Prove di caratterizzazione meccanica della canna comune (Arundo Donax) in prospettiva di un uso strutturale sostenibile

L’obiettivo di questa tesi è porre le basi dell’utilizzo dell’Arundo Donax in campo strutturale estendendo la conoscenza del suo comportamento meccanico attraverso una completa caratterizzazione meccanica. La canna comune vanta delle caratteristiche meccaniche molto simili a quelle di diverse specie di Bambù, materiale ampiamente utilizzato nei paesi dell’Asia orientale e dell’America Latina, dove è inserito nelle normative che ne regolarizzano l’utilizzo ai fini strutturali. La principale norma di riferimento per il bambù è la ISO 22157 (2019), che descrive le procedure di prova da seguire in laboratorio per una corretta caratterizzazione meccanica del materiale. La sopracitata norma è stata di riferimento nella definizione delle diverse prove eseguite sull’Arundo Donax, ma le esigue dimensioni dei campioni, se paragonate a quelle del bambù, hanno portato al progetto di nuove metodologie di prova, studiate “su misura” per ottenere una corretta caratterizzazione del materiale. La modalità di prova a compressione assiale non presenta particolari differenze da quanto indicato nella ISO 22157; lo studio si è quindi incentrato sulle possibili soluzioni da adottare nell’esecuzione dei test a trazione, a taglio e a compressione trasversale, prove che anche per il bambù presentano una significativa dispersione dei risultati e sono in continuo aggiornamento dal punto di vista normativo. Le ridotte dimensioni della sezione comportano diverse difficoltà nel monitoraggio della prova con tecniche di misurazione standard. Si utilizza la DIC, una tecnica di monitoraggio contactless in grado di costruire dei campi vettoriali di deformazione della superfice del campione; tale tecnica di acquisizione permette di cogliere al meglio il comportamento di un materiale fortemente anisotropo come l’Arundo Donax, le cui proprietà meccaniche sono dipendenti dalla direzione di applicazione del carico e le cui caratteristiche di rigidezza variano sullo spessore e lungo lo sviluppo del culmo

Enhancing Random Forest Classification with NLP in DAMEH: A system for DAta Management in EHealth Domain

The use of pervasive IoT devices in Smart Cities, have increased the Volume of data produced in many and many field. Interesting and very useful applications grow up in number in E-health domain, where smart devices are used in order to manage huge amount of data, in highly distributed environments, in order to provide smart services able to collect data to fill medical records of patients. The problem here is to gather data, to produce records and to analyze medical records depending on their contents. Since data gathering involve very different devices (not only wearable medical sensors, but also environmental smart devices, like weather, pollution and other sensors) it is very difficult to classify data depending their contents, in order to enable better management of patients. Data from smart devices couple with medical records written in natural language: we describe here an architecture that is able to determine best features for classification, depending on existent medical records. The architecture is based on pre-filtering phase based on Natural Language Processing, that is able to enhance Machine learning classification based on Random Forests. We carried on experiments on about 5000 medical records from real (anonymized) case studies from various health-care organizations in Italy. We show accuracy of the presented approach in terms of Accuracy-Rejection curves

COVID-19 in Low- and Middle-Income Countries (LMICs): A Narrative Review from Prevention to Vaccination Strategy

The management of the COVID-19 pandemic represents a challenging process, especially for low- and middle-income countries (LMICs) due to the serious economic and health resource problems it generates. In this article, we assess COVID-19 situation in LMICs and outline emerging problems and possible solutions. The prevention and control of COVID-19 would be based on focused tests exploiting those systems (e.g., GeneXpert®) already used in other scenarios. This would be less stressful for the healthcare system in LMICs. Avoiding close contact with people suffering from acute respiratory infections, frequent handwashing, and avoiding unprotected contact with farm or wild animals are recommended infection control interventions. The appropriate use of personal protective equipment (PPE) is required, despite its procurement being especially difficult in LMICs. Patients’ triage should be based on a simple and rapid logarithm to decide who requires isolation and targeted testing for SARS-CoV-2. Being able to estimate which patients will develop severe disease would allow hospitals to better utilize the already limited resources more effectively. In LMICs, laboratories are often in the capital cities; therefore, early diagnosis and isolation become difficult. The number of ICU beds is often insufficient, and the equipment is often old and poorly serviced. LMICs will need access to COVID-19 treatments at minimal prices to ensure that all who need them can be treated. Year-to-date, different vaccines have been approved and are currently available. The main obstacle to accessing them is the limited ability of LMICs to purchase significant quantities of the vaccine

Cefiderocol for Carbapenem-Resistant Bacteria: Handle with Care! A Review of the Real-World Evidence

