response in severe COVID-19 and predictive of disease trajectory including post-COVID-19 monitoring

Balancing pairs of interfering elements

Many decisions in different fields of application have to take into account the joint effects of two elements that can interfere with each other. For example, in Industrial Economics the demand for an asset can be influenced by the supply of another asset, with synergic or antagonistic effects. The same happens in Public Economics, where two differing economic policies can create mutual interference. Analogously, the same can be said about drugs in Veterinary Science and Medicine, additives in agriculture, diets in zoo-technics and so on. When it is necessary to use such elements, there is sometimes a primary interest for one effect rather than another: for instance, the effect/influence of one could be twice as large as that of the other. In such cases, it is important to consider the extent of influence of the elements in the dose of the elements. With this in mind, the model proposed here helps to determine optimal quantities of two elements that interfere with each other, taking into account the minimum quantities to be allocated. A method for determining solutions for continuous effects' functions is given. The specific quality of this model is that it provides a direct method, and not an iterative one, to obtain the solution

Frailty, multimorbidity patterns and mortality in institutionalized older adults in Italy

Background Little is known on how frailty influences clinical outcomes in persons with specific multimorbidity patterns. Aims To investigate the interplay between multimorbidity and frailty in the association with mortality in older individuals living in nursing homes (NH). Methods We considered 4,131 NH residents aged 60 years and over, assessed through the interRAI LTCF instrument between 2014 and 2018. Follow-up was until 2019. Considering four multimorbidity patterns identified via principal component analysis, subjects were stratified in tertiles (T) with respect to their loading values. Frailty Index (FI) considered 23 variables and a cut-off of 0.24 distinguished between high and low frailty levels. For each pattern, all possible combinations of tertiles and FI were evaluated. Their association (Hazard Ratio [HR] and 95% confidence interval) with mortality was tested in Cox regression models. Results In the heart diseases and dementia and sensory impairments patterns, the hazard of death increases progressively with patterns expression and frailty severity (being HR T3 vs. T1 = 2.36 [2.01-2.78]; HR T3 vs. T1 = 2.12 [1.83-2.47], respectively). In heart, respiratory and psychiatric diseases and diabetes, musculoskeletal and vascular diseases patterns, frailty seems to have a stronger impact on mortality than patterns' expression. Discussion Frailty increases mortality risk in all the patterns and provides additional prognostic information in NH residents with different multimorbidity patterns. Conclusions These findings support the need to routinely assess frailty. Older people affected by specific groups of chronic diseases need a specific care approach and have high risk of negative health outcomes

Polypharmacy in Home Care in Europe: Cross-Sectional Data from the IBenC Study

Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe.status: publishe

SARS-CoV-2 vaccine humoral response in adults with Down syndrome

Objective: People with Down syndrome (DS) are particularly vulnerable to coronavirus disease 2019 (COVID-19) and show altered immune response to vaccination. We aimed to evaluate the immune response of a group of adults with DS treated with standard regimens of SARS-CoV-2 vaccine as compared with an age- and sex-matched group of persons without DS. Methods: We compared antibody responses between 42 subjects with DS (41.6 ± 10.8 years, 57% male), and an age- and sex-matched comparison group of healthy health care workers (HCW) (41.4 ± 8.8 years, 54.8% male) after SARS-CoV-2 vaccination with the standard regimen of BNT162b2 mRNA COVID-19. Receptor binding domain (RBD) IgG antibodies were assessed at 4 time points (baseline, 21 days after the first dose, 21 days after the second dose, and 6 months after the first dose) with Siemens SARS-CoV-2 IgG (COV2G) antibody test. Results: We observed significantly different antibody responses at all time points after vaccination (HCW vs. DS: 7.9 ± 3.9 vs. 1.4 ± 3.6 IU/mL at 21 days after first dose; 358.5 ± 3.8 vs. 38.1 ± 3.0 IU/mL at 21 days after second dose; 34.6 ± 2.4 vs. 7.9 ± 3.1 IU/mL at 6 months after vaccination) and a significantly different time course of decline in antibody titers between the two groups. Discussion: Subjects with DS have a valid antibody response to SARS-CoV-2 vaccination. However, this response is lower than that of subjects in the HCW group. This finding could indicate a more rapid decline in the protective effects of the vaccination in subjects with DS and could suggest that people with DS may benefit from a booster dose of vaccine

Differences in clinical presentation, severity, and treatment of COVID-19 among individuals with Down syndrome from India and high-income countries: Data from the Trisomy 21 Research Society survey

Background: People with Down syndrome (DS) are one of the highest risk groups for mortality associated with COVID-19, but outcomes may differ across countries due to different co-morbidity profiles, exposures, and societal practices, which could have implications for disease management. This study is designed to identify differences in clinical presentation, severity, and treatment of COVID-19 between India and several high-income countries (HICs). Methods: We used data from an international survey to examine the differences in disease manifestation and management for COVID-19 patients with DS from India vs HIC. De-identified survey data collected from April 2020 to August 2021 were analysed. Results: COVID-19 patients with DS from India were on average nine years younger than those from HICs. Comorbidities associated with a higher risk for severe COVID-19 were more frequent among the patients from India than from HICs. Hospitalizations were more frequent among patients from India as were COVID-19-related medical complications. Treatment strategies differed between India and HICs, with more frequent use of antibiotics in India. The average severity score of 3.31 was recorded for Indian DS in contrast to 2.3 for European and 2.04 for US cases. Conclusions: Presentation and outcomes of COVID-19 among individuals with DS were more severe for patients from India than for those from HIC. Global efforts should especially target vaccination campaigns and other risk-reducing interventions for individuals with DS from low-income countries