(1) Background: healthcare-associated infections are one of the most frequent adverse events in healthcare delivery worldwide. Several antibiotic resistance mechanisms have been developed, including those to carbapenemase. Cefiderocol (CFD) is a novel siderophore cephalosporin designed to treat carbapenem-resistant bacteria. (2) Methods: we performed a systematic review of all cases reported in the literature to outline the existing evidence. We evaluated real-world evidence studies of CFD in the treatment of carbapenem-resistant (CR) bacteria. (3) Results: a total of 19 publications treating cases of infection by CR bacteria were included. The three most frequent CR pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. A regimen of 2 g every 8 h was most frequently adopted for CFD with a mean treatment duration of 25.6 days. CFD was generally well tolerated, with fewer side effects. The success rate of CFD therapy was satisfactory and almost 70% of patients showed clinical recovery; of these, nearly half showed negative blood cultures and infection-free status. (4) Conclusions: This review indicates that CFD is active against important GN organisms including Enterobacteriaceae, P. aeruginosa, and A. baumannii. CFD seems to have a safe profile

What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction

Breast surgery in the United States is common. Pain affects up to 50% of women undergoing breast surgery and can interfere with postoperative outcomes. General anesthesia is the conventional, most frequently used anaesthetic technique. Various locoregional anesthetic techniques are also used for breast surgeries. A systematic review of the use of locoregional anesthesia for postoperative pain in breast surgery is needed to clarify its role in pain management

An unusual cause of chest pain

Case report :We present the case of a 27year-old male who went to the Emergency Room for the acute onset of chest pain irradiated to left flank and fever by 2 days. An abdominal computed tomography (CT) scan, performed for the suspicion of a kidney stone, showed a left basal pulmonary opacity. The patient was admitted to our department for suspected community-acquired pneumonia (CAP) but, a few days later, a chest CT scan with intravenous contrast revealed a thoracic congenital malformation: intralobar pulmonary sequestration. The pulmonary lesion was resected and the histopathological examination of the lesion showed the features of pulmonary sequestration. Conclusions :Pulmonary sequestration is a rare congenital malformation that is usually diagnosed in the Pediatric age. We report here an unusual case of intralobar pulmonary sequestration in an adult mimicking a CAP and a lung cancer

Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis

Importance: Meropenem is a widely prescribed β-lactam antibiotic. Meropenem exhibits maximum pharmacodynamic efficacy when given by continuous infusion to deliver constant drug levels above the minimal inhibitory concentration. Compared with intermittent administration, continuous administration of meropenem may improve clinical outcomes. Objective: To determine whether continuous administration of meropenem reduces a composite of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria compared with intermittent administration in critically ill patients with sepsis. Design, setting, and participants: A double-blind, randomized clinical trial enrolling critically ill patients with sepsis or septic shock who had been prescribed meropenem by their treating clinicians at 31 intensive care units of 26 hospitals in 4 countries (Croatia, Italy, Kazakhstan, and Russia). Patients were enrolled between June 5, 2018, and August 9, 2022, and the final 90-day follow-up was completed in November 2022. Interventions: Patients were randomized to receive an equal dose of the antibiotic meropenem by either continuous administration (n = 303) or intermittent administration (n = 304). Main outcomes and measures: The primary outcome was a composite of all-cause mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28. There were 4 secondary outcomes, including days alive and free from antibiotics at day 28, days alive and free from the intensive care unit at day 28, and all-cause mortality at day 90. Seizures, allergic reactions, and mortality were recorded as adverse events. Results: All 607 patients (mean age, 64 [SD, 15] years; 203 were women [33%]) were included in the measurement of the 28-day primary outcome and completed the 90-day mortality follow-up. The majority (369 patients, 61%) had septic shock. The median time from hospital admission to randomization was 9 days (IQR, 3-17 days) and the median duration of meropenem therapy was 11 days (IQR, 6-17 days). Only 1 crossover event was recorded. The primary outcome occurred in 142 patients (47%) in the continuous administration group and in 149 patients (49%) in the intermittent administration group (relative risk, 0.96 [95% CI, 0.81-1.13], P = .60). Of the 4 secondary outcomes, none was statistically significant. No adverse events of seizures or allergic reactions related to the study drug were reported. At 90 days, mortality was 42% both in the continuous administration group (127 of 303 patients) and in the intermittent administration group (127 of 304 patients). Conclusions and relevance: In critically ill patients with sepsis, compared with intermittent administration, the continuous administration of meropenem did not improve the composite outcome of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28. Trial registration: ClinicalTrials.gov Identifier: NCT03452839